Skin Wound Reconstruction

When wound closure is not possible due to a lack of skin, a wound reconstruction technique such as skin transplants may be necessary.

The most common reconstruction techniques are skin flaps or skin grafts.

Axial Skin Flap

A skin flap involves lifting a section of skin from one part of the body and placing it to cover a wound in another part. A portion of this skin remains attached to the body, preserving blood circulation. This type of reconstructive surgery is stronger compared to a skin graft.

Axial Skin Flap Example:

A caudal superficial epigastric axial skin flap relies on the epigastric vein and artery (vessels of mammary glands) and is particularly robust, especially in female dogs. It was utilised to cover a surgical wound after the removal of a high-grade mast cell tumour (MCT) with 3 cm margins and one deep fascia plane.

Skin Graft

A skin graft involves collecting a free portion of skin from one part of the body and placing it on a distant wound. In this case, normal blood flow is lost, and the skin requires a new blood supply from the wound bed to survive.

Due to this reason, the surgery often involves a staged procedure. The initial surgery includes mass removal, followed by bandages. Reconstructive surgery is performed after 4-6 days when the wound bed is full of vessels (granulation tissue) and free from infections. However, some vets prefer to perform this surgery as a one-stage procedure. New scientific studies reveal a good skin graft success rate even when performed in a single stage.

Postoperative care is more challenging for skin grafts because bandages need routine changes every 2-4 days for 3-4 weeks. If the wound is close to a joint, temporary joint locking with pins and bars may be required.

Skin Graft Example:

The skin was harvested from the flank of the patient and used to cover a surgical defect after appendicular soft tissue sarcoma removal. The leg was bandaged for 5 days. Once granulation tissue was present, a skin graft was performed using mesh-shaped skin preparation, which exhibited a high success rate compared to non-meshed grafts.

Complications for Axial Skin Flap and Skin Graft

Like all transplants, skin grafts or skin flaps may be partially or completely rejected. In case of failure, a review surgery may be performed to remove necrotic tissue (dead skin), and healing with scar tissue may be considered. Frequent bandage changes will be required until the skin is completely healed.