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Atlas of Small Animal Wound Management and Reconstructive Surgery
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Table of Contents

Foreword xi Preface xii Acknowledgments xiii About the Companion Website xiv 1. The Skin 1 Skin Function 2 Skin Structure 2 Cutaneous Adnexa 5 The Hypodermis 8 Cutaneous Circulation 8 Pinna: Cutaneous Considerations 10 Congenital Skin Disorders 10 2. Basic Principles of Wound Healing 17 Introduction 18 Wound Healing 18 Acute Versus Chronic Open Wounds 29 Species Variations in Wound Healing 29 "Artificial Skin" 30 3. Basic Principles of Wound Management 33 Introduction 34 Patient Presentation 34 Mechanisms of Injury and Wound Terminology 34 Wound Classification 35 Options for Wound Closure 37 "Pointers" in Selecting the Proper Closure Technique 43 Basic Wound Management in Six Simple Steps 44 Exposed Bone: Osteostixis 49 Acute Versus Chronic Wounds 50 4. Topical Wound Care Products and Their Use 53 Wound Exudate 54 Wound Drainage Systems 54 Negative Pressure Wound Therapy (NPWT) 60 Concept of Moist Wound Healing (MWH) 67 Topical Wound Care Products 69 The Maggot and Leach in Wound Care 79 Common Topical Antiseptic and Cleansing Agents 81 Alternative Forms of Wound Therapy 85 Concluding Remarks 89 Plate 1: Vacuum?Assisted Closure 92 5. Dressings, Bandages, External Support, and Protective Devices 95 Introduction 96 Dressings: The Primary Layer 96 Dressings: The Secondary Layer 111 Dressings: The Tertiary Layer 112 Preventing Bandage Displacement 113 Tie?Over Dressing/Bandage Technique 114 Pressure Points: Bandage Options 115 Bandage "Access Windows" 115 Bandaging Techniques for Skin Grafts 115 Bandaging Techniques for Skin Flaps 115 Splints, Casts, Reinforced Bandages 115 Miscellaneous Protective Devices 116 Plate 2: Basic Bandage Application for Extremities 124 Plate 3: Tape Stirrups and Padding Dos and Don'ts 126 Plate 4: Elasticon Bandage Platforms and Saddles 128 Plate 5: Spica Bandages/Splints 130 Plate 6: Schroeder?Thomas Splint 132 Plate 7: Schroeder?Thomas Splint: Security Band Application 136 Plate 8: Body Brace 138 Plate 9: Tape Hobbles for the Rear Extremities 140 6. Common Complications in Wound Healing 143 Improper Nutritional Support 144 Medications and Their Influence on Healing 145 Hypovolemia and Anemia 146 The Nonhealing Wound: General Considerations 146 Failure to Heal by Second Intention 147 Scarring and Wound Contracture 152 Infection and Biofilm Formation 154 Draining Tracts 158 Use of Tourniquets for Lower Extremity Procedures 165 Seromas 166 Hematomas 167 Exposed Bone 167 Wound Dehiscence 169 7. Management of Specific Wounds 173 Bite Wounds 174 Burns 183 Inhalation Injuries 195 Chemical Burns 196 Electrical Injuries 197 Radiation Injuries 201 Frostbite 204 Projectile Injuries 205 Explosive Munitions: Ballistic, Blast, and Thermal Injuries 227 Impalement Injuries 227 Pressure Ulcers 228 Hygroma 234 Snakebite 239 Brown Recluse Spider Bites 240 Porcupine Quills 240 Lower Extremity Shearing Wounds 243 Plate 10: Pipe Insulation Protective Device: Elbow 248 Plate 11: Pipe Insulation to Protect the Great Trochanter 250 Plate 12: Vacuum Drain Management of Elbow Hygromas 252 8. Regional Considerations 255 The Canine and Feline Profiles 256 Plates 13A and 13B: Surgical Technique Menu 258 9. Tension?Relieving Techniques 265 Introduction 266 Skin Tension in the Dog and Cat 266 Plate 14: Tension Lines 282 Plate 15: Effects of Skin Tension on Wound Closure 284 Plate 16: Patient Positioning Techniques 286 Plate 17: Undermining Skin 288 Plate 18: Geometric Patterns to Facilitate Wound Closure 290 Plate 19: V?Y Plasty 292 Plate 20: Z?Plasty (Option I) 294 Plate 21: Z?Plasty (Option II) 296 Plate 22: Multiple Z?Plasties 298 Plate 23: Relaxing/Release Incisions 300 Plate 24: The "Hidden" Intradermal Release/ Relaxing Incision 302 Plate 25: Multiple Release Incisions for Extremity Wounds 304 Plate 26: Suture Options to Alter Skin Traction and Retraction 306 Plate 27: Walking Suture Technique 308 Plate 28: Skin Stretchers to Offset Incisional Tension 310 Plate 29: "Tension" Suture Patterns 312 Plate 30: Retention Sutures 314 Plate 31: Stent 316 Plate 32: Skin "Directing" for Maximum Coverage 318 Plate 33: Relaxing Incision to Reduce Flap Tension 320 10. Skin?Stretching Techniques 323 Physiology of Skin Stretching 324 Presuturing 324 Load Cycling 324 Skin Stretchers 326 Skin Expanders 335 Plate 34: Presuturing Technique 338 Plate 35: Application of Skin Stretchers 340 Plate 36: Skin Stretchers to Enhance Length of Axial Pattern Flaps 342 Plate 37: Skin Stretcher Substitution for Presuturing 344 Plate 38: Skin Expanders 346 11. Local Flaps 351 Introduction 352 Advancement Flaps 353 Rotating (Pivoting) Flaps 356 Plate 39: Single Pedicle Advancement Flap 370 Plate 40: Bipedicle Advancement Flap 372 Plate 41: Transposition Flap (90 degrees) 374 Plate 42: Transposition Flap (45 degrees) 378 Plate 43: Transposition Flap (Oblique Angle) 380 Plate 44: Local Facial Flap Options vs. Auricular Axial Pattern Flap 382 Plate 45: Transposition Flaps in Partial Wound Closure 384 Plate 46: Interpolation Flap 386 Plate 47: Rotation Flap 390 Plate 48: Forelimb Fold Flap 392 12. Distant Flap Techniques 395 Distant Flaps 396 Direct Flaps 396 Indirect Flaps 396 The Delay Phenomenon 400 Plate 49: Direct Flap: Single Pedicle (Hinge) Flap 402 Plate 50: Direct Flap Closure of Knee Defect 406 Plate 51: Direct Flap: Bipedicle (Pouch) Flap 408 Plate 52: Indirect Flap: Delayed Tube Flap 414 13. Axial Pattern Skin Flaps 417 Introduction: Axial Pattern Flaps 418 Island Arterial Flaps 418 Reverse Saphenous Conduit Flaps 421 Secondary Axial Pattern Flaps 421 Options to Extend the Length of Axial Pattern Flaps 427 Plate 53: Four Major Axial Pattern Flaps of the Canine Trunk 430 Plate 54: Skin Position and Axial Pattern Flap Development 432 Plate 55: Omocervical Axial Pattern Flap 434 Plate 56: Thoracodorsal Axial Pattern Flap 436 Plate 57: Lateral Thoracic Axial Pattern Flap 438 Plate 58: Superficial Brachial Axial Pattern Flap 440 Plate 59: Caudal Superficial Epigastric Axial Pattern Flap 442 Plate 60: Cranial Superficial Epigastric Axial Pattern Flap 444 Plate 61: Deep Circumflex Iliac Axial Pattern Flap: Dorsal Branch 446 Plate 62: Deep Circumflex Iliac Axial Pattern Flap: Ventral Branch 448 Plate 63: Flank Fold Flap: Hind Limb 450 Plate 64: Genicular Axial Pattern Flap 452 Plate 65: Reverse Saphenous Conduit Flap 454 Plate 66: Caudal Auricular Axial Pattern Flap 456 Plate 67: Superficial Temporal Axial Pattern Flap 458 Plate 68: Lateral Caudal (Tail) Axial Pattern Flap 460 14. Free Grafts 463 Free Skin Grafts 464 Classification of Free Grafts 465 Graft Thickness 465 Partial?Coverage Grafts 466 Dermatomes 467 Preservation by Refrigeration 467 Intraoperative Considerations 472 Bandaging Technique for Skin Grafts 472 Use of Plates 473 Plate 69: Punch Grafts 476 Plate 70: Pinch Grafts 478 Plate 71: Strip Grafts 480 Plate 72: Stamp Grafts 482 Plate 73: Sheet Grafts 484 Plate 74: Dermatome: Split?Thickness Skin Graft Harvesting 486 Plate 75: Mesh Grafts (With Expansion Units) 488 Plate 76: Mesh Grafts (With Scalpel Blades) 490 15. Facial Reconstruction 493 Introduction: Facial Reconstructive Surgery 494 Plate 77: Repair of Upper Lip Avulsion 515 Plate 78: Repair of Lower Labial Avulsion 516 Plate 79: Wedge Resection Technique 518 Plate 80: Rectangular Resection Technique 520 Plate 81: Full?Thickness Labial Advancement Technique (Upper Lip) 522 Plate 82: Full?Thickness Labial Advancement Technique (Lower Lip) 524 Plate 83: Buccal Rotation Technique 526 Plate 84: Lower Labial Lift?Up Technique 528 Plate 85: Upper Labial Pull?Down Technique 530 Plate 86: Labial/Buccal Reconstruction with Inverse Tubed Skin Flap 532 Plate 87: Skin Flap for Upper Labial and Buccal Replacement (Facial [Angularis Oris] Axial Pattern Flap) 536 Plate 88: Feline Facial Axial Pattern Flap 538 Plate 89: Cleft Lip Repair (Primary Cleft, Cheiloschisis, Harelip) 540 Plate 90: Unilateral Rostral Labial Pivot Flaps 542 Plate 91: Bilateral Rostral Labial Pivot Flaps 544 Plate 92: Oral Commissure Advancement Technique 546 Plate 93: Brachycephalic Facial Fold Correction 548 Plate 94: Cheilopexy Technique for Drooling 550 16. Myocutaneous Flaps and Muscle Flaps 553 Introduction 554 Myocutaneous Flaps 554 Muscle Flaps 554 Plate 95: Latissimus Dorsi Myocutaneous Flap 568 Plate 96: Cutaneous Trunci Myocutaneous Flap 570 Plate 97: Latissimus Dorsi Muscle Flap 572 Plate 98: Latissimus Dorsi Bipedicle Muscle Flap 574 Plate 99: Triceps Replacement with Latissimus Dorsi Muscle 576 Plate 100: External Abdominal Oblique Muscle Flap 578 Plate 101: Caudal Sartorius Muscle Flap 580 Plate 102: Cranial Sartorius Muscle Flap 582 Plate 103: Temporalis Muscle Flap 584 Plate 104: Transversus Abdominis Muscle Flap 586 Plate 105: Semitendinosus Muscle and Myocutaneous Flaps 588 Plate 106: Flexor Carpi Ulnaris Muscle Flap 590 Plate 107: Cranial Tibial Muscle Flap 592 Plate 108: Internal Obturator Muscle Flap 594 Plate 109: Superficial Gluteal Flap for Perineal Hernia Closure 596 17. Oral Reconstructive Surgical Techniques 599 Introduction 600 Cleft Palate 601 Palatal Defects/Oronasal Fistulas 602 Plate 110: Mucosal Flaps 606 Plate 111: Palatoplasty: Bipedicle Advancement Technique 608 Plate 112: Cleft Palate Repair: Mucoperiosteal Flap Technique 612 Plate 113: Palatine Mucosal Flap 614 Plate 114: Soft Palate/Pharyngeal Mucosal Flaps 616 Plate 115: Full?Thickness Labial Flap Closure of Oronasal Fistulas 618 Plate 116: Cartilage Grafts for Palatal Fistulas 620 Plate 117: Angularis Oris Mucosal Flap 622 18. Foot Pad Reconstruction 625 Introduction 626 Pad Laceration and Lesion Excision 626 Digital Pad Transfer 631 Metacarpal/Metatarsal Pad Transfer 632 Accessory Carpal Pad 632 Pad Grafting 634 Digital Flaps for Wound Closure 634 Fusion Podoplasty 634 Plate 118: Digital Flap Technique: Major Digital/ Interdigital Defects 642 Plate 119: Digital Flap Technique: Major Defects of Digits Two or Five 644 Plate 120: Digital Pad Transfer 646 Plate 121: Metatarsal/Metacarpal Pad Transfer 648 Plate 122: Pad Grafting 650 Plate 123: Segmental Pad Grafting Technique 652 Plate 124: Fusion Podoplasty 654 19. Major Eyelid Reconstruction 657 Introduction 658 The Eyelids 658 Plate 125: Skin Flap Options for Cutaneous Defects of the Eyelid Regions 660 Plate 126: Lip?to?Lid Procedure 662 Plate 127: Oral Mucosal Graft onto Skin Flap 666 Plate 128: Third Eyelid-Skin Flap Reconstruction of the Lower Eyelid 668 20. Nasal Reconstruction Techniques 671 Introduction: Nasal Anatomy 672 Traumatic Wound Management 672 Neoplasia 673 Neoplasms and Surgical Margins 673 Nasal Reconstruction Options 673 Options for Managing Nasal Stenosis 682 Plate 129: Septal Coverage Using Cutaneous Advancement Flaps 692 Plate 130: Bilateral Sulcus Flap Technique 694 Plate 131: Septal Resection Technique 696 Plate 132: Dorsal Nasal Splitting Technique to Enhance Exposure of Septum 698 Plate 133: Alar Fold Flaps 700 Plate 134: Musculofascial Island Labial Flap 702 Plate 135: Labial Mucosal Inversion Technique 706 Plate 136: Nasal Reconstruction with the "Lip?to? Lid Technique" Variation 708 Plate 137: Oral Mucosal Graft with Nasal Stenting 710 Plate 138: Intranasal Septal Window Technique 712 Plate 139: Cantilever Suture Technique 714 21. Cosmetic Closure Techniques 719 Cosmetic Considerations 720 Causes of Scars 720 Minimization of Scarring 720 Dog Ears 722 Plate 140: Scar Concealment 724 Plate 141: W?Plasty 726 Plate 142: Dog Ear: Surgical Correction 728 22. Preputial Reconstructive Surgery 731 Introduction 732 Surgical Conditions 732 Surgical Techniques 742 Plate 143: Preputial Ostium Enlargement 756 Plate 144: Preputial Ostium Reduction 758 Plate 145: Preputial Advancement Technique 760 Plate 146: Phallopexy 764 Plate 147: Urethral Reconstruction for Subanal Hypospadias 766 Plate 148: Preputial Urethrostomy Technique 768 Plate 149: Urine Diversion Technique 770 23. Pinnal Reconstructive Surgery 773 Introduction 774 Anatomy of the Pinna 774 Surgical Conditions 779 Wound Management and Reconstructive Surgical Techniques 780 Aural Hematoma Management Options 786 Plate 150: Skin Advancement Closure: Rostral Pinnal Base 796 Plate 151: Skin Advancement Closure: Caudal Pinnal Base 798 Plate 152: Transposition Flap Technique for Smaller Medial Pinnal Defects 800 Plate 153: Transposition Flap Technique for Minor Lateral Pinnal Defects 802 Plate 154: Large Transposition Flap Closure After Major Medial Pinnal Resection 804 Plate 155: Transposition Flap for Major Lateral Pinnal Defects 806 Plate 156: Direct Flap Reconstruction of the Pinna 808 Plate 157: Resection of the Terminal Third of the Pinna 810 Plate 158: Inverted "Triangle" Resection of the Central Third of the Pinna 812 Plate 159: Incisional Drainage of Aural Hematomas 814 Plate 160: Bandaging the Pinna 816 Plate 161: Vacuum Drain Management of Aural Hematomas 818 24. Miscellaneous Reconstructive Surgical Techniques 821 Omentum 822 Scrotum 822 Tail Fold Intertrigo (Screw Tail) 823 Disorders of the Vulva 827 Managing Skin Fold Inversion of Urethrostomies 835 Fecal Incontinence: Treatment Options 835 Plate 162: Omental Flap Options 838 Plate 163: Scrotal Flap Technique 840 Plate 164: Caudectomy for Tail Fold Intertrigo 842 Plate 165: Episioplasty 844 Plate 166: Fascia Lata Sling and Silicone Banding for Managing Fecal Incontinence 846 Plate 167: Spiral Rectal Diaphragm Technique (Rectal Rifling) 848 Index 851

About the Author

The author MICHAEL M. PAVLETIC, DVM, Diplomate ACVS, is Director of Surgical Services at Angell Animal Medical Center in Boston, Massachusetts, USA.

Reviews

"A top pick, unparalleled in detail, scope and the latest coverage." (The Mid West Book Review, July 2010) "The book is written for a wide audience from students or technicians to general practitioners or surgeons. There is not a more credible authority than the author of this book. The pictures are outstanding, especially compared to the previous edition. This is an excellent boards review... as well as a good reference for my practice to plan appropriate wound care options or reconstructive techniques. This edition is in far greater detail than any other book that covers both soft and orthopedic surgery." ("Doody's, " July 2010)

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"The third edition of "Small Animal Wound Management and Reconstructive Surgery" is a well-organized text that outlines the process of wound care from basic initial management to complicated reconstructive techniques. The addition of color pictures to the treatment of specific wound types is a welcome addition to previous editions of the text. The book is well written, and the color figures compliment the text well. Throughout the text, the author includes information boxes to emphasize important points and to add personal observations based on his experience. These information boxes add a personal feel and welcome procedural tips to the text that will help novice surgeons. Overall, the third edition of this book is a valuable addition as a reference for experienced surgeons as well as a guide for surgical residents and general practitioners interested in wound management and skin reconstruction." ("Journal of the American Veterinary Medical Association," December 2010)

"This book en


"I would recommend it with-out hesitation for those with a heavy surgical caseload (particularly surgical oncology) and for anyone who has a particular interest in wound management and reconstruction." (Veterinary Times, 14 March 2011)

"The third edition of "Small Animal Wound Management and Reconstructive Surgery" is a well-organized text that outlines the process of wound care from basic initial management to complicated reconstructive techniques. The addition of color pictures to the treatment of specific wound types is a welcome addition to previous editions of the text. The book is well written, and the color figures compliment the text well. Throughout the text, the author includes information boxes to emphasize important points and to add personal observations based on his experience. These information boxes add a personal feel and welcome procedural tips to the text that will help novice surgeons. Overall, the third edition of this book is a valuable addition as a reference f


"In the preface of this substantial book the author expresses his hope that readers will find it a "practical, informative and single-source reference for the surgical restoration of our small animal patients": he has, in my opinion, achieved his aim. I would recommend it without hesitation for those with a heavy surgical caseload (particularly surgical oncology) and for anyone who has a particular interest in wound management and reconstruction." ("Veterinary Times, " March 2011)

"The third edition of "Small Animal Wound Management and Reconstructive Surgery" is a well-organized text that outlines the process of wound care from basic initial management to complicated reconstructive techniques. The addition of color pictures to the treatment of specific wound types is a welcome addition to previous editions of the text. The book is well written, and the color figures compliment the text well. Throughout the text, the author includes information boxes to emphasize important pointsa


"This Atlas would be a very useful addition to the general practitioner's library. Recent graduates will benefit from the theory regarding wound healing and complications and the many different methods of wound closure. The more advanced surgeon could use this book as a quick visual reference for more complicated techniques. I would recommend this text for any general practitioner wanting to expand surgical skills to include flaps or to improve closure techniques." (Australian Veterinary Journal, 1 March 2011)

"In the preface of this substantial book the author expresses his hope that readers will find it a "practical, informative and single-source reference for the surgical restoration of our small animal patients": he has, in my opinion, achieved his aim. I would recommend it without hesitation for those with a heavy surgical caseload (particularly surgical oncology) and for anyone who has a particular interest in wound management and reconstruction." (Veterinary Times, March 2011)

"The third edition of Small Animal Wound Management and Reconstructive Surgery is a well-organized text that outlines the process of wound care from basic initial management to complicated reconstructive techniques. The addition of color pictures to the treatment of specific wound types is a welcome addition to previous editions of the text. The book is well written, and the color figures compliment the text well. Throughout the text, the author includes information boxes to emphasize important points and to add personal observations based on his experience. These information boxes add a personal feel and welcome procedural tips to the text that will help novice surgeons. Overall, the third edition of this book is a valuable addition as a reference for experienced surgeons as well as a guide for surgical residents and general practitioners interested in wound management and skin reconstruction." (Journal of the American Veterinary Medical Association, December 2010)

"This book encapsulates the clincial acumen that Dr. Pavletic has derived from 35 years' experience in wound management and reconstructive surgery. There is a good reason why the previous edition of this book is a staple in most surgeons' libraries!" (Veterinary Record, January 2011)

"The book is written for a wide audience from students or technicians to general practitioners or surgeons. There is not a more credible authority than the author of this book. The pictures are outstanding, especially compared to the previous edition. This is an excellent boards review... as well as a good reference for my practice to plan appropriate wound care options or reconstructive techniques. This edition is in far greater detail than any other book that covers both soft and orthopedic surgery." (Doody's, July 2010)

"Now in a fully updated and expanded third edition, Atlas of Small Animal Wound Management & Reconstructive Surgery provides a key reference any practicing vet collection needs. A top pick, unparalleled in detail, scope and the latest coverage." (The Midwest Book Review, July 2010)






















-This Atlas would be a very useful addition to the general practitioner's library. Recent graduates will benefit from the theory regarding wound healing and complications and the many different methods of wound closure. The more advanced surgeon could use this book as a quick visual reference for more complicated techniques. I would recommend this text for any general practitioner wanting to expand surgical skills to include flaps or to improve closure techniques.- (Australian Veterinary Journal, 1 March 2011)

-In the preface of this substantial book the author expresses his hope that readers will find it a -practical, informative and single-source reference for the surgical restoration of our small animal patients-: he has, in my opinion, achieved his aim. I would recommend it without hesitation for those with a heavy surgical caseload (particularly surgical oncology) and for anyone who has a particular interest in wound management and reconstruction.- (Veterinary Times, March 2011)

-The third edition of Small Animal Wound Management and Reconstructive Surgery is a well-organized text that outlines the process of wound care from basic initial management to complicated reconstructive techniques. The addition of color pictures to the treatment of specific wound types is a welcome addition to previous editions of the text. The book is well written, and the color figures compliment the text well. Throughout the text, the author includes information boxes to emphasize important points and to add personal observations based on his experience. These information boxes add a personal feel and welcome procedural tips to the text that will help novice surgeons. Overall, the third edition of this book is a valuable addition as a reference for experienced surgeons as well as a guide for surgical residents and general practitioners interested in wound management and skin reconstruction.- (Journal of the American Veterinary Medical Association, December 2010)

-This book encapsulates the clincial acumen that Dr. Pavletic has derived from 35 years' experience in wound management and reconstructive surgery. There is a good reason why the previous edition of this book is a staple in most surgeons' libraries!- (Veterinary Record, January 2011)

-The book is written for a wide audience from students or technicians to general practitioners or surgeons. There is not a more credible authority than the author of this book. The pictures are outstanding, especially compared to the previous edition. This is an excellent boards review... as well as a good reference for my practice to plan appropriate wound care options or reconstructive techniques. This edition is in far greater detail than any other book that covers both soft and orthopedic surgery.- (Doody's, July 2010)

-Now in a fully updated and expanded third edition, Atlas of Small Animal Wound Management & Reconstructive Surgery provides a key reference any practicing vet collection needs. A top pick, unparalleled in detail, scope and the latest coverage.- (The Midwest Book Review, July 2010)





















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