Article history: Received: 24-08-2017, Accepted: 18-11-2017, Published online: 27-12-2017
Corresponding author: Sabarish Babu Malli Sadhasivan
E-mail: email@example.comCitation: Sadhasivan SBM, Shafiuzama M, Shammi M, Rao GVS, Souza NJD, Senthilnayagam H, George RS, Prabhakar PM (2017) Studies on reconstruction of large skin defects following mammary tumor excision in dogs, Veterinary World, 10(12): 1521-1528.
Aim: The main objective of the study was to describe the use of skin fold advancement flaps (SFAFs) and other reconstructive techniques for closure of large skin defects following mammary tumor excision in dogs.
Materials and Methods: Twelve dogs underwent reconstruction of large ventral skin defects following mammary tumor excision with wide margins. Skin fold flaps (flank fold flap and elbow fold flap) were elevated from the flank and elbow region, respectively, and transposed and sutured onto the large ventral skin defect following mastectomy in all the dogs. In addition to the skin fold flaps, other reconstructive techniques such as undermining, walking sutures, and tension-relieving suture techniques were followed during surgery in the closure of large skin defects without skin tension and compromising limb mobility. The skin flap viability was assessed subjectively by gross observation of the flap such as color, temperature, capillary perfusion, and cosmetic appearance, and scoring (1-4) was done. Tissue samples were collected from a surgical site on days 3, 6, and 12 post-operatively for histopathological evaluation and healing status of the skin flap.
Results: All the surgical wounds healed primarily, without any major complications and the skin flap remained healthy throughout the healing process post-operatively. Distal flap necrosis was noticed in one case and necrosis of skin flap between two suture lines was noticed in another case in which the necrotized distal portion healed by secondary intention after 7 days. The mean survival of subdermal plexus flap in the above cases was 98% which was a subjective evaluation based on surface area of the skin defect measured by Image 'J software and the flap dimensions. The average healing of skin flap in days was 14.91±0.86.
Conclusion: The SFAFs along with other reconstructive techniques help in the reconstruction of large ventral skin defects following mastectomy in dogs without much compromising limb mobility.
Keywords: canine, histopathology, mammary tumors, reconstruction, skin fold flaps.
1. Patiskas, M.N., Karayannopoulou, M., Kaldrymidou, E., Papazoglou, L.G. and Papadopoulou, P.L. (2006) The lymph drainage of the neoplastic mammary glands in the bitch. A lymphographic study. Anat. Histol. Embryol., 35: 228-234. [Crossref] [PubMed]
2. Cyrta, J., Andreiuolo, F., Azoulay, S., Balleyguier, C., Bourgier, C., Mazouni, C., Mathieu, M.C., Delaloge, S. and Vielh, P. (2012) Pure and mixed mucinous carcinoma of the breast: Fine needle aspiration cytology findings and review of the literature. Cytopathology, 32(6):64-68.
3. Gupta, K., Sood, N.K., Uppal, S.K., Mohindroo, J., Mahajan, S., Raghunath, M. and Singh, K. (2012) Epidemiological studies on canine mammary tumor and its relevance for breast cancer studies. IOSR J. Pharm. Biol. Sci., 2(2):322-333.
4. Withrow, S.J. and Vail, D.M. (2007) Hematopoetic tumors. In: Withrow, S.J.,Vail, D.M. and Page, R.L., editors. Small Animal Clinical Oncology. 4thed.Saunders, W.B., Philadelphia, PA. pp 619-636.
5. Sorenmo, K.U., Kristiansen, V.M., Cofone, M.A., Shofer, F.S., Breen, A.M., Langeland, M., Mongil, C.M., Grondahl, A.M., Teige, J. and Goldschmidt, M.H. (2009) Canine mammary gland tumors; A histological continuum from benign to malignant; Clinical and histopathological evidence. Vet. Comp. Oncol., 7: 162-172. [Crossref] [PubMed]
7. MacEwen, E.G., Harvey, H.J. and Patnaik, A.K. (1985) Evaluation of effects of levamisole and surgery on canine mammary cancer. J. Biol. Response Mod., 4: 418-426. [PubMed]
8. Pavletic, M.M. (1993) Skin flap and skin grafting techniques in small animal surgery. Atlas of Small Animal Reconstructive Surgery. 3rd ed. Wiley-Blackwell, Iowa. pp 113-115.
9. Ijaz, M.S., Mahmood, A.K., Ahmad, N., Khan, M.A. and Farooq, U. (2012) Viability of split thickness autogenous skin transplantation in canine distal limb reconstruction. An experimental evaluation. Pak. Vet. J., 32(2): 193-196.
11. Heather, L.C. and Paul, R.W.S. (2011) Closing the gap: Skin grafts and flaps. Int. J. Surg., 29(10): 502-506.
12. Dunn, A., Buffa, E., Mitchell, R. and Hunt, G. (2011) Bilateral skin fold rotation-advancement flaps for the closure of large lumbosacral wounds in three dogs. Aust. Vet. J., 89(5): 174-179. [Crossref] [PubMed]
13. Sorenmo, K.U., Worley, D.R. and Goldschmidt, H. (2013) Tumors of the mammary gland. In: Withrow, S.J., Vail, D.M. and Page, R.L., editors. Small Animal Clinical Oncology. 5th ed. Elsevier, St. Louis. pp 118-1191. [Crossref]
15. Moyaser, G., Thannoon, S.I.M. and Muneer, A.S. (2012) Auto-Skin transplantation in dogs. Bas. J. Vet. Res., 11(2):113-119.
16. Pavletic, M.M. (1999) Tension suture patterns. Atlas of Small Animal Reconstructive Surgery. 2nd ed. Saunders, W. B., Philadelphia, PA. pp 276-279.
17. Reiter A.M. and Holt, D. (2012) Palate. In: Tobias, K.M. and Johnston, S.A., editors. Veterinary Small Animal Surgery. 1sted. Elsevier, Saunders, W.B., Canada. pp 1707-1710.
18. Kelly, K.M., Bardach, J. and Marretta, S.M. (2012) Palate surgery. In: Verstraete, F. and Lommer, M.L., editors. Oraland Maxillofacial Surgery in Dogs and Cats. 1sted. Elsevier, Europe. pp 343-373. [Crossref]
19. Pavletic, M.M. (2003) Pedicle grafts. In: Slatter, D.H., editor. Textbook of Small Animal Surgery. 3rded. Saunders, W. B. Philadelphia, PA. pp 292-321.
21. Medrado, A.R., Pugliese, L.S., Reis, S.R. and Andrale, Z.A. (2003) Influence of low level laser therapy on wound healing and its biological action upon my fibroblasts. Lasers. Surg. Med., 32: 239-244. [Crossref] [PubMed]
23. Gal, P., Toporcer, T., Vidinsky, B., Mokry, M., Novotny, M., Kilik, R., Smetana, K., Gal, T. and Sabo, J. (2006) Early changes in the tensile strength and morphology of primary sutured skin wounds in rats. Folia Biol., 52: 109-115.
24. Hunt, G.B. (2012) Local or sub dermal plexus flaps. In: Tobias, K.M. and Johnston, S.A., editors. Veterinary Surgery: Small Animal. 3rd ed. Elsevier, St. Louis, Philadelphia, PA. pp 1256-1270.
25. Defoor, J., Bosmans, T., Doom, M., Schwarzkopf, I. and De Rooster, H. (2013) The use of an islandized angularis oris axial pattern buccal flap for the reconstruction of a recurrent cleft palate in a cat. Flem. Vet. J., 83: 350-355.
26. Suyoung, H.E.O., Haebeom, L.E.E. and Nam, S.K.I. (2013) Use of a gracilis myocutaneous flap for reconstruction of a perineal defect in a dog: Case report. Turk. J. Vet. Anim. Sci., 37: 366-368.
27. Remedios, A.M. and Fowler, J.D. (1995) Axial pattern flaps in the cutaneous reconstruction of lower limb wounds. Comp. Cont. Educ. Pract. Vet., 17: 1356-1364.
29. Shafiee, R., Javanbakht, J., Atyabi, N., Kheramand, P., Kheramand, D., Bahrami, A., Daraei, H. and Khadivar, F. (2013) Diagnosis, classification and grading of canine mammary tumors as a model to study human breast cancer: An clinico-cytohistopathological study with environmental factors influencing public health and medicine. Cancer Cell Int., 13(1): 79. [Crossref] [PubMed] [PMC]30. Papazoglou, L.G., Tsioli, V., Karayannopoulou, M., Savvas, I., Kazakos, G. and Kaldrymidou, E. (2006) Comparison of three methods for closure of mastectomy incisions in dogs. Aust. Vet. J., 36: 156-162.