Skin Grafts: Alternative Wound Coverage After Tumor Removal?

Primary closure of skin defects after removal of a tumor from the distal limb is often not possible, particularly with large tumors and wide lateral margins. Immediate skin grafting could provide a single-stage alternative to second intention healing and other wound reconstruction techniques. Medical records of 7 dogs that received full-thickness, mesh, free skin grafts of the distal limb immediately following tumor removal were reviewed. Resection came from the antebrachium (n = 6) or tarso–metatarsal area (n = 1). When possible, surgical wounds were reduced by advancing skin edges together at the proximal and distal ends.

The prepared full-thickness, mesh graft was placed on the recipient bed, and its edges and recipient site were apposed with a simple interrupted pattern. Systemic and topical antibiotics were administered and nonadherent dressings and protective bandages applied. Patients were cage-confined in-hospital, then discharged with instructions for confinement. Frequency of bandage changes depended on appearance of the graft and bandage. Protective bandages were removed when grafts regained similar appearance to surrounding skin and showed hair growth. Six of 7 grafts yielded good to excellent hair regrowth and cosmetic results, supporting free grafting as a reliable alternative to reconstructive surgery or second-intention healing.

CommentaryThis technique’s overall success rate is 90%–100%; the disadvantage is the time (ie, 3–5 days) needed to establish a healthy granulation bed. With a nonsurgical, traumatic wound, this waiting period is often necessary for a clean, healthy site; however, with tumor removal requiring wide margins, this can be inefficient (time factor) and costly (bandaging supplies). Minimal loose skin on the distal limb makes it amenable to grafting. The single-stage technique described here provided good results and concrete evidence that mesh grafts can flourish on clean surgical wounds over tendons, ligaments, and muscles of distal extremities. Wisely, the authors stressed strict confinement and sedated bandage changes for the best results.—Kristy Broaddus, DVM, MS, DACVS

SourceFree skin grafts for immediate wound coverage following tumour resection from the canine distal limb. Tong T, Simpson DJ. J SMALL ANIM PRACT 53:520-525, 2012.