Surgery for Lick Granuloma

Canine acral lick dermatitis or lick granulomas are difficult to treat and in some cases surgical removal is indicated. Wound dehiscence, owing to excessive skin tension and repeated trauma, are often complications of the surgery. This report describes a technique using a phalangeal fillet to reconstruct a nonhealing wound on the lateral metatarsal region in a dog. The first step involved excising the wound en bloc. Open wound management with daily lavage and wet-to-dry dressings was started. Staphylococcus aureus was cultured, and the dog was treated with trimethoprim-sulfonamide. The dog was also given clomipramine in an attempt to address the suspected psychogenic cause of the original lesion. After 3 weeks of medical management, the first attempt at grafting was undertaken. The skin graft was full-thickness and meshed, harvested from the right lateral thoracic region. Ten days after surgery, it was apparent that the graft was failing. The phalangeal fillet technique was performed at that time. The neurovascular bundles on the plantar aspect of the foot were identified and retracted, and the proximal, middle, and distal phalanges were removed. The fifth digital pad was excised as well. Bipolar cautery and digital pressure were used to control bleeding. Partial separation of the most proximal aspect of the flap did occur but was managed with minimal debridement of the skin edges and addition of several more skin sutures. The dog recovered with good functional results.

COMMENTARY: Wounds of the phalangeal region are difficult to reconstruct when a large defect is created. Phalangeal fillet is a useful one-stage technique for cosmetically covering wounds due to the viable and local blood supply provided. This technique was very successful in this report given that the lesion involved the fifth digit, which is not a major weight-bearing digit and so is easily sacrificed. Caution should be taken using this technique on the major weight-bearing third or fourth digits, as it is likely to cause lameness.

Reconstruction of a nonhealing lick granuloma in a dog using a phalangeal fillet technique. Demetriou JL, Shales CJ, Hamilton MH, Sissener TR. JAAHA 43:288-291, 2007.