Troublesome collar injury wound

RE: Troublesome collar injury wound

Clare Tapsfield-Wright — Sun, 09 Jul 2017 14:43:42 GMT

Has anyone had any failures with the anatomical skin fold technique ? I had tried something similar with a skin flap before opting for the omental graft when it failed. it was a longstanding case in a previously stray cat.

RE: Troublesome collar injury wound

serena holmes — Sun, 09 Jul 2017 13:57:09 GMT

+1 for the anatomical skin fold technique

Done this in 3 cases, all worked well, basically removing granulation bed, undermining extensively so elbow easily fits in space created then simp int closure

RE: Troublesome collar injury wound

Rob Loxley — Fri, 07 Jul 2017 18:54:46 GMT

[quote user="roland bulkyn-rackowe"]

reconstructing the anatomical skin fold:

https://www.ncbi.nlm.nih.gov/pubmed/17286666

[/quote]

IME this technique works really well and is very simple, no flaps or omentum involved.

RE: Troublesome collar injury wound

Clare Tapsfield-Wright — Fri, 07 Jul 2017 18:39:11 GMT

[quote user="Anthony Dennison"]

[quote user="Clare Tapsfield-Wright"]I had a case just like this and tried everything. There didn't seem much tension on the skin but the tissue deficit subcut caused it it to break down. I did an omental advancement and it healed really quickly, very satisfying. [/quote]

Sounds exactly like my case!

I've just done a quick google on omental advancement, never heard of that before! Is it a particularly tricky thing to do? Subcutaneous tunnel to the non healing site, spread it out then suture the skin back together over the top?

[/quote] that's how I did it though it was quite a new procedure at that time. Ian Barclay told me how over the phone ( client with no cash for referral ) . I think the size of the graft I did was overlarge but I didn't want it to die off nor create a potential ventral hernia but everything remodelled beautifully post op. You will probably get much better advice from a more qualified surgeon . I was a GP who enjoyed soft tissue surgery ( hate that past tense):)

RE: Troublesome collar injury wound

Yantha Smyth — Fri, 07 Jul 2017 17:38:33 GMT

I have done two non-healing axillary wounds using the 'reconstruction of the anatomical skin fold' technique following the guide in the published article, and it worked brilliantly both times. The second one was an especially savage cat that would have had to have GA for suture removal, so tried it with intradermals and was fine thankfully

RE: Troublesome collar injury wound

Anthony Dennison — Fri, 07 Jul 2017 17:32:07 GMT

Sounds exactly like my case!

RE: Troublesome collar injury wound

Clare Tapsfield-Wright — Fri, 07 Jul 2017 15:50:00 GMT

I had a case just like this and tried everything. There didn't seem much tension on the skin but the tissue deficit subcut caused it it to break down. I did an omental advancement and it healed really quickly, very satisfying.

RE: Troublesome collar injury wound

Lucy Fleming — Fri, 07 Jul 2017 14:55:31 GMT

[quote user="roland bulkyn-rackowe"]The two courses of action I've heard discussed are either advancing omentum (which seems a bit extreme)[/quote]

A few classmates of mine have managed this way - it's less extreme than it sounds, I think. One was only very recent but I can see if she can update me with how it went. Generally apparently they do very well.

RE: Troublesome collar injury wound

Roland Bulkyn-Rackowe — Fri, 07 Jul 2017 14:44:07 GMT

Is this an axilla wound? The two courses of action I've heard discussed are either advancing omentum (which seems a bit extreme) or reconstructing the anatomical skin fold:

https://www.ncbi.nlm.nih.gov/pubmed/17286666

RE: Troublesome collar injury wound

Linda Filshie — Fri, 07 Jul 2017 14:43:25 GMT

Axillary wound? May need to do a skin flap with a direct cutaneous blood supply. I've done these for inguinal wounds using caudal epigastric - i think there are a couple of options for the axillary region.

This Clinicians' Brief article may also be useful: http://www.cliniciansbrief.com/sites/default/files/sites/cliniciansbrief.com/files/Nonhealing%20Wounds.pdf