What can I use to cover this?

RE: What can I use to cover this?

Neil Wheadon — Tue, 08 Feb 2022 15:50:42 GMT

So here's the result

Can I publicly thank the vets at Bath Vet Group who took over after I had stitched the leg.

Some of the original stitched skin did not survive but with a skin graft, body stocking and great care the leg was saved.

My part was small in this I guess in pulling everything back together which helped to save the leg

I recently saw the fence this greyhound tried to jump having done a house visit to attend the other dog

As Lawrence Guerring said in our equine lectures 35 years ago, just stitch it, you've got nothing to loose and he was right bless him

Neil

RE: What can I use to cover this?

Jill Butterworth — Sun, 27 Jun 2021 19:10:09 GMT

Similar, but not the same.

RE: What can I use to cover this?

Minnie — Sat, 26 Jun 2021 20:30:52 GMT

walking sutures?

RE: What can I use to cover this?

Jill Butterworth — Sat, 26 Jun 2021 19:55:52 GMT

Something I've done in these deglovings in greyhounds is after repairing these huge flaps with such thin skin, is to take some tension off by placing single sutures through the skin and into the muscle/sub cut area below, like mattress tufts. Don't know if it has a name or is contra indicated but it works well enough.

RE: What can I use to cover this?

Anthony Todd — Sat, 26 Jun 2021 16:07:54 GMT

How do you staple stitch, or in any other way, close a gap......!?

Hoping the adjustable "stretchable" skin, with daily "pull ups" vis vecro and a bit of tension, enables the edges to be stitched together in any way the surgeon fancies!

If the edges aren't side-by-side the "any stitchin" solution isn't even possible.

Will be interesting to know how well the [brilliant!!] velcro method works.

My guess is 2cms closer in every 24 hours if no evidence of skin loss.

Cosmetic surgeons, who do face lifts all the time, might be worth a call!!

RE: What can I use to cover this?

Rob Davis — Fri, 25 Jun 2021 14:32:55 GMT

[quote userid="3094" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29902/what-can-i-use-to-cover-this/230958#230958"] I fond stapling to be quick, neat and efficient[/quote]

I agree, it's very quick and easy and definitely has its place but....

"Factors associated with a significantly lower rate of infection-inflammation included the use of suture material other than stainless-steel staples for skin closure and postoperative oral administration of antimicrobials" from this paper

"Factors significantly associated with SSI in the multivariate analysis were: use of staples for skin closure (odds ratio [OR] 3.85, P<.001) and surgical site closure by a 1st or 2nd year resident (OR 2.20, P=.016)" from this paper (admittedly about horses)

I have not done a thorough literature search, so there may be other evidence to the contrary and I'm very happy to be corrected.

RE: What can I use to cover this?

Anthony Todd — Fri, 25 Jun 2021 11:57:01 GMT

Brilliant solution!! I had a cattle dog with half the whole thorax stripped like half removing a sock by pulling the toe [not sure velcro was around then......]

I think we may be surprised at how much skin under gentle pressure will stretch.....and also how much is retraction rather than actual loss?? Serial pics may surprise [hint]

RE: What can I use to cover this?

Julian Earl — Fri, 25 Jun 2021 08:37:02 GMT

Thanks Rob, I beg to differ but all just different experience is all it is? I would argue that wound infections are only affected by the duration of the repair process plus he other usual surgical risks. I found stapling to be quick, neat and efficient! But each to their own I guess? But thanks for your opinion on this...

RE: What can I use to cover this?

Rob Davis — Fri, 25 Jun 2021 08:18:20 GMT

[quote userid="3094" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29902/what-can-i-use-to-cover-this/230946#230946"]Would you agree that staples enable better healing than sutures? [/quote]

No. I think well-placed sutures provide more accurate apposition. I seem to remember that there is a slightly higher incidence of wound infections with staples than sutures, but I don't have a reference to hand.

RE: What can I use to cover this?

Joyce Whitehead — Thu, 24 Jun 2021 21:05:58 GMT

Lovely bit of work there Neil,I always think if you can get cover, even if it breaks down it allows better granulation underneath. It’s always the sight hounds - we had one with a massive chest wound extending under the shoulder (ran onto a broken tree stump) which did remarkably considering what it looked like at first.

RE: What can I use to cover this?

Julian Earl — Thu, 24 Jun 2021 17:33:00 GMT

Would you agree that staples enable better healing than sutures? Ialways felt so, and being Metal, I presumed that this meant they held the wound-edges more securely. like mini-metal splints? Z That was my reasoning anyway. Your thoughts please? TIA!

Oh yes, and faster to put in and remove as well if that counts?

RE: What can I use to cover this?

Neil Wheadon — Thu, 24 Jun 2021 17:19:46 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29902/what-can-i-use-to-cover-this/230944#230944"]Incredible work! That looks great![/quote]

Well thankyou

It started as a help!! however as I worked at it, the piece of skin I thought wouldn't survive, looked a bit better than I thought, so tried to cover the stifle and gradually undermining and manipulating got it all together. No tension either, I could fully flex and extend the stifle post operation

Lulu is hopefully in a dog crate for 14 days and whined like a grehound only can

I remember a horse lecture from Lawrence Gearing at College. In regards to suturing, he said 'Just stitch it. If it breaks down you've lost nothing, sound advise indeed

You also may notice that I broke out the nylon, fortunately it was there as few use it.

Neil

RE: What can I use to cover this?

Anthony Dennison — Thu, 24 Jun 2021 17:12:52 GMT

Incredible work! That looks great! Do you have access to a k laser at all? I don't know how it works, but the cases we've used it on it really accelerates wound healing.

One piece of surgery CPD that always sticks with me was from LVS a few years ago; if wondering whether the wound will close by primary closure or not, get a load of towel clamps and see if you can appose the edges with them. If you can, it should close.

RE: What can I use to cover this?

Neil Wheadon — Thu, 24 Jun 2021 15:16:56 GMT

Well I'm not quite sure how, but after 2 hours, looking, appraising, stitching

Just hope it holds

Guess that getting at it 4 hours post injury and doing it within 30 minutes of presentation helped

RE: What can I use to cover this?

Utlendigur — Thu, 24 Jun 2021 12:32:58 GMT

Further proximal than yours but worked ok on this - about a week apart. Going a bit off the beaten track but also heard of sterilised tilapia skin being used veterinary-practice.com/.../pioneering-surgical-fish-skin-graft-saves-dog

RE: What can I use to cover this?

Anthony Dennison — Thu, 24 Jun 2021 12:14:52 GMT

Tidy up as much as you can, then use intra site and a foam dressing and bandage, then monitor for 2ndry healing

RE: What can I use to cover this?

Utlendigur — Thu, 24 Jun 2021 12:04:46 GMT

I've used velcro and elastic before now - very Heath Robinson Squares of velcro sutured onto skin then strips of wide elastic with velcro on the ends over the dressing (allevyn/similar) and also provide some tension to stop the skin retracting down the leg