Skin stretchers

Re: Skin stretchers

Georgie Hollis — Wed, 11 Aug 2010 13:55:27 GMT

Sounds like whatever happened to the dog it has made a very good effort at trying to get you as complex a wound as possible!

Would like to see pics of your velcro in action, have seen velcro used successfully on a horse's knee recently. Bandage rub was getting worryingly bad and seemed to persist despite the best efforts and care with bandaging technique. Velcro was glued to clipped skin about 2 inches from the wound edge to avoid the glue slowing down the contraction process (it gets hard and inhibits epithelial migration) then in theory you can stick the other part of the velcro - (the partner piece, often comes with a sticky backing) to the border of an oversized secondary dressing such as an allevyn or Advazorb foam. Put your primary dressing underneath, and hey presto... ??!!!

Best wishes and would love to know how you get on.

Georgie.

Re: Skin stretchers

Utlendigur — Wed, 11 Aug 2010 13:38:06 GMT

I agree with the comments on local flaps and axial pattern flaps and have always been able to use these in the past. I inherited this case at the point where it was sloughing with a raging skin infection so I didn't see the original injuries, but I suspect the bite on the back end destroyed the deep circumflex iliac artery (both branches) as what sloughed is the area that would be used for the associated axial pattern flap (plus some!). There were also further wounds to the inguinal area and ventral flank/abdomen so the caudal superficial epigastric may also be sub-optimal. I tried a rotation flap (after debriding/dressing until granulting) to to cover the deficit on the upper part of the hind leg but found there were bite wounds and subcut trauma which made mobilising it difficult and it's vascularity probably wasn't great, so the tip sloughed allowing the skin on the hindleg to slide down again. A transposition flap wouldn't stretch far enough without being so big it would impinge on the large cranial deficit. The cranial deficit was also a problem as the dog had had numerous injections in the scruff causing severe reaction/thickening. It's a bit different to a situation with a tumour where you have one neat deficit and normal stretchy skin - the poor dog has bite wounds all over his body. There is still quite a lot of exudate which seems to be necrotic tissue rather than pus so I'm just managing it as an open wound for now. Have tried the velcro again with superglue (tried tissue glue initially) and so far is holding. Many thanks for the replies and apologies for delay - computer crashed. I'll try and upload some photos later

Re: Skin stretchers

Malcolm Ness — Tue, 10 Aug 2010 08:42:45 GMT

Agree with what's been said above - cog and cat skin is much more amenable to reconstructive surgery than human or horse skin and consequently skin stretchers are rarely needed. I can't rrecall us ever using them.

There are dozens of axial pattern and other flaps (Pavletic led this area of research in vet surgery and his book is excellent) and numerous other techniques described for closing big wounds.

It is quite depressing to note that we will regularly see tumour cases that have been deemed unresectable elsewhere - I would encourage anyone tempted to tell a client "That can't be removed" to pick up the 'phone and speak to a surgeon with experience of reconstructive techniques. Most of the techniques are do-able in practice providing you can handle surgical instruments and follow instructions.

Re: Skin stretchers

Georgie Hollis — Tue, 10 Aug 2010 07:22:23 GMT

Hi, i have seen this velcro type system demonstrated by Michael Pavletic, and i believe there are a couple of other versions available to choose from - Admittedly all from the US. Michael Pavletic is the man to get in touch with, he would i'm sure help get you the velcro version you are after as i believe he designed it himself, however depends how long you've got as not sure how long it would take to come from the states?

Other options are available so feel free to get in touch. I can give you Michael's contact details, and I'm sure he would be happy to advise.

best wishes, Georgie.

georgie@intelligentwoundcare.com

Re: Skin stretchers

stuart mcmorrow — Mon, 09 Aug 2010 21:25:48 GMT

This sort of thing is often mentioned in CPD courses but not too much in books.

You can find a mention in:

Atlas of Small Animal Reconstructive Surgery, Michael M. Pavletic, chapter 9 - Skin Stretching Techniques.

I have used this technique in the past and just used simple velcro - you can buy strips of it in places like Asda,Tesco etc - and stuck it to the skin with superglue (clip the skin, give it a good clean, wipe with spirit then allow to dry). You then leave the velcro stuck on with superglue to fall off by themselves - they don't cause any bother.

I have found it very rare that I have had to use this technique as most wounds can usually be closed surgically by using local flaps or axial pattern flaps.

Do you have any pictures we could see?

Cheers,

Stuart.