Mass removal from the antebrachium of a dog

Re: Mass removal from the antebrachium of a dog

Louisa Huntington — Mon, 15 Aug 2011 09:20:31 GMT

Thank you very much for all your advice. The foot swelled over the first night but soon reduced after a bandage enclosing the toes had been applied. (I had originally left these open so the foot could be monitored for swelling and blood supply!). The wound is healing nicely and fingers crossed is not going to need any further surgery. It has been really interesting hearing all the different ways and think maybe a bit of skin flap cpd wouldnt go amiss!

Thank you

Re: Mass removal from the antebrachium of a dog

Evelyn Barbour-Hill — Thu, 11 Aug 2011 01:08:44 GMT

[quote user="robloxley"]

[quote user="Evelyn Barbour-Hill"]My point is that while immediate reconstruction as suggested above is surely the best way, there is no shame whatever in doing it as you have done already[/quote]

Agreed, but my reading of the OP was for suggestions of what else could have been done? I don't think anyone suggested any shame?

[/quote]

No, indeed, perhaps a poor choice of words on my part. I just meant, I suppose, that perhaps the way she did it was the best way in all the circumstances.

Re: Mass removal from the antebrachium of a dog

Rob Loxley — Wed, 10 Aug 2011 19:39:28 GMT

[quote user="Evelyn Barbour-Hill"]My point is that while immediate reconstruction as suggested above is surely the best way, there is no shame whatever in doing it as you have done already[/quote]

Agreed, but my reading of the OP was for suggestions of what else could have been done? I don't think anyone suggested any shame?

Re: Mass removal from the antebrachium of a dog

Alan Tevendale — Wed, 10 Aug 2011 16:34:29 GMT

[quote user="Evelyn Barbour-Hill"]

My point is that while immediate reconstruction as suggested above is surely the best way, there is no shame whatever in doing it as you have done already, waiting a couple of weeks to see what sort of defect is left and then proceeding to the reconstructive surgery.

[/quote]

Good point

Re: Mass removal from the antebrachium of a dog

Evelyn Barbour-Hill — Wed, 10 Aug 2011 14:06:02 GMT

It's one of those wise sayings - that ideally the cancer should be removed by one surgeon, and another surgeon then come in to repair the damage.

Not a practical suggestion for private practice of course, but the point is that while wearing your oncological surgeon's hat you might, even unconsciously, do a job that's less than perfect because you are considering also how to close the hole.

Re: Mass removal from the antebrachium of a dog

Alan Tevendale — Wed, 10 Aug 2011 08:31:06 GMT

For these types of masses I would suggest a superficial brachial axial pattern flap. You should be able to get down to just proximal to the carpus with this one. Obvious advantages of this over free skin graft is that it is easier to perform presuming you can identify the appropriate cutaneous artery and also that given that it has a blood supply it should have a better success rate.

If you interested in doing this sort of surgery there are some good courses out there but I've also bought a copy of 'Atlas of small animal reconstructive surgery' by Pavletic

Re: Mass removal from the antebrachium of a dog

nikki — Tue, 09 Aug 2011 22:46:06 GMT

my own dog had a soft tissue sarcoma on her forearm just above the carpus and right next to the cephalic vein. I have to say I didn't try and take huge margins - i knew i couldn't get deep margins without cutting through her cephalic vein and some rather important nerves. I ended up only taking 5mm margins and even then only just closed the skin. the histology said i had got clear margins but only just, and the chances of distant spread were remote but local recurrence was a possibility. i have opted to just monitor it from here on. if it comes back we'll have to do more radical surgery with some kind of skin graft i think as i dont think a flap will reach down that far. but for now she has a nice healed leg and not a huge wound.

Re: Mass removal from the antebrachium of a dog

Alan Tevendale — Tue, 09 Aug 2011 15:59:34 GMT

My understanding was distant direct flaps were going out of fasion with better success rates now being achieved from free skin grafts.

Re: Mass removal from the antebrachium of a dog

Rob Loxley — Tue, 09 Aug 2011 13:43:58 GMT

[quote user="Alan Tevendale"]Of course this will depend on exactly where the mass was as to whether you can reach it with a flap or not[/quote]

A distant direct flap could be an option for a distal limb, but this is really beyond my experience

Re: Mass removal from the antebrachium of a dog

Ben Walton — Tue, 09 Aug 2011 13:15:53 GMT

[quote user="Louisa Huntington"]

[quote user="Richard Fox"]

Being pedantic I presume you meant a soft tissue sarcoma not carcinoma?

[/quote]

Is it too late to perform a graft?

[/quote]

Probably not. You could allow a granulation bed to form (although it might be better to remove the mattress sutures if you think they'll interfere), and graft onto that. I'd harvest from the inguinal fold: the dermis is thin and less apt to necrose, and there is plenty of slack at the donor site.

Re: Mass removal from the antebrachium of a dog

Julian Earl — Tue, 09 Aug 2011 08:38:10 GMT

You need to plan a thoracodorsal flap, not a transplant. Transplants are very prone to complications whereas flaps are only moderately prone! With the dog being a large breed, you should be able to reach just beyond the elbow with a flap. They do require careful planning and can take some time to do.

Don't worry about the cephalic vein by the way - there must be thousands of dogs out there with chronically inflamed an/or obstructed cephalic veins relying on their collateral circulation.

Edit: You will have to wait for a granulation bed to develop and then think about covering it with a flap.

Re: Mass removal from the antebrachium of a dog

Louisa Huntington — Tue, 09 Aug 2011 08:34:58 GMT

[quote user="Richard Fox"]

Being pedantic I presume you meant a soft tissue sarcoma not carcinoma?

[/quote]

Sorry yes - i did mean that!

Sadly no photos - i can t say I have any experience of performing a flap but from what I have read I think the mass would be too distal. Is it too late to perform a graft?

I also agree with regards to the deep margins, I did the best I could but there is only so deep that you can go! I have sent the mass off to find out.

Re: Mass removal from the antebrachium of a dog

Richard Fox — Tue, 09 Aug 2011 07:37:39 GMT

Being pedantic I presume you meant a soft tissue sarcoma not carcinoma?

Re: Mass removal from the antebrachium of a dog

Alan Tevendale — Tue, 09 Aug 2011 07:34:37 GMT

I would definately be thinking about a skin flap in this case. Means the surgery itself will take longer but in the long run everything would be alot easier. Of course this will depend on exactly where the mass was as to whether you can reach it with a flap or not. If not your left with a skin graft. Don't suppose you've any photos?

I'd agree that in these cases it's often the deep margins that are trickier.

Re: Mass removal from the antebrachium of a dog

Rob Loxley — Mon, 08 Aug 2011 23:48:58 GMT

[quote user="Louisa Huntington"]Due to the nature of the mass I obviously had to take large margins[/quote]

As well as lateral margins, which it sounds like where the struggle closing arose, how were your deep margins - that's often the harder to achieve IMHO

[quote user="Louisa Huntington"]Does anyone have any magic tips for this[/quote]

I guess beyond the techniques you used you're really looking at planning a skin flap or graft to close the large deficit which it sounds like you had.