Closure of skin defeets in limbs with the use of skin stretchers. An experimental study in the dog

The aim of the present study was: 1) to evaluate the effectiveness of three skin- stretching devices that were used to cover large skin defects that were created in the distal limbs of dogs, 2) to determine the effect of skin stretching in cutaneous microcirculation and 3) to determine the effect of skin stretching in cutaneous histology. Twenty -four adult mongrel dogs were used that were randomly allotted in 3 groups. In group A polypropylene sutures were passed through staples that were placed around the wound edges and were tied over a cylinder. In group B sutures connected 2 hypodermic needles that were placed on either side of the wound in parallel fashion and were tied over a cylinder. In group C the Pavletic skin stretching device was used. All animals were anesthetized and antibrachial skin defects were created on the lateral and frontal surface. The defects measured 5 cm in length, whereas their width was equal to 50% of the circumference of the mid-antibrachium. Additionaly, in all 3 groups undermining of the wound edges was performed on the left limb. In groups A and B on day 1 after the creation of the defects and the application of the skin stretchers, sutures were tightened and the tension of 1.5-3 kg exerted on the wound edges was measured with a special device. On day 2 cycle loading of 1.5-2 kg was applied for 2-3 minutes followed by periods of 1 minute of relaxation. Sutures were tightened once again and tension was measured. On day 3, the same procedure was performed, then skin stretchers were removed and defects were closed primarily. In group C cycle loading was not performed. In all groups, after primary closure, the wounds were bandaged and changed daily, while the course of healing was graded according to a 5 grade scale. Skin perfusion was assessed in 6 predetermined sides by Laser Doppler velocimetry. Measurements were performed before the creation of the defect, 24 hours after creation of the defect and before cycle loading and tightening of sutures and 48 hours after creation of the defects. Biopsy specimens were taken before the creation of the defects (day 1), when they were closed primarily (day 3) and finally when sutures were removed (day 15). Skin perfusion values among the 3 groups and between the left and the right limb were not significantly different. However, significant differences were found among the measurement sides and between days 1 to 3 and 2 to 3, mostly on the left limb. A statistically significant positive correlation was observed in only 10 of the 24 measurement sides between the applied tension and skin perfusion, which mainly concerned the right limb. Correlation of skin perfusion and grading of healing was statistically significant on the right limb. There were statistically significant differences, concerning the applied tension, between days 1 to 3 and among the 3 groups. In addition, a statistically significant correlation was found between the applied tension and the grading of postoperative healing. The histological parameters, which were evaluated, did not have any statistically significant differences between the 3 groups, although there was some histological evidence that inflammatory reaction was milder in group B compared to groups A and C. In addition, collagen fibers were straightened and realigned parallel to one another in groups A and B, whereas in group C they were convoluted. In conclusion it was found that: 1. Skin stretchers can be used for the closure of large skin defects in the middle and distal limb of dogs. 2. Hypodermic needles can be used effectively as skin stretchers on limbs, whereas the Pavletic skin stretching device is not indicated. 3. Blood perfusion of the wound edges, during skin stretching, is not altered significantly. 4. Tensions applied to the skin, ranging from 1.5 to 3 kg, are safe and when used in combination with cycle loading contributed in skin elongation. 5. Skin undermining did not significantly decrease wound closure tension and did not affect blood perfusion. 6. Skin stretchers produce thinning of the epidermis and an increase in the overall thickness of dermis.Η δυσκολία αντιμετώπισης δερματικών ελλειμμάτων στο περιφερικό τμήμα των άκρων, εξαιτίας της μικρής ελαστικότητας του δέρματος στην περιοχή, αποτελεί πρόκληση για το χειρουργό. Οι τρόποι οι οποίοι συνιστώνται για την κάλυψη τέτοιων ελλειμμάτων είναι: α) η κατά πρώτο σκοπό σύγκλεισή τους με απλές τεχνικές μείωσης της τάσης, όταν είναι μικρού μεγέθους, β) η επούλωση κατά δεύτερο σκοπό και γ) η χρήση κρημνών, μοσχευμάτων, εσωτερικών διατατήρων δέρματος και εξωτερικών εκτατήρων όταν η έκτασή τους είναι μεγάλη. Οι εκτατήρες χρησιμοποιώντας τις μηχανικές και ιξωδοελαστικές ιδιότητες του δέρματος αξιοποιούν την ικανότητά του για διάταση συμβάλλοντας στη σύγκλειση μεγάλων δερματικών ελλειμμάτων. Ωστόσο, δεν αναφέρεται η χρήση τους στο σκύλο, για αυτό και σκοπός της μελέτης αυτής ήταν η διερεύνηση της δυνατότητας χρήσης τους στη σύγκλειση δερματικών ελλειμμάτων στο περιφερικό τμήμα των άκρων, καθώς και οι κλινικές και ιστολογικές μεταβολές που υφίστανται το δέρμα μετά από την εφαρμογή τους. Παράλληλα, σκοπός ήταν η μελέτη της αιματικής ροής καθώς και η επίδραση της ασκούμενης τάσης στο δέρμα. Στο πειραματικό μέρος χρησιμοποιήθηκαν 24 ενήλικες σκύλοι, οι οποίοι χωρίστηκαν σε 3 ομάδες των 8 ζώων. Στα ζώα της ομάδας Α χρησιμοποιήθηκαν ως εκτατήρες συνδετήρες μεταξύ των οποίων, καθώς και διαμέσου ενός δικής μας κατασκευής κυλίνδρου, διέρχονταν ράμματα από πολυπροπυλένιο που προσδένονταν επάνω στον κύλινδρο. Στα ζώα της ομάδας Β χρησιμοποιήθηκαν ως εκτατήρες βελόνες με υποδερμική διαδρομή μεταξύ των οποίων και ενός διάτρητου κυλίνδρου διέρχονταν ράμματα, τα οποία όπως και στα ζώα της ομάδας Α, προσδένονταν επάνω στον κύλινδρο. Τέλος, στα ζώα της ομάδας Γ χρησιμοποιήθηκε για την έκταση του δέρματος η συσκευή Pavletic. Και στις τρεις ομάδες, αφού χορηγούνταν στα ζώα γενική αναισθησία, δημιουργούνταν ελλείμματα δέρματος στην έξω και πρόσθια επιφάνεια των αντιβραχίων με σταθερό μήκος 5 cm και πλάτος ίσο με το μισό της περιμέτρου (50% της περιμέτρου). Ανεξάρτητα από την τεχνική που εφαρμοζόταν στην κάθε ομάδα, στο αριστερό αντιβράχιο πραγματοποιούνταν αποκόλληση των χειλέων του τραύματος από τους υποκείμενους ιστούς, ενώ στο δεξιό αντιβράχιο δεν γινόταν αποκόλληση. Στα ζώα των ομάδων Α και Β την 1η ημέρα, μετά τη δημιουργία των δερματικών ελλειμμάτων και την τοποθέτηση των εκτατήρων, γινόταν πρόσδεση των ραμμάτων και μέτρηση της τάσης που ασκούνταν στα χείλη του τραύματος με ειδική συσκευή. Την 2η ημέρα ασκούνταν 3 διαδοχικές έλξεις (cycle loading) στα χείλη του τραύματος με δύναμη ίση με 1,5-2 kg, οι οποίες διαρκούσαν 2΄-3΄ λεπτά, ενώ μεταξύ τους παρεμβάλλονταν διαστήματα χαλάρωσης διάρκειας 1΄ λεπτού. Στη συνέχεια, γινόταν νέα σύσφιξη των ραμμάτων και μέτρηση της τάσης. Την 3η ημέρα επαναλαμβανόταν η ίδια διαδικασία και ακολουθούσε αφαίρεση των συνδετήρων και σύγκλειση του τραύματος κατά πρώτο σκοπό. Στα ζώα της ομάδας Γ δεν ήταν δυνατό να εφαρμοστεί η διαδικασία των διαδοχικών έλξεων. Σε όλες τις ομάδες, μετά τη συρραφή, τα τραύματα επιδένονταν και γινόταν καθημερινά αλλαγή της επίδεσης και έλεγχος της πορείας της μετεγχειρητικής τους εξέλιξης. Για την εκτίμηση της κλινικής εικόνας χρησιμοποιήθηκε κλίμακα 5 διαβαθμίσεων. Οι μετρήσεις της αιματικής ροής με Laser Doppler γίνονταν σε έξι καθορισμένα σημεία. Η πρώτη μέτρηση γινόταν πριν τη δημιουργία του ελλείμματος, η δεύτερη 24 ώρες αργότερα, πριν τη διενέργεια των διαδοχικών έλξεων και τη σύσφιξη των ραμμάτων και η τρίτη 24 ώρες μετά. Η λήψη των ιστοτεμαχίων του δέρματος για ιστοπαθολογική εξέταση έγινε πριν τη δημιουργία των ελλειμμάτων (ημέρα 1), την ημέρα σύγκλεισής τους κατά πρώτο σκοπό (ημέρα 3) και την ημέρα αφαίρεσης των ραμμάτων (ημέρα 15). Οι μεταβολές της αιματικής ροής δεν ήταν στατιστικώς σημαντικές μεταξύ των τριών ομάδων καθώς και μεταξύ του δεξιού και του αριστερού άκρου. Αντίθετα ήταν στατιστικώς σημαντικές μεταξύ της πρόσθιας και της οπίσθιας επιφάνειας καθώς και μεταξύ των σημείων μέτρησης. Επίσης, υπήρχαν στατιστικώς σημαντικές μεταβολές της αιματικής ροής μεταξύ των ημερών 1 και 3, καθώς και μεταξύ των ημερών 2 και 3 που αφορούσαν κυρίως το αριστερό άκρο. ...................................................................................................................................

Evaluation of the effectiveness of an ointment based on Alkannins/Shikonins on second intention wound healing in the dog

The enantiomeric naphthoquinones alkannins and shikonins (A/S) have been established as potent wound healing agents. The purpose of this study was to evaluate the effectiveness of an A/S based ointment for humans on second intention wound healing in the dog, as compared to wound flushing with Lactated Ringer’s solution (LRS). Ten mixed breed dogs, aged 2 to 5 y, were used. One 2.5 × 2.5 cm full-thickness skin defect was created on the lateral aspect of each arm for subjective evaluation, laser-Doppler flowmetry (LDF), and planimetry. Additionally, 3 matching 2 × 2 cm wounds were created on opposite sides of the dorsal midline for histologic evaluation. Wounds were treated once daily with the A/S based ointment on the right side and by flushing with LRS on the left until healed (about 20 d). During the healing process, tissue perfusion (mean LDF value) was found to be significantly higher on the side treated with the A/S based ointment compared with the LRS-treated side. Histologically, angiogenesis (on days 4 and 11), collagen production score (on days 4, 11, and 20), and epithelial thickness score (on day 11) were significantly higher in the wounds treated with the A/S based ointment. Wound size, as evaluated by planimetry, decreased significantly from day 0 to day 20 on both sides, but no significant differences were found between the A/S based ointment and LRS-treated wounds

Comparison of absorbable and nonabsorbable sutures for intradermal skin closure in cats

Paired skin incisions were made in 6 cats and closed intradermally with the copolymer of glycolide, ɛ-caprolacton, and trimethylene-carbonate, or polypropylene suture. The macroscopic and histologic appearance of the incisions was compared. Polypropylene suture compared favorably to glycolide, ɛ-caprolacton, and trimethylene-carbonate suture for closure of skin incisions in cats

First-Intention Incisional Wound Healing in Dogs and Cats: A Controlled Trial of Dermapliq and Manuka Honey

This study aimed to compare incisional wound healing in cats and dogs after the topical application of Μanuka honey and a new medical device, Dermapliq. Comparisons were made between each treatment and control, between the two treatments, and between dogs and cats. Twelve cats and twelve dogs were included in this study, and the impact of the two substances was examined through cosmetic, clinical, ultrasonographical, and histological evaluation. The use of Dermapliq in first-intention wound healing achieved a significantly better cosmetic evaluation score and better total clinical score at days 20–41, compared to the control, in both dogs and cats. The ultrasonographically estimated wound area was smaller with Dermapliq compared to the control. Wounds treated with Dermapliq showed histologically less inflammation compared to the control. The use of Manuka honey did not show a significantly better cosmetic score compared to the control. Skin thickening was significantly higher after using Manuka honey compared to the control and so was the total clinical score. However, the median wound area, as was evaluated ultrasonographically, was significantly smaller when wounds were treated with Manuka honey, the difference being more apparent in dogs. Dermapliq was proven to be a better choice in achieving favorable wound healing than Manuka honey in dogs and cats in first-intention healing. In our study, cats had a statistically better cosmetic score and less skin thickening and scar width compared to dogs. Histologically, cats showed significantly less edema, higher inflammation and angiogenesis scores, and lower fibroblast and epidermis thickening scores when compared to dogs

Comparison of three skin-stretching devices for closing skin defects on the limbs of dogs

Our objective was to evaluate the effectiveness of skin-stretching devices for closing defects on the extremities of dogs. Antebrachial skin defects were created on the limbs of 24 dogs randomly divided into three groups. Skin stretchers included staples and sutures passing through them (group A), sutures and hypodermic needles (group B), and Pavletic device (group C). Wounds on the left were further undermined in all groups. Tension and blood perfusion were assessed. After removing the stretchers on day 3, the defects were sutured and wound healing was clinically scored. Histological variables evaluated were cellular infiltration, edema, collagen orientation, and thickness of epidermis. Significant differences in tension were found among groups (p < 0.0005) and between measurement times for undermined (p = 0.001) or non-undermined (p < 0.0005) wounds. In contrast, blood perfusion values did not differ significantly. Clinical scores for group B seemed to be better than those for groups A and C, but differences were not significant. Primary wound closure using the Pavletic device was not feasible. No significant differences in histological variables were found between groups. Skin stretching with staples or hypodermic needles resulted in successful wound management with minor side effects on skin histology and circulation. © 2015 The Korean Society of Veterinary Science