Page 437 - WSAVA2017
P. 437

WSVA7-0478
NAVC (HOW I TREAT...)
A LESION ON THE FOOT TOO BIG FOR PRIMARY CLOSURE
J. Kirpensteijn1
1Hill’s Pet Nutrition, GPVA, Topeka, USA
Reconstruction of wounds on the distal limbs
Jolle Kirpensteijn, DVM, PhD. Diplomate ACVS & ECVS
Chief Professional Relations Officer, Hill’s Pet Nutrition, Topeka, Kansas, USA.
Email: jolle_kirpensteijn@hillspet.com
Introduction
Wounds on distal limbs are often challenging for the advanced soft tissue surgeon because of limited supply of soft tissue in the area. Most wounds will be traumatic in origin and should be treated appropriately before the reconstruction technique is attempted. Because there is no major anatomic difference between the front and hind distal limbs, these are treated identically.
Small wounds
Small wounds can be treated by primary closure, if there is not excessive wound tension. Tension should be checked in full range of motion of the foot. Simple tension relieving techniques, as described, allow closure of moderately sized wounds, but for larger wounds additional techniques are necessary. The use of small suture material will decrease excessive scar formation associated with large sutures.
Large wounds
Most large wounds will need additional reconstruction techniques to prevent excessive tension on the suture line. Many reconstruction techniques have been described of which the toe-filet technique, the reversed saphenous and the mesh graft are a couple of examples.
Toe-filet technique
Footpad injuries can occur as a consequence of lacerations, degloving injuries, abrasion, avulsion, burns and tumours. Because of the weight-bearing function of the footpad, complications may develop during wound healing. Degloving or crushing injuries to the paw may cause the paw to become non-functional. Indoor cats and small dogs that walk only on carpet may function acceptably with skin grafts that do not include footpads. However, in most cases replacement of the metacarpal or metatarsal pad is necessary. Replacement of pad
may be achieved by transposing adjacent pads or by microneurovascular free pad transfer. Pad transfer should
not be performed in cases where pad injury is caused by tendon malfunction.
The toe filet technique is indicated for the management of partial injuries to the metacarpal/metatarsal pad or as a replacement for the pad when it has been completely lost. The principle of this technique is the removal of the proximal, middle and distal phalanges in order to use the distal pad to fill a defect in the metacarpal/metatarsal pad. The bony phalanges can be removed via a plantar/ palmar or via a dorsal incision.
Step by step: toe filet flap (palmar/plantar technique)
1. Select the digit nearest the defect (usually the second or fifth digit)
2. Remove the proximal, middle and distal phalanges by incising the joint capsule and ligament attachments to the bone. Use blunt dissection to remove the bone from the surrounding soft tissue, making sure the blood supply remains intact.
3. The surface and edge of the pad defect are debrided.
4. Fold back the digital fillet to fill the defect.
5. Suture the edges of the pad to the edges of the defect using 3-0 monofilament nonabsorbable suture material
Toe filet flap (dorsal technique)
6. Make a longitudinal incision on the dorsal aspect of the digit.
7. Remove the phalanges of the digit as described in the palmar/plantar technique.
8. Close the skin with simple interrupted sutures of 3-0 nonabsorbable monofilament sutures (leaving an opening for drainage where the nail was removed)
9. Make an incision between the wound and the edge of the metacarpal/metatarsal pad and perform the rest of the flap transfer as described in the metacarpal/ metatarsal technique.
An Urban Experience
   Transpose digital pad to defect
 Remove skin and phalangeal bones
 Skin incision
 Pad defect
Figure 1 Toe filet flap technique
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