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and medial canthi. This is the result of linear alignment of fibrous tissues within the skin in this area.
The tension lines of the head and neck region resemble the orientation of the underlying muscles. Generally speaking, incisions should always be made parallel to tension lines to minimize wound tension during closure. Incisions that are made in an angle or perpendicular to these lines may result in wound deformation, wound dehiscence and necrosis. If this is impossible, methods to reduce skin tension should be employed upon closure. These include, from simple to more advanced, undermining the wound edges, selecting tension- relieving suture patterns, using tension-releasing incisions or skin stretching and tissue expansion techniques. If these methods do not allow primary closure of the wound, secondary intention healing
or reconstruction with skin flaps or grafts have to be considered.
Reconstruction of the face
Reconstruction of the facial area can be challenging. There are 3 major reasons for the challenge: 1. skin
is less abundant than in other areas of the body, 2. There are major essential structures that make proper reconstruction more difficult and 3. It is an obvious area, i.e. people immediately see if something is
not completely right. Specific facial reconstructive techniques include the caudal auricular axial pattern flap, the crescentic nasojugal flap, the facial artery axial pattern flap.doc and the superficial temporal artery axial pattern flap.
Wound closure techniques
Most plastic and reconstructive techniques used in companion animals involve the creation of new surgical wounds. The general surgical principles of using aseptical techniques, proper instruments, and delicate tissue handling while creating a surgical wound apply here as well. In addition, appropriate suture materials and suture techniques have to be used for any type of surgery, but for reconstructive surgery in particular.
Complications in performing plastic and reconstructive surgery
Complications of wound closure in plastic and reconstructive surgery are similar to those in general soft tissue surgeries and include wound dehiscence, infection, hematoma or seroma formation, and excessive scar formation. Most complications can be avoided
by a proper pre-operative planning and skin mobility assessment, by using a meticulous surgical technique and achieving haemostasis. Chances of flap survival
will increase if the size and localisation of the wound
is suitable for receiving the flap, if the wound is neither contaminated nor infected and if the wound is not older than 4-6 hours. It is also important that the recipient
bed for the flap is fully prepared. Another complication that should be avoided is the development of dead space, which can lead to the formation of abscesses, seromas or hematomas. Formation of dead space can be overcome by placing drains, subcutaneous and walking sutures and bandages. The authors recommend the use of either passive or active drains whenever possible while taking care not to damage the blood supply at the base of the flap by making exit ports.
References
1. Swaim SF, Henderson RA. Small animal wound management, 2nd ed. Philadelphia: Williams & Wilkins; 1997:143-275.
2. Pavletic MM. The integument. In: Slatter D, ed. Textbook of small animal surgery. 3rd ed. Saunders; 2007.
3. Kirpensteijn J, ter Haar G. Reconstructive surgery and wound management in the dog and cat. Manson Publishing/ The Veterinary Press 2013 (ISBN: 978-1- 84076-163-4).
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