Skills Laboratory: Reconstructive surgery techniques, Part 3: Multiple punctate relaxing incisions

When a wound, especially one on a distal limb, is too wide for adequate skin apposition, consider creating these small incisions to relax the surrounding skin and allow for good closure.
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Oct 01, 2009

Multiple punctate relaxing incisions are small parallel, staggered incisions made unilaterally or bilaterally (usually bilaterally) in skin adjacent to a wound to relieve the tension associated with wound closure.1

These incisions are most commonly used on distal limb wounds. They can also be used for wound closure on the tail where skin is sparse for closure. This technique could help close trunk wounds; however, walking sutures are generally sufficient for stretching skin on the trunk for wound closure. And theoretically, these incisions could be used if necessary after presutures or adjustable horizontal mattress sutures have been placed.

ADVANTAGES AND DISADVANTAGES
Multiple punctuate relaxing incisions are more cosmetically appealing and heal faster than one large relaxing incision. Thus, they are more acceptable to the pet owner. But these incisions require making wounds to close a wound, and relaxation may not be as great as that with one relaxing incision. Also, if the punctuate relaxing incisions are either too numerous or too large, there is danger of vascular insufficiency in the skin adjacent to the wound; this could result in skin sloughing. Even with relaxation, it is possible to create a biologic tourniquet if tension is excessive when the skin is closed. In this instance, suture removal would be indicated.

Editors’ Note: This technique was demonstrated on a canine specimen obtained from a specimen supply company.

ACKNOWLEDGMENT
Thank you to Lori Lind, RVT, Gladstone Animal Clinic, Gladstone, Mo., for her assistance during the demonstration.

REFERENCE
1. Swaim SF, Henderson RA. Small animal wound management. 2nd ed. Baltimore, Md: Williams & Wilkins, 1997;188-190.

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