This article on placing a full-thickness mesh skin graft is the fourth in a series of step-by-step reconstructive surgeries
I will be covering to help you better manage patients with wounds and skin defects.
Each article is accompanied by a video that shows the complete process as well. (To view a video of this technique, visit
http://dvm360.com/Swaim4/)
To access the first three articles and videos in this series—presutures for skin stretching, adjustable horizontal mattress
sutures, and multiple punctate relaxing incisions—go to http://dvm360.com/ and search for "Swaim."
In future issues, look for skills laboratories on placing walking sutures and creating rotation skin flaps. 
1. Skin stretching or relaxing procedures will be neffective for wound closure.
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A full-thickness mesh graft is a sheet of skin that includes only the epidermis and the entire dermis and is fenestrated
to allow for expansion and drainage. All subcutaneous tissue is removed from the graft. Full-thickness mesh grafts are indicated
to cover defects when skin is not available for local flaps or for moving local tissue or when excessive tension would be
created by using such wound closure techniques as placing presutures or an adjustable horizontal mattress suture or making
multiple punctate relaxing incisions (Figure 1). They are most commonly used to close mid- and distal-limb defects. Full-thickness mesh grafts are indicated for excision
sites or for fresh wounds with well-vascularized tissue—enough vascularization to produce granulation tissue—or a bed of healthy
granulation tissue that has started to epithelialize. PRESURGICAL PREPARATION
A few days before grafting, apply a topical silver sulfadiazine cream or nitrofurazone ointment to reduce bacteria on a contaminated
or an infected granulating wound.1,2 Systemic antibiotics may also be indicated for infected wounds. Wounds should be treated until infection is controlled.
A healthy bed of granulation tissue with epithelium starting to grow over it from the wound edges is an indication the wound
is healthy enough to graft. If granulation tissue is healthy enough to support epithelium, it is healthy enough to support
a graft.
The day before grafting, administer a neuroleptanalgesic and use a No. 10 scalpel blade to scrape the wound's surface of granulation
tissue to remove any coagulum on the wound surface. Bandage the wound with mesh gauze coated with gentamicin sulfate antibiotic
ointment (not cream). Apply an absorbent secondary wrap and a tertiary adhesive wrap.1 Removing coagulum, applying an antibiotic, and bandaging may help reduce bacterial flora on the wound surface, helping ensure
that infection will not interfere with graft healing.1
Dogs and cats have an abundance of loose, well-haired skin on the lower craniolateral thoracic area. This area is ideal for
obtaining skin for a graft, with sufficient skin to close the defect after graft harvest. Before surgery, tent the skin on
the proposed donor site to ensure that sufficient skin is available for obtaining the graft and for wound closure after graft
removal. If closure of the donor site causes tension, you may place walking sutures to relieve the tension. (Walking sutures
will be covered in the next Skills Laboratory, which will appear in the March 2010 issue.)
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