Skin reconstruction techniques: Full-thickness mesh grafts - Veterinary Medicine
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Skin reconstruction techniques: Full-thickness mesh grafts
Areas that are particularly difficult to close, such as uneven surfaces and locations with lots of movement, benefit from mesh grafts that include the entire epidermis and dermis.


VETERINARY MEDICINE



Figure 8. The graft shown in Figure 7 seven days after graft placement. A superficial layer of epidermis is sloughing. A small central portion of the graft has been lost because of either a lack of vascular tissue underlying the graft or poor graft-bed contact.
Immediately after harvesting, grafts appear pale. For the next 48 hours, they may appear cyanotic, but color gradually improves as revascularization occurs, and the graft may take on a reddish hue (Figure 7). 6 By seven days you will be able to determine how much of the graft will survive (Figure 8), and by three weeks you can assess the cosmesis of the repair (Figures 9-11). Some grafts may have a partial-thickness take, with sloughing of the epidermis and upper part of the dermis, healing of the deeper dermis, and subsequent reepithelialization.6 These grafts will be functional but may lack good hair growth.

Complications


Figure 9. The graft shown in Figure 7 10 days after grafting. The sutures have been removed. The mesh holes have contracted, and the necrotic area has healthy granulation tissue.
Three common factors cause graft loss. First, seroma or hematoma formation under a graft separates the graft from the wound and impairs revascularization. Second, infection produces exudation that also separates the graft and wound bed; additionally, the exudates contain enzymes that digest the fibrin bond that is weakly holding the graft in place, further impairing revascularization. Third, early movement of the graft breaks the tenuous bonds between the graft and bed and leaves space for fluid accumulation, damaging vessels and impairing vascular ingrowth.3,4,6 Meshing a graft helps avoid all three of these factors. It allows serum, blood, and exudates to drain for good graft-bed contact. Meshing also allows placement of tacking sutures to immobilize the graft without causing hematoma formation, since blood can drain through the mesh holes. In unexpanded grafts, this blood may clot in the mesh openings, impeding drainage.2


Figure 10. The graft shown in Figure 7 14 days after grafting. The mesh holes are barely visible, and the necrotic area has almost completely healed.
Infection is uncommon if the original graft bed is healthy, proper sterile technique is maintained during surgery, and bandages are changed on a regular basis. If the graft begins to necrose, obtain a new punch biopsy sample, and submit it for culture to rule out infection.3 Abnormal hair regrowth is a minor complication that occurs when the bulbs of the hair follicles are traumatized during removal of subcutaneous fat or with inadequate revascularization from seroma or hematoma formation or excessive graft movement and subsequent necrosis of the epidermis and outer dermis.6 Although a minor complication overall, this abnormal hair growth may be the most important to owners and must be discussed with them.2

Conclusion


Figure 11. The graft shown in Figure 7 three weeks after grafting. Hair growth is evident.
Mesh grafting is a relatively simple surgical procedure with valuable clinical applications. By taking adequate preparatory steps, performing careful measurements, and using atraumatic surgical techniques and attentive postoperative care, mesh grafting can be rewarding for clinicians and patients.

Amanda Gibbs, BS
Karen M. Tobias, DVM, MS, DACVS
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
The University of Tennessee
Knoxville, TN 37996-4544

REFERENCES

1. Pope, E.R.: Skin grafting in small animal surgery. Part II. Full-thickness skin grafting techniques. Compend. Cont. Ed. 10(9):1068-1076; 1988.

2. Swaim, S.F. et al.: Evaluation of a practical skin grafting technique. JAAHA 20(4):637-645; 1984.

3. Pope, E.R.: Mesh skin grafting. Vet. Clin. North Am. (Small. Anim. Pract.) 20(1):177-187; 1990.

4. Pope, E.R.: Effect of skin graft preparation and graft survival on the secondary contraction of full-thickness skin grafts in dogs. AJVR 46(12):2530-2535; 1985.

5. Bauer, M.S.; Pope, E.R.: The effects of skin graft thickness on graft viability and change in original graft area in dogs. Vet. Surg. 15(4):321-324; 1986.

6. Swaim, S.F.: Skin grafts. Textbook of Small Animal Surgery, 3rd Ed. (D. Slatter, ed.). W.B. Saunders, Philadelphia, Pa., 2003; pp 321-338.

7. Pavletic, M.M.: Free grafts. Atlas of Small Animal Reconstructive Surgery, 2nd Ed. W.B. Saunders, Philadelphia, Pa., 1999; pp 276-295.

8. Swaim, S.F.; Henderson, R.A.: Wounds on limbs. Small Animal Wound Management, 2nd Ed. Williams & Wilkins, Baltimore, Md., 1997; pp 295-370.


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