The authorMICHAEL M. PAVLETIC, DVM, Diplomate ACVS, is Director of Surgical Services at Angell Animal Medical Center in Boston, Massachusetts, USA.

• Foreword xiPreface xiiAcknowledgments xiiiAbout the Companion Website xiv1. The Skin 1Skin Function 2Skin Structure 2Cutaneous Adnexa 5The Hypodermis 8Cutaneous Circulation 8Pinna: Cutaneous Considerations 10Congenital Skin Disorders 102. Basic Principles of Wound Healing 17Introduction 18Wound Healing 18Acute Versus Chronic Open Wounds 29Species Variations in Wound Healing 29“Artificial Skin” 303. Basic Principles of Wound Management 33Introduction 34Patient Presentation 34Mechanisms of Injury and Wound Terminology 34Wound Classification 35Options for Wound Closure 37“Pointers” in Selecting the Proper Closure Technique 43Basic Wound Management in Six Simple Steps 44Exposed Bone: Osteostixis 49Acute Versus Chronic Wounds 504. Topical Wound Care Products and Their Use 53Wound Exudate 54Wound Drainage Systems 54Negative Pressure Wound Therapy (NPWT) 60Concept of Moist Wound Healing (MWH) 67Topical Wound Care Products 69The Maggot and Leach in Wound Care 79Common Topical Antiseptic and Cleansing Agents 81Alternative Forms of Wound Therapy 85Concluding Remarks 89Plate 1: Vacuum‐Assisted Closure 925. Dressings, Bandages, External Support, and Protective Devices 95Introduction 96Dressings: The Primary Layer 96Dressings: The Secondary Layer 111Dressings: The Tertiary Layer 112Preventing Bandage Displacement 113Tie‐Over Dressing/Bandage Technique 114Pressure Points: Bandage Options 115Bandage “Access Windows” 115Bandaging Techniques for Skin Grafts 115Bandaging Techniques for Skin Flaps 115Splints, Casts, Reinforced Bandages 115Miscellaneous Protective Devices 116Plate 2: Basic Bandage Application for Extremities 124Plate 3: Tape Stirrups and Padding Dos and Don’ts 126Plate 4: Elasticon Bandage Platforms and Saddles 128Plate 5: Spica Bandages/Splints 130Plate 6: Schroeder‐Thomas Splint 132Plate 7: Schroeder‐Thomas Splint: Security Band Application 136Plate 8: Body Brace 138Plate 9: Tape Hobbles for the Rear Extremities 1406. Common Complications in Wound Healing 143Improper Nutritional Support 144Medications and Their Influence on Healing 145Hypovolemia and Anemia 146The Nonhealing Wound: General Considerations 146Failure to Heal by Second Intention 147Scarring and Wound Contracture 152Infection and Biofilm Formation 154Draining Tracts 158Use of Tourniquets for Lower Extremity Procedures 165Seromas 166Hematomas 167Exposed Bone 167Wound Dehiscence 1697. Management of Specific Wounds 173Bite Wounds 174Burns 183Inhalation Injuries 195Chemical Burns 196Electrical Injuries 197Radiation Injuries 201Frostbite 204Projectile Injuries 205Explosive Munitions: Ballistic, Blast, and Thermal Injuries 227Impalement Injuries 227Pressure Ulcers 228Hygroma 234Snakebite 239Brown Recluse Spider Bites 240Porcupine Quills 240Lower Extremity Shearing Wounds 243Plate 10: Pipe Insulation Protective Device: Elbow 248Plate 11: Pipe Insulation to Protect the Great Trochanter 250Plate 12: Vacuum Drain Management of Elbow Hygromas 2528. Regional Considerations 255The Canine and Feline Profiles 256Plates 13A and 13B: Surgical Technique Menu 2589. Tension‐Relieving Techniques 265Introduction 266Skin Tension in the Dog and Cat 266Plate 14: Tension Lines 282Plate 15: Effects of Skin Tension on Wound Closure 284Plate 16: Patient Positioning Techniques 286Plate 17: Undermining Skin 288Plate 18: Geometric Patterns to Facilitate Wound Closure 290Plate 19: V‐Y Plasty 292Plate 20: Z‐Plasty (Option I) 294Plate 21: Z‐Plasty (Option II) 296Plate 22: Multiple Z‐Plasties 298Plate 23: Relaxing/Release Incisions 300Plate 24: The “Hidden” Intradermal Release/ Relaxing Incision 302Plate 25: Multiple Release Incisions for Extremity Wounds 304Plate 26: Suture Options to Alter Skin Traction and Retraction 306Plate 27: Walking Suture Technique 308Plate 28: Skin Stretchers to Offset Incisional Tension 310Plate 29: “Tension” Suture Patterns 312Plate 30: Retention Sutures 314Plate 31: Stent 316Plate 32: Skin “Directing” for Maximum Coverage 318Plate 33: Relaxing Incision to Reduce Flap Tension 32010. Skin‐Stretching Techniques 323Physiology of Skin Stretching 324Presuturing 324Load Cycling 324Skin Stretchers 326Skin Expanders 335Plate 34: Presuturing Technique 338Plate 35: Application of Skin Stretchers 340Plate 36: Skin Stretchers to Enhance Length of Axial Pattern Flaps 342Plate 37: Skin Stretcher Substitution for Presuturing 344Plate 38: Skin Expanders 34611. Local Flaps 351Introduction 352Advancement Flaps 353Rotating (Pivoting) Flaps 356Plate 39: Single Pedicle Advancement Flap 370Plate 40: Bipedicle Advancement Flap 372Plate 41: Transposition Flap (90 degrees) 374Plate 42: Transposition Flap (45 degrees) 378Plate 43: Transposition Flap (Oblique Angle) 380Plate 44: Local Facial Flap Options vs. Auricular Axial Pattern Flap 382Plate 45: Transposition Flaps in Partial Wound Closure 384Plate 46: Interpolation Flap 386Plate 47: Rotation Flap 390Plate 48: Forelimb Fold Flap 39212. Distant Flap Techniques 395Distant Flaps 396Direct Flaps 396Indirect Flaps 396The Delay Phenomenon 400Plate 49: Direct Flap: Single Pedicle (Hinge) Flap 402Plate 50: Direct Flap Closure of Knee Defect 406Plate 51: Direct Flap: Bipedicle (Pouch) Flap 408Plate 52: Indirect Flap: Delayed Tube Flap 41413. Axial Pattern Skin Flaps 417Introduction: Axial Pattern Flaps 418Island Arterial Flaps 418Reverse Saphenous Conduit Flaps 421Secondary Axial Pattern Flaps 421Options to Extend the Length of Axial Pattern Flaps 427Plate 53: Four Major Axial Pattern Flaps of the Canine Trunk 430Plate 54: Skin Position and Axial Pattern Flap Development 432Plate 55: Omocervical Axial Pattern Flap 434Plate 56: Thoracodorsal Axial Pattern Flap 436Plate 57: Lateral Thoracic Axial Pattern Flap 438Plate 58: Superficial Brachial Axial Pattern Flap 440Plate 59: Caudal Superficial Epigastric Axial Pattern Flap 442Plate 60: Cranial Superficial Epigastric Axial Pattern Flap 444Plate 61: Deep Circumflex Iliac Axial Pattern Flap: Dorsal Branch 446Plate 62: Deep Circumflex Iliac Axial Pattern Flap: Ventral Branch 448Plate 63: Flank Fold Flap: Hind Limb 450Plate 64: Genicular Axial Pattern Flap 452Plate 65: Reverse Saphenous Conduit Flap 454Plate 66: Caudal Auricular Axial Pattern Flap 456Plate 67: Superficial Temporal Axial Pattern Flap 458Plate 68: Lateral Caudal (Tail) Axial Pattern Flap 46014. Free Grafts 463Free Skin Grafts 464Classification of Free Grafts 465Graft Thickness 465Partial‐Coverage Grafts 466Dermatomes 467Preservation by Refrigeration 467Intraoperative Considerations 472Bandaging Technique for Skin Grafts 472Use of Plates 473Plate 69: Punch Grafts 476Plate 70: Pinch Grafts 478Plate 71: Strip Grafts 480Plate 72: Stamp Grafts 482Plate 73: Sheet Grafts 484Plate 74: Dermatome: Split‐Thickness Skin Graft Harvesting 486Plate 75: Mesh Grafts (With Expansion Units) 488Plate 76: Mesh Grafts (With Scalpel Blades) 49015. Facial Reconstruction 493Introduction: Facial Reconstructive Surgery 494Plate 77: Repair of Upper Lip Avulsion 515Plate 78: Repair of Lower Labial Avulsion 516Plate 79: Wedge Resection Technique 518Plate 80: Rectangular Resection Technique 520Plate 81: Full‐Thickness Labial Advancement Technique (Upper Lip) 522Plate 82: Full‐Thickness Labial Advancement Technique (Lower Lip) 524Plate 83: Buccal Rotation Technique 526Plate 84: Lower Labial Lift‐Up Technique 528Plate 85: Upper Labial Pull‐Down Technique 530Plate 86: Labial/Buccal Reconstruction with Inverse Tubed Skin Flap 532Plate 87: Skin Flap for Upper Labial and Buccal Replacement (Facial [Angularis Oris] Axial Pattern Flap) 536Plate 88: Feline Facial Axial Pattern Flap 538Plate 89: Cleft Lip Repair (Primary Cleft, Cheiloschisis, Harelip) 540Plate 90: Unilateral Rostral Labial Pivot Flaps 542Plate 91: Bilateral Rostral Labial Pivot Flaps 544Plate 92: Oral Commissure Advancement Technique 546Plate 93: Brachycephalic Facial Fold Correction 548Plate 94: Cheilopexy Technique for Drooling 55016. Myocutaneous Flaps and Muscle Flaps 553Introduction 554Myocutaneous Flaps 554Muscle Flaps 554Plate 95: Latissimus Dorsi Myocutaneous Flap 568Plate 96: Cutaneous Trunci Myocutaneous Flap 570Plate 97: Latissimus Dorsi Muscle Flap 572Plate 98: Latissimus Dorsi Bipedicle Muscle Flap 574Plate 99: Triceps Replacement with Latissimus Dorsi Muscle 576Plate 100: External Abdominal Oblique Muscle Flap 578Plate 101: Caudal Sartorius Muscle Flap 580Plate 102: Cranial Sartorius Muscle Flap 582Plate 103: Temporalis Muscle Flap 584Plate 104: Transversus Abdominis Muscle Flap 586Plate 105: Semitendinosus Muscle and Myocutaneous Flaps 588Plate 106: Flexor Carpi Ulnaris Muscle Flap 590Plate 107: Cranial Tibial Muscle Flap 592Plate 108: Internal Obturator Muscle Flap 594Plate 109: Superficial Gluteal Flap for Perineal Hernia Closure 59617. Oral Reconstructive Surgical Techniques 599Introduction 600Cleft Palate 601Palatal Defects/Oronasal Fistulas 602Plate 110: Mucosal Flaps 606Plate 111: Palatoplasty: Bipedicle Advancement Technique 608Plate 112: Cleft Palate Repair: Mucoperiosteal Flap Technique 612Plate 113: Palatine Mucosal Flap 614Plate 114: Soft Palate/Pharyngeal Mucosal Flaps 616Plate 115: Full‐Thickness Labial Flap Closure of Oronasal Fistulas 618Plate 116: Cartilage Grafts for Palatal Fistulas 620Plate 117: Angularis Oris Mucosal Flap 62218. Foot Pad Reconstruction 625Introduction 626Pad Laceration and Lesion Excision 626Digital Pad Transfer 631Metacarpal/Metatarsal Pad Transfer 632Accessory Carpal Pad 632Pad Grafting 634Digital Flaps for Wound Closure 634Fusion Podoplasty 634Plate 118: Digital Flap Technique: Major Digital/ Interdigital Defects 642Plate 119: Digital Flap Technique: Major Defects of Digits Two or Five 644Plate 120: Digital Pad Transfer 646Plate 121: Metatarsal/Metacarpal Pad Transfer 648Plate 122: Pad Grafting 650Plate 123: Segmental Pad Grafting Technique 652Plate 124: Fusion Podoplasty 65419. Major Eyelid Reconstruction 657Introduction 658The Eyelids 658Plate 125: Skin Flap Options for Cutaneous Defects of the Eyelid Regions 660Plate 126: Lip‐to‐Lid Procedure 662Plate 127: Oral Mucosal Graft onto Skin Flap 666Plate 128: Third Eyelid–Skin Flap Reconstruction of the Lower Eyelid 66820. Nasal Reconstruction Techniques 671Introduction: Nasal Anatomy 672Traumatic Wound Management 672Neoplasia 673Neoplasms and Surgical Margins 673Nasal Reconstruction Options 673Options for Managing Nasal Stenosis 682Plate 129: Septal Coverage Using Cutaneous Advancement Flaps 692Plate 130: Bilateral Sulcus Flap Technique 694Plate 131: Septal Resection Technique 696Plate 132: Dorsal Nasal Splitting Technique to Enhance Exposure of Septum 698Plate 133: Alar Fold Flaps 700Plate 134: Musculofascial Island Labial Flap 702Plate 135: Labial Mucosal Inversion Technique 706Plate 136: Nasal Reconstruction with the “Lip‐to‐ Lid Technique” Variation 708Plate 137: Oral Mucosal Graft with Nasal Stenting 710Plate 138: Intranasal Septal Window Technique 712Plate 139: Cantilever Suture Technique 71421. Cosmetic Closure Techniques 719Cosmetic Considerations 720Causes of Scars 720Minimization of Scarring 720Dog Ears 722Plate 140: Scar Concealment 724Plate 141: W‐Plasty 726Plate 142: Dog Ear: Surgical Correction 72822. Preputial Reconstructive Surgery 731Introduction 732Surgical Conditions 732Surgical Techniques 742Plate 143: Preputial Ostium Enlargement 756Plate 144: Preputial Ostium Reduction 758Plate 145: Preputial Advancement Technique 760Plate 146: Phallopexy 764Plate 147: Urethral Reconstruction for Subanal Hypospadias 766Plate 148: Preputial Urethrostomy Technique 768Plate 149: Urine Diversion Technique 77023. Pinnal Reconstructive Surgery 773Introduction 774Anatomy of the Pinna 774Surgical Conditions 779Wound Management and Reconstructive Surgical Techniques 780Aural Hematoma Management Options 786Plate 150: Skin Advancement Closure: Rostral Pinnal Base 796Plate 151: Skin Advancement Closure: Caudal Pinnal Base 798Plate 152: Transposition Flap Technique for Smaller Medial Pinnal Defects 800Plate 153: Transposition Flap Technique for Minor Lateral Pinnal Defects 802Plate 154: Large Transposition Flap Closure After Major Medial Pinnal Resection 804Plate 155: Transposition Flap for Major Lateral Pinnal Defects 806Plate 156: Direct Flap Reconstruction of the Pinna 808Plate 157: Resection of the Terminal Third of the Pinna 810Plate 158: Inverted “Triangle” Resection of the Central Third of the Pinna 812Plate 159: Incisional Drainage of Aural Hematomas 814Plate 160: Bandaging the Pinna 816Plate 161: Vacuum Drain Management of Aural Hematomas 81824. Miscellaneous Reconstructive Surgical Techniques 821Omentum 822Scrotum 822Tail Fold Intertrigo (Screw Tail) 823Disorders of the Vulva 827Managing Skin Fold Inversion of Urethrostomies 835Fecal Incontinence: Treatment Options 835Plate 162: Omental Flap Options 838Plate 163: Scrotal Flap Technique 840Plate 164: Caudectomy for Tail Fold Intertrigo 842Plate 165: Episioplasty 844Plate 166: Fascia Lata Sling and Silicone Banding for Managing Fecal Incontinence 846Plate 167: Spiral Rectal Diaphragm Technique (Rectal Rifling) 848Index 851

The authorMICHAEL M. PAVLETIC, DVM, Diplomate ACVS, is Director of Surgical Services at Angell Animal Medical Center in Boston, Massachusetts, USA.

• Foreword xiPreface xiiAcknowledgments xiiiAbout the Companion Website xiv1. The Skin 1Skin Function 2Skin Structure 2Cutaneous Adnexa 5The Hypodermis 8Cutaneous Circulation 8Pinna: Cutaneous Considerations 10Congenital Skin Disorders 102. Basic Principles of Wound Healing 17Introduction 18Wound Healing 18Acute Versus Chronic Open Wounds 29Species Variations in Wound Healing 29“Artificial Skin” 303. Basic Principles of Wound Management 33Introduction 34Patient Presentation 34Mechanisms of Injury and Wound Terminology 34Wound Classification 35Options for Wound Closure 37“Pointers” in Selecting the Proper Closure Technique 43Basic Wound Management in Six Simple Steps 44Exposed Bone: Osteostixis 49Acute Versus Chronic Wounds 504. Topical Wound Care Products and Their Use 53Wound Exudate 54Wound Drainage Systems 54Negative Pressure Wound Therapy (NPWT) 60Concept of Moist Wound Healing (MWH) 67Topical Wound Care Products 69The Maggot and Leach in Wound Care 79Common Topical Antiseptic and Cleansing Agents 81Alternative Forms of Wound Therapy 85Concluding Remarks 89Plate 1: Vacuum‐Assisted Closure 925. Dressings, Bandages, External Support, and Protective Devices 95Introduction 96Dressings: The Primary Layer 96Dressings: The Secondary Layer 111Dressings: The Tertiary Layer 112Preventing Bandage Displacement 113Tie‐Over Dressing/Bandage Technique 114Pressure Points: Bandage Options 115Bandage “Access Windows” 115Bandaging Techniques for Skin Grafts 115Bandaging Techniques for Skin Flaps 115Splints, Casts, Reinforced Bandages 115Miscellaneous Protective Devices 116Plate 2: Basic Bandage Application for Extremities 124Plate 3: Tape Stirrups and Padding Dos and Don’ts 126Plate 4: Elasticon Bandage Platforms and Saddles 128Plate 5: Spica Bandages/Splints 130Plate 6: Schroeder‐Thomas Splint 132Plate 7: Schroeder‐Thomas Splint: Security Band Application 136Plate 8: Body Brace 138Plate 9: Tape Hobbles for the Rear Extremities 1406. Common Complications in Wound Healing 143Improper Nutritional Support 144Medications and Their Influence on Healing 145Hypovolemia and Anemia 146The Nonhealing Wound: General Considerations 146Failure to Heal by Second Intention 147Scarring and Wound Contracture 152Infection and Biofilm Formation 154Draining Tracts 158Use of Tourniquets for Lower Extremity Procedures 165Seromas 166Hematomas 167Exposed Bone 167Wound Dehiscence 1697. Management of Specific Wounds 173Bite Wounds 174Burns 183Inhalation Injuries 195Chemical Burns 196Electrical Injuries 197Radiation Injuries 201Frostbite 204Projectile Injuries 205Explosive Munitions: Ballistic, Blast, and Thermal Injuries 227Impalement Injuries 227Pressure Ulcers 228Hygroma 234Snakebite 239Brown Recluse Spider Bites 240Porcupine Quills 240Lower Extremity Shearing Wounds 243Plate 10: Pipe Insulation Protective Device: Elbow 248Plate 11: Pipe Insulation to Protect the Great Trochanter 250Plate 12: Vacuum Drain Management of Elbow Hygromas 2528. Regional Considerations 255The Canine and Feline Profiles 256Plates 13A and 13B: Surgical Technique Menu 2589. Tension‐Relieving Techniques 265Introduction 266Skin Tension in the Dog and Cat 266Plate 14: Tension Lines 282Plate 15: Effects of Skin Tension on Wound Closure 284Plate 16: Patient Positioning Techniques 286Plate 17: Undermining Skin 288Plate 18: Geometric Patterns to Facilitate Wound Closure 290Plate 19: V‐Y Plasty 292Plate 20: Z‐Plasty (Option I) 294Plate 21: Z‐Plasty (Option II) 296Plate 22: Multiple Z‐Plasties 298Plate 23: Relaxing/Release Incisions 300Plate 24: The “Hidden” Intradermal Release/ Relaxing Incision 302Plate 25: Multiple Release Incisions for Extremity Wounds 304Plate 26: Suture Options to Alter Skin Traction and Retraction 306Plate 27: Walking Suture Technique 308Plate 28: Skin Stretchers to Offset Incisional Tension 310Plate 29: “Tension” Suture Patterns 312Plate 30: Retention Sutures 314Plate 31: Stent 316Plate 32: Skin “Directing” for Maximum Coverage 318Plate 33: Relaxing Incision to Reduce Flap Tension 32010. Skin‐Stretching Techniques 323Physiology of Skin Stretching 324Presuturing 324Load Cycling 324Skin Stretchers 326Skin Expanders 335Plate 34: Presuturing Technique 338Plate 35: Application of Skin Stretchers 340Plate 36: Skin Stretchers to Enhance Length of Axial Pattern Flaps 342Plate 37: Skin Stretcher Substitution for Presuturing 344Plate 38: Skin Expanders 34611. Local Flaps 351Introduction 352Advancement Flaps 353Rotating (Pivoting) Flaps 356Plate 39: Single Pedicle Advancement Flap 370Plate 40: Bipedicle Advancement Flap 372Plate 41: Transposition Flap (90 degrees) 374Plate 42: Transposition Flap (45 degrees) 378Plate 43: Transposition Flap (Oblique Angle) 380Plate 44: Local Facial Flap Options vs. Auricular Axial Pattern Flap 382Plate 45: Transposition Flaps in Partial Wound Closure 384Plate 46: Interpolation Flap 386Plate 47: Rotation Flap 390Plate 48: Forelimb Fold Flap 39212. Distant Flap Techniques 395Distant Flaps 396Direct Flaps 396Indirect Flaps 396The Delay Phenomenon 400Plate 49: Direct Flap: Single Pedicle (Hinge) Flap 402Plate 50: Direct Flap Closure of Knee Defect 406Plate 51: Direct Flap: Bipedicle (Pouch) Flap 408Plate 52: Indirect Flap: Delayed Tube Flap 41413. Axial Pattern Skin Flaps 417Introduction: Axial Pattern Flaps 418Island Arterial Flaps 418Reverse Saphenous Conduit Flaps 421Secondary Axial Pattern Flaps 421Options to Extend the Length of Axial Pattern Flaps 427Plate 53: Four Major Axial Pattern Flaps of the Canine Trunk 430Plate 54: Skin Position and Axial Pattern Flap Development 432Plate 55: Omocervical Axial Pattern Flap 434Plate 56: Thoracodorsal Axial Pattern Flap 436Plate 57: Lateral Thoracic Axial Pattern Flap 438Plate 58: Superficial Brachial Axial Pattern Flap 440Plate 59: Caudal Superficial Epigastric Axial Pattern Flap 442Plate 60: Cranial Superficial Epigastric Axial Pattern Flap 444Plate 61: Deep Circumflex Iliac Axial Pattern Flap: Dorsal Branch 446Plate 62: Deep Circumflex Iliac Axial Pattern Flap: Ventral Branch 448Plate 63: Flank Fold Flap: Hind Limb 450Plate 64: Genicular Axial Pattern Flap 452Plate 65: Reverse Saphenous Conduit Flap 454Plate 66: Caudal Auricular Axial Pattern Flap 456Plate 67: Superficial Temporal Axial Pattern Flap 458Plate 68: Lateral Caudal (Tail) Axial Pattern Flap 46014. Free Grafts 463Free Skin Grafts 464Classification of Free Grafts 465Graft Thickness 465Partial‐Coverage Grafts 466Dermatomes 467Preservation by Refrigeration 467Intraoperative Considerations 472Bandaging Technique for Skin Grafts 472Use of Plates 473Plate 69: Punch Grafts 476Plate 70: Pinch Grafts 478Plate 71: Strip Grafts 480Plate 72: Stamp Grafts 482Plate 73: Sheet Grafts 484Plate 74: Dermatome: Split‐Thickness Skin Graft Harvesting 486Plate 75: Mesh Grafts (With Expansion Units) 488Plate 76: Mesh Grafts (With Scalpel Blades) 49015. Facial Reconstruction 493Introduction: Facial Reconstructive Surgery 494Plate 77: Repair of Upper Lip Avulsion 515Plate 78: Repair of Lower Labial Avulsion 516Plate 79: Wedge Resection Technique 518Plate 80: Rectangular Resection Technique 520Plate 81: Full‐Thickness Labial Advancement Technique (Upper Lip) 522Plate 82: Full‐Thickness Labial Advancement Technique (Lower Lip) 524Plate 83: Buccal Rotation Technique 526Plate 84: Lower Labial Lift‐Up Technique 528Plate 85: Upper Labial Pull‐Down Technique 530Plate 86: Labial/Buccal Reconstruction with Inverse Tubed Skin Flap 532Plate 87: Skin Flap for Upper Labial and Buccal Replacement (Facial [Angularis Oris] Axial Pattern Flap) 536Plate 88: Feline Facial Axial Pattern Flap 538Plate 89: Cleft Lip Repair (Primary Cleft, Cheiloschisis, Harelip) 540Plate 90: Unilateral Rostral Labial Pivot Flaps 542Plate 91: Bilateral Rostral Labial Pivot Flaps 544Plate 92: Oral Commissure Advancement Technique 546Plate 93: Brachycephalic Facial Fold Correction 548Plate 94: Cheilopexy Technique for Drooling 55016. Myocutaneous Flaps and Muscle Flaps 553Introduction 554Myocutaneous Flaps 554Muscle Flaps 554Plate 95: Latissimus Dorsi Myocutaneous Flap 568Plate 96: Cutaneous Trunci Myocutaneous Flap 570Plate 97: Latissimus Dorsi Muscle Flap 572Plate 98: Latissimus Dorsi Bipedicle Muscle Flap 574Plate 99: Triceps Replacement with Latissimus Dorsi Muscle 576Plate 100: External Abdominal Oblique Muscle Flap 578Plate 101: Caudal Sartorius Muscle Flap 580Plate 102: Cranial Sartorius Muscle Flap 582Plate 103: Temporalis Muscle Flap 584Plate 104: Transversus Abdominis Muscle Flap 586Plate 105: Semitendinosus Muscle and Myocutaneous Flaps 588Plate 106: Flexor Carpi Ulnaris Muscle Flap 590Plate 107: Cranial Tibial Muscle Flap 592Plate 108: Internal Obturator Muscle Flap 594Plate 109: Superficial Gluteal Flap for Perineal Hernia Closure 59617. Oral Reconstructive Surgical Techniques 599Introduction 600Cleft Palate 601Palatal Defects/Oronasal Fistulas 602Plate 110: Mucosal Flaps 606Plate 111: Palatoplasty: Bipedicle Advancement Technique 608Plate 112: Cleft Palate Repair: Mucoperiosteal Flap Technique 612Plate 113: Palatine Mucosal Flap 614Plate 114: Soft Palate/Pharyngeal Mucosal Flaps 616Plate 115: Full‐Thickness Labial Flap Closure of Oronasal Fistulas 618Plate 116: Cartilage Grafts for Palatal Fistulas 620Plate 117: Angularis Oris Mucosal Flap 62218. Foot Pad Reconstruction 625Introduction 626Pad Laceration and Lesion Excision 626Digital Pad Transfer 631Metacarpal/Metatarsal Pad Transfer 632Accessory Carpal Pad 632Pad Grafting 634Digital Flaps for Wound Closure 634Fusion Podoplasty 634Plate 118: Digital Flap Technique: Major Digital/ Interdigital Defects 642Plate 119: Digital Flap Technique: Major Defects of Digits Two or Five 644Plate 120: Digital Pad Transfer 646Plate 121: Metatarsal/Metacarpal Pad Transfer 648Plate 122: Pad Grafting 650Plate 123: Segmental Pad Grafting Technique 652Plate 124: Fusion Podoplasty 65419. Major Eyelid Reconstruction 657Introduction 658The Eyelids 658Plate 125: Skin Flap Options for Cutaneous Defects of the Eyelid Regions 660Plate 126: Lip‐to‐Lid Procedure 662Plate 127: Oral Mucosal Graft onto Skin Flap 666Plate 128: Third Eyelid–Skin Flap Reconstruction of the Lower Eyelid 66820. Nasal Reconstruction Techniques 671Introduction: Nasal Anatomy 672Traumatic Wound Management 672Neoplasia 673Neoplasms and Surgical Margins 673Nasal Reconstruction Options 673Options for Managing Nasal Stenosis 682Plate 129: Septal Coverage Using Cutaneous Advancement Flaps 692Plate 130: Bilateral Sulcus Flap Technique 694Plate 131: Septal Resection Technique 696Plate 132: Dorsal Nasal Splitting Technique to Enhance Exposure of Septum 698Plate 133: Alar Fold Flaps 700Plate 134: Musculofascial Island Labial Flap 702Plate 135: Labial Mucosal Inversion Technique 706Plate 136: Nasal Reconstruction with the “Lip‐to‐ Lid Technique” Variation 708Plate 137: Oral Mucosal Graft with Nasal Stenting 710Plate 138: Intranasal Septal Window Technique 712Plate 139: Cantilever Suture Technique 71421. Cosmetic Closure Techniques 719Cosmetic Considerations 720Causes of Scars 720Minimization of Scarring 720Dog Ears 722Plate 140: Scar Concealment 724Plate 141: W‐Plasty 726Plate 142: Dog Ear: Surgical Correction 72822. Preputial Reconstructive Surgery 731Introduction 732Surgical Conditions 732Surgical Techniques 742Plate 143: Preputial Ostium Enlargement 756Plate 144: Preputial Ostium Reduction 758Plate 145: Preputial Advancement Technique 760Plate 146: Phallopexy 764Plate 147: Urethral Reconstruction for Subanal Hypospadias 766Plate 148: Preputial Urethrostomy Technique 768Plate 149: Urine Diversion Technique 77023. Pinnal Reconstructive Surgery 773Introduction 774Anatomy of the Pinna 774Surgical Conditions 779Wound Management and Reconstructive Surgical Techniques 780Aural Hematoma Management Options 786Plate 150: Skin Advancement Closure: Rostral Pinnal Base 796Plate 151: Skin Advancement Closure: Caudal Pinnal Base 798Plate 152: Transposition Flap Technique for Smaller Medial Pinnal Defects 800Plate 153: Transposition Flap Technique for Minor Lateral Pinnal Defects 802Plate 154: Large Transposition Flap Closure After Major Medial Pinnal Resection 804Plate 155: Transposition Flap for Major Lateral Pinnal Defects 806Plate 156: Direct Flap Reconstruction of the Pinna 808Plate 157: Resection of the Terminal Third of the Pinna 810Plate 158: Inverted “Triangle” Resection of the Central Third of the Pinna 812Plate 159: Incisional Drainage of Aural Hematomas 814Plate 160: Bandaging the Pinna 816Plate 161: Vacuum Drain Management of Aural Hematomas 81824. Miscellaneous Reconstructive Surgical Techniques 821Omentum 822Scrotum 822Tail Fold Intertrigo (Screw Tail) 823Disorders of the Vulva 827Managing Skin Fold Inversion of Urethrostomies 835Fecal Incontinence: Treatment Options 835Plate 162: Omental Flap Options 838Plate 163: Scrotal Flap Technique 840Plate 164: Caudectomy for Tail Fold Intertrigo 842Plate 165: Episioplasty 844Plate 166: Fascia Lata Sling and Silicone Banding for Managing Fecal Incontinence 846Plate 167: Spiral Rectal Diaphragm Technique (Rectal Rifling) 848Index 851

The authorMICHAEL M. PAVLETIC, DVM, Diplomate ACVS, is Director of Surgical Services at Angell Animal Medical Center in Boston, Massachusetts, USA.

• Foreword xiPreface xiiAcknowledgments xiiiAbout the Companion Website xiv1. The Skin 1Skin Function 2Skin Structure 2Cutaneous Adnexa 5The Hypodermis 8Cutaneous Circulation 8Pinna: Cutaneous Considerations 10Congenital Skin Disorders 102. Basic Principles of Wound Healing 17Introduction 18Wound Healing 18Acute Versus Chronic Open Wounds 29Species Variations in Wound Healing 29“Artificial Skin” 303. Basic Principles of Wound Management 33Introduction 34Patient Presentation 34Mechanisms of Injury and Wound Terminology 34Wound Classification 35Options for Wound Closure 37“Pointers” in Selecting the Proper Closure Technique 43Basic Wound Management in Six Simple Steps 44Exposed Bone: Osteostixis 49Acute Versus Chronic Wounds 504. Topical Wound Care Products and Their Use 53Wound Exudate 54Wound Drainage Systems 54Negative Pressure Wound Therapy (NPWT) 60Concept of Moist Wound Healing (MWH) 67Topical Wound Care Products 69The Maggot and Leach in Wound Care 79Common Topical Antiseptic and Cleansing Agents 81Alternative Forms of Wound Therapy 85Concluding Remarks 89Plate 1: Vacuum‐Assisted Closure 925. Dressings, Bandages, External Support, and Protective Devices 95Introduction 96Dressings: The Primary Layer 96Dressings: The Secondary Layer 111Dressings: The Tertiary Layer 112Preventing Bandage Displacement 113Tie‐Over Dressing/Bandage Technique 114Pressure Points: Bandage Options 115Bandage “Access Windows” 115Bandaging Techniques for Skin Grafts 115Bandaging Techniques for Skin Flaps 115Splints, Casts, Reinforced Bandages 115Miscellaneous Protective Devices 116Plate 2: Basic Bandage Application for Extremities 124Plate 3: Tape Stirrups and Padding Dos and Don’ts 126Plate 4: Elasticon Bandage Platforms and Saddles 128Plate 5: Spica Bandages/Splints 130Plate 6: Schroeder‐Thomas Splint 132Plate 7: Schroeder‐Thomas Splint: Security Band Application 136Plate 8: Body Brace 138Plate 9: Tape Hobbles for the Rear Extremities 1406. Common Complications in Wound Healing 143Improper Nutritional Support 144Medications and Their Influence on Healing 145Hypovolemia and Anemia 146The Nonhealing Wound: General Considerations 146Failure to Heal by Second Intention 147Scarring and Wound Contracture 152Infection and Biofilm Formation 154Draining Tracts 158Use of Tourniquets for Lower Extremity Procedures 165Seromas 166Hematomas 167Exposed Bone 167Wound Dehiscence 1697. Management of Specific Wounds 173Bite Wounds 174Burns 183Inhalation Injuries 195Chemical Burns 196Electrical Injuries 197Radiation Injuries 201Frostbite 204Projectile Injuries 205Explosive Munitions: Ballistic, Blast, and Thermal Injuries 227Impalement Injuries 227Pressure Ulcers 228Hygroma 234Snakebite 239Brown Recluse Spider Bites 240Porcupine Quills 240Lower Extremity Shearing Wounds 243Plate 10: Pipe Insulation Protective Device: Elbow 248Plate 11: Pipe Insulation to Protect the Great Trochanter 250Plate 12: Vacuum Drain Management of Elbow Hygromas 2528. Regional Considerations 255The Canine and Feline Profiles 256Plates 13A and 13B: Surgical Technique Menu 2589. Tension‐Relieving Techniques 265Introduction 266Skin Tension in the Dog and Cat 266Plate 14: Tension Lines 282Plate 15: Effects of Skin Tension on Wound Closure 284Plate 16: Patient Positioning Techniques 286Plate 17: Undermining Skin 288Plate 18: Geometric Patterns to Facilitate Wound Closure 290Plate 19: V‐Y Plasty 292Plate 20: Z‐Plasty (Option I) 294Plate 21: Z‐Plasty (Option II) 296Plate 22: Multiple Z‐Plasties 298Plate 23: Relaxing/Release Incisions 300Plate 24: The “Hidden” Intradermal Release/ Relaxing Incision 302Plate 25: Multiple Release Incisions for Extremity Wounds 304Plate 26: Suture Options to Alter Skin Traction and Retraction 306Plate 27: Walking Suture Technique 308Plate 28: Skin Stretchers to Offset Incisional Tension 310Plate 29: “Tension” Suture Patterns 312Plate 30: Retention Sutures 314Plate 31: Stent 316Plate 32: Skin “Directing” for Maximum Coverage 318Plate 33: Relaxing Incision to Reduce Flap Tension 32010. Skin‐Stretching Techniques 323Physiology of Skin Stretching 324Presuturing 324Load Cycling 324Skin Stretchers 326Skin Expanders 335Plate 34: Presuturing Technique 338Plate 35: Application of Skin Stretchers 340Plate 36: Skin Stretchers to Enhance Length of Axial Pattern Flaps 342Plate 37: Skin Stretcher Substitution for Presuturing 344Plate 38: Skin Expanders 34611. Local Flaps 351Introduction 352Advancement Flaps 353Rotating (Pivoting) Flaps 356Plate 39: Single Pedicle Advancement Flap 370Plate 40: Bipedicle Advancement Flap 372Plate 41: Transposition Flap (90 degrees) 374Plate 42: Transposition Flap (45 degrees) 378Plate 43: Transposition Flap (Oblique Angle) 380Plate 44: Local Facial Flap Options vs. Auricular Axial Pattern Flap 382Plate 45: Transposition Flaps in Partial Wound Closure 384Plate 46: Interpolation Flap 386Plate 47: Rotation Flap 390Plate 48: Forelimb Fold Flap 39212. Distant Flap Techniques 395Distant Flaps 396Direct Flaps 396Indirect Flaps 396The Delay Phenomenon 400Plate 49: Direct Flap: Single Pedicle (Hinge) Flap 402Plate 50: Direct Flap Closure of Knee Defect 406Plate 51: Direct Flap: Bipedicle (Pouch) Flap 408Plate 52: Indirect Flap: Delayed Tube Flap 41413. Axial Pattern Skin Flaps 417Introduction: Axial Pattern Flaps 418Island Arterial Flaps 418Reverse Saphenous Conduit Flaps 421Secondary Axial Pattern Flaps 421Options to Extend the Length of Axial Pattern Flaps 427Plate 53: Four Major Axial Pattern Flaps of the Canine Trunk 430Plate 54: Skin Position and Axial Pattern Flap Development 432Plate 55: Omocervical Axial Pattern Flap 434Plate 56: Thoracodorsal Axial Pattern Flap 436Plate 57: Lateral Thoracic Axial Pattern Flap 438Plate 58: Superficial Brachial Axial Pattern Flap 440Plate 59: Caudal Superficial Epigastric Axial Pattern Flap 442Plate 60: Cranial Superficial Epigastric Axial Pattern Flap 444Plate 61: Deep Circumflex Iliac Axial Pattern Flap: Dorsal Branch 446Plate 62: Deep Circumflex Iliac Axial Pattern Flap: Ventral Branch 448Plate 63: Flank Fold Flap: Hind Limb 450Plate 64: Genicular Axial Pattern Flap 452Plate 65: Reverse Saphenous Conduit Flap 454Plate 66: Caudal Auricular Axial Pattern Flap 456Plate 67: Superficial Temporal Axial Pattern Flap 458Plate 68: Lateral Caudal (Tail) Axial Pattern Flap 46014. Free Grafts 463Free Skin Grafts 464Classification of Free Grafts 465Graft Thickness 465Partial‐Coverage Grafts 466Dermatomes 467Preservation by Refrigeration 467Intraoperative Considerations 472Bandaging Technique for Skin Grafts 472Use of Plates 473Plate 69: Punch Grafts 476Plate 70: Pinch Grafts 478Plate 71: Strip Grafts 480Plate 72: Stamp Grafts 482Plate 73: Sheet Grafts 484Plate 74: Dermatome: Split‐Thickness Skin Graft Harvesting 486Plate 75: Mesh Grafts (With Expansion Units) 488Plate 76: Mesh Grafts (With Scalpel Blades) 49015. Facial Reconstruction 493Introduction: Facial Reconstructive Surgery 494Plate 77: Repair of Upper Lip Avulsion 515Plate 78: Repair of Lower Labial Avulsion 516Plate 79: Wedge Resection Technique 518Plate 80: Rectangular Resection Technique 520Plate 81: Full‐Thickness Labial Advancement Technique (Upper Lip) 522Plate 82: Full‐Thickness Labial Advancement Technique (Lower Lip) 524Plate 83: Buccal Rotation Technique 526Plate 84: Lower Labial Lift‐Up Technique 528Plate 85: Upper Labial Pull‐Down Technique 530Plate 86: Labial/Buccal Reconstruction with Inverse Tubed Skin Flap 532Plate 87: Skin Flap for Upper Labial and Buccal Replacement (Facial [Angularis Oris] Axial Pattern Flap) 536Plate 88: Feline Facial Axial Pattern Flap 538Plate 89: Cleft Lip Repair (Primary Cleft, Cheiloschisis, Harelip) 540Plate 90: Unilateral Rostral Labial Pivot Flaps 542Plate 91: Bilateral Rostral Labial Pivot Flaps 544Plate 92: Oral Commissure Advancement Technique 546Plate 93: Brachycephalic Facial Fold Correction 548Plate 94: Cheilopexy Technique for Drooling 55016. Myocutaneous Flaps and Muscle Flaps 553Introduction 554Myocutaneous Flaps 554Muscle Flaps 554Plate 95: Latissimus Dorsi Myocutaneous Flap 568Plate 96: Cutaneous Trunci Myocutaneous Flap 570Plate 97: Latissimus Dorsi Muscle Flap 572Plate 98: Latissimus Dorsi Bipedicle Muscle Flap 574Plate 99: Triceps Replacement with Latissimus Dorsi Muscle 576Plate 100: External Abdominal Oblique Muscle Flap 578Plate 101: Caudal Sartorius Muscle Flap 580Plate 102: Cranial Sartorius Muscle Flap 582Plate 103: Temporalis Muscle Flap 584Plate 104: Transversus Abdominis Muscle Flap 586Plate 105: Semitendinosus Muscle and Myocutaneous Flaps 588Plate 106: Flexor Carpi Ulnaris Muscle Flap 590Plate 107: Cranial Tibial Muscle Flap 592Plate 108: Internal Obturator Muscle Flap 594Plate 109: Superficial Gluteal Flap for Perineal Hernia Closure 59617. Oral Reconstructive Surgical Techniques 599Introduction 600Cleft Palate 601Palatal Defects/Oronasal Fistulas 602Plate 110: Mucosal Flaps 606Plate 111: Palatoplasty: Bipedicle Advancement Technique 608Plate 112: Cleft Palate Repair: Mucoperiosteal Flap Technique 612Plate 113: Palatine Mucosal Flap 614Plate 114: Soft Palate/Pharyngeal Mucosal Flaps 616Plate 115: Full‐Thickness Labial Flap Closure of Oronasal Fistulas 618Plate 116: Cartilage Grafts for Palatal Fistulas 620Plate 117: Angularis Oris Mucosal Flap 62218. Foot Pad Reconstruction 625Introduction 626Pad Laceration and Lesion Excision 626Digital Pad Transfer 631Metacarpal/Metatarsal Pad Transfer 632Accessory Carpal Pad 632Pad Grafting 634Digital Flaps for Wound Closure 634Fusion Podoplasty 634Plate 118: Digital Flap Technique: Major Digital/ Interdigital Defects 642Plate 119: Digital Flap Technique: Major Defects of Digits Two or Five 644Plate 120: Digital Pad Transfer 646Plate 121: Metatarsal/Metacarpal Pad Transfer 648Plate 122: Pad Grafting 650Plate 123: Segmental Pad Grafting Technique 652Plate 124: Fusion Podoplasty 65419. Major Eyelid Reconstruction 657Introduction 658The Eyelids 658Plate 125: Skin Flap Options for Cutaneous Defects of the Eyelid Regions 660Plate 126: Lip‐to‐Lid Procedure 662Plate 127: Oral Mucosal Graft onto Skin Flap 666Plate 128: Third Eyelid–Skin Flap Reconstruction of the Lower Eyelid 66820. Nasal Reconstruction Techniques 671Introduction: Nasal Anatomy 672Traumatic Wound Management 672Neoplasia 673Neoplasms and Surgical Margins 673Nasal Reconstruction Options 673Options for Managing Nasal Stenosis 682Plate 129: Septal Coverage Using Cutaneous Advancement Flaps 692Plate 130: Bilateral Sulcus Flap Technique 694Plate 131: Septal Resection Technique 696Plate 132: Dorsal Nasal Splitting Technique to Enhance Exposure of Septum 698Plate 133: Alar Fold Flaps 700Plate 134: Musculofascial Island Labial Flap 702Plate 135: Labial Mucosal Inversion Technique 706Plate 136: Nasal Reconstruction with the “Lip‐to‐ Lid Technique” Variation 708Plate 137: Oral Mucosal Graft with Nasal Stenting 710Plate 138: Intranasal Septal Window Technique 712Plate 139: Cantilever Suture Technique 71421. Cosmetic Closure Techniques 719Cosmetic Considerations 720Causes of Scars 720Minimization of Scarring 720Dog Ears 722Plate 140: Scar Concealment 724Plate 141: W‐Plasty 726Plate 142: Dog Ear: Surgical Correction 72822. Preputial Reconstructive Surgery 731Introduction 732Surgical Conditions 732Surgical Techniques 742Plate 143: Preputial Ostium Enlargement 756Plate 144: Preputial Ostium Reduction 758Plate 145: Preputial Advancement Technique 760Plate 146: Phallopexy 764Plate 147: Urethral Reconstruction for Subanal Hypospadias 766Plate 148: Preputial Urethrostomy Technique 768Plate 149: Urine Diversion Technique 77023. Pinnal Reconstructive Surgery 773Introduction 774Anatomy of the Pinna 774Surgical Conditions 779Wound Management and Reconstructive Surgical Techniques 780Aural Hematoma Management Options 786Plate 150: Skin Advancement Closure: Rostral Pinnal Base 796Plate 151: Skin Advancement Closure: Caudal Pinnal Base 798Plate 152: Transposition Flap Technique for Smaller Medial Pinnal Defects 800Plate 153: Transposition Flap Technique for Minor Lateral Pinnal Defects 802Plate 154: Large Transposition Flap Closure After Major Medial Pinnal Resection 804Plate 155: Transposition Flap for Major Lateral Pinnal Defects 806Plate 156: Direct Flap Reconstruction of the Pinna 808Plate 157: Resection of the Terminal Third of the Pinna 810Plate 158: Inverted “Triangle” Resection of the Central Third of the Pinna 812Plate 159: Incisional Drainage of Aural Hematomas 814Plate 160: Bandaging the Pinna 816Plate 161: Vacuum Drain Management of Aural Hematomas 81824. Miscellaneous Reconstructive Surgical Techniques 821Omentum 822Scrotum 822Tail Fold Intertrigo (Screw Tail) 823Disorders of the Vulva 827Managing Skin Fold Inversion of Urethrostomies 835Fecal Incontinence: Treatment Options 835Plate 162: Omental Flap Options 838Plate 163: Scrotal Flap Technique 840Plate 164: Caudectomy for Tail Fold Intertrigo 842Plate 165: Episioplasty 844Plate 166: Fascia Lata Sling and Silicone Banding for Managing Fecal Incontinence 846Plate 167: Spiral Rectal Diaphragm Technique (Rectal Rifling) 848Index 851