What is Skin Graft?
When your dog has a wound that is too large to close on its own or a wound that becomes chronic and does not heal, treatment with a skin graft may be beneficial in achieving wound closure. Skin grafts not only provide better cosmetic results for wound repair when required, but help quickly and effectively restore the skin barrier, which restores functioning and provides protection from environmental factors, including infection and parasites. A skin graft requires the use of a piece of skin harvested from another part of the body and placed on the wound bed where blood vessels present in the wound attach to the underside of the grafted skin, nourishing it, which allows that skin to remain viable and expand to achieve wound coverage. This requires that the wound be adequately supplied with blood vessels that can nourish the graft or it will fail. Epithelial cells present in skin, if supplied with adequate blood supply, are quick to regenerate, which allows this procedure to be successful and useful for affecting healing in large wounds or where extensive tissue damage has occurred, such as in the case of burns or when neoplasia removal has been necessary. Skin grafts are performed in your dog using sedation and local anesthetic, intravenous general anesthetic, or in cases where more substantial anesthetic is required, general anesthesia by gas may be utilized.
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Skin Graft Procedure in Dogs
Wounds will be prepared prior to skin graft procedure by cleaning, excising necrotic tissue, applying antibiotics and medications to promote healing, and bandaging if necessary to establish a clean wound with good blood supply. If excessive granulation exists in the wound to receive grafting, this needs to be trimmed down so granulation does not extend above the skin surface and healing established prior to procedure. A decision on what type of anesthetic is required will be made prior to the procedure and if general anesthesia is required your dog will need to fast prior to the skin graft procedure. Your dog will be sedated and given local or general anesthetic to ensure their comfort during the procedure. Skin from an area of the body with loose skin such as the neck, chest or abdomen will be selected, and skin carefully incised and harvested to obtain an appropriately sized skin graft. The skin is raised with a scalpel and underlying fat and connective tissue released. The graft tissue may have small holes made in it to allow fluid to escape during the healing grafting and healing process. This graft is then placed over the open wound and sutures put in place to affix it. Alternately, if loose skin is available adjacent to the wound, that skin may be stretched and manipulated to cover the wound and sutured in place. The wound is bandaged using a non adhesive bandaging that will not stick to the skin graft or cause it to become dislodged. Your dog will be monitored while they recover from anesthesia and their movement restricted.
Efficacy of Skin Graft in Dogs
Skin graft procedures are generally well understood and effective, providing, debridement, cleaning, and granulation of the wound is conducted prior to the grafting procedure.
Conditions which impede effectiveness include wounds where radiation therapy has been used, wounds over bones, tendons, or ligaments, wounds where blood supply is poor, wounds in high motion area such as joints, or where infection is present.
Skin grafts may not grow hair depending on the depth of the graft tissue used to affect repair.
Skin Graft Recovery in Dogs
It is imperative that your dog's activity be restricted and that they not be allowed to interfere with the wound during healing. Activity should be restricted for three weeks post-surgery. An e-collar will usually be necessary to prevent interference with the site. Bandaging of the skin graft site post surgery with non-stick bandaging to protect the graft site is also important. The bandaging should be changed and cleaned as instructed by your veterinarian. This may require follow-up appointments at your veterinary office to provide clean, dry bandages and check to ensure that the graft has remained in place and that infection is not present. You should check your dog's extremities where bandages are present to ensure that adequate circulation is maintained and that bandages are not too tight. The graft site will need to be protected for several weeks, even after bandaging is removed your dog may require an e-collar to prevent interference. A sock placed over the graft on a limb may help protect it after bandages have been removed. Ice packs should not be applied to skin grafts as this can damage skin and prevent vascularization from establishing.
Cost of Skin Graft in Dogs
The cost of skin graft procedure varies widely depending on the anesthesia required and the area to be covered. Costs range from $200 to $1,000 or more depending on your veterinarian's expertise, the cost of living in your area, and the requirements of the procedure.
Dog Skin Graft Considerations
If the wound bed is not adequately prepared prior to grafting, the graft is likely to fail. Removing dead tissue, cleaning the wound and ensuring that granulation is established but not excessive are vital to the success of the procedure.
Skin Graft Prevention in Dogs
You can prevent trauma to your dog by “pet proofing” your home and ensuring that hazards are removed that would cause lacerations. Keeping your dog in a fenced or restricted area when outside or on leash will greatly reduce the likelihood that they will be involved in car accidents or fights with other animals that may result in lacerations requiring skin graft procedures. Ensuring adequate, prompt veterinary treatment when wounds do occur so that they may be sutured or heal on their own and not become chronic requiring further intervention will also reduce the likelihood of skin graft requirement.
Skin Graft Questions and Advice from Veterinary Professionals
My doggie Bella has a large fibro sarcoma tumor on the right side of the nose/mouth. She received SRS radiation and the necrotic tissue is blocking her nostrils and cannot breath through her nose. Im desperately looking for a surgeon that is willing to perform surgery, but 3 of them have said that they will not have enough healthy skin to close the wound. Can I suggest to them to use a skin graft? Maybe they don't have the skill set and that' why they have not offered that option to me.
Skin grafts for pets are not uncommon, it is a skill set that every Veterinarian covers during Veterinary School; full thickness meshed skin grafts are the most common where a section of skin is excised (all layers) and lots of small parallel incisions are made in the skin which allows for a larger area to be covered by the graft, the small incisions will heal on their own by secondary intention healing. Problems arise after radiation therapy as there may not be sufficient viable skin and low blood supply to the underlying for a graft to be placed; one of the most common causes of a failed graft is poor blood supply to the graft. If you have questions, you should speak with the Surgeon who I am sure will explain Bella’s individual case. Regards Dr Callum Turner DVM
www.vetsurgerycentral.com/images/skin/skin_graft/fig2.jpg (this image is a good example of how a mesh skin graft looks)
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