Skin Grafting in the Dog Elroy C

Volume 19 | Issue 3 Article 1

1957 Skin Grafting in the Dog Elroy C. Jensen Iowa State College

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Recommended Citation Jensen, Elroy C. (1957) "Skin Grafting in the Dog," Iowa State University Veterinarian: Vol. 19 : Iss. 3 , Article 1. Available at: https://lib.dr.iastate.edu/iowastate_veterinarian/vol19/iss3/1

This Article is brought to you for free and open access by the Journals at Iowa State University Digital Repository. It has been accepted for inclusion in Iowa State University Veterinarian by an authorized editor of Iowa State University Digital Repository. For more information, please contact [email protected]. SKIN GRAFTING In The Dog

Elroy C. J,ensen, D.V.M.

THERE are several histological factors the arm instead of from the forehead. which have made skin grafting pos This technique is now known as the Ital sible in man and animals. First, the com ian method of rhinoplasty. Free skin parative ease which epithelium can regen grafting started early in the 19th century erate is a factor. This new growth of tis by two charlatans which is related by sue occurs either from the periphery of a Baroni, the physi'Ologist, "A woman wound or it may result from proliferation named Gamba Curat, in order to show of the external root sheath of the hair the efficiency of an ointment she was sel follicles providing the dermis has not been ling, cut a piece of skin from her thigh completely destroyed. Another fea:ture of and after passing it around for inspection, skin is that its constituent cells may be replaced it in its original bed, and dres kept alive for several days by means of sed the area with the .ointment. The next the tissue fluid from below the graft by evening the graft was S'O far healed that the process of osmosis. This affords suf no further dressing was necessary. The ficient time for new vessels to be formed second charlatan also sold an ointment which will then nourish the skin. Also, described as a cure for all ills and named the ability of the capillaries to proliferate by him 'The ointment of the French and then anastomose with those of the Army'. He cut a large piece of skin, in graft make this feat possible. It is only cluding some of the underlying muscle, because of these physiological processes from his forearm and after holding it up that this type of surgery is successful. for the spectators to see, replaced it, and According to Neuhofl, the first attempts dressed the wound with his ointment. at skin grafting were made centuries ago Eight days later he exhibited his arm, by some members of the tile makers' and the scar of the wound could scarcely caste in India. They used pedunculated be seen." This incident suggested to skin flaps from the forehead and cheek to Baroni a series of experiments with 'auto reconstruct the nose. The use of this type grafts on the sheep. Maltz2 relates in his of graft has since been called the Indian book, "Evolution of Plastic Surgery" that method of rhinoplasty. In 1597 Gaspar Giusepp Baroni, in 1804 "carried out a Tagliocozzi modified the method of rhino series of successful experiments on ani plasty so as to transplant the skin from mals (mainly sheep) transplanting pieces of skin 12.5 by 7.5 cm. In his initial ex Dr. Jensen received his D.V.M. from Michigan periment, two whole thickness portions State University in 1951. He is now an assistant of skin of equal size and devoid of subcu professor in the Department of Veterinary Med icine and Surgery at Iowa State College. taneous tissue were removed from the

Issue 3, 1957 163 sides of the root of the tail of a sheep. be more likely to receive a blood supply. The pieces were transferred directly to Another advantage of this graft is that the opposite sides. In his second experi the donor area doesn't have to be re ment along similar lines, the pieces of grafted as the small pieces of skin are skin were placed after an interval of removed so that intact skin remains be eighteen minutes. In his third experiment tween each d'Onor site so that epitheliz Baroni procured a larger piece of skin ation from the periphery of the intact (5 by 5 inches) including the subjacent skin will close the wound. The disad tissue and a small muscle fragment. These vantage of this type of graft is that the were not transplanted for an hour." cosmetic appearance results in 'a "spotted" Davis3 in an editorial entitled "The or "pitted" area, both 'On the recipent and Nomenclature of Skin Grafting", lists and the donor areas. Another fault is that the defines the four skin grafts commonly donor site cannot be re-used for further used today. His definition 'Of a graft might grafts due to the appearance it has when also be quoted: "A mass of tissue cut free healed. Probably in the dog this would to be transplanted where desired which not be as ser~ous a fault as in the human. receives its blood supply from the sur The whole-thickness or Wolfe-Krause face on which it is placed." Thus he has graft is the ideal graft in many respects reference to free skin grafts when he as it contains the entire skin layers. Ad enumerates the following type of grafts: vantages of this graft 'are: that it shrinks (1) Reverdin graft 'Or "pinch graft" less when healing than the other types; which are 3-5 mm in diameter and con it affords more resistance to trauma than sist of the epidermis and a very small any of the other three methods, as a good amount of the dermis, (2) small deep deposit of subcutaneous tissue will form graft which is about the same size as the underneath this graft; it 'also has an ad Reverdin, but includes almost the entire vantage in that it can be used to graft thickness of the corium at least in the hairy areas, as most of the hair follicles center, (3) Wolfe-Krause or the whole are viable after transplanting. Disad thickness graft which includes the entire vantages of this graft are several: (1) skin and (4) the Ollier Thiersch or "split It is very susceptible to infection and can thickness graft" which consists of the ep not be used on infected or even granu idermis and only a portion of the dermis. lating wounds (the latter is true in the The pedicle or flap is another type of human at least), (2) it is more difficult plastic surgery. In this type of graft, the to get satisfactory "takes" due to the skin is attached at some portion of its thickness of the skin and the establish periphery or base by a pedicle through ment of a satisfactory blood supply, and which it receives its blood supply. This (3) the donor site must be regrafted or graft can be shifted only so far as its else the skin shifted to cover the area pedicle will allow. from which it was donated. Each type of graft has its indications The split thickness or Ollier-Thiersch although there are times when one of graft consists of the epidermis and a por severa,l could be used with nearly equal tion of the dermis, but enough of the der results. The Reverdin or "pinch graft" mis remains so that epithelization occurs and the small deep graft can be used un at the donor site. This type of graft is der similar conditions. These are small usually obtained from the abdomen and pieces of skin 3-5 mm. in diameter which medial aspects of the thigh. Dermatomes are seeded on 'a recipient area. The ad or mechanical cutting instruments are vantage of this method is that a small usually used to cut this skin for grafting donor area will go a long way to seed an although it can be done free-hand. The area as the grafts are placed about 3-5 advantages are several: (1) The graft mm. apart. Epithelization occurs from is thin and is less likely to die from lack these seeded areas and eventually covers of nutrition during the first few days af the area. The grafts are small and hence ter transplanting, 'and (2) the donor area a better chance of "takes" as they would regenerates by itself; in fact, in the hu-

164 Iowa State College Veterinarian man some areas have been used 4-5 times grow from a graft of this nature as hair at intervals of 4-5 weeks. Several disad follicles are not e'asily destroyed during vantages, however, limit the use of this this transfer. graft. The cosmetic appearance is not as Just what occurs after a graft has been good as that of the full thickness graft as transplanted on a recipient area was there is some shrinkage. In our experi studied by Davis and Trautl who were mental work on dogs we have been cut interested in whether vessels of the graft ting the grafts at .030 inches and find that anastomosed with those of the grafted shrinkage is not excessive. The graft will area; whether capillaries of the grafted be dry and desquamate for several area grew into the graft by extending months during which time it will have to into the old vessels of the graft or whether be softened with lotions. Due to it being capillary up-growth from the grafted rather thin, it does not resist trauma very areas penetrated the connective tissue of well. A fatty cushion does not develop the transplant and thus established a underneath tIllS type of transplant. Hair blood supply. This work was done on dogs will not grow from this type of graft. in which they removed grafts 3 cm. long However, if the skin lesion resulted in by 1 % cm. wide, sutured skin to muscle destruction of the hair follicles, there and then closed the wound edges over would be no hair growth under the nor the graft to apply pressure. They found mal epithelization process which would that a fibrin network was formed in just occur from the wound edges. Besides, a few hours. During the next 24 hours this normal process would resuit in a there was nligration of round cells and much longer recovery time varying from wandering cells from the graft bed in the several weeks to months depending on fibrin and then into the graft. These cells the size of the denuded area. found their way into the connective tis The pedicle graft in the human is used sue stroma and all parts of the corium primarily in reconstructive surgery such but not in the epidermis. During the same as replacing an ear, nose, lower jaw, 24 hours there was a development of cheek and the like. In the dog it has ex highly vascular granular tissue which cellent application for lesions of the lower replaces the fibrin network. As a result, extremities where a graft can be reflected the graft rests on rich newly formed cap from the medial aspects of the leg and illaries transporting blood 18-24 hours eventually grafted in an area such as a after transplantation. There are some de granulomatous lesion of the metatarsal generative changes also. The epidermis region which has failed to heal. It is the sloughs down to the Malpighian layer. graft most likely to "take" as it always The endothelium of the blood vessels has a blood supply from one of its ends. degenerate except in an occasional area. It will also grow on slightly contamin Hair and sebaceous glands are affected ated areas which is not true of the other very little. The degenerative process oc types of grafts. It does have its linlita curs up to 7-8 days which seems to be the tions as only a limited amount of skin turning point since the first vacularization can be removed from a given area at one reaches all of the parts at this time. The time. Since the skin removed from the first blood supply forms by anastomosis area is full thickness, the donor area must of vessels of the granulation tissue to either be undermined and shifted to those of the graft. Davis and Traut found gether, if possible, or the denuded area that the first blood supply takes place in covered with a split thickness graft from this way as early as 22-72 hours. The another part of the body. Another feature second means of blood supply is slower, of this graft is that it affords a "padding" according to these authors, but a more to the area as the transplant is full thick voluminous blood supply forms by the ness and hence allows for good deposit upward growth of capillaries of granu of fat and connective tissue underneath lating tissue, develops loops and pene which does not occur with a split thick trates the connective tissue of the corium. ness transplant. Also, hair continues to Probably most of the vascularization

Issue 3, 1957 165 forms in these ways. Invading loops reach the Malpighian layer by the 12th day. They are more numerous than in normal skin and are less numerous in older grafts so some must degenerate. The third lileans found by Davis and Traut was by the sprouting capillaries in granulating tissue. The capillary finds its way inside the old vessel of the graft and grows rapidly due to less resistance than found in the connective tissue stroma. They found that this only occurs occasion ally and that large vessels of the graft are usually absorbed after transplanta tion. Davis and Traut found that the earliest time in which circulation in the graft was demonstrated was at the end of 22 hours. They stated that adequate circulation was not established until the end of the eighth day. During the interum the graft is nourished by a plasmatic cir culation and by early an'astomosis of small capillaries. Very little literature is available con cerning skin grafting in the dog and cat. Self5 in 1934 reported the use of small pin point grafts on five dogs in which he re ported the results 'as being successful. Keefe6 reported a skin graft in the cat Fig. 1. Delayed pedicle graft 7 days post-oper which was partially successful. atively. It is my opinion that skin grafting in the dog has possibilties. Because of the relative loose skin of the dog in the re and the desire to know how effective skin gions of the neck, thorax, flanks and lum grafting would be when 'applied to the bar region, skin grafting would seldom dog, this study was undertaken. be indicated in these areas. Undermining I have found the use of the delayed of the skin and skin shifting usually pedicle graft very successful in 13 out of would suffice unless the wound should be 14 cases in which it has been used. Twelve exceptionally large. However, the skin of of these successful cases were on experi the legs is not very loose and as a result, mental dogs and one on a clinical case. a wound in this 'area of several centi This work has been done in the met'atar meters is rather difficult to close even sal region where skin coverage is some by shifting of the skin. The area of the times a problem. A pedicle or tube was face is another location in which surplus formed on the medial aspect of the tibia skin would be hard to obtain. "Pentobarbi by making two parallel longitudinal in tal sloughs" as well as from other irritating cisions about one inch apart leaving the drugs being accidentally given perivascu skin attached on both ends and elevating larly produce ugly looking wounds for this strip of skin from the subcutaneous weeks. The removal of tumors from the tissue. This skin was then formed into a leg of a dog often results in insufficient tube by placing interrupted sutures of skin to bring the wound edges into ap 4-0 braided silk in the skin margins and position. It is in these cases that skin reflecting the skin edges so they were in grafting would be indicated. Because of apposition to each O'ther, thus forming a the scarcity of literature on the subject tube or pedicle. The area from which the

166 Iowa State College Veterinarian tube was raised was closed by shifting of this technique the hair which grows from the adjacent skin so that the denuded the graft will be in the wrong direction. area was covered with skin. Interrupted Keeping the hair which grows in the area sutures of medium Vetafil were used. It trimmed to correspond to that of the is surprising to what extent skin can be surrounding area would add to the cos shifted in this 'area. The tube was al metic appearance of the graft. The graft lowed to heal for two or more weeks be area is soft, pHable and resists trauma fore further surgery was performed. This just as well as the surrounding skin. method is known as the "delayed pedicle Figure 1 shows a "delayed pedicle graft" as it allows time for a sufficient graft" in place for seven days. This graft blood supply to develop in the tube so was used clinically to cover 'an area in that it will be better able to nourish the which the soft tissue was completely de new graft when it is transplanted. The nuded so as to expose the metatarsal length of the tube should not exceed bones as a result of an automohile injury. three times its width, or necrosis of the Near the distal end there is a little area pedicle might occur. In order to obtain a in which the superficial layer of skin is better blood supply ror the skin which is necrotic. I:t is doubtful whether 'all of the to be transplanted it is advisable to incise layers are involved. the skin beyond the tube along its lateral margins commensurate with :the size of the graft needed. Resuture this skin with interrupted sutures of 4-0 silk. This pro cedure has a tendency to increase the blood supply to the skin which is to be transplanted. The recipient area must be free of in fection and possess a bed of healthy gran ulation tissue when used to cover chronic skin lesions. After two or more weeks the tube plus the desired amount of skin needed to cover the recipient area is removed and the tube reflected down ward so that it will beat the proximal margin of the recipient area and the un tubed skin extending over the 'area to be grafted. Interrupted stitches of 4-0 silk are used. The tension of the skin on the grated area should be that of normal skin. Several layers of sterile Telfa bandages (Bauer & Black) are placed over the Fig. 2. Two pedicle type grafts 4 and one-haH graft due to their non-adhesive proper months post-operatively. ties. Several ,layers of sterile 3x3 gauze sponges are then applied followed by a layer of cotton surrounding the entire Figure 2 shows two pedicle grafts on foot. A 2-inch roller gauge bandage is an experimental dog. The tubes have been then 'applied followed by adhesive tape. removed and the grafts have taken 100 The toe is allowed to protrude through per cent. The grafts have been in place the handage. A two inch stockinet is used for 4% months. Cosmetic appearance and to protect the tube from injury. The band function are excellent. Delayed pedicle age is changed in three days and then ev grafts of this type can usually result in ery other day until the 8-10th day when 95-100 per cent "takes" when properly no bandaging is required. The pedicle executed. furnishing the blood supply to the new Figure 3 shows a split thickness graft graft may be severed in 10-14 days. With on an experimental dog. The skin was

Issue 3, 1957 167 removed with a Brown Dermatome (Zim be satisfactory in this particular area. mer Mfg. Co., W'arsaw, Indiana) at a This type of graft would have better thickness of .030. The remaining dermis chances of taking if it were applied to a was removed with a scalpel and then the granulating area which we haven't done skin graft replaced over the denuded in 'the four cases in which it has been area. Continuous sutures were used to done experimentally. bring the edges into apposition. Three Free transplant'ation of full thickness strips of skin were used to cover the skin grafts have also been attempted us area. Polyotic mastitis ointment (Leder ing grafts 2x2 inches in size from the thor Ie) was applied to the skin edges. Several ax. The percentage of "takes" has been layers of sterile Telfa were applied fol very poor probably due to the large size of lowed by 3 to 4 layers of 4x4 sponges. the graft and the difficulty encountered in A 3-inch Tensor Elastic Bandage (Bauer removing all of the subcutaneous tissue & Black) was placed over the area and from the graft prior to transplantation. continued around the thorax of the dog It is also more difficult to obtain a suf to apply pressure to the grafted area. A ficient blood supply when the graft is of 3-inch roller gauze bandage was then ap full thickness. Bandaging and restraint plied fol1owed by 2-inch tape to hold the are also 'a problem which make this type of graft very difficult. It is also more susceptible to infection than either the pedicle or the spHt thickness, so in the dog this is an important factor to con sider. Recently we have attempted full thickness grafts on the metatarsal region of the foot, using the medial aspect of the thigh for the donor region. The size of the grafts have averaged 1 and one-half inches long by three-fourths inches wide. To date we have done three with 100 percent "takes." This apparent success is probably due to the fact that we are having less trouble in securing skin free from subcu taneous tissue from the region of the thigh which was more difficult when obtaining it from the thorax due to the large deposit of fat under the skin in that particular region. From ,the experimental work which we have done thus far, it appears that the pedicle graft and the split thickness graft Fig. 3. Split thickness graft in the thoracolum are the transplants of choice to use in bar region 0.030 inch thick. skin grafting in the dog. Recent researcn, however, seems to indicate that the free full thickness graft will be successful to bandages in place. The graft was checked cover relatively small denuded areas in 4 days and rebandaged every third which are free from infection and in areas day until the tenth day. The area was where a pressure bandage can be held rather dry following the tenth day so intact for sufficient time for the grafts to Moruguent ointment (Massengill) was "take." applied daily for about two weeks. There was some exfoliation of the epithelium BIBLIOGRAPHY during this period which is normal for 1. Neuhof, H. 1923. The Transplantation of Tis a graft of this type. This picture was sues. D. Appeton and Company, New York, N.Y. taken 42 days postoperatively and shows 2. Maltz, M. 1946. Evolution of Plastic Surgery. a good coverage of the skin which would Froben Press, New York, N.Y.

168 Iowa State College Veterinarian 3. Davis, J. S. 1925. The nomenclature of skin grafting. Surg., Gynec., and Obts. 11:811-842. 4. Davis, J. S. and Traut, H. F. 1925. Origin and development of the blood supply of whole thickness skin grafts. Ann. Surg. 82:871-879. Curriculum 5. Self, R. A. 1934. Skin grafting in canine practice. Jour. Am. Vet. Med. Assoc. 2:163- 164. 6. Keefe, Fred. 1946. Skin grafting in a cat. Committee Jour. Am. Vet. Med. Assoc. 108:43-48. Progress Report HE MACROSCOPIC TUBE-AG T GLU'fINATION TEST FOR LEP TOSPIROSIS. Advance in knowledge in the field of leptaspirasis is closely corre HE MEMBERS of the student cur lated with methods of seralagical testing. T riculum committee wish to thank all Determination of the disease depends on those who spent the necessary time and accurate and simplified methads of de effort on the questionnaire ta contribute tecting presence 'Of leptospiral antibodies a valuable opinion. Response to ques in serums. tionnaires sent to recent graduates has Of the three general types 'Of serological now exceeded 20 percent, which demon tests which have been developed, none strates a gratifying degree of interest in are suitable as an agglutinatian test the curriculum by th'Ose no longer direct which is practical far laboratories nat spe ly affected by it. cializing in leptaspiral research. As you recall, the student curriculum Leptospira pomona, Leptospira cani cammittee is an undergraduate group cola, and Leptospira icterahemorrhagiae charged by the ISC Student Chapter of organisms were propagated in culture the American Veterinary Medical As media and formalized when maximum sociation with the responsibility of ob grawth had been 'Obtained. In perfarming taining, studying and approving sug the test, ten-fold dilutions of the serum in gestions for improvement of the curric saline were mixed with the appropriate ulum made by the students of the divi antigens and incubated. A grossly visible sion. These suggestions are then to be floccule in the battam 'Of the cone-shaped submi1tted to the faculty curriculum com tubes denoted a pasitive reaction. mittee. The test was highly specific for lepto This year we have attempted, by use spiral infections. Serums containing an of the questionnaire, to obtain a complete tibodies of varia us bovine, porcine and and accurate student opinion 'and to canine diseases failed ta agglutinate lep compare it with a cr'Oss-section of alumni tospiral antigens. The test compared fa opinion. vorably with the classic agglutination Our current report to the faculty com lysis test. mittee includes suggestions which were quite uniformly fav'Ored by those answer Howarth, J. A., D.V.M, Ph.D. American Jour ing the questionnaire-both studen'ts and nal of Veterinary Research, 17:789-792. (Octo alumni. ber) 1956. The student committee presently is meeting with the staff of each 'Of the de Cows are less taler ant ta heat than man partments to discuss 'those recommenda because of their inability ta shed heat by tions which apply. It is hoped that the perspiring. joint discussion of the curriculum by the faculty and student committee will rfhere are 800 dressed animal carcasses strengthen our course of study which is inspected each hour of an 8-hour work now one of the best in the country. day by the meat inspectian service. -Dean Thackery '57

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