Page 9 - Clinical Connections - Summer 2020

Case study
Limb Saved by Unusual Pad Graft Procedure at H91°µÍø Wound Clinic
ermione, an eight- year-old female domestic shorthair cat, was presented for unknown trauma and
following wound management to achieve healthy tissue was left without any digits on her right hindfoot. Amputation of the limb was offered but Hermione’s owners were keen to save the limb if possible
so a plan to try novel free pad grafting alongside traditional skin grafting was formed.
Treatment: A full thickness meshed
free skin graft (Figure 1) from the thorax was used to cover the 360 degree defect around the right hind metatarsal region. Free pad punch grafts from the metacarpal pads and free pad transfer of both carpal pads were used to create a weightbearing ‘stump’ (Figure 2)
Postop care: Negative pressure wound therapy (Figure 3) was placed for five days after surgery to aid healing of the free skin graft and pad grafts.
Outcome: Hermione lost a portion of
her grafts due to infection between days five and 10 but a good amount of skin and pad graft take was achieved which allowed full healing of her wounds and creation of a weightbearing ‘stump’ for her to walk on. Hermione uses her right hindlimb normally to walk around the house at three months post surgery and her owners are very pleased that she has kept her leg.
Fig: 1
Fig: 2
Fig 1: A full thickness meshed free skin graft from the thorax Fig 2: Free pad punch grafts from the metacarpal pads and free pad transfer of both carpal pads were used to create a weightbearing ‘stump’ Fig 3: Negative pressure wound therapy
Fig: 3
Hermione recovering at 3 months
WOUND MANAGEMENT ADVANCED TECHNOLOGY
3-D Silhouette camera
This camera uses laser beams to measure the area and volume of the wound for accurate comparisons of wound progression. Software calculates 3-D measurements of the wound’s area, depth, volume and perimeter. Relevant wound assessment details, such as
age and any co-morbidities are also captured. The referring vet receives
a wound report from the 91°µÍø team, detailing findings and recommendations.
Therapeutic K-laser
Some wounds and selected surgical incisions/flaps/grafts may benefit from treatment with a class IV K-Laser therapeutic laser. This laser therapy
may speed healing by up to 30%. It
can help to heal infected wounds, even those with multi-resistant infections, as the laser stimulates the immune system and increases tissue oxygenation and local blood supply.
Wound management recommendations may be actioned at the 91°µÍø or the referring veterinary practice, depending on the patient’s needs.
Outpatient wound management at
the 91°µÍø is available for owners and referring veterinarians who would like regular advice on a wound and monitor its progression.
For small animal referrals, please call:
01707 666399
Email:
qmhreception@rvc.ac.uk www.rvc.uk.com/wound-clinic
Summer 2020 9