Comparison of a new hydro-surgical technique to traditional methods for the preparation of full-thickness skin grafts from canine cadaveric skin and report of a single clinical case

Summary

Objective: To compare the hydro-surgical technique to traditional techniques for removal of subcutaneous tissue in the preparation of full-thickness skin grafts.

Study design: Ex vivo experimental study and a single clinical case report.

Sample population: Four canine cadavers and a single clinical case.

Methods: Four sections of skin were harvested from the lateral flank of recently euthanatized dogs. Traditional preparation methods used included both a blade or scissors technique, each of which were compared to the hydro-surgical technique individually. Preparation methods were compared based on length of time for removal of the subcutaneous tissue from the graft, histologic grading, and measurable thickness as compared to an untreated sample.

Results: The hydro-surgical technique had the shortest skin graft preparation time as compared to traditional techniques (p = 0.002). There was no significant difference in the histological grading or measurable subcutaneous thickness between skin specimens.

Clinical significance: The hydro-surgical technique provides a rapid, effective debridement of subcutaneous tissue in the preparation of full-thickness skin grafts. There were not any significant changes in histological grade and subcutaneous tissue remaining among all treatment types. Additionally the hydro-surgical technique was successfully used to prepare a full-thickness meshed free skin graft in the reconstruction of a traumatic medial tarsal wound in a dog.

Presented at the ACVS symposium during the resident seminar, Seattle, Washington,USA on October 22, 2010.

Keywords

Hydro-surgery - Versajet - skin graft

• References

• 1 Swaim SF. Skin grafts. In: Slatter DH. editor. Textbook of Small Animal Surgery. 3rd edition.. Philadelphia, PA: W. B. Saunders; 2003: 321-338.
• 2 Pavletic MM. Free grafts. In: Atlas of Small Animal Wound Management and Reconstructive Surgery. 3rd edition.. Philadelphia, PA: Wiley-Blackwell; 2010: 403-430.
• 3 Pope ER. Mesh skin grafting. Vet Clin North Am Small Anim Pract 1990; 20: 177-187.
• 4 Pope ER, Swaim SF. Wound drainage from under full-thickness skin grafts in dogs; Part I. Quantitative evalution of four techniques. Vet Surg 1986; 15: 65-71.
• 5 Pope ER, Swaim SF. Wound drainage from under full-thickness skin grafts in dogs; Part II. Effect on cosmetic appearance. Vet Surg 1986; 15: 72-78.
• 6 Bauer MS, Pope ER. The effects of skin graft thickness on graft viability and change in original graft area in dogs. Vet Surg 1986; 15: 321-324.
• 7 Pope ER. Effect of skin graft preparation and graft survival on the secondary contraction of full-thickness skin grafts in dogs. Am J Vet Res 1985; 46: 2530-2535.
• 8 Hanselka DV, Boyd CL. Use of mesh grafts in dogs and horses. J Am Anim Hosp Assoc 1976; 12: 650-653.
• 9 Ross Jr GE. Clinical canine skin grafting. J Am Vet Med Assoc 1968; 153: 1759-1765.
• 10 Ben-Amotz R, Lanz OI, Miller JM. et al. The use of vacuum-assisted closure therapy for the treatment of distal extremity wounds in 15 dogs. Vet Surg 2007; 36: 684-690.
• 11 Granick MS, Datiashvili RO, Granchi PA. Case Studies from New Jersey Medical School: Wound Management [publication from New Jersey Medical School]. Newark, NJ: Smith & Nephew. Inc; 2008
• 12 Stetter C, Plaza T, Driesch P. Skin grafting of a chronic leg ulcer with combined Versajet- V. A. C. therapy. J Dtsch Dermatol Ges 2006; 4: 739-742.
• 13 Tenenhaus M, Bhavsar D, Rennekampff HO. Treatment of deep partial thickness and indeterminate depth facial burn wounds with water-jet debridement and a biosynthetic dressing. Injury 2007; 38S S38-S44.
• 14 Lonergan I, Moquin K. Use of the Versajet for pedicle deepithelialization during breast reduction surgery. Aesthesic Plast Surg 2009; 33: 250-253.
• 15 Cubison TC, Pape SA, Jeffery SL. Dermal preservation using the Versajet hydrosurgery system for debridement of paediatric burns. Burns 2006; 32: 714-720.
• 16 Caputo WJ, Beggs DJ, DeFede JL. et al. A prospective randomized controlled clinical trial comparing hydrosurgery debridement with conventional surgical debridement in lower extremity ulcers. Int Wound J 2008; 5: 288-294.
• 17 Granick MS, Posnett J, Jacoby M. et al. Efficacy and cost-effectiveness of a high-powered parallel water jet for wound debridement. Wound Repair Regen 2006; 14: 394-397.
• 18 Granick MS, Jacoby M, Noruthrun S. et al. Clinical and economic impact of hydrosurgical debridement on chronic wounds. Wounds 2006; 18: 35-39.
• 19 Gravante G, Delogu D, Esposito G. et al. Versajet hydrosurgery versus classic escharectomy for burn debridement: A prospective randomized trial. J Burn Care Res 2007; 28: 720-724.
• 20 Bibbo C. Versajet hydrosurgery technique for the preparation of full thickness skin grafts and the creation of retrograde split thickness skin grafts. J Foot Ankle Surg 2010; 49: 404-407.
• 21 Liedberg NC, Reiss E, Artz CP. The effect of bacteria on the take of split-thickness skin grafts in rabbits. Ann Surg 1955; 142: 92-96.
• 22 Conover WJ. In: Practical Nonparametric Statistics. 3rd edition.. New York NY: John Wiley & Sons; 1999: 592.
• 23 Brown DC, Conzemius MG, Shofer F. et al. Epidemiologic evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc 2007; 210: 1302
• 24 Samuelson DA. Integument. In: Textbook of Veterinary Histology. Philadelphia, PA: Saunders Elsevier; 2007: 281-282.
• 25 Granick M, Boykin J, Gamelli R. et al. Toward a common language: surgical wound bed preparation and debridement. Wound Repair Regen 2006; 14: S1-10.