How to Learn from My Mistakes... Major Skin Trauma Reconstruction Disasters!

Introduction
Avoiding Disaster: Planning for Elective Cases
Many elective reconstructive procedures are performed after tumor removal. Lack of appropriate investigation of cutaneous or subcutaneous masses can lead to incisional dehiscence or rapid tumor recurrence. Masses should be evaluated by palpation and aspiration at a minimum. Depending on the results of aspiration, regional lymph nodes should be evaluated and aspirated. Advanced imaging may be required to determine the extent of the tumor and margins necessary for complete excision.

Once a diagnosis has been made the appropriate surgical procedures to remove the tumor and reconstruct the wound can be planned. Mast cell tumors require 1-3 cm wide margins and a fascial layer deep to the tumor, depending on the tumor grade. Incomplete excision of mast cell tumors can result in wound breakdown and hemorrhage. Residual mast cells can proliferate and degranulate, resulting in an inflamed, non-healing wound. The wounds will often drip blood because of local heparin release from residual mast cells.

The normal lines of skin tension should be considered in planning incisions. If this step is overlooked large wounds are created that are often impossible to close with local skin because of the orientation of the wound.

Emergency cases/Traumatic Wounds
Traumatic wounds present the surgeon with many challenges. The patient must be stabilized prior to definitive wound management. Immediate threats to life include injuries to the central nervous, respiratory, and cardiovascular systems. Once immediate, life-threatening injuries have been addressed, wounds should be covered with sterile dressings whilst the animal is stabilized to prevent colonization with resistant hospital organisms.  [...]