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Vet Comp Orthop Traumatol 2015; 28(02): 140-144
DOI: 10.3415/VCOT-14-04-0056
Case Report
Schattauer GmbH

Pedicle digital pad transfer and negative pressure wound therapy for reconstruction of the weight-bearing surface after complete digital loss in a dog

M. Or
1   Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
,
B. Van Goethem
1   Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
,
I. Polis
1   Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
,
A. Spillebeen
1   Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
4   Current Institution: Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
,
P. Vandekerckhove
2   DAC Malpertuus, Heusden, Belgium
,
J. Saunders
3   Department of Medical Imaging of Domestic Animals and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
,
H. de Rooster
1   Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
› Author Affiliations
Further Information

Publication History

Received:09 April 2014

Accepted:04 November 2014

Publication Date:
26 December 2017 (online)

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Summary

A young Labrador Retriever was presented for treatment of severe distal hindlimb necrosis caused by bandage ischemia. During digit amputation at the metatarsophalangeal joints, the third and fourth digital pads were salvaged and transferred to the metatarsal stump to create a weight-bearing surface. Negative pressure wound therapy (NPWT) was utilized for flap immobilization and to promote granulation tissue in the remaining wound defect. Sturdy adherence of the digital pads was achieved after only four days. The skin defect healed completely by second intention and the stump was epithelialized with a thin pad after three months. At the nine month follow-up examination, the stump had a thick hyperkeratinized pad. The dog walked and ran without any apparent signs of discomfort and compensated for the loss of limb length by extending the stifle and tarsocrural joints.

Despite a challenging wound in a difficult anatomical location, digital pad flap transfer and NPWT proved successful in restoring long-term ambulation in an active large breed dog.

Keywords

Digit amputation - digital pad transfer - NPWT - negative pressure wound therapy - wound healing
 

  • References

  • 1 Swaim SF, Garrett PD. Foot salvage techniques in dogs and cats: options, “do’s” and “don’ts”. J Am Anim Hosp Assoc 1985; 21: 511-519.
    PubMedGoogle Scholar
  • 2 Besancon MF, Conzemius MG, Evans RB. et al. Distribution of vertical forces in the pads of greyhounds and Labrador retrievers during walking. Am J Vet Res 2004; 65: 1497-1501.
    CrossrefPubMedGoogle Scholar
  • 3 Pavletic MM. Footpad reconstruction. In: Atlas of Small Animal Reconstructive Surgery. 2nd ed. Philadelphia: WB Saunders; 1999: 365-380.
    Google Scholar
  • 4 Barclay CG, Fowler JD, Basher AW. Use of the carpal pad to salvage the forelimb in a dog and cat: an alternative to total limb amputation. J Am Anim Hosp Assoc 1987; 23: 527-532.
    PubMedGoogle Scholar
  • 5 Bradley DM, Shealy PM, Swaim SF. Meshed skin graft and phalangeal fillet for paw salvage: a case report. J Am Anim Hosp Assoc 1993; 29: 427-433.
    PubMedGoogle Scholar
  • 6 Bradley DM. et al. Construction of a weight-bearing surface on a dog’s distal pelvic limb. J Am Anim Hosp Assoc 1998; 34: 387-394.
    CrossrefPubMedGoogle Scholar
  • 7 Kaufman KL, Mann FA. Short- and long-term outcomes after digit amputation in dogs: 33 cases (1999-2011). J Am Vet Med Assoc 2013; 242: 1249-1254.
    CrossrefPubMedGoogle Scholar
  • 8 Swaim SF, Scardino S. Paw and distal limb salvage and reconstructive techniques. In Bojrab MJ. editor Current Techniques in Small Animal Surgery. 4th ed. Baltimore: Williams & Wilkins; 1998: 625-639.
    Google Scholar
  • 9 Hardie RJ, Lewallen JT. Use of a custom orthotic boot for management of distal extremity and pad wounds in three dogs. Vet Surg 2013; 42: 678-682.
    CrossrefPubMedGoogle Scholar
  • 10 Fitzpatrick N. et al. Intraosseous transcutaneous amputation prosthesis (ITAP) for limb salvage in 4 dogs. Vet Surg 2011; 40: 909-925.
    PubMedGoogle Scholar
  • 11 Neat BC, Smeak DD. Reconstructing weight-bearing surfaces: digital pad transposition. Compend Contin Educ Vet 2007; 29: 39-46.
    PubMedGoogle Scholar
  • 12 Ben-Amotz R. 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.
    CrossrefPubMedGoogle Scholar
  • 13 Guille AE. et al. Use of vacuum-assisted closure for management of a large skin wound in a cat. J Am Vet Med Assoc 2007; 230: 1669-1673.
    CrossrefPubMedGoogle Scholar
  • 14 Gemeinhardt KD, Molnar JA. Vacuum-assisted closure for management of a traumatic neck wound in a horse. Equine Vet Educ 2005; 17: 27-33.
    PubMedGoogle Scholar
  • 15 Owen L, Hotston-Moore A, Holt P. Vacuum-assisted wound closure following urine-induced skin and thigh muscle necrosis in a cat. Vet Comp Orthop Traumatol 2009; 22: 417-421.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Stanley BJ. et al. Effects of negative pressure wound therapy on healing of free full-thickness skin grafts in dogs. Vet Surg 2013; 42: 511-522.
    CrossrefPubMedGoogle Scholar
  • 17 Demaria M, Stanley BJ, Hauptman JG. et al. Effects of negative pressure wound therapy on healing of open wounds in dogs. Vet Surg 2011; 40: 658-669.
    CrossrefPubMedGoogle Scholar
  • 18 Gorden-Evans W, Knap K, Schults K. Fundamentals of physical rehabilitation. In Fossum TW. editor Small Animal Surgery. 4th ed. Missouri: Elsevier; 2013: 114-130.
    Google Scholar
  • 19 Argenta LC. et al. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38: 563-577.
    CrossrefPubMedGoogle Scholar
  • 20 Fowler JD, Moens NMM. The microvascular carpal foot pad flap: Results in three clinical cases. Vet Comp Orthop Traumatol 1997; 10: 24-28.
    PubMedGoogle Scholar
  • 21 Fowler JD. Reconstructive microsurgical applications. In Bojrab MJ. editor Current techniques in Small Animal Surgery. 4th ed. Baltimore: Williams & Wilkins; 1998: 607-622.
    Google Scholar
  • 22 Swaim SF. et al. Free segmental paw pad grafts in dogs. Am J Vet Res 1993; 54: 2161-2170.
    PubMedGoogle Scholar
  • 23 Clivatti J, Sakata RK, Issy AM. Review of the use of gabapentin in the control of postoperative pain. Rev Bras Anestesiol 2009; 59: 87-98.
    CrossrefPubMedGoogle Scholar
  • 24 Dworkin RH, O’Connor AB, Audette J. et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc 2010; 85: 3-14.
    PubMedGoogle Scholar
  • 25 KCI Licensing, Inc. Application Quick Reference Guide [document on Internet]; 2012 [cited 2011 July 10]. Available at http://kcianimalhealth.com/files/downloads/Vet_VAC_Flipbook_10-12.pdf
    PubMedGoogle Scholar
  • 26 V.A.C. Therapy for Veterinary Use. User Manual [Document Internet]. KCI USA; Rev E 07/2012 [cited on 2011 July 10]. Available at http://kcianimalhealth.com/files/downloads/320310E_Manual_VETVAC_User_WEB.pdf
    PubMedGoogle Scholar
  • 27 KCI Licensing, Inc. V.A.C. Therapy Clinical Guidelines: A reference source for clinicians [Document Internet]. KCI Licensing Inc.; 2-B-128 Rev. 7-07; 2007 [cited 2011 July 10]. Available at http://www.viha.ca/NR/rdonlyres/4E43D523-11E6-4E75-BFD3-7A55F92567DA/0/Clinical_Guidelines_VAC.pdfw
    PubMedGoogle Scholar
  • 28 Argenta LC. et al. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg 2006; 117: 127-142.
    CrossrefPubMedGoogle Scholar
  • 29 Harrison TM. et al. Surgical amputation of a digit and vacuum-assisted closure (V.A.C.) management in a case of osteomyelitis and wound care in an Eastern Black Rhinoceros (Diceros bicornis michaeli). J Zoo Wild Med 2011; 42: 317-321.
    CrossrefPubMedGoogle Scholar
  • 30 Lafortune M, Fleming GJ, Wheeler JL. et al. Wound management in a juvenile tiger (Pantheratigris) with vacuum-assisted closure (V.A.C. Therapy). J Zoo Wild Med 2007; 38: 341-344.
    CrossrefPubMedGoogle Scholar
  • 31 Mullally C, Carey K, Seshadri R. Use of a nanocrystalline silver dressing and vacuum-assisted closure in a severely burned dog. J Vet Emerg Crit Care 2010; 20: 456-463.
    CrossrefPubMedGoogle Scholar
  • 32 KCI Licensing, Inc. V.A.C.®WhiteFoam Dressings [homepage on Internet]. USA: KCI; 2013 [cited on 2011 July 10]. Available from http://www.kci1.com/KCI1/vacwhitefoamdressings
    PubMedGoogle Scholar
  • 33 Rahal SC. et al. Mortariskin graft and digital pad transfer to reconstruct the weight-bearing surface in a dog. Can Vet J 2007; 48: 1258-1260.
    PubMedGoogle Scholar
  • 34 Duval JM, Budsberg SC, Flo GL. et al. Breed, sex, and body weight as risk factors for rupture of the cranial cruciate ligament in young dogs. J Am Vet Med Assoc 1999; 215: 811-814.
    PubMedGoogle Scholar