PIPE INSULATION FOR PROTECTION OF THE OLECRANON AREA

摘要

Difficulties in closing skin wounds overlying the olecranon in dogs is largely due to this region's susceptibility to repeated impact and compression. This is particularly evident in large breed dogs where their body weight can enhance these two factors. Closure techniques for elbow wounds include a.) healing by second intention, b.) simple appositional closure of the wound, c.) local skin flaps, d.) axial pattern flaps (APF), e.) myocutaneous flaps (MCF), f.) distant direct flaps, and g.) skin grafts.1 Each option has advantages and disadvantages. Healing by second intention, for example, can be prolonged or futile; should healing occur, the epithelialized scar may lack the long-term durability required during daily activities, especially in largerdogs. Direct apposition requires sufficient skin laxity to offset postoperative tension or distraction forces. Closure of wounds under tension over the olecranon will increase the probability of wound dehiscence. Tension relieving techniques may be useful under these circumstances. Simple local skin flap techniques may be useful to close problematic wounds unsuitable for simple appositional closure. Local flaps are comparatively easy to perform, providing full-thickness skin coverage with a variable amount of subcutaneous tissue to provide some cushion between the olecranon and the flap's overlying dermal surface. Axial pattern flaps (in particular the Thoracodorsal axial pattern flap) and myocutaneous flaps (including the Latissimus Dorsi or Cutaneous Trunci Myocutaneous Flaps) are normally reserved for the larger problematic elbow wounds. The underlying subcutaneous tissues or muscle layer of these large flaps can provide a thicker cushion of tissue over the olecranon, adding protection against direct impact forces over this bony prominence. Distant direct flaps can be used for wound closure but are more labor intensive to execute, requiring prolong immobilization of the affected limb to the trunk of the patient during the healing and transfer process. Skin grafts, devoid of an underlying subcutaneous.layer during their preparation, usually lack the durability required for permanent wound closure over the elbow prominence of larger dogs.