The distal extremity of the limb was protected by a padded splint that was replaced every 3 d.
Simple interrupted sutures of 3–0 nylon apposed the free edges of the digital pad and the linear incision to the skin edges of the metatarsal area. A transverse incision was made on the skin over the distal end of the metatarsal bones, the incised skin edges were undermined and a skin segment was removed to accommodate transfer of the digital pad. The distal phalanx and nail were removed by a circular incision around the base of the nail that connected to the linear incision, leaving the digital pad intact ( 3). A linear incision was made on the medial aspect of the right 5th digit, extending from the proximal part of the digit to the digital pad, whereupon the middle and proximal phalanges were removed by incising the joint capsules and the ligamentous attachments to the bones. The general anesthesia was as before, but it was induced with thiopental (Thiopentax Cristália, Itapira, Brazil), 10 mg/kg BW, IV. Since the dog was unable to bear weight on the right hind limb with only the 5th digit, 3 mo after grafting, a phalangeal fillet technique was performed. Ampicillin (Ampicilina Novartis, São Paulo, Brazil), 22 mg/kg BW, PO, q8h, was administered for 15 d and buprenorphine hydrochloride (Temgesic Schering Plough), 15 μg/kg BW, SC, was administered as required. In spite of partial graft loss (approximately 25%), progressive epithelialization covered the granulation tissue and 30 d after surgery, there was complete epithilialization of the wounds. Bandages were replaced every 2 to 3 d and the sutures were removed after 10 d. The grafted areas were protected by using a nonadherent absorbent dressing with a thin coating of neomycin and bacitracin ointment (Nebacetin Altana Pharma, São Paulo, Brazil), followed by a secondary absorbent layer and an elastic bandage.
The subcutaneous tissue from the graft was removed by using sharp scissor and the graft was meshed with a scalpel blade. The wounds on both paws were covered with a full-thickness meshed skin graft harvested from a site over the left lateral thorax ( Figure 1b). The right 2nd, 3rd, and 4th digits and metatarsi were amputated to the mid metatarsal region by using a bone rongeur. (b) Immediate postoperative appearance after the use of full-thickness mesh skin graft in both hindpaws.Īfter premedication with buprenorphine hydrochloride (Temgesic Schering Plough, Rio de Janeiro, Brazil), 15 μg/kg body weight (BW), IV, and levomepromazine (Neozine Rhodia Farma, São Paulo, Brazil), 1.0 mg/kg BW, IV, anesthesia was induced and maintained with halothane (Halothano Cristália, Itapira, Brazil). On the right paw, the metatarsal pad and the 2nd, 3rd, and 4th digits were lost, leaving only the 5th digit and its digital pad.
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