Case Brief: Successful primary closure with excessive tension on wide soft

tissue sarcoma excision in a dog using negative pressure wound therapy.

Valley Central Veterinary Referral Center, Whitehall, PA
Ezra J Steinberg, VMD, DAVCS
Signalment
12 year old neutered male Collie

Presenting Complaint/Initial Assessment

Patient was admitted to the clinic for a 20x20x6cm mass on the left
lateral hemithorax (Fig 1). The mass had a healed incision from the
cranial aspect to the caudal aspect from a previous biopsy by the
referring veterinarian.

History
The patient had no known health issues before the mass appeared.
Fig. 1
It had grown steadily for a period of several months. Thoracic
radiographs showed no obvious metastatic disease.

Treatment
Surgical options were discussed with the owner. The concern due to B
the size of the mass was that clean margins were not going to be
easily obtained. If a wide excision was not performed, regrowth
would be likely. If wide margins were attempted, primary closure
would be difficult and more likely a staged procedure, open wound
management with second intension healing, or a skin flap would be
needed. The owners had severe financial concerns and decided they
could only afford one procedure and would not be willing to deal Fig. 2
with chronic wound management.

A plan was formulated to attempt a wide excisional biopsy with primary closure assisted with negative pressure
wound therapy to decrease the amount of tension on the incision. The dog was placed in right lateral recumbency
and the left hemithorax was aseptically prepped for surgery. The mass was excised with approximately 3cm lateral
margins and tissue including the latissimus dorsi was exised to the chest wall (Fig 2). The skin was approximated
with towel clamps and closed with simple interrupted sutures (Fig 3).
The initial tension on the incision was so great that the towel clamps were
causing tears in the skin. No drain was placed in the wound. Upon closure
of the wound, a negative pressure wound system (V.A.C. Therapy
System, KCI, www.kcianimalhealth.com) was placed on top of the incision
(Fig 4). The dressing consisted of foam on top of a non-adherent material
incision interface. The system was left in place for 48 hours and then
removed. NOTE: Any concerns of malignant areas should be addressed
or removed prior to placement of the V.A.C. Therapy System.

Negative Pressure Therapy

The negative pressure system consisted of a therapy unit which was
connected to a proprietary dressing via a tube interface. When initiated,
Fig. 3
the system applied -125mmHg of negative pressure over the incision site
continuously. An insignificant amount of exudate was collected in the
canister, and the negative pressure was maintained the entire time it was
in use. Ioban adhesive draping was used to reinforce the Tegaderm
surrounding the foam.

Clinical Outcome
No dehiscence was seen at the time of removal of the negative pressure
system nor at the 1, 2, and 4 week recheck examinations. There was a
Fig. 4
small eschar at the middle of the incision that fell off at 21 days
postoperatively with no defect in the skin (Fig 5). No regrowth of the
tumor has been noted. The histopathologic margins were clean with
greater than 10mm lateral margins and greater than 6mm deep margins.
The mass was proven to be a low to intermediate grade myxosarcoma and
no adjuvant therapy was performed. The patient will be monitored for
recurrence and/ or distant metastasis. It is unlikely that this aggressive
resection would have been possible as a single procedure without the
assistance of KCI products due to excessive tension and likely dehiscence. Fig. 5

As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary
depending on the patient's circumstances and condition.

NOTE: Please reference the V.A.C. Therapy for Veterinary Use User Manual for specific indications, contraindications, safety
information and detailed instructions for use.
2011 KCI Licensing, Inc. All rights reserved. Ioban and Tegaderm are trademarks of 3M Company. All other trademarks designated herein are proprietary to KCI
Licensing, Inc., its affiliates and/or licensors. DSL#12-0112 (2/12)