All the dogs had normal heart rate, respiration rate and rectal temperature at the time of presentation. Haematological parameters were also within the normal range, except ALKP the mean ± standard deviation of ALKP was found higher in both preoperative (143.5±75.5) and postoperative period (230±127.8).This increase in ALKP may be tumour associated and surgery induced stress
(Karayannopoulou et al., 2003; Karayannopoulou et al., 2006 and
Fernandez and Kidney, 2007). Chest radiography revealed metastatic lesions in the lungs in 2 dogs of age 4.5 years and 6 years.
FNAC of tumours in all dogs’ revealed liposarcoma (n=2), hepatoid gland adenocarcinoma (n=2), mast cell tumour (n=2), osteochondrosarcoma (n=1), hemangiosarcoma (n=1) and abscess (n=1). Keratinzed cells with connective tissue were seen in 3 dogs and inflammatory cells were seen in 4 dogs. No tumour cells were detected in 2 dogs. Previous studies suggested that FNAC is reliable and useful diagnostic procedure for neoplastic masses and tumour type can be identified cytologically and histologically
(Pavel et al. 2016 and
Sabatlini et al., 2017). In the current study too, FNAC was helpful in providing a tentative diagnosis and manage the tumour accordingly.
CST revealed systemic infection in 17 dogs with staphylococcus (n=14), streptococcus (n=2) and pseudomonas (n=1) which were resistant to 10 different antibiotics namely Cefaxime, Cefotaxime, Amikacin, Amoxycillin, Ampicillin, Cephalothin, Erythromycin, Trimethoprim, Sulfadiazine and Cephazolin. Cited literature reports that staphylococcus is the most common identified organism followed by streptococcus, enterococcus and pseudomonas
(Normand et al., 2000; Prescott et al., 2002 and
Awosile et al., 2018) which is similar with the findings of the current study.
Single pedicle advancement flaps (n=3)(Fig1), bipedicle advancement flaps (n=8)(Fig 2) and rotational flap (n=8) (Fig 3) and transpositional flap (n=1)(Fig 4) were made in 20 dogs. Intraoperative findings revealed adequate skin defect coverage in all 20 dogs with severe skin tension (n=1), moderate skin tension (n=5) and mild skin tension (n=9) and no tension (n=5). A study by
Prohaska and Cook (2020) reported that excessive tension or wound contracture occurs in rotation flap as tension does not disperse properly and results in distortion of surrounding tissue. Dog ears were present in 14 dogs (70%) resulting in uneven skin edges. Dog ear formation may increase the dead space which can increase the chance of post-operative complications but in the current study only two dogs with dog ear formation out of fourteen show dead space formation. Pressure bandaging in the post-operative period may have reduced the dead space below the flap. Previous studies by
Weisberg et al., (2000) and
Jaber et al., (2015) suggested that dog ears are common problem in plastic surgery practice and should be managed accordingly. The mean surgical time recorded was 72 minutes. Surgical resection and skin flap creation were time consuming procedures. Similar surgical time was recorded by
Salvatori et al., (2014) and
Marsh et al., (2016) for skin reconstruction. The subdermal flaps were rectangular (n=3), H (n=8) and semilunar (n=9) in shape.
Postoperative evaluation revealed healing of flaps in 15 dogs (75%). Subdermal flap necrosis was recorded in 5 dogs accounting 25 % of the cases of which 4 of them had mobility of flap base. Movement around the flap may be a cause for flap necrosis
(Prohaska and Cook 2020). Major complications were recorded in group II and III dogs of which flap necrosis was seen in growth located in ventral abdomen repaired with rotational flap (n=3) and single pedicle advancement (n=1) while one dog with transpositional flap of limb showed flap necrosis (Fig 4). Overall recurrence was recorded in 3 dogs (15%) from Group III of which 2 dogs had lung metastasis and the tumours were malignant. This implies the possibility of successful surgical management of malignant tumours by using wide surgical resection and skin reconstruction in those cases where there is no lung metastasis
(Choi et al., 2016). Another dog with mild interstitial lung pattern also showed recurrence of tumour in Group III even though it was benign. Recurrence in this dog may be due to insufficient growth removal and infection of the flap.
Wound scoring in Group I noted normal healing of all the skin flaps except one dog that recorded grade III. In Group II, Southampton wound grade V was recorded in 4 dogs and IV a in 2 dogs. In Group III, 2 dogs had 0 grade while the other dogs had V and IVb respectively. Wound score reveal better healing of subdermal flaps in Group I followed by Group III and Group II. The aesthetic appearances were excellent in all the subdermal flaps of Group I. In Group II, aesthetic appearance was excellent in two dogs, good in two, scar formation in three and could not be evaluated in one dog as the dog died in the post-operative period. In Group II, the aesthetic appearance was excellent in two dogs of which one had scar while another dogs had visible scar formation but one dog was euthanized due torecurrence of growth.
Histopathological findings revealed that 30% of the tumours were benign (n=6) while 65% of the tumours were malignant (n=13). FNAC findings of 10 dogs were in concurrent with the histopathological findings. But epidemiological study of canine neoplasm by
Babu et al (2012) shows that benign neoplasm are more common in dogs than malignant of which skin and soft tissue tumours were frequently occurred. Majority of the skin tumours studied by
Mathew et al. (2020), were also benign with more number of epithelial/melanocytic tumours.
Haematobiochemical analysis (Table 1) of normally healed and complicated dogs was performed by using SPSS 16 software and revealed that there was significant reduction in Hb on day 0 and day 7. Significant reduction in TEC value was seen in the complicated dogs as compared to normally healed dogs on day 0. The TLC value on day 0 and day 7 in both groups were higher than the normal but no significant difference was present in between normally healed and complicated dogs. Significant increase in lymphocyte count was recorded on day 0 in complicated group as compared to normally healed group. Significant increase in ALKP was recorded between normally healed group and complicated group preoperatively on day 0and postoperatively on day 7. This concludes that low Hb, high lymphocyte count, low TEC and high ALKP may be prognostic factors for flap survival.
