Veterinary Surgical Oncology. Группа авторов

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Veterinary Surgical Oncology - Группа авторов


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outcome and prognosis, however, wound closure is slow and possible complications include a relatively fragile new skin after epithelization and the risk of developing wound contracture, especially in locations with high degree of motion such as the carpus. In one study evaluating second intention healing after STS removal over an extremity, the average time it took for wounds to heal was approximately two months and over 90% of wounds healed completely by second intention alone. Complications occurred in 23% of wounds during healing and 26% of wounds had complications long‐term (Prpich et al. 2014).

Photo depicts excision of STS at distal medial aspect of the metatarsus using a phalangeal fillet flap of digit II in a Heidewachtel.

      Another rarely discussed reconstructive technique is the cuticular purse string technique. In a retrospective study by Cohen et al. (2007), the authors reviewed 98 human patients after cuticular purse‐string suture placement. These sutures will achieve partial surgical wound closure and the postoperative wound area decreased by 6–90%, with a mean of 60% following purse‐string partial closure. The circumferential placement of the cuticular purse‐string suture makes it possible to recruit skin from the entire diameter without needing to undermine the wound edges. Generally, the purse string suture is removed three or four weeks after closure to allow the partially closed wound to completely heal by second intention. According to the authors of this study, this closure technique provides uniform tension to the wound, enhances hemostasis at the tissue edge, and significantly decreases the size of the defect. The technique has been described in people after surgical removal of skin tumors (Cohen et al. 2007) and is reported to be particularly suitable in older human patients because of their skin laxity (Raposia et al. 2014).

      Pavletic (2000) described the use of skin stretchers 72–96 hours before excision of large tumors. Skin stretching is an easy way to mobilize skin and is reported to be successful in most cases. Two other techniques for stretching the skin after creating the surgical wound have been studied: staples as anchor points along the edge of each surgical wound margin and a hypodermic needle “skewered” through the skin parallel to each surgical wound margin (needle transpiercing the skin along the length of the margin, going in and out of the skin). Sutures are then placed between the staples or the needles on either side of the wound and tightened over a bandage material covering the open wound (Tsioli 2015).

      Cryosurgery

      Cryosurgery is a type of cytoreductive therapy that has been described for superficial skin tumors. Cryosurgery may be used in cases when surgery is not possible because of concurrent debilitating factors that prevent safe anesthesia. Cryosurgical ablation uses tissue freezing to destroy selected lesions. There are several methods of cryosurgery: open‐spray, closed‐spray, and cryoprobe method. Liquid nitrogen is sprayed on the tumor from a specified distance for 15–60 seconds. For malignant lesions, two to three freeze‐thaw cycles are recommended, while for benign lesions, two cycles are recommended. Before application, large vessels feeding the tumor may be ligated to prevent hemorrhage and to improve the freezing effect. Wounds heal by second intention. Patients should be closely monitored following cryosurgery to control the healing of the treated site and to treat possible complications. Reported complications include hemorrhage, pain, edema, depigmentation, tissue retraction, tendon rupture, alopecia, odor, and lameness (De Queiroz et al. 2008).

      Adjuvant Therapies

      According to several studies, surgical resection, often described as “aggressive,” “radical,” or “wide,” is the first or primary treatment of choice with the best overall outcome in STS treatment. The surgical goal should always be removal of the complete tumor. If complete tumor removal is not achievable, for instance where there are important adjacent anatomical structures, cytoreductive surgery can be used as palliative care or in combination with adjunctive therapies. Multimodal therapy including adjuvant radiotherapy and/or chemotherapy may allow reduction in surgical dose without compromising local recurrence rates (Bostock and Dye 1980; Bray 2016; Davidson et al. 1997; Dernell et al. 1998; Ehrhart 2005; Liptak and Forrest 2013). Palliative care can be used to reach an acceptable survival time and, above all, a reasonable quality of living.

       Radiotherapy

      Treatment


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