Annie, a black Labrador, had a lump removed from her side in late 2010. It looked suspiciously like a malignant Sarcoma tumour (cancer) to the operating vet, so the lump was kept (in formalin) just-in-case it re-grew and we could then send it to the laboratory for histopathology testing, to see what it actually, really was.
At the Findon Vet Surgery, if a client initially decides not to send a sample to the lab, we keep it in safe storage for TWO years - just in case it is needed later! In most cases, they eventually end up in our medical waste - but occasionally it proves highly beneficial - as it did in Annie's case.
After eight months, another lump was noted at the bottom end of the scar from the initial surgery and we sent off the original lump for testing. The results confirmed our suspicion that we were dealing with a malignant sarcoma, and although the original vet had taken a lot of skin and other tissue around the tumour in the original surgery, cancer cells had obviously already spread and were now regrowing.
Regrowth of a cancerous tumour is usually MORE aggressive, faster growing AND more likely to spread by metastases, so the next surgery had to be a RADICAL resection.
Radial surgery requires deep tissue reconstruction and skin plastic surgery. See "H" Plasty Plastic Surgery technique. For such cancer surgery the aim is to take 3 cm of margins - extra skin and deep tissue, including an underlyin muscle layer - to ensure maximum chance of getting all of the cancer. The surgery was referred to Dr Ian Hogben for surgery.
Once the incision is made, the skin contracts inwards around the tumour, and pulls outwards elsewhere, so that the 'hole' becomes enormous! The 'hole' measured 250mm across!
Surgery continues downward through the layers under the skin and through the fat layers. To maximise the chance of getting ALL of the malignant cancer.
The incision continues deep enough to include a full layer of the underlying muscle. Here you can see the white layer of another deeper layer or normal fat tissue.
In human cancer surgery, there are usually two teams of surgeons - one team to remove the cancer, and do their very best to ensure none is left behind. Thus very large deficits result AND it is left to the second reconstruction team to work out how-on-earth they are going to close the massive hole left by the first team!!!
The deep chest muscle layer is closed first. If you look closely you can see me placing (purple) stitches continuously from the right side in a 'corset-like' fashion. Once stitching has been placed along both edges of the muscle, it can be 'drawn' together over the white fat layer.
To 'Map-out' what I am to do, I make incisions in the skin in the shape I intend closing the final skin layer. Closing a circular hole is difficult - in the middle the tension (tightness) of the stitches is extreme and they will pull through and the surgery will tear apart (a disaster!).
To ensure an even spread of tension, I must change the shape of the hole so that it has straight edges to stitch together. Here, the two small triangles of skin are removed (yes, I make the hole even larger!).
The straight-edged flap with the cuts made further up into the skin at both ends, can then be pulled down to meet a similar flap made in the skin on the lower side.
Again I use a continuous pattern of stitching in a 'corset-like' method to pull the deep tissues together.
To maximise the chance of excellent and un-eventful healing, the surgery is closed
in several layers.
As I bring the sub-dermal and sub-cutaneous tissue layers together, you'll note that the skin edges end up meeting together.
This is extremely important and it demonstrates how little tension there will be on the skin stitches when they are placed. This helps prevent the skin stitches pulling apart, reduces pain and importantly speeds up healing.
As the opposing straight skin edge are brought together, you'll notice that it creates very loose skin on either side - in fact they form 'DOG-EARS' !!!
A rubber tube called a 'Penrose drain' is placed under the sub-dermal stitches, in the sub-cutaneous tissue, and will allow any tissue fluid that will form to drain away and not collect as a deep sack of fluid.
The drain is in place as one continuous tube of rubber, and you will clearly see the big 'DOG-EAR' I am holding in my fingers. This is cut away as a triangular piece of skin and discarded and the edges stitched together.
How Annie's surgery ended up.
Not all 'H' Plasties look the same, depending on where the sugery site is and how much and how elastic/loose the skin is.
A full body-wrap bandage helps compress the surgery site to further ensure minimal fluid build up in the area, and reduce movement of the tissues as Annie moves about - helping reduce pain.
Here is the resected tumour and surrounding tissue, placed upside-down to show the chest muscle layer (held in forceps) that was removed as the deep base-layer.
Annie recovered extremely well and the surgery was successful in that there was no re-currence of the aggressive cancer. Annie lived a wonderful two and a half more years with mum, Monica, until she passed away of an unrelated illness at the splendid age of thirteen and a half.