Canine distal hindlimb soft tissue sarcoma – a novel approach to surgical defect closure

Summary

A 10-year-old, male, neutered whippet was presented with a soft tissue mass located on the medial aspect of the distal right tibia. The mass was 4 cm in diameter and of two months duration. Recent biopsy by the referring veterinarian, prompted by noticeable enlargement, identified the mass as a soft tissue sarcoma. Staging assessments did not reveal any evidence of metastases. Marginal excision was performed. The resultant defect was closed primarily by the creation of a bipedicle flap on the distal caudo-lateral aspect of the crus to enclose the Achilles tendon separately, leaving a defect between the Achilles tendon and the tibia. Postoperative management entailed support dressings and exercise restriction. Complete wound healing was attained three weeks postoperatively with excellent return of function. No recurrence was noted at eight months post-resection.

Keywords

Canine - reconstruction - distal crus - sarcoma

• References

• 1 Liptak JM, Forrest LJ. Soft Tissue Sarcomas. In: Withrow SJV. editor Withrow and MacEwen's Small Animal Clinical Oncology Louis, MO, USA: Saunders Elsevier; 2007: 425-449.
• 2 Baker-Gabb M, Hunt GB, France MP. Soft tissue sarcomas and mast cell tumours in dogs; clinical behaviour and response to surgery. Aust Vet J 2003; 81: 732-738.
• 3 Chase D, Bray J, Ide A. et al. Outcome following removal of canine spindle cell tumours in first opinion practice: 104 cases. J Small Anim Pract 2009; 50: 568-574.
• 4 McKnight JA, Mauldin GN, McEntee MC. et al. Radiation treatment for incompletely resected soft-tissue sarcomas in dogs. J Am Vet Med Assoc 2000; 217: 205-210.
• 5 Williamson MM, Middleton DJ. Cutaneous soft tissue tumours in dogs: classification, differentiation, and histogenesis. Vet Dermatol 1998; 9: 43-48.
• 6 Forrest LJ, Chun R, Adams WM. et al. Postoperative radiotherapy for canine soft tissue sarcoma. J Vet Intern Med 2000; 14: 578-582.
• 7 Plavec T, Kessler M, Kandel B. et al. Palliative radiotherapy as treatment for non-resectable soft tissue sarcomas in the dog – a report of 15 cases. Vet Comp Oncol 2006; 4: 98-103.
• 8 Havlicek M, Straw RS, Langova V. et al. Intra-operative cisplatin for the treatment of canine extremity soft tissue sarcomas. Vet Comp Oncol 2009; 7: 122-129.
• 9 Kuntz CA, Dernell WS, Powers BE. et al. Prognostic factors for surgical treatment of soft-tissue sarcomas in dogs: 75 cases (1986–1996). J Am Vet Med Assoc 1997; 211: 1147-1151.
• 10 Bostock DE, Dye MT. Prognosis after surgical excision of canine fibrous connective tissue sarcomas. Vet Pathol 1980; 17: 581-588.
• 11 Postorino NC, Berg RJ, Powers BE. et al. Prognostic variables for canine hemangiopericytoma: 50 cases (1979–1984). J Am Anim Hosp Assoc 1988; 24: 501-509.
• 12 Graves GM, Bjorling DE, Mahaffey E. Canine hemangiopericytoma: 23 cases (1967–1984). J Am Vet Med Assoc 1988; 192: 99-102.
• 13 Bacon NJ, Dernell WS, Ehrhart N. et al. Evaluation of primary re-excision after recent inadequate resection of soft tissue sarcomas in dogs: 41 cases (1999–2004). J Am Vet Med Assoc 2007; 230: 548-554.
• 14 Selting KA, Powers BE, Thompson LJ. et al. Outcome of dogs with high-grade soft tissue sarcomas treated with and without adjuvant doxorubicin chemotherapy: 39 cases (1996–2004). J Am Vet Med Assoc 2005; 227: 1442-1448.
• 15 Stefanello D, Morello E, Roccabianca P. et al. Marginal excision of low-grade spindle cell sarcoma of ca-nine extremities: 35 dogs (1996–2006). Vet Surg 2008; 37: 461-465.
• 16 Potter DA, Kinsella T, Glatstein E. et al. High-grade soft tissue sarcomas of the extremities. Cancer 1986; 58: 190-205.
• 17 Withrow SJ. Surgical Oncology. In: Withrow SJV. editor Withrow & MacEwen's Small Animal Clinical Oncology Louis, Missouri, USA: Saunders Elsevier; 2007: 157-162.
• 18 Regan RC, Rassnick KM, Balkman CE. et al. Comparison of first-opinion and second-opinion histo-pathology from dogs and cats with cancer: 430 cases (2001–2008). Vet Comp Onc 2010; 8: 1-10.
• 19 Gilbert PJ, Shmon C, Linn K. et al. Macroscopic and microvascular blood supply of the canine common calcaneal tendon. Vet Comp Orthop Traumatol 2010; 23: 81-86.
• 20 Evans HE, Christensen G. C. Miller's Anatomy of the Dog. Philadelphia, USA: W. B. Saunders Company; 1979
• 21 Cuddon PA, Kitchell RL, Johnson RD. Motor fibers in the canine distal caudal cutaneous sural nerve--dual innervation of the hind limb plantar muscles. Anat Histol Embryol 1989; 18: 366-373.
• 22 Andrade MG, Weissman R, Reis SR. Tissue reaction and surface morphology of absorbable sutures after in vivo exposure. J Mater Sci Mater Med 2006; 17: 949-961.
• 23 Freeman LJ, Pettit GD, Robinette JD. et al Tissue reaction to suture material in the feline linea alba. A retrospective, prospective, and histologic study. Vet Surg 1987; 16: 440-445.
• 24 Nary Filho H, Matsumoto MA, Batista AC. et al. Comparative study of tissue response to polygleca-prone 25, polyglactin 910 and polytetrafluorethylene suture materials in rats. Braz Dent J 2002; 13: 86-91.
• 25 Sonmez K, Bahar B, Karabulut R. et al. Effects of different suture materials on wound healing and infection in subcutaneous closure techniques. B-Ent 2009; 5: 149-152.
• 26 Lemarie RJ, Hosgood G, Read RA. et al. Distant abdominal and thoracic pedicle skin flaps for treatment of distal limb skin defects. J Small Anim Pract 1995; 36: 255-261.
• 27 Hedlund CS. Surgery of the Integumentary System. In: Fossum TW. editor Small Animal Surgery. 2^nd ed. St. Louis, Missouri, USA: Mosby, Inc.; 2002: 134-186.
• 28 Swaim SF. Skin grafts. In: Slatter DH. editor Textbook of Small Animal Surgery Philadelphia, USA: Saunders; 2003: 321-338.
• 29 Pavletic MM. Pedicle Grafts. In: Slatter DH. editor Textbook of Small Animal Surgery Philadelphia, USA: Saunders; 2003: 292-321.
• 30 Briere C. Use of a reverse saphenous skin flap for the excision of a grade II mast cell tumor on the hind limb of a dog. Can Vet J 2002; 43: 620-622.
• 31 Spodnick GJ, Pavletic MM, Clark GN. et al. Controlled tissue expansion in the distal extremities of dogs. Vet Surg 1993; 22: 436-443.
• 32 Kostolich M, Pavletic MM. Axial pattern flap based on the genicular branch of the saphenous artery in the dog. Vet Surg 1987; 16: 217-222.