In cats, the duration of healing of large open wounds is often prolonged. With the loss of overlying skin, exposed muscle fascia is frequently the tissue that comprises much of the wound bed. Compared with dogs, the formation of granulation tissue over the exposed underlying muscle fascia is markedly delayed in cats, which results in subsequent delays in skin grafting, secondary closure, or second intention healing.1 Granulation tissue is a capillary-dense repair tissue that acts as an excellent surface for epithelial cell migration from the wound edges and that is also required for wound contraction.2 Delayed formation of granulation tissue may result in an increased infection risk, as well as increased treatment costs, pain, and likelihood of euthanasia.
To the authors' knowledge, methods to promote granulation tissue formation on exposed muscle fascia in cats have not been studied. Dermabrasion—the removal of the epidermis with a variety of abrasive instruments—has been used to speed healing and improve cosmetic outcome following excision of hypertrophic burn scars and has had positive effects on type I collagen synthesis when used to treat photodamaged skin in humans.3–6 Tissue abrasion has also been reported7 to speed the healing of partial-thickness meniscal tears in humans, presumably via stimulation of fibrin clot formation and vascular ingrowth. Although abrasion of nonbleeding tissues in wound beds has been reported anecdotally to stimulate granulation tissue formation, we could find no veterinary medical literature to support this concept. Osteostixis, forage, and curettage involve the drilling or scraping of poorly vascularized bone or cartilage lesions to promote vascular penetration and granulation tissue formation in people, horses, and dogs.8–15 A similar technique to enhance granulation tissue coverage of exposed fascia has seemingly not been reported. It is known that, in rats, the fibroblasts derived from incised fascia have properties that result in improved wound healing, compared with those derived from the dermis.16–18 This suggests that fibroblasts that are derived from these 2 sites are phenotypically different.16 Results of both in vitro and in vivo studies16–18 have indicated that proliferation and subsequent collagen production of fibroblasts derived from the fascia in a wound bed are markedly increased, compared with proliferation and collagen production of fibroblasts derived from the dermis at the wound edge. In rats, the combination of a rapid increase in fibroblast number and associated collagen production in fascial wounds results in a more rapid return to expected wound strength compared with findings in skin wounds.17 Therefore, it is possible that fascial incisions at the base of an open wound may result in high numbers of fibroblasts in the wound bed with more rapid migration kinetics and increased collagen production.
Although the vascular supply to the deep fascia that overlies the dorsal thoracolumbar region of cats and dogs has not been described to the authors' knowledge, it is our impression that vascular penetration through the intact fascia is sporadic at best. Therefore, it is possible that exposure of the underlying highly vascular muscle may also improve granulation tissue formation and wound oxygenation.
The purpose of the study reported here was to evaluate the effects of fascial abrasion, fasciotomy, and fascial excision on cutaneous wound healing in cats. Our null hypothesis was that there would be no differences between any of the 3 surgical treatments and a control treatment (no disturbance of muscle fascia) with regard to wound area, epithelialization, or granulation tissue formation.
Surgi-Sox, Pacific Features LLC, Edmonds, Wash.
Telfa, Tyco Healthcare Group LP, Mansfield, Mass.
Elastikon, Johnson & Johnson, Skillman, NJ.
Specialist Cast Padding, BSN Medical Ltd, Brierfield, England.
Conform, Kendall Healthcare Products Co, Mansfield, Mass.
Vetwrap, 3M Animal Care Products, Saint Paul, Minn.
Image-Pro Plus, version 3.0.1, Media Cybernetics Inc, Bethesda, Md.
SAS, version 9.02, SAS Institute Inc, Cary, NC.
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Silfen R, Amir A, Feinmesser M, et al. Subdermabrasion in the treatment of post-burn facial hypertrophic scars. Aesthetic Plast Surg 2002;26:139–141.
Nelson BR, Majmudar G, Griffiths CE, et al. Clinical improvement following dermabrasion of photoaged skin correlates with synthesis of collagen I. Arch Dermatol 1994;130:1136–1142.
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Tetik O, Kocabey Y, Johnson DL. Synovial abrasion for isolated, partial thickness, undersurface, medial meniscus tears. Orthopedics 2002;25:675–678.
Latenser J, Snow SN, Mohs FE, et al. Power drills to fenestrate exposed bone to stimulate wound healing. J Dermatol Surg Oncol 1991;17:265–270.
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Bouwmeester PSJM, Kuijer R, Homminga GN, et al. A retrospective analysis of two independent prospective cartilage repair studies: autogenous perichondrial grafting versus subchondral drilling 10 years post-surgery. J Orthop Res 2002;20:267–273.
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Dubay DA, Wang X, Kirk S, et al. Fascial fibroblast kinetic activity is increased during abdominal wall repair compared to dermal fibroblasts. Wound Repair Regen 2004;12:539–545.
Franz MG, Smith PD, Wachtel TL, et al. Fascial incisions heal faster than skin: a new model of abdominal wall repair. Surgery 2001;129:203–208.
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Wunderlich RP, Peters EJG, Armstrong DG, et al. Reliability of digital videometry and acetate tracing in measuring the surface area of cutaneous wounds. Diabetes Res Clin Pract 2000;49:87–92.
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