Resumo
Background: Preputial injuries are significant in the clinical routine. Traumas, conditions, and mass excision result in extensive and full-thickness defects that lead to chronic penile exposure and consequential injuries. Severe injuries may require preputial reconstructive surgery to restore function and aesthetics. The objective is to report the use of the preputial reconstruction technique using the caudal superficial epigastric axial standard flap associated with a single-stage, full-thickness oral mucosa graft in 3 dogs where the loss of the prepuce was significant. Cases: Three dogs were admitted to the Veterinary Teaching Hospital of UFMT with preputial lesions of different etiologies. All cases were referred for preventive reconstruction using a flap in the caudal axial epigastric pattern associated with a single-stage oral mucosa graft. In the 3 reported cases, changes that compromised surgical success, such as suture dehiscence, necrosis, or infection, were not observed during hospitalization. Cutaneous stitch dehiscence, however, was observed in all 3 cases. Dog 1. A small point of dehiscence and tissue necrosis was found and treated with chemical debridement and healed by second intention, which proved to be sufficient on the 30th day. Dog 2. A half-moon rotation flap was performed, which closed the defect. Dog 3. A new procedure using the reporting theme technique was necessary in order to cover the cranial portion of the foreskin. The dehiscence present in dogs 2 and 3 was significant. Flap retraction was observed in all 3 cases. In dogs 1 and 3, the retraction was slight, and the exposure of a small portion of the penile glans were observed, showing no changes that required intervention. In dog 2, retraction was important, leading to partial stenosis of the preputial ostium. A larger ostium was obtained by suturing the mucosa to the edge of the wedge. Considering the possibility of adhesion formation, "captons" were made in sterile silicone tubes, and sutures were placed in the dorsal and ventral aspects to prevent adherence of the oral mucosa graft located on the inside of the new foreskin. The captons were removed on the tenth post-operative day, revealing a good opening of the preputial orifice and adequate penile exposure. Discussion: The absence of a foreskin caused by trauma or surgical excision leads to chronic penile exposure, dryness, and ulcerations. The simple covering of the skin with an axial-type flap of the caudal superficial epigastric region tends to fail since only the graft edges are sutured into the abdominal skin. In these circumstances, the subcutaneous region on the penis is exposed and comes in direct contact with urine and the penile mucosa, causing the flap skin to grow to exacerbated retraction. The transplantation of a free-lip mucosa graft allows the subcutaneous region of the transposed skin flap to create adhesions in the fenestrated regions of the lip tissue through the formation of granulation tissue buds, which is performed in a single stage. The permanence of the penis protects the lower urinary system from the occurrence of infections relative to what is normally observed in cases where partial or total penile amputation is practiced in combination with adjunctive scrotal urethrostomy. Given the observations of the 3 cases described here, the technique of pre-facial reconstruction with an axial skin flap of the caudal superficial epigastric region, combined with free-labial mucosa graft, was found to be feasible for the single-stage foreskin technique, but that paraphimosis remanagement may be necessary when cutaneous portions of the penile skin caudal to the glans are removed.
Assuntos
Animais , Masculino , Cães , Transplante de Tecidos/veterinária , Prepúcio do Pênis/lesões , Mucosa Bucal/transplante , Procedimentos de Cirurgia Plástica/métodosResumo
The objective of this study was to evaluate the use of cyclosporine 1% alone or associated with oral mucosa transplantation (OMT) in dogs with dry keratoconjunctivitis (KCS). Schirmer Tear Test (STT-1) and Tear Film Osmolarity (TFO) were measured in both eyes of 30 adult dogs (before and 45 days after treatment. The animals were divided into three groups (10 dogs for group): control (normal dogs), group I (GI, treated with 1% cyclosporine alone), and group II (GII, treated with 1% cyclosporine and OMT). All STT-1 and TFO values were subjected to the Shapiro-Wilk normality test, and all were normally distributed. STT-1 and TFO values before and after treatment were subjected to the T-Student Test. The STT1 and TFO values of the right eye were subjected to Repeated Measures ANOVA followed by a Tukey Test for comparison between groups I and II. Means with a value of p≤0.05 were considered significant. There was a decreased osmolarity in both groups after treatment. Mean osmolarity in GII (322.60±16.56 mOsm/L) was significantly lower than GI (336.40±5.66 mOsm/L). The OMT associated with cyclosporine 1% improved the osmolarity of the tear film in dogs with KCS with a seeming synergism between the clinical and surgical treatments.(AU)
Avaliou-se o uso de ciclosporina 1% isolada ou associada ao transplante de mucosa oral (TMO) em cães com ceratoconjuntivite seca (CCS). O teste lacrimal de Schirmer (TLS-1) e a osmolaridade do filme lacrimal (OFL) foram medidos em ambos os olhos, em 30 cães adultos, antes e 45 dias após o tratamento. Os animais foram divididos em três grupos (10 cães por grupo): controle (cães saudáveis), grupo I (GI, tratados apenas com ciclosporina 1%) e grupo II (GII, tratados com 1% de ciclosporina associada ao TMO). Todos os valores do TLS-1 e da OFL foram submetidos ao teste de normalidade Shapiro-Wilk, e todos foram distribuídos normalmente. Os valores de TLS-1 e OFT antes e depois do tratamento foram submetidos ao teste T-Student. Os valores TLS-1 e OFT do olho direito foram submetidos à ANOVA de medidas repetidas, seguida por um teste de Tukey para comparação entre os grupos I e II. Valor de P≤0,05 foi considerado significativo. Houve uma diminuição da osmolaridade em ambos os grupos após o tratamento. A osmolaridade média no GII (322,60±16,56 mOsm/L) foi significativamente inferior à no GI (336,40±5,66 mOsm/L). O TMO associado à ciclosporina 1% melhorou a osmolaridade do filme lacrimal em cães com CCS, com uma sinergia aparente entre os tratamentos clínicos e cirúrgicos.(AU)