This afternoon I performed the most delicate operation that I have performed to date. I was allowed to perform a skin flap to close up the skin over the kitten with the hole in its head that I wrote about a week or two ago.
Since then the kitten has had two surgeries – the first to clean up the wound and soft tissue as it was very dirty. Then following this a second surgery was performed to remove the fragments of the skull bone that were unfortunately not viable. Since then the kitten has been on antibiotics – and we were waiting for a clean wound so that we could close the skin over the hole in the skull to cover the brain.
This was a relatively simple operation to move some skin from one place to another. However in doing so I was using a scalpel blade just millimetres away from the kittens brain tissue – a single slip wouldn’t really be a good thing.
Now there are many different techniques that could be used for creating and using the skin flap, however I believe that simple is best, and so I created what is called a rotation flap. This is where I take the skin next to the wound and rotate it over the defect.
Here you can see where the defect was originally, and then I made my incision along the dotted line on the middle image before then moving this piece of skin over to cover the hole. Different people suture wounds like this in different ways, however in this case I like the half theory. I started my first suture in the top left corner of the wound, then placed my next suture halfway between this and the end. And then placed my further sutures halfway between these spaces as well. For me doing it this way makes a lot of sense as I can see where things are going go bad without losing too much time, or having to change too many sutures to fix them.
So after this the hope is that the skin heals and as the kitten is still growing that the defect in the skull will close up with time.