See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/50255012

Comparison of Three Methods for Closure of Mastectomy Incisions in Dogs

Article  in  Australian Veterinary Practitioner · December 2006

Source: OAI

CITATIONS READS

4 2,310

7 authors, including:

Lysimachos Papazoglou Vassiliki Tsioli

Aristotle University of Thessaloniki University of Thessaly
213 PUBLICATIONS   1,808 CITATIONS    31 PUBLICATIONS   458 CITATIONS   

SEE PROFILE SEE PROFILE

Maria Karayannopoulou Ioannis Savvas

Aristotle University of Thessaloniki, Faculty of Health Sciences, School of Veterina… Aristotle University of Thessaloniki
43 PUBLICATIONS   878 CITATIONS    98 PUBLICATIONS   917 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Small animal intensive care at a glance View project

Exotic Animal Medicine and Surgery View project

All content following this page was uploaded by Lysimachos Papazoglou on 27 September 2015.

The user has requested enhancement of the downloaded file.

 CLINICAL REVIEW

Comparison of Three Methods for

Closure of Mastectomy Incisions
in Dogs
LG Papazoglou, V Tsioli, M Karayannopoulou, I Savvas,
G Kazakos and E Kaldrymidoua
Faculty of Veterinary Medicine
Aristotle University of Thessaloniki
aDepartment of Clinical Sciences and Laboratory of Pathology

Aristotle University of Thessaloniki

11 S. Voutyra Street, 54627 Thessaloniki, Greece

ABSTRACT
Sixty dogs underwent regional or unilateral mastectomies for the management
of mammary tumours. These were randomly allocated into three groups;
conventional mastectomy closure (with closed suction drainage), skin-only
closure (with closed suction drainage) and a conventional closure group
without any drain placement. Conventional mastectomy closure was with a
combination of absorbable sutures for dead space elimination and skin
sutures. On days one, six and 10 after surgery each incision was graded
according to a clinical scale. All dogs were re-examined one month after
surgery. Duration of surgery was significantly shorter in the group with skin
closure alone, compared to the conventional mastectomy closure groups with
drainage (P=0.014) or without (P=0.008). No significant differences were
found in respect of complications over time among the three closure
techniques. Drain presence or absence had no effect on the outcome.
[Papazoglou LG et al (2006) Aust Vet Practit 36:156]

INTRODUCTION (Chang et al 2005), or concurrently with or less than two

Canine mammary tumours account for 25 to 50% of all
tumours in the bitch (Dorn et al 1968, Brodey et al 1983)
and they are the second most common tumours after skin
tumours (Kitchell 1995). Early ovariohysterectomy
significantly reduces the risk of mammary tumour
development (Schneider et al 1969, Taylor et al 1976).
Several studies have shown that performing an
ovariohysterectomy concurrently with or after surgical
excision of the mammary tumour has no effect on
survival time (Yamagami et al 1996, Morris et al 1998,
Philibert et al 2003). In contrast, two recent studies have
found that ovariohysterectomy before surgical excision
Ph: 030231099426. Fax: 0302310994400
Email: makdvm@vet.auth.gr
years before surgical excision, improved survival rate
(Soremno et al 2000).
Surgical excision remains the treatment of choice for
most mammary tumours (Rutteman et al 2002). The aim
of surgical treatment is complete tumour removal, with
clean histologic margins, by the simplest technique and
improvement of prognosis and quality of life (Rutteman
et al 2002, White 2003). Closure of mastectomy wounds
may be the most challenging part of the surgical
procedure and can be achieved by using various
techniques. In fact dead space elimination and
management of tension on the incision line have been
considered the most important issues concerning
mastectomy closure (Withrow 1975). Many authors
favour conventional mastectomy closure by using

156 — Aust Vet Practit 36(4) December 2006 Aust Vet Practit 36(4) December 2006 — 156
MASTECTOMY INCISION CLOSURE
absorbable suture patterns to eliminate dead space
(Withrow 1975, Fossum 1997, Harvey 1998, Stone 2000,
Waldron 2001, White 2003). In contrast, some others
prefer a non-conventional approach to eliminate dead
space merely by inserting subcutaneous drains rather
than using large amounts of buried suture material
(Bright & Aberle 1979, Wilson & Hayes 1983). This
study in dogs was designed to compare complications
and operative times of mastectomy incisions, closed by
three different methods.
MATERIALS AND METHODS
Sixty dogs admitted to the Veterinary Teaching Hospital,
between January 2001 and December 2005, for surgical
management of mammary tumours were assessed for
this study. Criteria for inclusion were that regional or
unilateral mastectomies (MacEwen et al 1985, Allen and
Mahafey 1989, Fossum 1997, Stone 2000) were per-
formed for management of solitary or multiple
mammary tumours. The size, location and number of
tumours determined the extent of the resection.
Mastectomies of glands 3-5 and of glands 4-5 were the
majority of the regional mastectomies performed. Dogs
with inflammatory carcinoma, with tumours grossly
invading underlying tissues and those with distant
metastases, were excluded.
Diagnostic evaluation included history and clinical
examination. Thoracic radiography (left, right and
ventrodorsal views) was also performed to exclude
metastatic disease. Complete blood counts and serum
biochemistry panels were also performed.
Animals for regional or unilateral mastectomies were
premedicated with acetylpromazine1 (0.05mg/kg im)
and butorphanol2 (0.1mg/kg im). Anaesthesia was
induced with propofol3 (2-3mg/kg iv) and maintained
with isoflurane4 in oxygen. Resection margins were
determined pre-operatively. An elliptical incision was
performed around the involved mammary glands and a
margin of at least 2cm of normal tissue was removed
with the tumour. Superficial inguinal lymph nodes were
also removed en bloc. Haemorrhage was controlled with
electrocoagulation and/or ligation. After excision the
surgical wound was thoroughly lavaged with warm
normal saline solution.
Dogs were then randomly allocated into three groups:
conventional mastectomy closure (CMC), skin-only
closure (OSC) and conventional non-drain closure
(CNDC). In the conventional mastectomy groups (CMC
and CNDC) closure was accomplished with a
combination of absorbable sutures for dead space
elimination and skin sutures. Before closure in the CMC
and OSC groups, an active closed drain5 was placed in
the wound, exiting in the inguinal area. The drain was
secured to the skin at the exit site with a Chinese finger
trap suture and with simple interrupted sutures placed in
the skin of the lateral abdominal wall.
The CMC and CNDC groups underwent closure of the
mastectomy incisions by using simple interrupted
walking sutures with 2/0 or 3/0 polyglycolic acid6 for
dead space elimination and tension distribution away
from the skin incision line (Swaim 1976). This was
followed by a continuous 3/0 gluconate suture7 for
158 — Aust Vet Practit 36(4) December 2006
CLINICAL SCORING SCALE
Score Description
1 No visible reaction
2 Minimal swelling at the rostral or proximal
edge of the incision
3 Suture line inflammation at least 1cm thick
with pain and redness
4 Seroma or abscess formation (confirmed
by cytology)
5 Dehiscence and clinical treatment
6 Evidence of tumour regrowth (confirmed
by cytology and/or histopathology)
TABLE 1. Scale for the clinical scoring of mastectomy
incisions after closure (modified from Freeman et al 1987).
subcutaneous closure and staple8 placement for skin
closure.
Closure of incisions in dogs of group OSC was
accomplished by tension relieving mattress sutures
(Swaim 1980), by using 2/0 polyamide 6 sutures9, which
were pre-placed in the skin along the total length of the
incision and then were tightened. No walking or
subcutaneous sutures were used for dead space
elimination and tension distribution away from the skin
incision. Staples were then placed inside each mattress
sutures for skin closure. The same surgeons performed
the surgery in all groups.
In groups CMC and OSC the incisions were then
covered with a non-adhesive dressing10, covered with
cotton roll11, and secured in place with a stockinet
bandage12, that was placed around the thorax, abdomen
and inguinal region for the protection of the incision and
drain device. The reservoir portion of the drain was
secured underneath the stockinet bandage. In group
CNDC no coverage of the incisions was performed.
Drains were removed as soon as fluid collection in the
reservoir bag was minimal. On the sixth post-operative
day the bandage was replaced and on Day 10 mattress
sutures and staples were removed. Excised tissues were
histopathologicly examined on sections stained with
haematoxylin- eosin and were classified according to the
World Health Organisation scheme (Misdorp et al 1999).
On Days 1, 6 and 10 after surgery all dogs were re-
examined by the same clinician and each incision was
graded according to a scale (Freeman et al 1987),
modified for the purpose of this study (Table 1).
1Calmivet, Vetoquinol, France
2Butomidor, Richter Pharma AG, Austria
3Propofol, Abbott
4Aerrane, Baxter
5Red-O-Pack, Vygon, France
6Safil, Braun Aesculap, Germany
7Monosyn, Braun Aesculap, Germany
8Appose ULC, USS DG, USA
9Dafilon, Braun Aesculap, Germany
10Melolin, Smith & Nephew, United Kingdom
11Velband, Johnson & Johnson
12Bend-a-rete, Artsana, Italy
Aust Vet Practit 36(4) December 2006 — 158
 MASTECTOMY INCISION CLOSURE

SURGICAL DATA IN 60 MASTECTOMIES

Parameters CMC OSC CNDC
Age (y) 9.18 ± 2.49 8.38 ± 2.29 9.1 ± 2.32
(range, 5 to 13) (range, 5 to 15) (range, 5 to 14)
Weight (kg) 17.45 ± 8.90 19.38 ± 8.67 15.265 ± 9.71
(median 16; (median 17.5; (median 10.75;
range, 4.5 to 33) range, 4.6 to 39) range, 5.2 to 37)
Mastectomy site left 9 15 10
(no of dogs)
Mastectomy site right 11 5 10
(no of dogs)
Length of incision (cm) 25.5 ± 6.05 25.5 ± 6.68 24.8 ± 7.49
(range, 15 to 40) (range, 13 to 40) (range, 15 to 40)
Duration of procedure (min) 29.30 ± 10.12 22.55 ± 7.62 28.7 ± 8.56
(median 27.50; (median 20; (median 26.5;
range, 15 to 60) range, 15 to 40) range, 20 to 45)
Volume of fluid collected 19.00 ± 16.40 41.50 ± 46.416 –
in the reservoir bag (mL) (median 15; (median 20;
range, 1 to 60) range, 2 to 160)
Duration of drainage (d) 1.55 ± 0.51 1.45 ± 0.60 –
(range, 1 to 2) (range, 1 to 3)
Duration of hospitalisation (d) 2.15 ± 0.74 2.15 ± 0.87 1.2 ± 0.41
(range, 1 to 3) (range, 1 to 4) (range, 1 to 2)

TABLE 2. Surgical Data in 60 Mastectomies. Groups (n=20 each) were: CMC – conventional mastectomy closure; OSC –
skin-only closure; CNDC – conventional non-drain closure. Data are presented as mean ± SD.

Analgesia was provided with postoperative
administration of pethidine (3-6mg/kg im) and fentanyl
(2-4µg/kg iv) or morphine (0.5-1 mg/kg im) and fentanyl
(2-4µg/kg iv) for the first 24 hours. Caprofen13 (4 mg/kg
iv) was administered 30 minutes before surgery followed
by 2mg/kg orally twice daily for four days. Cefazolin14
(30mg/kg iv) was also administered pre-operatively.
Dogs were observed closely in the immediate post-
operative period and discharged from the hospital from
the first to fourth post-operative day.
All dogs were re-examined for incisional complications
one month after surgery.
Data recorded during the process included age, weight,
site of mastectomy (right vs. left), type of mastectomy
(regional 3-5, regional 4-5 and unilateral), length of
incision, duration of surgical procedure (from skin
incision to skin closure), volume of fluid collected in the
reservoir bag, clinical grade of incision, histologic type
of the tumour, duration of drainage and duration of
hospitalisation.
Data are presented as mean ± standard deviation (SD).
Kruskal-Wallis statistics were performed to compare
differences among groups in age, weight, and length of
incision and to detect homogenous distribution of the
mastectomy type among the groups.
The Mann-Whitney test was performed to compare
differences among the groups in duration of surgical
13Rimadyl, Pfizer
14Vifazolin, Vianex, Greece
procedure, volume of fluid collected in the reservoir bag,
duration of drainage and duration of hospitalisation, as
well as to determine the effect of mastectomy site (right
vs. left) to the volume of fluid collected in the reservoir
bag in either group.
The Kruskal-Wallis test was also used to analyse the
effect of mastectomy type (regional vs. unilateral) to the
volume of fluid collected in the reservoir bag in either
group. The number of dogs per clinical grade on Days 1,
6 and 10 were analysed using Pearson chi-square test and
Friedman test to determine any differences among or
within groups, respectively. Values of P<0.05 were
considered significant.
RESULTS
Clinical parameters of dogs of all groups are presented in
Table 2. There were no significant differences regarding
age (P=0.428) and weight (P=0.286) among groups.
Overall, 34 dogs had left site and 26 dogs had right site
mastectomies. Thirty-five dogs had regional mastectomy
of glands 3-5, 15 of glands 4-5 and 10 had unilateral
mastectomies (Table 3). Mastectomy types had a homo-
geneous distribution among the groups (P=0.08). No
differences were found among groups regarding length
of incision (P=0.746). Duration of surgical procedure
was shorter in OSC compared to CMC (P=0.014) and to
CNDC (P=0.008) but no difference was present between
groups CMC and CNDC (P=1). No differences were
determined for volume of fluid collected in the reservoir
bag (P=0.127) and duration of drainage (P=0.527)
between groups CMC and OSC. Duration of hospital-
isation was not different between groups CMC and OSC
(P=0.973), but was shorter for group CNDC, compared

159 — Aust Vet Practit 36(4) December 2006 Aust Vet Practit 36(4) December 2006 — 159
MASTECTOMY INCISION CLOSURE

number of tumours may determine the extent of surgical

MASTECTOMIES PER GROUP
Type of mastectomy Groups
CMC OSC CNDC
Regional 3-5 13 12 10
Regional 4-5 4 6 5 the adjacent caudal abdominal and inguinal glands rather
Unilateral 3 2 5 than to perform a simple mastectomy to separate them
TABLE 3. Type of mastectomy per group. Groups (n=20
each) were: CMC – conventional mastectomy closure; OSC
– skin-only closure; CNDC – conventional non-drain
closure.
to group CMC (P<0.001) and group OSC (P=0.001)
respectively. Site of mastectomy (P=0.062) and
mastectomy type (P=0.739) had no effect on the volume
of fluid collected in the reservoir bag in either of groups
CMC and OSC.
Number of animals per clinical grade on Days 1, 6 and
10 after surgery are presented in Table 4. On Day 10 after
surgery, seromas had formed along the incision in one
dog of group CMC and in two dogs of group CNDC.
These were managed conservatively. A dehiscence (5cm
length and 2cm width), which developed on Day 10 in
the caudal part of the incision in one dog of group OSC,
was debrided and closed primarily with similar sutures.
No differences were detected in the number of animals
per clinical grade within group CNDC between Days 1
and 6 (P= 0.063) and Days 6 and 10 (P= 0.063), but
differences were detected between Days 1 and 10
(P=0.008).
Histopathologicly, 54 dogs had malignant tumours (51
carcinomas and three sarcomas) and six had benign
tumours.
All dogs were re-examined one month after surgery and
found to be clinically well. All incisions were inspected
and no incisional complications were present.
DISCUSSION
Most surgeons favour regional or unilateral
mastectomies because surgical anatomy is simpler with
those approaches (White 2003). The type of surgery does
not seem to affect survival (MacEwen et al 1985, Allen
& Mahafey 1989) but the size of the primary tumour, its
location and fixation to surrounding tissue and the total
excision (Rutteman et al 2002). Regional mastectomy is
performed when large mammary tumours are located in
adjacent glands or a tumour is found between two glands
(Allen & Mahafey 1989, Fossum 1997). Additionally, it
is sometimes easier and less traumatic to remove both
(Birchard 1995, Fossum 1997). Unilateral mastectomy is
commonly selected when multiple mammary tumours
occur in most or all glands of a chain, as it is faster and
easier to perform than multiple mastectomies (Rutteman
et al 2002).
In this study, no difference in the length of incisions was
found because there was an even distribution of
mastectomy-type among the groups and most of the
animals belonged to medium and large breeds. The
shorter durations of the surgical procedures in group
OSC, compared to those of groups CMC and CNDC,
might be attributed to placement of fewer sutures and
less tissue handling for wound closure. Staples were used
for skin apposition in all groups in an attempt to further
decrease surgical time.
As in the present study considerable tension is often
required for skin approximation to close large
mastectomy wounds. Walking sutures were used, in
groups CMC and CNDC, to move the skin from around
the wound to appose skin edges. This helped to distribute
tension along the incision, to prevent dehiscence and to
aid in dead space elimination (Swaim 1976). Interrupted
horizontal mattress tension sutures, that were placed
away from the skin edges, were used in group OSC as
tension relieving sutures (Swaim 1980).
Post-operative complications associated with
mastectomy may include seroma formation, wound
infection, dehiscence, ischaemic necrosis, self-
mutilation, blood loss, hind limb oedema and tumour
recurrence. (Birchard 1995, Fossum 1997, Harvey
1998). Regional or unilateral mastectomies may cause
considerable amount of dead space, especially in the
inguinal area. In the absence of proper drainage,
haematoma/ seroma formation may be seen, as a result of
inflammation and lymphatic injury, in association with
wound oozing because of surgical trauma (Swaim &
Henderson 1997, Pavletic 1999). This protein-rich fluid
may predispose to bacterial colonisation and abscess
development (Bright & Probst 1985). Seroma formation

CLINICAL GRADE SCORES

CMC Group OSC Group CNDC Group
Clinical Grade Day 1 Day 6 Day 10 Day 1 Day 6 Day 10 Day 1 Day 6 Day 10
1 16 15 13 11 13 12 20 15 12
2 4 4 5 9 6 6 0 3 6
3 0 1 1 0 1 1 0 2 0
4 0 0 1 0 0 0 0 0 2
5 0 0 0 0 0 1 0 0 0

TABLE 4. Clinical Grades after Mastectomy. Groups (20 each) were: CMC – conventional mastectomy closure; OSC – skin-
only closure; CNDC – conventional non-drain closure. Clinical grades modified from Freeman et al 1987.

160 — Aust Vet Practit 36(4) December 2006 Aust Vet Practit 36(4) December 2006 — 160
 MASTECTOMY INCISION CLOSURE
may be minimised by following Halsted’s principles:
careful tissue handling, dead space obliteration and
meticulous haemostasis (Mason 1993).
In a human study, reporting the effect of dead space
closure on seroma formation after mastectomy, it was
found that closed suction drainage was significantly less
compared to the control group; dead space was
decreased in the group that had flaps sutured to under-
lying muscle and fewer patients in this group developed
seromas (Coveney et al 1993). In the present study, dead
space was minimised by using closed suction drainage
units (group OSC), a combination of tacking sutures and
closed suction drainage units (group CMC) or tacking
sutures alone (group CNDC). Drains may themselves
incite fluid formation, depending on the size of the drain
and the size of the wound. As much as 50mL of fluid
production can be caused over time by the presence of a
drain in a large subcutaneous wound (Fox & Golden
1976, Lee et al 1986).
In the present study, in order to identify the necessity of
drainage in mastectomy incisions and the effect of the
drain on fluid formation a group that had the
conventional technique without drain placement was
included and comparisons among groups CMC, OSC
and CNDC were performed. The findings of the present
study support the view that when the conventional
technique is used for mastectomy closure, and provided
that Halsted’s principles are followed, placement of a
drain is not necessary.
Serious incisional complications were seen in very few
dogs of all groups of this study. However, the seroma
formation that developed, on Day 10 in one dog of group
CMC, might be attributed to inadequate drainage,
possibly because of premature discontinuation of the
drain or its obstruction. In addition, the seroma
formation that developed on Day 10 in two dogs of group
CNDC might have been caused by inadequate dead
space elimination and not the lack of drainage.
Moreover, the dehiscence that developed at the caudal
end of the incision in one dog from group OSC might be
attributed to an increased tension in the inguinal region.
Duration of hospitalisation was significantly shorter for
dogs of group CNDC compared to the other groups and
this might be attributed to the absence of management
issues associated with wound dressing and drain in this
group compared to groups CMC and OSC.
In conclusion, in terms of surgical time, closure of
mastectomy incisions with skin apposition alone,
combined with a closed drainage device, was superior to
conventional closure techniques. Drain placement or
absence of drain had no effect on the outcome.
REFERENCES
ALLEN, SW & MAHAFFEY, EA (1989) Canine mammary
neoplasia: prognostic indicators and response to surgical
therapy, J Am Anim Hosp Assoc 25:540
BIRCHARD, SJ (1995) Kirk’s Current Veterinary Therapy XII, Ed
Bonagura, p462, Saunders, Philadelphia
BRIGHT, RM & ABERLE, S (1979) Mammary Neoplasia, Comp
Cont Educ Pract Vet 1:774
BRIGHT, RM & PROBST, CW (1985) Textbook of Small Animal
Surgery, Ed Slatter, p431, Saunders, Philadelphia
162 — Aust Vet Practit 36(4) December 2006
View publication stats
BRODEY, RS, GOLDSCMIDT, MH & ROSZEL, JR (1983) Canine
mammary gland neoplasms, J Am Anim Hosp Assoc 19:61
CHANG, SC, CHANG, CC, CHANG, TJ & WONG, ML (2005)
Prognostic factors associated with survival two years after
surgery in dogs with malignant mammary tumors: 79 cases
(1998-2002), J Am Vet Med Assoc 227:1625
COVENEY, EC, O’DWYER, PJ, GERAGHTY, JC & O’HIGGINS,
NJ (1993) Effect of closing dead space on seroma formation
after mastectomy – a prospective randomized clinical trial, Eur
J Surg Oncol 19:143
DORN, CR, TAYLOR, DN, FYRE, FL & HIBBARD, HH (1968)
Survey of animal neoplasms in Alameda and Contra Costa
Counties, California. I. Methodology and description of cases,
J Nat Cancer Inst 40:295
FOSSUM, TW (1997) Small Animal Surgery, p539, Mosby, St
Louis
FOX, JW & GOLDEN, GT (1976) The use of drains in
subcutaneous surgical procedures, Am J Surg 132:673
FREEMAN, LJ, PETTIT, GD, ROBINETTE, JD, LINCOLN, JD &
PERSON, MW (1987) Tissue reaction to suture material in the
feline linea alba. A retrospective, prospective, and histologic
study, Vet Surg 16:440
HARVEY, HJ (1998) Current Techniques in Small Animal Surgery,
Ed Bojrab, 4th edn, p579, Lea & Febiger, Philadelphia
KITCHELL, BE (1995) Kirk’s Current Veterinary Therapy XII, Ed
Bonagura, p1098, Saunders, Philadelphia.
LEE, AH, SWAIM, SF & HENDERSON, RA (1986) Surgical
Drainage, Comp Cont Educ Pract Vet 8:94
MASON, LK (1993) Surgical Complications and Wound Healing in
the Small Animal Practice, Ed Harari, p33, Saunders,
Philadelphia
MacEWEN, EG, HARVEY, HJ & PATNAIK, AK (1985) Evaluation
of effects of levamisole and surgery on canine mammary
cancer, J Biol Response Mod 4:418
MISDORP, W, ELSE, R & LIPSCOMB, T (1999) Histological
Classification of Mammary Tumors of the Dog and Cat, p11,
Armed Forces Institute of Pathology, Washington DC
MORRIS, JS, DOBSON, JM, BOSTOCK, DE & O’FARRELL, E
(1998) Effect of ovariohysterectomy in bitches with mammary
neoplasms, Vet Rec 142:656
PAVLETIC, MM (1999) Atlas of Small Animal Reconstructive
Surgery, 2nd edn, p41, Saunders, Philadelphia
PHILIBERT, JC, SNYDER, PW, GLICKMAN, N, GLICKMAN, LT,
KNAPP, DW & WATER, DJ (2003) Influence of host factors on
survival in dogs with malignant mammary gland tumors, J Vet
Intern Med 17:102
RUTTEMAN, GR, WITHROW, SJ & MacEWEN, EG (2002) Small
Animal Clinical Oncology, Eds Withrow & MacEwen, 3rd edn,
p455, Saunders, Philadelphia
SCHNEIDER, R, DORN, CR & TAYLOR, DN (1969) Factors
influencing canine mammary cancer development and
postsurgical survival, J Nat Cancer Inst 43:1249
SOREMNO, KU, SHOFER, FS & GOLDSCHMIDT, MH (2000)
Effect of spaying and timing of spaying on survival of dogs
with mammary carcinoma, J Vet Intern Med 14:266
STONE, EA (2000) Saunders Manual of Small Animal Practice,
Eds Birchard & Sherding, 2nd edn, p222, Saunders,
Philadelphia
SWAIM, SF (1976) A “walking” suture technique for closure of
large skin defects in the dog and cat, J Am Anim Hosp Assoc
12:597
SWAIM, SF (1980) Management of skin tension in dermal surgery,
Comp Cont Educ Pract Vet 2:758
SWAIM, SF & HENDERSON, RA (1997) Small Animal Wound
Mangement, 2nd edn, p387, Williams & Wilkins, Baltimore
TAYLOR, GN, SAHESTARI, L, WILLIAMS, J, MAYS, WA &
McFARLAND, S (1976) Mammary neoplasia in a closed
beagle colony, Cancer Res 36:2740
WALDRON, DR (2001) Diagnosis and surgical management of
mammary neoplasia in dogs and cats, Vet Med 96:943
WHITE, RAS (2003) Textbook of Small Animal Surgery, Ed Slatter,
3rd edn, p339, Saunders, Philadelphia
WILSON, GP & HAYES, HM (1983) Current Techniques in Small
Animal Surgery, Ed Bojrab, 2nd edn, p414, Lea & Febiger,
Philadelphia
WITHROW, SJ (1975) Surgical management of canine mammary
tumors, Vet Clin Nth Am 5:495
YAMAGAMI, T, KOBAYASHI, T, TAKAHASHI, K & SUGIYAMA, M
(1996) Influence of ovariectomy at the time of mastectomy on
the prognosis for canine malignant mammary tumours, J Small
Anim Pract 37:462
Aust Vet Practit 36(4) December 2006 — 162