Ray L. Ball, DVM; Clif Martel, BS, MBA
A 5-year-old female Cuban iguana (Cyclura nubila nubila) was presented to the Busch Gardens Tampa Bay Zoo Hospital after receiving a degloving injury to the left forearm from a male of the same species. A full-thickness, 3-cm portion of skin was removed extending from the carpus proximally to just below the elbow. The iguana was anesthetized with isoflurane via mask (IsoSol®, VEDCO, Inc., St. Joseph, MO, USA), then intubated for assessment and treatment. Radiographs confirmed no fractures of the area and no other injuries. Because of the fresh nature of the wound a skin graft approach was considered to heal this wound primarily. The arm and the left lateral thorax were prepared in routine fashion for surgery. A flap of skin 2 cm wide by 3 cm tall was created on the left lateral thorax just caudal to the axilla. This flap was deep enough that the panniculus muscle layer was included. The flap was created in a similar fashion as described for a surgical treatment of a hygroma of the elbow in dogs.1 The flap was created to encompass the entire wound. The arm was then extended and adducted to the body wall with the newly created flap wrapping around the defect. The surgical incision edges were sutured to the traumatic wound edges using simple interrupted sutures of 3-0 polydioxanone. A small roll of gauze was used to close the dead space where the limb met the body wall to lessen seroma formation. The limb was then wrapped in place to the body. Injectable enrofloxacin (Baytril 100®, Bayer Corp., Agriculture Division, Animal Health, Shawnee Mission, KS, USA) was initiated at 5 mg/kg IM every 24 h for 7 days. The bandage was changed periodically for 4 weeks and the surgical site assessed, but little care was needed. At 4 weeks post surgery, the site was surgically prepared, and the flap was then excised from the body wall and wrapped around the limb. The flap was about 5 mm short of encompassing the entire circumference of the arm. This defect was managed with a biosynthetic absorbent wound dressing (BioDres®, DVM Pharmaceuticals, Inc., Miami, FL, USA) and granulated well in the next 4 weeks. The defect on the lateral thorax wall could not be entirely closed primarily and again was managed with the same bandaging materials. Four weeks after the second surgery, the iguana had the bandages removed and it was released from the hospital. The surgical site has continued to look well over the past 2 years.
The skin of reptiles is similar to that of other animals in that it consists of an epidermis and a dermis. A major difference from mammals is that the epidermis has a keratin layer that can be thickened into scales. Information of the cutaneous circulation in reptiles is scarce and relates primarily to thermoregulation. Because of this, the surgeon must assume that the distribution of vessels is generally the same in quadrupeds. Ensuring that the panniculus layer is incorporated into the graft will ensure a reasonable blood supply to the graft. Immobilization of the graft was thought to be essential in the management of this wound, and the location of the wound facilitated this. Avoiding dead space and seroma formation is also a must for a graft to take to a new location. The complication in this case was minimal and directly related to not accurately sizing the wound and allowing any margin of error in the initial graft. Careful planning is needed before any skin grafting is attempted.
Traumatic injuries are not uncommon in zoological collections. If fresh, they are good candidates for primary healing with grafting techniques. Infected wounds must be aggressively treated first and a healthy granulation bed produced before any attempts can be made. Following basic principles of skin grafting will provide a reasonable guide to surgical repair of wounds in iguanids and perhaps other reptiles with similar skin types.
1. Pope, E.R. 1990. Surgical treatment of hygroma of the elbow. In: Bojrab, M.J. (ed.) Current Techniques in Small Animal Surgery. Lea and Febiger, Philadelphia, PA. Pp. 496–489.