Undermining: Explained and Demonstrated

Explore 12+ workshops in veterinary surgery and anesthesia: focusandflourish.com 🔗 Download our free OR Checklist here: https://focusandflourish.myflodesk.com/free-or-checklist In this video, Dr. Anne Sylvestre explains skin undermining, a key technique for closing large or high-tension wounds. Many veterinarians are unsure how deep to go and worry about causing harm, so they often avoid it. This session shows the main anatomical layers of the canine and feline trunk and explains where to dissect to keep the skin healthy. By understanding how the cutaneous trunci muscle and direct cutaneous vessels work together, surgeons can move the skin as needed to close difficult incisions without risking the wound reopening. Key Takeaways * Tension Management: Undermining is the main way to reduce tension at the edges of an incision. Too much tension is the most common reason surgical sites fail. * The Golden Rule of Depth: When working on the trunk, always dissect below the cutaneous trunci (panniculus) muscle. This keeps the blood supply connected to the skin. * Preserve Direct Cutaneous Vessels: These vessels begin in the deep muscles and branch out above the deep fascia. Cutting too close to the skin can damage the blood supply and put the skin at risk. * Blunt vs. Sharp Dissection: Use Metzenbaum scissors with the “insert-open-remove” method and your fingers to gently separate connective tissue. * Atraumatic Handling: Use towel clamps instead of forceps to hold the skin edges. Towel clamps cause less tissue damage than forceps, which can crush the skin. * Don’t Ignore the Apex: Always undermine at the top and bottom of an incision to prevent puckering and help the skin lie flat. Chapters: 0:00 - Introduction to undermining and common surgical timidity. 0:42 - The purpose of undermining: Tension relief. 1:09 - Anatomy: Epidermis, dermis, and fascial layers. 1:38 - Understanding direct cutaneous blood supply. 2:21 - The role of the cutaneous trunci (panniculus) muscle. 3:18 - Surgeon’s shortcut: Identifying the correct surgical plane. 4:11 - Tools of the trade: Metzenbaums, fingers, and towel clamps. 5:17 - Visual demonstration: Working around blood vessels and muscle. 6:26 - Managing accidental bleeders and finishing the apex. Action Items 1. Review Anatomy: Before your next trunk surgery, review the order of the layers: SubQ, Superficial Fascia, Panniculus, Practice Scaled Dissection: Start with small areas of undermining and gradually increase the distance as you get better at identifying blood vessels. 2. Upgrade your instruments: Use towel clamps instead of forceps for skin traction to reduce trauma to the edges. Technique: Practice entering with the scissors closed, opening them, and withdrawing before closing the blades to get the best blunt separation. Resources Mentioned * Focus and Flourish: Educational platform for veterinary surgical skills. * Metzenbaum Scissors: Recommended for blunt dissection. * Towel Clamps: Recommended for atraumatic skin manipulation. This video is intended for veterinary professionals and is not a substitute for formal veterinary training or clinical judgment. #veterinarymedicine #veterinary #veterinarysurgeon #veterinariantips #vet #focusandflourish