Evaluation of Cosmetic Results of Surgical Wound Closure in Dogs

  • Rachel Williams Western University of Health Sciences College of Veterinary Medicine East 2nd St Pomona, CA 91766
  • Wanda Gordon-Evans University of Minnesota College of Veterinary Medicine, 1365 Gortner Ave, St Paul, MN 55108, USA
  • Jeffery Biskup University of Tennessee College of Veterinary Medicine, 2407 River Dr, Knoxville, TN 37996, USA
  • Dominique Griffon Western University of Health Sciences College of Veterinary Medicine, East 2nd Street Pomona CA, CA 91766, United States



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Objective: To evaluate the correlation between wound cosmesis and pet owner satisfaction, to determine the agreement among vet surgeons, and pet owners evaluating a surgical wound with a visual assessment score (VAS), and to determine the agreement between the VAS, a semi-quantitative score of wound inflammation, and wound width.

Background: Perception of post-surgical cosmesis by human patients has been found to influence their satisfaction and perceived adequacy of vet surgeons. Due to the trend of owners anthropomorphising pets, this logic can be extended to veterinary patients. Also, there is a lack of consistent, reliable methods to evaluate cosmesis have been developed, creating the need for a scoring system that is accurate and reproducible.

Evidentiary value: This was a prospective cohort study with one hundred and seven patients. This study may not change day-to-day practices, but it will bring to light for practitioners the discordance between pet owners and vet surgeons concerning attractiveness of an incision as well as overall satisfaction with a procedure.

Methods: Photographs of surgical wounds were taken immediately, 2 weeks, and 8 weeks after surgery in dogs. Owners were asked to evaluate satisfaction with the procedure and attractiveness of the incision using the VAS. Photos were evaluated for cosmetic outcome by pet owner and vet surgeon evaluators with different scoring systems. The reliability of the scoring systems was evaluated using intraclass correlations and kappa statistics as appropriate.

Results:  Owners’ evaluation of cosmetic outcome correlated with their overall satisfaction. (r2=0.37, where r2 is the coefficient of determination, and can be used to determine what proportion of variance in one variable is predictable from the other variableThere was generally poor reliability of the subjective scoring between both vet surgeons and pet owners, and the less subjective scoring systems.

Conclusion: The cosmetic outcome as judged by the owner accounted for 37% of the variability in satisfaction, that is to say that 37% of the total variation in satisfaction could be explained by the cosmetic outcome as evaluated by the owner. This suggests that wound cosmesis significantly influences clients’ satisfaction. However, the other methods of rating cosmesis evaluated in this study were unreliable.

Application: The results of this study are relevant to all veterinarians in clinical practice, from general practice to tertiary referral centers. This study should be kept in mind when speaking with owners to establish pre-surgical expectations as well as mediating conflict due to a difference in opinion with regards to a surgical outcome.

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Boni, S. (2008). Anthropomorphism: how it affects the human-canine bond. Journal of Applied Companion Animal Behavior, 2(1), 16-21.

Boulding, W. Glickman S. Manary M. et al. (2011). Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. American Journal of Managed Care, 17(1), 41-48.

Donnell, J. Frisbie, D. King, M. et al. (2015). Comparison of subjective lameness evaluation, force platforms and an inertial-sensor system to identify mild lameness in an equine osteoarthritis model The Veterinary Journal, 206(2), 136-142. http://dx.doi.org/10.1016/j.tvjl.2015.08.004

Duncan, J. Bond, J. Mason, T. et al. (2006). Visual analogue scale scoring and ranking: a suitable and sensitive method for assessing scar quality? Plastic and Reconstructive Surgery, 118(4), 909-918. http://dx.doi.org/10.1097/01.prs.0000232378.88776.b0

Etter, S. Ragetly, G. Bennett, R. et al. (2013). Effect of using triclosan-impregnated suture for incisional closure on surgical site infection and inflammation following tibial plateau leveling osteotomy in dogs. Journal of the American Veterinary Medical Association, 242(3), 355-358. http://dx.doi.org/10.2460/javma.242.3.355

Exner, R. Krois, W. Mittlböck, M. et al. (2012). Objectively measured breast symmetry has no influence on quality of life in breast cancer patients. European Journal of Surgical Oncology, 38(2), 130-136. http://dx.doi.org/10.1016/j.ejso.2011.10.012

Flanagan M. (2009). The physiology of wound healing. Journal of Wound Care, 9(6), 299-300. http://dx.doi.org/10.12968/jowc.2000.9.6.25994

Gallegos, J. Schmiedt, C. McAnulty J. (2007). Cosmetic rostral nasal reconstruction after nasal planum and premaxilla resection: technique and results in two dogs. Veterinary Surgery, 36(7), 669-674. http://dx.doi.org/10.1111/j.1532-950X.2007.00319.x

Hallgren, K. (2012). Computing inter-rater reliability for observational data: an overview and tutorial. Quantitative Methods for Psychology, 8(1), 23-34. http://dx.doi.org/10.20982/tqmp.08.1.p023

Holland, J. Smith, G. Ross, F. et al. (2001). HOSE: an objective scoring system for evaluating the results of hypospadias surgery. BJU International, 88(3), 255-258. http://dx.doi.org/10.1046/j.1464-410x.2001.02280.x

Keppie, N. Rosenstein, D. Holcombe, S. et al. (2008). Objective radiographic assessment of abdominal sand accumulation in horses. Veterinary Radiology and Ultrasound, 49(2), 122-128. http://dx.doi.org/10.1111/j.1740-8261.2008.00337.x

Kim, M. Kim, T. Moon, H. et al. (2015). Effect of cosmetic outcome on quality of life after breast cancer surgery. European Journal of Surgical Oncology, 41(3), 426-432. http://dx.doi.org/10.1016/j.ejso.2014.12.002

Landis, J. Koch, G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159-174. http://dx.doi.org/10.2307/2529310

Maninchedda, U. Nottrott, K. Gangl, M. (2015). Enucleation in equids with and without the use of an orbital suture meshwork implant: a retrospective study of 37 cases. Veterinary Record, 177(14), 367. http://dx.doi.org/10.1136/vr.103305

Peeters, M. Kirpensteijn, J. (2011). Comparison of surgical variables and short-term postoperative complications in healthy dogs undergoing ovariohysterectomy or ovariectomy. Journal of the American Veterinary Medical Association, 238(2), 189-194. http://dx.doi.org/10.2460/javma.238.2.189

Sylvestre, A. Wilson, J. Hare, J. (2002). A comparison of 2 different suture patterns for skin closure of canine ovariohysterectomy. Canadian Veterinary Journal, 43(9), 699-702.

Waxman, A. Robinson, D. Evans, R. et al. (2008). Relationship between objective and subjective assessment of limb function in normal dogs with an experimentally induced lameness. Veterinary Surgery, 37(3), 241-246. http://dx.doi.org/10.1111/j.1532-950X.2008.00372.x