Male Cross-bred, 10 years, not neutered, has several tumours. But circum-anal tumours were massive and extended around the anus from 12 to 6 o'clock. A cluster of tumours appeared at 10 to 11 o'clock.

May 1, 2013
Tumour excision was done by Dr Daniel but the skin was under high tension after stitching as there was insufficient nearby skin to close the wound. After 7 days, the stitches broke down. The anal opening shrank deep into the big wound caused by the breakdown. Stools clogged inside the skin folds of the large wound. Flies appeared from nowhere and settled on the wound. I got the dog washed twice daily to clear the stools and keep the wound clean. 

"This wound will never heal by secondary intention as the stools keep falling into the wound, contaminating it," I said to Dr Daniel. "There is a need for another operation to close it. The retained stools keep contaminating the wound. The owner's permission must be given."

Dr Daniel said: "The dog is old and had difficulty in surviving the long anaesthesia. So I did not create a flap to close up."

"In old dogs, to ensure survival from anaesthesia on the operating table, it is best to do a 2-stage surgery. Stage 1 to excise the wound. Stage 2 to create a skin flap to close the wound. However, the owner must be informed early and told of the financial costs in 2 operations."   

I sketched two surgical plans for Dr Daniel to consider.  I phoned the owner who asked about the costs and gave permission to close up the big wound.

May 17, 2013
The dog had been cleaned twice daily for the past 16 days. There was diarrhoea earlier and the wound would not heal.  Creating a flap to cover the wound was done by Dr Daniel on May 17, 2013. On the 3rd day, the dog went home as the wound was healing well.
 

UPDATE
As at Jun 2, 2013, no complaints about the wound from the owner. I text-message her on May 28, 2013 and did not get a reply. Will follow up again.  Owing to financial constraints of the owner, some large wounds can be left to heal by secondary intention rather than using a skin flap. For example, large umbilical or sternal area tumours. Financial costs are much higher when tumours are massive and two-stage surgeries are advised in dogs over 7 years old to minimise anaesthetic deaths.