Digital images are best evidence of surgery as shown in this case.

The young lady phoned me at night as her mother had doubts that I had resected all the skin tumours. She had been shown the images of the tumour marked by ink at 1-cm margin from the edge of the tumour inside my digital camera as the interns had been instructed to take still images while videoing. 

However, I did not instruct my intern to take an image of the excised tumour and its ventral area while he had been videoing my surgery. The tumour with a one-cm margin had been sent to the laboratory early on the day of surgery while the owner came in the evening. No image was taken of this tumour inside the formalin bottle. It will be best to show the owner the resected tumour before sending to the lab. The lesson learnt:  Delay sending till the next day.

So I asked him to take the relevant image off the video and will be sending them to the owner. "The skin looked "puckered" at the middle area, showing an inverted skin edge, owing to the stitching of the wound," I said. It is difficult to explain over the phone as this was too technical.

 

What happened was that the wound was large, at 4 cm in diameter. Dr Daniel commented on this large wound when he saw the image in the camera. He was not present during the surgery. I created a Z-plasty to close the wound properly. Without Z-plasty, just stitching the 4-cm wound will not be satisfactory as the stitches will break down.

The wound was under very high tension and so a "Z" line extending the skin, undermining the skin to loosen tension is the best way to ensure proper closure, in my experience. In this case, the "Z" could not be closed normally. There was insufficient skin. So, there was a central circular wound of around 2 cm in diameter. I stitched up this circle. The overall result is a straight line instead of a "Z". The video will illustrate clearly what I mean.

The name of the veterinary educational video will be "Removal of skin tumour in a poodle".