Evaluation of the Cranial Rectus Abdominus Muscle Pedicle Flap as a Blood Supply for the Caudal Superficial Epigastric Skin Flap in Dogs

This study evaluates the cranial rectus abdominus muscle pedicle flap as the sole blood supply for the caudal superficial epigastric skin flap. This flap was composed of a cranially based rectus abdominus muscle pedicle flap that was attached to the caudal superficial epigastric island skin flap (including mammary glands 2 to 5) via the pudendoepigastric trunk. Selective angiography of the cranial epigastric artery in eight cadaver dogs proved that the arterial vasculature in the cranial rectus abdominus was contiguous with that in the caudal superficial epigastric skin flap. In the live dog study, three of six of the flaps failed because of venous insufficiency. Necrosis of mammary gland 2 occurred in two of six flaps. One of six flaps survived with the exception of the cranial most aspect of mammary gland 2. Angiography of the cranial epigastric artery proved that arterial blood supply to these flaps was intact. Histological evaluation of the failed flaps showed full-thickness necrosis of the skin and subcutaneous tissues, the presence of severe congestion, and venous thrombosis. Retrograde venous blood flow through the flap was inconsistent, and hence resulted in failure of this myocutaneous flap. Use of this flap for clinical wound reconstruction cannot be recommended.     

Wound management in a juvenile tiger (Panthera tigris) with vacuum-assisted closure (V.A.C. Therapy).

A 6-wk-old tiger (Panthera tigris) was evaluated for severe skin lacerations from an adult tiger attack. A caudal superficial epigastric skin flap was surgically placed to cover a defect that could not be closed over the hind limb; however, the skin flap did not adhere well to the granulation tissue over a period of 1 mo. The granulation bed matured and deteriorated. A subatmospheric pressure technique (vacuum-assisted closure, V.A.C. Therapy, Kinetic Concepts Inc., San Antonio, Texas 78219, USA) was utilized, and flap adherence occurred after 4 wk. This technique should be considered when dealing with severe or chronic wounds in tractable animals.     

Repair of a canine forelimb skin deficit by microvascular transfer of a caudal superficial epigastric flap

Extensive skin loss from the forelimb of a Border collie was repaired by a microvascular caudal superficial epigastric flap, with secondary meshing of the flap to increase coverage. The caudal superficial epigastric artery and vein were anastomosed to the brachial artery and vein. End-to-end anastomosis to the brachial artery and vein did not compromise peripheral blood flow, and no flap necrosis was observed after subsequent limited meshing of the flap.     

A novel internal abdominal oblique muscle flap to close a major abdominal wall defect

This report describes a novel technique for abdominal wall reconstruction using an internal abdominal oblique muscle flap in an Australian kelpie. En bloc resection of a chondrosarcoma and biopsy scar centred on the 13th rib was performed to include full thickness thoracic wall (12th rib, extending caudally) and lateral abdominal wall (including the vascular pedicle of the external abdominal oblique muscle). The diaphragm was advanced to close the thorax. A flap using the caudal internal abdominal oblique muscle with the base dorsally was elevated and rotated 90° to fill the dorsal defect. The ventral defect was closed using the composite ventral abdominal muscles. The skin was closed primarily. The dog developed a self-resolving seroma. Twelve months postoperatively, the dog was able to engage in agility competitions. A viable muscle flap using the internal abdominal oblique muscle provides a useful alternative to previously described techniques for autogenous closure of a large abdominal wall wound.     

Radical Lateral Body-Wall Resection for Fibrosarcoma With Reconstruction Using Polypropylene Mesh and a Caudal Superficial Epigastric Axial Pattern Flap: A Prospective Clinical Study of the Technique and Results in 6 Cats

OBJECTIVE: To describe and evaluate a technique for radical resection of the lateral body wall for treatment of fibrosarcoma with reconstruction using polypropylene mesh and a caudal superficial epigastric axial pattern flap in cats. STUDY DESIGN: Prospective, clinical study. ANIMALS OR SAMPLE POPULATION: Six client-owned cats with fibrosarcoma. METHODS: Six cats with histologically confirmed fibrosarcoma of the lateral body wall were staged using radiography and/or computer tomography scanning. Preoperative radiotherapy was used in 3 cats. All cats had the lateral abdominal wall resected and reconstructed with polypropylene mesh. A caudal superficial epigastric flap was mobilized and rotated to close the skin deficit. The animals were evaluated after surgery for wound complications, tumor recurrence, and metastasis. Outcome was assessed by patient examination and client consultation. RESULTS: Minor dehiscence of the skin flaps occurred in 2 cats, and 1 other cat was successfully resuscitated from respiratory and cardiac arrest after surgery. All tissue specimens were tumor-free at the surgical margins. Follow-up times ranged from 12 to 21 months, with a mean time of 17.2 months. None of the cats had evidence of local tumor recurrence or metastasis; outcome was judged good to excellent in all cats. CONCLUSIONS AND CLINICAL RELEVANCE: Radical lateral body-wall resection and reconstruction is an effective technique for achieving local tumor control with acceptable patient morbidity. Further studies are needed to assess whether the technique will result in improved tumor-free intervals and survival times.     

The Effect of Hyperbaric Oxygen Treatment on a Compromised Axial Pattern Flap in the Cat

A pedicle skin flap based on the caudal superficial epigastric artery was created in 12 cats. The artery was ligated and the vein left intact. Six cats were treated with hyperbaric oxygen at 2 atm absolute for 90 minutes daily for 14 days, starting the day after surgery. Skin flap color was significantly better in the treated cats on days 1, 2, and 3. The amount of exudate was significantly less in the treated cats on day 3. There was no difference in the amount of swelling between treated and nontreated control cats. Although five of six of the treated cats had 100% skin flap survival, there was no significant difference in total flap survival between treated and nontreated control cats.     

Nasal planum reconstruction after tumour resection using a lip-to-nose flap in a dog

Here we describe the use of a novel lip-to-nose flap technique for nasal planum reconstruction after tumour removal in a dog. A mast cell tumour involving the nasal planum was first resected by removing the roof and the wing of the left nasal vestibule. An interpolation subdermal plexus flap was derived from the left caudal lip with vascular contribution from the lateral nasal artery. This lip-to-nose flap was rotated into the defect via a bridging incision. The mucocutaneous junction of the lip was used to emulate the keratinised nasal planum and the buccal mucosa was sutured to be congruent with the mucosa of the vestibule. This resulted in the lip-to-nose flap successfully closing the surgical defect and giving an aesthetic appearance similar to the original nasal planum.     

Thoracodorsal and Caudal Superficial Epigastric Axial Pattern Skin Flaps in Cats

Nonselective angiography, selective angiography, and gross dissection of 15 cadavers were performed to delineate direct cutaneous arteries in the cat. The omocervical, deep circumflex iliac, thoracodorsal, and caudal superficial epigastric arteries were identified by nonselective angiography. Selective angiography and gross dissection allowed assessment of the origin and vascular territories of the thoracodorsal and caudal superficial epigastric arteries. Orthotopic and heterotopic transfers of thoracodorsal and caudal superficial epigastric island flaps were performed on eight cats. All flaps were successful although areas of necrosis at the caudodistal tips were evident in most of the thoracodorsal flaps. The rotated thoracodorsal flaps extended to the carpi. Caudal superficial epigastric flaps enabled coverage to the metatarsus. Seroma formation and partial dehiscence were minor complications.     

Surgical correction of ear curling caused by scar tissue formation in a horse

An 18-month-old Belgian Warmblood mare was evaluated because it had injured the outer convex aspect of the left auricle. Second intention healing of the wound area caused tissue contracture, which resulted in the tip of the ear curling backward. By use of a technique involving undermining of the skin and a flap of granulation tissue on the medial aspect of the wound area and multiple incisions of the auricular cartilage, the curling was relieved and the ear regained a more normal shape. A skin graft was applied to cover the existing wound defect in an attempt to accelerate wound healing; thermoplastic material was contoured to fit the inner concave surface of the ear for immobilization and fixation of the ear in its final shape after surgery. Thirty days after surgery, the graft had healed completely and the ear had a normal conformation. The successful outcome of this treatment suggests that correction of an ear deformity secondary to scar tissue formation by use of an adapted surgical technique and appropriate materials can be achieved with good cosmetic results in horses.     

Use of the scrotum as a transposition flap for closure of surgical wounds in three dogs

OBJECTIVE: To describe use of the scrotum as a pedicle flap to cover defects created by tumor excision in the perineum or caudal and medial aspect of the thigh. STUDY DESIGN: Clinical study. ANIMALS: Three dogs. METHODS: After tumor excision and prescrotal castration, an incision was made around the base of the scrotum, leaving a pedicle on the side opposite the skin defect. After removal of the tunica dartos and abdominal fascia, the scrotal skin was stretched and shaped to the defect, then sutured in position with a simple interrupted pattern. Bandages that were changed every 48 hours compressed the flaps, and healing was observed until sutures were removed. RESULTS: Two dogs had first intention healing in 15 days, whereas 1 dog developed necrosis of 10% of the flap, and this area healed by second intention. CONCLUSION: In male dogs, the scrotal skin can be used as a pedicle flap for reconstructive surgery of wounds in the perineum and the proximomedial and caudal aspect of the thigh. CLINICAL RELEVANCE: The perineal region remains a surgical challenge because of the lack of the available skin for reconstruction of surgical wounds. The scrotal skin should be considered for use as a transposition flap to cover skin defects in this region.     

Hemidiaphragmatic reconstruction with a transversus abdominis muscle flap after resection of a solitary diaphragmatic mesothelioma in a dog

CASE DESCRIPTION: A 2-year-old Siberian Husky was evaluated because of a 2-week history of coughing and gagging and decreased appetite and activity level. CLINICAL FINDINGS: Radiography, surgery, and immunohistochemical examination revealed a solitary sclerosing mesothelioma extending from the left thoracic diaphragmatic surface that was adherent to the pericardium and the caudal mediastinum. TREATMENT AND OUTCOME: The tumor was resected along with most of the left hemidiaphragm, and the left transversus abdominis muscle was used to reconstruct the diaphragm. The 13th rib formed the base of the muscle flap. The muscle flap was transposed into the defect so that the mesothelium-lined surface faced the thoracic cavity and the deep aspect of the muscle formed the abdominal surface of the diaphragm. To minimize risk of adhesions, the exposed raw aspect of the abdominal surface was covered with porcine small intestinal submucosa. Recovery was uncomplicated, and the dog's appetite and activity level soon returned to normal. Evaluation 54 days after surgery revealed 2 subcutaneous masses on the thorax and masses in the liver and both kidneys; histologic and immunohistochemical analyses revealed metastasis of the original tumor. The dog was euthanatized. CLINICAL RELEVANCE: Hemidiaphragmatic reconstruction with a transversus abdominis muscle flap after resection of a diaphragmatic tumor was successful. The muscle flap was easily harvested and transposed into the diaphragmatic defect.     

Clinical evaluation of caudal superficial epigastric axial pattern flap reconstruction of skin defects in 10 dogs (1989-2001)

Ten dogs with caudal superficial epigastric axial pattern flap reconstruction of extensive skin defects were reviewed. Nine dogs had complete survival of the flap. In one dog, a small area of necrosis occurred near the flap tip. Other complications included seroma formation (n=3), partial incisional dehiscence (n=3), flap edema (n=9), and bruising (n=7). Use of the caudal superficial epigastric axial pattern flap provided full-thickness skin coverage of extensive skin defects of the rear limb and inguinal region, with relatively minor complications that were amenable to conservative management.     

Development of surgical techniques for preparation of in vitro-isolated perfused porcine skin flaps for percutaneous absorption studies

We developed a single-pedicle, axial pattern tubed skin flap that could be transferred to an in vitro perfusion apparatus. On the basis of results of prosections, angiography, contact radiography, and surviving-length studies, it was concluded that a single-pedicle, axial pattern skin flap measuring 4 cm x 12 cm incorporating the caudal superficial epigastric artery would survive to its entire length. Subsequently, a surgical (stage 1) procedure was developed for the routine preparation of single-pedicle, axial pattern tubed skin flaps. Healing after the stage-1 procedure was evaluated by visual inspection and fluorescein angiography. Stage-1 procedures were performed successfully 149 of 160 (93%) times. A second surgical (stage 2) procedure was developed for routine cannulation of the caudal superficial epigastric artery and harvest of the tubed skin flap. Stage-2 procedures were performed successfully 136 of 144 (94%) times.     

Assessment of a caudal external thoracic artery axial pattern flap for treatment of sternal cutaneous wounds in birds

OBJECTIVE: To assess the use of a caudal external thoracic artery axial pattern flap to treat sternal cutaneous wounds in birds. ANIMALS: 16 adult Japanese quail. PROCEDURE: A cutaneous defect in the region of the mid-sternum was surgically created in all quail. In 6 quail (group I), an axial pattern flap was created from the skin of the lateral aspect of the thorax and advanced over the sternal defect. In 8 quail (group II), a flap was similarly created and advanced but the flap vasculature was ligated. All quail were euthanatized at 14 days after surgery and had necropsies performed. Sections of the flap and the surrounding tissue were examined histologically to assess flap viability. RESULTS: All axial pattern flaps in group-I quail had 100% survival. In group II, mean percentage area of flap survival was 62.5%; mean area of necrosis and dermal fibrosis of flaps were significantly greater than that detected in group I. In flaps of group-II quail, neovascularization in the deep dermis and profound necrosis of the vascular plexus in the superficial dermis were observed. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the caudal external thoracic artery axial pattern flap could be used successfully in the treatment of surgically created sternal cutaneous defects in quail with no signs of tissue necrosis or adverse effects overall. Use of this technique to treat self-mutilation syndromes or application after surgical debulking of tumors or other masses might be beneficial in many avian species.     

Use of skin stretchers to elongate a peninsular thoracodorsal axial pattern flap for antebrachial wound closure in a dog

Objective: To describe preoperative use of skin stretchers to elongate a peninsular thoracodorsal axial pattern flap to close a large antebrachial wound on a dog. Study Design: Case report. Animals: A 21 kg, 7‐year‐old, male intact mixed breed dog. Methods: Two skin stretchers were applied to the site of the thoracodorsal axial pattern flap 4 days before surgery. The elastic cables connecting the adhesive pads were tightened daily to increase the skin available for a peninsular thoracodorsal axial pattern flap, which was created and rotated 180° to cover an antebrachial defect to a level 2 cm proximal to the carpus. Results: The entire flap survived; there was a small amount of incisional separation at the distal margin of the flap that healed without further treatment. Conclusion: Preoperative skin stretching provided additional skin for the axial pattern flap used.     

Transposition of first digital pad for reconstruction of a palmar antebrachial soft tissue defect in a cat

An 8-year-old female neutered Siamese cat was presented with a recent history of incomplete excision of an apocrine gland adenocarcinoma from the palmar aspect of the right antebrachium, just proximal to the carpal joint. There was no evidence of metastasis. Wide surgical excision of the previous surgery site was performed resulting in a soft tissue defect. Partial reconstruction was achieved using digital pad transposition of the first digit (dewclaw), forming a local axial pattern flap that was transposed into the adjacent defect. The remaining defect was closed by primary apposition. The skin flap healed successfully. Some breakdown of the skin closed by primary apposition necessitated open wound management. The cosmetic and functional result of the first digital pad transposition was considered excellent, rendering it a useful means to reconstruct soft tissue defects in the carpal region.     

The Isolated Perfused Equine Skin Flap Preparation and Metabolic Parameters

A model for the study of equine cutaneous physiology, pharmacology, and toxicology was developed. Four 4 x 12 cm and twenty-one 6 x 12 cm single-pedicle axial pattern skin flaps based on the caudal superficial epigastric artery, and eight 6 x 12 cm flaps based on the saphenous artery and medial saphenous vein, were raised and sutured in a tubed configuration. On day 2, each flap was removed, the artery was cannulated, and the flap was perfused with a modified Krebs-Ringer's albumin-based medium for at least 6 hours. Flap viability was assessed by glucose use, lactate production, and histologic examination at the end of the perfusion period. The 4 x 12 cm flaps had evidence of skin necrosis, but the 6 x 12 cm flaps remained histologically viable. Results were compared to those previously reported from perfusion of porcine skin flaps based on the caudal superficial epigastric artery. While the ratios of glucose use to lactate production were similar, equine flaps used less glucose and produced less lactate per gram of tissue than similar pig flaps. Equine skin flaps perfused by saphenous vessels used more glucose and produced more lactate than flaps perfused by caudal superficial epigastric vessels. These results indicate that conclusions drawn from cutaneous physiology studies should not be extrapolated across species lines and that site-specific skin should be used for cutaneous physiology, pharmacology, and toxicology studies. The identified skin flaps may have applications in equine reconstructive surgery.     

Carbon dioxide laser resection of a distal carpal pilomatricoma and wound closure using swine intestinal submucosa in a dog

A carbon dioxide laser was used to incise around, dissect, and remove a 2-cm intradermal mass from the left carpus of an 8-year-old, spayed female wheaten terrier. The wound was partially closed, resulting in a 3-cm diameter circular defect with extensor tendons exposed. A swine intestinal submucosa graft was utilized to cover the remaining defect. The graft was removed 5 days later, revealing a healthy granulation tissue bed covering previously exposed tendons with minimal wound margin retraction. The remaining wound was allowed to heal by contraction and epithelialization that was complete by 5 weeks postoperatively. The mass, a pilomatricoma, had not recurred at the last follow-up contact 18 months after surgery. Pilomatricoma, laser application, swine intestinal submucosa grafting, and postoperative wound management are discussed.     

Use of laser Doppler flowmetry to determine blood flow in and viability of island axial pattern skin flaps in rabbits

Perfusion and viability of island axial pattern skin flaps were tested in 37 healthy New Zealand white rabbits, using laser Doppler monitoring of blood flow in the capillary loops and the subpapillary plexus of the dermis. Skin flaps, selected on the basis of the caudal superficial epigastric vein and artery, were lifted and replaced in their original locus after selective occlusion of their vascular pedicles. Subjects were allotted into groups: control group (n = 10); arterial occlusion (n = 7); venous occlusion (n = 10); and arterial and venous occlusion (n = 10). The rabbits were monitored from 48 hours before surgery until euthanasia 48 to 72 hours after replacement of the flap. Flap viability was assessed on a clinical basis, using a comparative scoring method based on a numeric scale. The degree of necrosis in histologic sections was evaluated, using a scoring system. Laser Doppler measurements were obtained on 3 consecutive days before surgery, to establish the normal basal blood flow in the skin. Postsurgical measurements were obtained at 2-hour intervals for the first 8 hours and at 24, 48, and 72 hours after surgery. Measurements of basal blood flow varied significantly (P less than 0.05) from site to site on the surface of individual flaps and over time. When laser Doppler flowmetric (LDF) measurements from 6 sites on a flap were used as a measure of laser Doppler flow for the total flap, there was no significant difference between contralateral flap areas outlined on the abdomen of the rabbits. Temporal variations over 3 days for each rabbit or among rabbits were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prepubic urethrostomy and placement of a caudal superficial epigastric flap for treatment of a self-mutilation injury in a serval

A 10-year-old male serval was examined for treatment of a self-inflicted perineal wound that obliterated the ventral anocutaneous junction, penis, scrotum, testicles, and proximal portions of the caudomedial thigh muscles. Repair required placement of a caudal superficial epigastric flap and prepubic urethrostomy. Although it is generally preferable to delay repair of contaminated wounds until a healthy wound bed is established, circumstances related to wound location, affected tissues, and patient compliance led to a decision for immediate wound closure. In this serval, a history of food intolerance, recent diet change, eosinophilia, and eosinophilic granuloma-like skin lesions suggested that the self-mutilation injury was a result of food hypersensitivity, although foreign body or a spider bite could not be ruled out.