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.     

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.     

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.     

Axial Pattern Flap Based on the Superficial Brachial Artery in the Dog

An axial pattern flap based on the superficial brachial artery and vein (brachial axial pattern flap) was developed on the forelimbs of five dogs. The flap was immediately transferred to a distal cutaneous defect created on the antebrachium of that limb. A control flap was elevated on the opposite limb and transferred to a similar distal site after ligation of the superficial brachial artery and vein at the base of the flap. Mean brachial axial pattern flap survival (98%) was significantly more than mean control flap survival (77%) (p less than 0.05). Results of this study suggest that the brachial axial pattern flap has potential application for closure of major cutaneous defects involving the canine antebrachium above the carpus.     

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.     

Caudal Superficial Epigastric Arterial Pedicle Grafts in the Dog

A direct cutaneous arterial pedicle graft (axial pattern flap) was created from the mammary chain including glands 2 through 5 using the caudal superficial epigastric artery and vein in 4 male and 4 female dogs. All grafts survived immediate development and transfer to the recipient site which was either the flank, inner thigh, or lower limb region. A high per cent survivability rate can be expected if precautions are taken. This procedure has special application for reconstruction of extensive flank, inner thigh and inguinal skin losses.     

Simultaneous use of bilateral caudal superficial epigastric axial pattern flaps for wound closure in a dog

A neutered male German shorthaired pointer sustained severe bite wounds to the left caudal flank and thigh area. Thorough wound lavage and debridement was performed immediately and also three days after presentation. Daily wound dressing resulted in the production of a mature granulation tissue bed. Prior to wound closure, colour flow Doppler ultrasonography was used to confirm blood flow through the right and left caudal superficial epigastric arteries and veins. Sixteen days after presentation, right and left caudal superficial epigastric axial pattern flaps were simultaneously elevated to cover the defect. The right flap was elevated as an island flap, rotated 120 degrees and used to cover the caudodorsal aspect of the defect. The left flap was elevated and rotated dorsally to cover the cranioventral aspect of the defect. Ninety per cent wound coverage was achieved and flap survival was total. The donor site defect was closed primarily and no dehiscence occurred. Three months postsurgery, the entire defect was closed and limb function was normal.     

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.     

Reverse Saphenous Conduit Flap in Cats: An Anatomic Study

The vascular anatomy of the reverse saphenous conduit flap in cats was denned by contrast radiography of both hindlimbs of 18 feline cadaver specimens. In all 36 flaps, flow of contrast medium from the femoral artery to the distal end of the flap was documented. Direct anastomosis of the superficial branch of the cranial tibial artery with the cranial branch of the saphenous artery and communication of the caudal branch of the saphenous artery with the perforating metatarsal artery, via the medial and lateral plantar arteries, was documented. The cranial branch of the medial saphenous vein was shown to anastomose with the cranial branch of the lateral saphenous vein. The presence of these anastomoses support the feasibility of the reverse saphenous conduit flap as an option for reconstruction of wounds of the metatarsus in cats.     

Veins of the thoracic limb of the Van cat

The drainage of the thoracic limb of the Van cat was performed by the superficial and deep vein systems. The superficial system was constituted by the cephalic vein and its branches. The deep vein system was constituted by the axillary vein and its branches. The two vein systems anastomosed with each other at various points along their courses. The cephalic vein emerged from the external jugular vein together with the superficial cervical vein. The axillary vein continued the subclavian vein. It ran caudoventrally and gave off the subscapular vein, at the level of the shoulder joint, then gave off two independent branches, which were the external thoracic veins. Then the rest of the vessel continued as the brachial vein. The thoracodorsal vein was formed by the communicate ramus vein which arose between the subscapular vein and the brachial vein. The cranial circumflex humeral vein arose double from the subscapular vein. One of them anastomosed with the deep brachial vein and the other one drained the biceps and the deep pectoral muscles. The cranial interosseous vein from the caudal aspects of the brachial vein and passed the interosseous space of the antebrachium then ran to the lateral aspect of the forearm. The caudal interosseous vein arose from the ulnar vein (in two specimens) and the median vein together with the ulnar vein (in two specimens) or independently from the median vein (in one specimen). Although many similarities were found in the veins of the thoracic limb of the Van cat as compared with the domestic cat, some significant differences were noted in the origin, course, anastomosing and ramification of veins of the thoracic limb.     

Macroanatomic investigations of the blood supply of thoracic limb of Kangal dogs

In this study, the arterial supply of the thoracic limb was investigated in Kangal dogs. Twelve adult healthy Kangal dogs of either sex were used. Latex was injected into the common carotid artery, and then the axillary artery was dissected. The axillary artery is a continuation of the subclavian artery and supplies the thoracic limb in Kangal dogs. The axillary artery gave off a deltoid branch and external thoracic, lateral thoracic, and subscapular thoracic arteries in its course along the thoracic wall. The axillary artery continues distally as the brachial artery in the arm. The brachial artery gives rise to the cranial humeral circumflex, deep brachial, bicipital, ulnar collateral, superficial brachial, transverse cubital, and common interosseus arteries. It continues as the median artery after giving off the common interosseus artery. It was observed that the deep antebrachial artery arose from the median artery at the proximal third of the forearm. In the distal third of the forearm, the median artery divided into the palmar carpal and dorsal carpal branches. The deep palmar branch of the radial artery and deep branch of the palmar branch of the caudal interosseus artery form the deep palmar arch. The median artery joined the superficial branch of the palmar branch of the caudal interosseus artery to constitute the superficial palmar arch. The radial artery and cranial interosseus artery contributed to the dorsal carpal rete. The ulnar artery contributed to the formation of the deep and superficial palmar arches.     

Axial pattern flap based on the caudal auricular artery in dogs

An axial pattern flap that was based on the sternocleidomastoideus branches of the caudal auricular artery and vein was developed. Control flaps, which included ligation and division of the caudal auricular artery and vein, were similarly developed on the contralateral aspect of the neck. Mean survival of caudal auricular artery axial pattern flaps (85.2%), compared with control flaps (63.9%), was significantly different (P less than 0.05). On the basis of results of this study, an axial pattern flap based on the sternocleidomastoideus branches of the caudal auricular artery and vein may be a source of skin for reconstructive procedures of the head and neck.     

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.     

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)     

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 Anatomic Basis for a Trapezius Muscle Flap in Dogs

The anatomy of the cervical part of the trapezius muscle and its dominant vascular supply, the prescapular branch of the superficial cervical artery, was studied by dissection and selective angiography of 16 canine cadavers. The prescapular branch of the superficial cervical artery supplies blood to the skin of the caudal half of the neck and the cervical part of the trapezius muscle and is a minor contributor to other muscles of the neck. In these dogs, the mean length of the vascular pedicles was 4.4 cm and the mean diameter was 1.0 mm. With this information, it is possible to design a broad musculocutaneous flap suitable for reconstructive microsurgery in dogs. The potential for successful incorporation of the scapular spine in such a flap remains uncertain.     

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.     

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.     

Experimental definition of latissimus dorsi, gracilis, and rectus abdominus musculocutaneous flaps in the dog

Dissection and injection studies in canine cadavers and in anesthetized dogs were conducted to determine the feasibility of using the latissimus dorsi, gracilis, and rectus abdominus muscles as musculocutaneous free flaps. Lengths of vascular pedicles for the latissimus dorsi (2 +/- 0.8 cm), gracilis (1.8 +/- 0.8 cm), and rectus abdominus (1.9 +/- 0.9-cm cranial deep epigastric, 1.7 +/- 0.5-cm caudal deep epigastric), as well as arterial diameters (1.28 +/- 0.31-mm thoracodorsal for the latissimus dorsi, 1.10 +/- 0.33-mm muscular branch for the gracilis, 1.25 +/- 0.25-mm cranial deep epigastric and 1.26 +/- 0.32-mm caudal deep epigastric for the rectus abdominus) were considered satisfactory for microvascular transfer. Fluorometry demonstrated overlying cutaneous perfusion in all flaps based on their muscle vascular pedicles, with the exception of the rectus abdominus flap based on the caudal deep epigastric artery. In this instance, up to 20% of the cutaneous element had questionable or no perfusion.