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.     

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.     

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.     

ULTRASONOGRAPHIC DIAGNOSIS OF CONGENITAL PORTOSYSTEMIC SHUNTS IN DOGS: RESULTS OF A PROSPECTIVE STUDY

The aims of this study were to determine if accurate diagnosis of congenital portosystemic shunt was possible using two dimensional, grey-scale ultrasonography, duplex-Doppler, and color-flow Doppler ultrasonography in combination, and to determine if dogs with congenital portosystemic shunts have increased or variable mean portal blood flow velocity. Eighty-two dogs with clinical and/or clinicopathologic signs compatible with portosystemic shunting were examined prospectively. Diagnosis of congenital portosystemic shunt was subsequently confirmed in 38 of these dogs using operative mesenteric portography: 14(37%) dogs had an intrahepatic shunt and 24(63%) had an extrahepatic shunt. Ultrasonography had a sensitivity of 95%, specificity of 98%, and accuracy of 94%. Ultrasonographic signs in dogs with congenital portosystemic shunts included small liver, reduced visibility of intrahepatic portal vessels, and anomalous blood vessel draining into the caudal vena cava. Correct determination of intra - versus extrahepatic shunt was made ultrasonographically in 35/38 (92%) dogs. Increased and/or variable portal blood flow velocity was present in 21/30 (70%) dogs with congenital portosystemic shunts. In one dog with an intrahepatic shunt the ultrasonographic diagnosis was based partly on finding increased mean portal blood flow velocity because the shunting vessel was not visible. Detection of the shunting vessel and placement of duplex-Doppler sample volumes were facilitated by use of color-flow Doppler. Two-dimensional, grey-scale ultrasonography alone is sufficient to detect most intrahepatic and extrahepatic shunts; sensitivity is increased by additional use of duplex-Doppler and color-flow Doppler. Increased and/or variable portal blood flow velocity occurs in the majority of dogs with congenital portosystemic shunts.     

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.     

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.     

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.     

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.     

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)     

A Comparison of the Cutaneous Trunci Myocutaneous Flap and Latissimus Dorsi Myocutaneous Flap in the Dog

Latissimus dorsi and cutaneous trunci myocutaneous flaps of equal dimension and location were randomly elevated on opposite sides of the thorax in 10 dogs (group 1) and resutured to their respective bed. The procedure was repeated in four additional dogs (group 2); however, the short perforating branches of the thoracodorsal artery and vein were divided at the base of each cutaneous trunci myocutaneous flap, whereas the cutaneous pedicle and underlying cutaneous trunci muscle were divided in the latissimus dorsi myocutaneous flaps to determine subsequent skin survivability and the major source of circulation of each myocutaneous flap. There was little difference in the percentage of skin survival between the latissimus dorsi and cutaneous trunci myocutaneous flaps in group 1 dogs. Circulation to the "skin island" of group 2 latissimus dorsi myocutaneous flaps originated from intramuscular anastomotic connections between the major branch of the thoracodorsal artery entering the latissimus dorsi muscle and the proximal lateral intercostal arteries perforating the muscle. Ligation of the short perforating branches of the thoracodorsal artery resulted in partial skin necrosis in all group 2 cutaneous trunci myocutaneous flaps. Results from this study indicate that it is unnecessary to elevate the latissimus dorsi muscle for major skin flap elevation and survival. The thicker latissimus dorsi myocutaneous flap is more difficult to develop surgically and appears to have no clinical major advantage over the more mobile cutaneous trunci myocutaneous flap or the adjacent thoracodorsal axial pattern flap for closure of large skin defects within the radius of flap rotation.     

Axial pattern flap based on the lateral caudal arteries of the tail in the dog: an experimental study

OBJECTIVE: To determine applicability and size limits of an axial pattern flap based on the lateral caudal arteries in dogs to reconstruct caudodorsal trunk skin defects. STUDY DESIGN: Experimental study. ANIMALS: Ten mature, mixed breed dogs. METHODS: The lateral caudal vessels of the tail were incorporated in the flaps of the treatment group (n=5) and were ligated in the control group (n=5). Flaps were rotated and placed into experimentally created caudodorsal skin defects on the trunk. The length and area of tissue that remained viable in each flap were determined. RESULTS: Mean (+/-SD) survival area (222.8+/-32.9 cm2) and length (25.1+/-4.5 cm) of vascularized flaps were significantly greater (P<.05) compared with control flaps (94.9+/-13.4 cm2 and 14.61+/-4.7 cm). Necrosis occurred in all control flaps, resulting in lower percentage flap area (48.8%) and length (47.1%) survival compared with vascularized flaps (78.1%, 77.5%). CONCLUSIONS: Axial pattern flap based on lateral caudal arteries of the tail was successfully elevated and transferred in a single procedure, with 78% survival for closure of large experimentally created caudodorsal trunk defects in dogs. CLINICAL RELEVANCE: Large cutaneous defects of the caudodorsal trunk area in dog could be reconstructed with tail axial pattern flap. Limitations in terms of size and changes in animal appearance have to be considered before flap elevation.     

Myoperitoneal Microvascular Free Flaps in Dogs: An Anatomical Study and a Clinical Case Report

The purpose of the anatomical study was to identify potential myoperitoneal microvascular free flaps, in dogs, that are based on a single artery and vein. The angiosomes of the right deep circumflex iliac artery and left phrenicoabdominal (cranial abdominal) artery were evaluated in six medium-sized canine cadavers. The right deep circumflex iliac artery and left phrenicoabdominal (cranial abdominal) artery were injected with a mixture of barium and latex (equal parts). The entire right and left transversus abdominis muscles were dissected from the abdominal wall and radiographed. The angiograms of the deep circumflex iliac artery showed poor arborization of the vessels within the transversus abdominis muscle in all six cadavers. The angiograms of the phrenicoabdominal (cranial abdominal) artery showed consistent filling of the vascular bed of the cranial half of the transversus abdominis muscle flap in all six dogs. The vascular pedicle lengths and the diameter of the arteries and veins of both the deep circumflex iliac and phrenicoabdominal (cranial abdominal) myoperitoneal free flaps were found to be acceptable for microvascular anastomosis. The deep circumflex iliac flap was unacceptable because of inadequate vascular perfusion. The cranial abdominal artery had a consistent, large branch that supplied the cranial half of the transversus abdominis muscle, thereby making a myoperitoneal flap supplied by this vessel a potentially useful free flap. An 8-year-old male, neutered, mixed-breed dog was evaluated for possible repair of a large defect of the hard palate. Previous operations, using local tissue flaps, had been unsuccessful. A myoperitoneal free flap, based on the right cranial abdominal artery, and consisting of the cranial portion of the transversus abdominis muscle, was used successfully to reconstruct the hard palate. Migrating epithelium from the edges of the wound covered the myoperitoneal flap by 10 weeks after surgery. Therefore, the cranial abdominal myoperitoneal free flap can be considered for reconstruction of intra-oral defects that cannot be repaired using conventional local flap techniques.     

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.     

Complications and outcome after thoracodorsal axial pattern flap reconstruction of forelimb skin defects in 10 dogs, 1989-2001

OBJECTIVE: To determine (1) the frequency and extent of complications associated with thoracodorsal axial pattern flap reconstruction of forelimb skin defects in dogs and (2) outcome after treatment of such complications. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Ten dogs. METHODS: Medical records for 10 dogs that had a thoracodorsal axial pattern skin flap reconstruction of a forelimb skin defect were reviewed. RESULTS: Three dogs had complete flap survival. Partial necrosis of the distal flap, ranging from an estimated 2% to 53% (mean, 21%) of the flap surface area, occurred in 7 dogs. Six dogs required surgical management of the skin necrosis, resulting in successful resolution in 5 dogs, whereas, in 2 dogs, the wound healed by second intention. Positive bacterial cultures were obtained from 3 dogs with distal flap necrosis. Seroma formation was noted in 2 dogs; the entire flap survived in 1 dog, whereas the second dog developed distal flap necrosis. Edema and bruising of the distal portion of the flap were noted in 8 dogs; distal flap necrosis subsequently developed in 7 dogs. Partial incisional dehiscence, which healed by second intention, occurred in 2 dogs. Of 6 owners available for follow-up, all were satisfied with the functional outcome, but 1 owner was not satisfied with the cosmetic appearance. CONCLUSIONS: Partial flap necrosis was a frequent complication of thoracodorsal axial pattern flap reconstruction of forelimb skin defects and required additional wound care or surgical intervention to achieve healing. CLINICAL RELEVANCE: Thoracodorsal axial pattern flaps can provide full-thickness skin coverage of extensive skin defects of the forelimb, but owners should be aware of the likelihood of local wound complications.     

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.     

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.     

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.     

Regional Peripheral Vascular Supply Based on the Superficial Temporal Artery in Dogs and Cats

Cutaneous arterial blood supply to the temporal region was evaluated in 8 dogs and 8 cats. Subtraction radiography and angiography of the carotid and superficial temporal arteries were used in 4 dogs and 4 cats to determine arterial blood supply to the temporal region and frontalis muscle. A myocutaneous axial pattern flap based on the superficial temporal artery and frontalis muscle may be indicated for cosmetic reconstruction in dogs and cats following surgical resection of neo-plastic lesions or traumatic wounds in the maxillofacial region. The frontalis muscle was identified as the thin subcutaneous continuation of the platysma muscle extending cranially and rostrally. Dissection of the temporal region in 4 dogs and 4 cats revealed the subcutaneous location of the superficial temporal artery as it continues rostrally from the caudal aspect of the zygomatic arch.     

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.     

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.