Download companion animal

1
Companion Animal
SEARCH
Print
BACK
HOME
Reconstructive Surgery
Reconstruction techniques in oncological
surgery: thorax and thoracic limb
Introduction
Axial pattern flaps that can be used for thoracic and upper forelimb reconstruction
are the omocervical, thoracodorsal, the cranial and caudal superficial epigastric and
brachial axial pattern flaps.(1,2) The muscle and myocutanous flaps that can be used
include the external abdominal oblique, the cutaneous trunci and lattisimus dorsi
myocutaneous flaps as well as the flexor carpi ulnaris muscle flap. The forelimb fold
transposition flap technique can be used for defects of the upper arm or sternal region.
(3) Mesh grafting is used for distal limb lesions, when no local tissue is available at all.
Gert ter Haar DVM, PhD,
MRCVS, DECVS
Royal Veterinary College,
Department of Clinical
Sciences and Services
Thoracodorsal axial pattern flap(1,2)
This flap is based upon the cutaneous branch of the thoracodorsal artery which
arborizes in a dorsal direction behind the scapula. The cranial boundary of this flap is
the spine of the scapula. The caudal boundary is the skin parallel to the cranial incision,
equal to the distance from the cranial incision to the caudal shoulder depression. The
incisions are made to the dorsal midline, but can be extended to the contralateral side.
United Kingdom
[email protected]
Cranial superficial epigastric axial pattern flap(1,2)
The cranial superficial epigastric axial pattern flap is based on the cranial superficial
epigastric artery. The base of the flap is located in the region of the cranial epigastric
vessel, entering the skin lateral to the abdominal midline and a few centimeters caudal
to the cartilaginous border of the ventral thorax. The flap may include mammary glands
three, four, and possibly, five. In the male, the end of the flap must be cranial to the
prepuce to enable closure of the donor site. The midline of the abdomen serves as the
central border of the flap, whereas the distance from the midline to the mammary teats
serves as the reference of measurement for the lateral incision.
Brachial axial pattern flap(2,4)
This axial pattern flap is used to cover antebrachial wounds and defects involving the
elbow. A cutaneous branch of the superficial brachial artery supplies the craniomedial
Abstracts | European Veterinary Conference Voorjaarsdagen 2014
antebrachium. The animal is positioned in dorsal recumbency with the thoracic limb
stretched. Two lines are drawn parallel to the humerus, from the elbow joint to the
greater tubercle of the humerus. The flap is progressively tapered approaching the
greater tubercle, where the two lines are connected, the length of the flap is defined by
measuring from the pivot point. Incisions are made following the lines from the end to
the base of the flap, after which the flap is elevated and rotated laterally into the defect.
Lattisimus dorsi myocutaneous flap and cutaneous trunci myocutaneous flap(1)
The landmarks for the latissimus dorsi myocutaneous flap are the ventral border
of the acromion, the caudal border of the triceps muscle, the head of the 13th rib
and the axillary skin fold. The latissimus dorsi myocutaneous flap is well suited for
reconstruction of thoracic wall defects. The landmarks for the cutaneous trunci
myocutaneous flap are: the ventral border of the acromion, the caudal border of the
triceps muscle, the head of the 13th rib and the axillary fold. The dorsal flap border is
drawn from a point ventral to the acromion caudal to the border of the triceps muscle,
towards the last rib. The ventral border is parallel to the dorsal border, starting in the
axillary skin fold.
Flexor carpi ulnaris muscle flap(4)
The flexor carpi ulnaris muscle flap consist of the humeral head of the flexor carpi
ulnaris and is used in cases of chronic wounds involving the antebrachial, carpal and
metacarpal areas. The origin of the humeral head is the medial humeral epicondyle.
The humeral head of the flexor carpi ulnaris muscle is vascularised by the caudal
interosseous artery that enters the muscle at the distal tendon.
Forelimb fold flap(3)
The forelimb skin fold, loosely overlying the triceps musculature, can be elevated as
a transposition flap and used to close skin wounds in the adjacent axillary, thoracic
and sternal area of the dog and cat. The forelimb skin fold is grasped to determine
the amount of skin that can be harvested as a skin flap. Symmetrical lateral - medial
skin incisions are outlined with a marking pen where the folds can still easily be
compressed with the fingers without compromising closure of the donor site. Incisions
are connected in a U fashion, proximal to the elbow after which the flap is carefully
www.voorjaarsdagen.eu
1
Companion Animal
SEARCH
Print
BACK
HOME
Reconstructive Surgery
undermined, elevated, opened and transposed into the desired destination. Hunt has
described the use of this flap for large defects encroaching on the axillary and sternal
areas of the dog and cat.
Mesh graft(4)
The mesh graft is a nonvascularised skin flap that uses skin from another part of the
body, which is transferred to the recipient defect side. Extreme care should be taken
in fast and atraumatic harvesting and attachment of the flap. For full thickness grafts,
which have the advantage of better cosmetic end results, the skin is elevated from the
site without the panniculus muscle or subcutaneous fat. Slits are made in the graft, to
allow drainage, which will expand the graft size significantly.
References
1. Delden M, Buiks SC, Haar ter G. Reconstructive techniques of the neck and trunk. In: Kirpensteijn J, Haar ter
G, editors. Reconstructive Surgery & Wound Management of the Dog & Cat. London: Manson Publishing Ltd;
2012. pp. 153–82.
2. Pavletic MM. Axial Pattern Skin Flaps. In: Pavletic MM, editor. Atlas of Small Animal Wound Management and
Reconstructive Surgery. 3rd ed. Wiley-Blackwell; 2010. pp. 357–402.
3. Hunt GB, Tisdall PL, Liptak JM, et al. Skin-fold advancement flaps for closing large proximal limb and trunk
defects in dogs and cats. Vet Surg 2001;30(5):440–8.
4. Buiks SC, Reijntjes T, Kirpensteijn J. Reconstructive techniques of the forelimb. In: Kirpensteijn J, Haar ter G,
editors. Reconstructive Surgery & Wound Management of the Dog & Cat. London: Manson Publishing Ltd;
2012. pp. 183–208.
Abstracts | European Veterinary Conference Voorjaarsdagen 2014
www.voorjaarsdagen.eu