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Reconstructive Surgery
Reconstruction techniques in oncological
surgery: abdomen, perineum and pelvic limb
Gert ter Haar DVM, PhD,
MRCVS, DECVS
Royal Veterinary College,
Department of Clinical
Sciences and Services
United Kingdom
[email protected]
Introduction
Reconstruction of the more caudal part of the trunk and in particular of the perineal
area is challenging. The axial pattern flaps that can be used are the thoracodorsal, the
cranial and caudal superficial epigastric, the deep circumflex iliac, the genicular and
the tail axial pattern flap as well as the reversed saphenous conduit flap. The muscle
and myocutanous flaps available are the external abdominal oblique, tensor fascia lata,
cutaneous trunci, lattisimus dorsi myocutaneous and the cranial and caudal sartorius
flaps.(1,2) The scrotum flap can be used in the perineal area, whereas the hind limb
(flank) fold transposition flap can be used for defects of the upper limb or inguinal
region. The toe fillet technique can be used for reconstruction of the lower limb and
paw.
Caudal superficial epigastric axial pattern flap(2)
The caudal superficial epigastric axial pattern flap can be used to cover skin defects on
the medial and lateral aspect of the pelvic limb, caudal abdomen, flank, inguinal area,
prepuce and perineum. In a female patient the mammary glands are included. If the
procedure is performed on a male patient, the base of the prepuce must be included, to
prevent ischemia of the flap.
Lateral caudal artery axial pattern flap(1)
To use the tail flap, amputation of the tail is necessary. The skin of the proximal cranial
75% of the flap can be used to reduce the possibility of distal flap necrosis. A dorsal
midline incision along the length of the tail is used to cover dorsocaudal defects, a
ventral midline skin incision is used to cover defects of the perineum and upper pelvic
limb.
cranioventral of the wing of the ilium. With the animal in lateral recumbency, the flap is
drawn. The first, caudal line, starts on the proximal half of the ilium, and extends distally
following the femoral shaft. The second, cranial line is drawn parallel to the caudal. The
ventral and dorsal borders are drawn as far as is needed.
Reversed saphenous conduit flap(2)
The reverse saphenous conduit flap is a flap used to repair defects on the tarsal joint,
or more distal. It consists of a skin flap of the medial distal paw, including the medial
saphenous vein and artery. The veins and arteries are proximally ligated to reverse the
blood flow, and the flap is rotated distally. An adequate blood supply is secured through
anastomoses with the cranial lateral and medial saphenous artery and the metatarsal
artery.
Cranial and caudal sartorius muscle flap(2)
The cranial sartorius muscle is used to cover defects in the caudal abdomen and
inguinal area. With the animal in dorsal recumbency, incisions are made in the skin
following the caudal border of the sartorius muscle, extending the incision up to
the patella. The cranial belly of the sartorius muscle is exposed, which is then freed
from its caudal belly. The muscle is dissected free of its origin, close to the tibial joint
and transected from its aponeurosis. The flap is rotated and sutured into the defect.
Alternatively, the caudal part of the muscle can be used. After dissection of the caudal
belly, the saphenous artery and vein are ligated and transected where they originate
from femoral artery and vein, to reverse blood flow from distal to proximal.
Scrotum flap(1)
The scrotum flap can be used to cover large defects in the perineal area or caudal and
medial aspect of the thigh. The scrotal skin is thin and has a greater elasticity than
truncal skin. Perineal branches of the external pudendal and cremaster artery supply
the scrotum with blood. A prescrotal castration is performed in intact male dogs prior to
reconstruction of the defect.
Deep circumflex iliac axial pattern flap(2)
The deep circumflex iliac axial pattern flap, ventral branch, can be used to cover
defects of the flank, medial and lateral thigh, and pelvic region. The artery emerges just
Abstracts | European Veterinary Conference Voorjaarsdagen 2014
www.voorjaarsdagen.eu
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Reconstructive Surgery
Hindlimb flank fold flap(2,3)
The skin fold cranial to the knee in the dog and cat can be used to cover defects of the
caudal abdominal area and pelvic limb. This flap has its own blood supply through the
ventral branch of the deep circumflex iliac artery. With the animal in dorsal recumbency,
the flank fold is held between the fingers to assess the amount of skin that can be
removed. A line is drawn from the medial proximal thigh to the distal thigh returning to
the proximal lateral thigh, creating a U-shaped flap.
Toe fillet flap(4)
The phalangeal fillet technique is indicated for the management of partial injuries
to the metacarpal/metatarsal pad or as a replacement for the pad when it has been
completely lost. The principle of this technique is the removal of the proximal, middle
and distal phalanges in order to use the distal pad to fill a defect in the metacarpal/
metatarsal pad. The bony phalanges can be removed via a plantar/palmar or via a dorsal
incision.
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. Reijntjes T, Kirpensteijn J. Reconstructive techniques of the hindlimb. In: Kirpensteijn J, Haar ter G, editors.
Reconstructive Surgery & Wound Management of the Dog & Cat. London: Manson Publishing Ltd; 2012. pp.
209–32.
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