Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
1 Companion Animal SEARCH Print BACK HOME 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 1 Companion Animal SEARCH Print BACK HOME 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