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47 Cards in this Set

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what is an axial pattern flap and how does it differ from other flaps?
contain direct cutaneous artery and vein. allow for larger flap with better survival
how far can an axial pattern flap be rotated? why?
up to 180 degrees at its base
greater rotation can cause venous congestion
what are the 2 differrent ways you can create an axial pattern flap?, and how are they different?
peninsular or island

peninsular has intact skin at its base, protects vascular pedicle. the drawback is the dog ear at point of rotation

with island flap the skin is incised along all edges and flap is rotated on the vascular pedicle. 

island are
peninsular or island

peninsular has intact skin at its base, protects vascular pedicle. the drawback is the dog ear at point of rotation

with island flap the skin is incised along all edges and flap is rotated on the vascular pedicle.

island are more cosmetic, but more susceptible to vascular damage.
name several specialized forms of axial pattern flaps
composite or compound flaps

myocutaneous flaps
overall success rate of apfs?
some advantages of them?
overall success: 87-100%
although tips are prone to necrose, overall survival is at least 50% better than subdermal pkexus flaps

can be placed directly over bone/tendon/ligament
dont need staged procedures
early closure
why might obese patients have higher failure rates?
harder to find blood supply

doppler can help
which vessels are easies/hardest to find
easiest: caudal superficial epigastric

hardest: superficial cervical artery
major diff between cats and dogs in terms of cutaneous vasculature?
dogs have higher density of tertiary vessels than cats, especially on trunk--less cutaneous circulation for cats
major diff in healing wounds between dogs and cats
cats have slower epitheliazation, contraction, GT formation
50% less wound strength at 7 days
GT forms around edges in cats rather than across entire bed
cats more affected by loss of SQ

(its recommended to retain SQ in cats with flaps)
1.caudal auricular
2.omocervical
3.thoracodorsal
4.caudal superficial epigastric
5.lateral genicular
6. deep circumflex iliac
7/lateral caudal
8.superficial brachial
superficial temporal
name a few other axial pattern flaps not shown in diagram
angularis orbis: (labial commisure), usues for palatal, facial, nasal defects

superficial brachial:centered over dorsal third of elbows flexor surface, good for antebrachial and elbow defects

lateral caudal: base of tail
should drains be placed with axial pattern flaps?
almost always indicated, except for very small area, or areas not amenable. should not course directly under the flap?
which are the most robust flaps
thoracodorsal and caudal superficial epigastric
what vessel is the omocervical flap based on?

some uses?

where does vessel originate
superficial cervical artery (cervical cutaneous)

uses: head, neck, facial, ear, cervical , shoulder, axillary, palate (experimental)

superficial cervical branch of omocervical artery originate at the level of the prescap LN and course cranial to scapula in dorsal direction
landmarks of omocervical flap:
caudal icision along border of scap spine. cranial incision cranial to scapula width equidistant to width between incision and cranial border of scapula.  peninsular can go also to level of contralateral scapulohumeral joint. L-shaped should be shorter.
caudal icision along border of scap spine. cranial incision cranial to scapula width equidistant to width between incision and cranial border of scapula. peninsular can go also to level of contralateral scapulohumeral joint. L-shaped should be shorter.
what vessel is thoracodorsal flap based on? uses?
thoradorsal artery

uses for thoracic, shoulder, forelimb, axillary defects
landmarks for thoracodorsal flap
vessel originates caudal to the shoulder at level of acromion and continues dorsally along scapular spine

very similar to omocervical except cranial incision is along caudal scapular spine.
vessel originates caudal to the shoulder at level of acromion and continues dorsally along scapular spine

very similar to omocervical except cranial incision is along caudal scapular spine.
complications of thoracodorsal flap
partial tip necrosis in 70% when flaps used to repair distal limb defects.

one study percent necrosis ranged from 2-53%, mean 21%
thoracodorsal flaps and cats?
paricularly useful because of small leg-trunk ratio. 98% survival experimentally. can even cover carpus.
where does the deep circumflex iliac artery exit the abdomen?

uses?
cranioventral to ilial wing, and then divides in dorsal and ventral branches (both can be used for flaps)

dorsal flap: ipsilateral flank, lateral lumbar, pelvic, lateromedial thigh, over greater trochanter.

ventral: lat abd wall, pelvic, sacral

s
cranioventral to ilial wing, and then divides in dorsal and ventral branches (both can be used for flaps)

dorsal flap: ipsilateral flank, lateral lumbar, pelvic, lateromedial thigh, over greater trochanter.

ventral: lat abd wall, pelvic, sacral

success rates not reported for either technique.
vessel for caudal superficial epigastric flap?

uses?
caudal superficial epigastric artery: exits at the inguinal canal

uses: caudal abdominal, flank, inguinal, preputial, perineal, thigh, stifle defects. dorsal body reconsrtucts, full thickness body wall defects in cats. can even reach distal libs in some animals
caudal superficial epigastric technique
skin incised on midline  beginning just behind caudal teat (base of prepuce included in male dogs).  maximum flap length is to second teat
ditance between teat and midline is measured and equidsitant incision is made lateral to teat
flap undermined deep
skin incised on midline beginning just behind caudal teat (base of prepuce included in male dogs). maximum flap length is to second teat
ditance between teat and midline is measured and equidsitant incision is made lateral to teat
flap undermined deep to supermammarius mm and superfical to rectus sheath
outcome specifics with caudal superficial epigastric
in intact females the mammary glands remain functional.
(can do OVH)
30% complication
Experimentally 95% success
Clinically 90% success
where is the cranial superficial epigastric vessel? uses?
based on short cutaneous branches of cranial superficial epigastric artery, located in the hypogastric area caudoventral to thoracic cage

uses: sternal wounds
based on short cutaneous branches of cranial superficial epigastric artery, located in the hypogastric area caudoventral to thoracic cage

uses: sternal wounds
technique cranial superficial epigastric
base of flap is just caudal to ribcage
width determined by 3rd teat
flap length includes teat 3,4, and sometimes 5.
in male dogs just cranial to tip of prepuce
include panniculus
outcome cranial superficial epigastric
ecperimentally without rotation: 87%


vessel much shorter than caudal superficial epigastric, mor susceptible to vasc injury, anatomy less reliable.

no diff in survival between peninsular an island

clinical results in 1 dog only:93% flap survival
what vessel is angularis oris flap based on?
sngularis oris artery, includes tributaries of facial artery and vein, and inferior and superior labial arteries
angularis oris flap technique

see pg. 1265
deep structures include branches of facial nerve, auriculotemporal nerve, parotid duct, facial vein.
complications of angularis oris flap
movement of flap with respiration
nasal discharge
flap necrosis

when accompanied by maxillectomy, can see billowing of myocutaneous flap b/c communication with nasal cavity

usually resolves with 10 days
technique and uses of superficial temporal artery
uses: maxilofacial, medial eyelif, palate

base defined by caudal aspect of zygomaic arch caudally and lateral orbit and rim  rostrally

width limited by eye and ear and equal to zygomatic arch

length no more than to dorsal rim of contralateral orb
uses: maxilofacial, medial eyelif, palate

base defined by caudal aspect of zygomaic arch caudally and lateral orbit and rim rostrally

width limited by eye and ear and equal to zygomatic arch

length no more than to dorsal rim of contralateral orbit
outcome superficial temporal
experimentally flaps extending to dorsal orbital rim of contralateral eye: 93% dog, 99% cat

69% for flaps extending to contralateral zygomatic arch, so not recommended
caudal auricular flap--what vessel based on?
uses?
based on: caudal auricular axial pattern flap based on sternocleidomastoideus branches of caudal auricular artery

uses: neck, facial area, dorsal head, ear
caudal auricular technique
base of flap at the depression between wing of atlas and vertical ear canal.  dorsal and ventral inciions parallel and centered over lateral cervical area.

length can extend to spine of scapula
base of flap at the depression between wing of atlas and vertical ear canal. dorsal and ventral inciions parallel and centered over lateral cervical area.

length can extend to spine of scapula
outcome caudal auricular flap?
survival reported 85% in dogs
may be better for cats
keeping the flap short may help
superficial brachial flap: vessel? uses? outcome?
based on superficial brachial artery, branch of brachial artery

uses: reconstruction of antebrachial and elbow defects
(does not extend to carpus)

experimentally:98% survival

less tobust in reality--not recommended
technique superficial brachial
parallel incisions along shaft of humerus (slowly taper together dorsally)

should end before reaching greater tubercle
genicular flap vessel? uses? outcome?
vessel: genicular branch of medial saphenous vein
artery extends cranially over medial aspect of stifle and terminates over craniolateral surface

uses: defects from stifle to tarsus medial or lateral

outcome: no clinical reports.
experimental: 89%
flap necrosis ranged from 11-33%
genicular flap technique
base of flap 1cm proximal to patella
and 1.5 cm distal to tib tub on lateral aspect
dorsal and ventral incisions parallel to femoral shaft

keep flap short
base of flap 1cm proximal to patella
and 1.5 cm distal to tib tub on lateral aspect
dorsal and ventral incisions parallel to femoral shaft

keep flap short
reverse saphenous conduit flap
uses?
how does it work?
uses: distal aspect hindlimb

dependent on reverse flow through anastomoses between branches of cranial tibial and saphenous arteries and between medial and lateral saphenous veins

at level of tarsus, cranial branch of saphenous artery anastomoses wi
uses: distal aspect hindlimb

dependent on reverse flow through anastomoses between branches of cranial tibial and saphenous arteries and between medial and lateral saphenous veins

at level of tarsus, cranial branch of saphenous artery anastomoses with superficial branch of cranial tibial artery to form common digital artery.

could be a composite flap including proximal tibia (bone)!, in theory
outcome reverse saphenous?
venous congestion b/c reverse flow through vens. usually subsides within a few days

limited clinical results
experimentally, survival rate 100%in 15dogs
in another study: complete failure in 17% and 33% with branches of cranial and caudal vascular branches respectively. angiography recommended to ensure that both branches are present
lateral caudal flap

vessel?
uses?
based on right and left caudal arteries and veins which branch from the caudal gluteal arteries and veins. located ventral to coccygeal vertebrae

uses: perineal and caudodorsal pelvic regions
lateral caudal flap technique
cranial border is a horizontal line at the level of tail attachement
dorsal or ventral midline incision made over tail

tail amputated between cd2/cd3

flap is rotated.

outcome: only experimental: 79% survival
latissimus dorsi myocutaneous flap. what vessel (s) is it based on? uses?
latissimus has V shaped vascular pattern.
single dominant pedicle relies on thoracodorsal artery: supplies dorsal portion of the muscle
ventral portion supplied lateral thoracic arteries

uses: enables closure of myocutaneous defects like body wall

less pliable and elastic so dimensions must be careful
latissimus dorsi myocutaneous flap technique
caniodorsal point: ventral to acromion and caudal to triceps
skin incised from this point to level of head of thirteenth rib
ventral border at the thoracic skin fold, level to lower third of humerus

paradoxical respiratory movement may be seen when used as thoracic body wall reconstruction
what is the most common cause of flap necrosis? why does this happen
inadequate blood supply
flap elevation
tension
hematoma/seroma-flap pressure
what are some ways to monitor flaps? when do they usually declare themselves by?
color
warmth
bleeding
most declare themselves by day 6

can prick middle of flap to see if it bleeds

doppler and fluorescein are very unreliable

in 1 study of superficial temporal flaps in dogs, fluorescence at days 0 and 3 did not correlate with survival at day 7.
ways to salvage a failing flap:
if under to much tension, release the edges

if infection, C&S

in humans, VAC helps

other things that have been looked at with conflicting results:
pentoxyfilline, dextrans, vasodilators, Ca blockers, hyperbaric O2