canis - Articles
Skin flap: pedicle
Synonym(s): plastic surgery; reconstructive surgery
Introduction
- Wound reconstruction, eg carcinoma external nose
, following wide local excision 
, hemangiopericytoma 
, deficit following compartmental resection 
or reconstruction of a traumatic wound, utilizing skin flap(s) retaining its original vascular supply.
Uses
Conventional flaps - random subdermal flaps
- Vascularized solely by capillaries in subdermal plexus until neovascularization establishes a secondary blood supply from the recipient bed
: - Advancement flaps
. - Rotation flaps
. - Transposition flaps
.
- Advancement flaps
Axial flaps
- Vascularized by single direct cutaneous vessel
. - Common axial flaps include:
- Caudal superficial epigastric for lower abdomen, groin and medial thigh.
- Deep circumflex iliacs for lateral thigh and lumbar region.
- Omocervical for cranial shoulder and cervical region.
- Thoracodorsal for thoracic, forelimb and axillary region.
- Caudal auricular for head.
Advantages
Axial flaps
- Longer and more mobile than conventional flaps.
- Mobility increased by:
Either Complete detachment of skin: direct cutaneous vasculature left attached to donor site.
Or Microvascular techniques used to re-anastomose to fresh vascular supply in local area of defect. - Intentional incorporation of an axial vessel in a flap improves blood supply to the distal region, improving results, reducing risk of wound infection.
- Allows for long, narrow pedicles to transfer donor skin to remote areas.
Disadvantages
Conventional flaps
- Viability determined largely by pedicle base width and vascularity .
- Smaller and less mobile than axial flaps.
Axial flaps
- Careful pre-operative planning and patient positioning to include axial vessel in reconstruction.
- Technically more challenging.
- Some techniques complex, eg microvascular anastomosis for orthotopic graft transfer.
- Surgeon must ensure that axial vessel has not been damaged.
Alternative techniques
- Primary closure Wound closure: primary.
- Delayed primary closure Wound closure: delayed primary.
- Healing by secondary intention Wound: secondary intention healing.
- Free skin grafting Skin: free grafting.
Decision taking
Criteria for choosing test
- Same as: primary closure Wound closure: primary.
- Axial pattern flaps should be used wherever possible if the location is suitable.
- Local flaps can be used if adjacent skin is available.
- Wound must be healthy and free of infection or neoplasia.
Requirements
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Preparation
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Technique
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Aftercare
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Outcomes
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
Other sources of information
- How to perform a transposition flap. dvm360: https://www.youtube.com/watch?v=eqs3Czi6CSM.
- Single pedicle advancement flap. dvm360: www.youtube.com/watch?v=A9C7-86qL-Y.
- Pavletic M M (1992) Atlas of small animal reconstructive surgery. Philadelphia: J B Lippincott.