Axial pattern flaps

Abstract

Reconstruction of large skin defects following trauma or radical excision of neoplastic masses can be problematical, particularly when wounds occur on the extremities where there is not enough skin for primary closure. Options for management include: axial pattern flaps; local subdermal plexus flaps; skin grafts; and second intention healing. There may, however, be insufficient skin adjacent to the wound to allow second intention healing or the use of local subdermal plexus flaps. Second intention healing may also result in formation of fragile epithelium or wound contracture. Axial pattern flaps are used for the one-stage reconstruction of wounds. Flaps are usually raised from the trunk, neck or proximal limbs, where there is sufficient loose skin to allow closure of the donor site with minimal morbidity. They provide durable full-thickness skin with a predictable vascular supply, resulting in normal to near-normal hair growth and minimal visible scar tissue, although hair growth is in the opposite direction and may be of different length and texture to the hair in the local area. Functional results after successful axial pattern flap use are good, although some owners are dissatisfied with cosmetic results. The chapter considers Blood supply and axial pattern flaps; and Complications and flap failure. Case examples: Superficial cervical axial pattern flap for a face wound in a cat; Thoracodorsal axial pattern flap for an elbow wound in a dog. Operative techniques: Axial pattern flap; Thoracodorsal axial pattern flap; Superficial cervical (omocervical) axial pattern flap; Caudal superficial epigastric axial pattern flap; Lateral thoracic axial pattern flap; Deep circumflex iliac (ventral branch) axial pattern flap; Deep circumflex iliac (dorsal branch) axial pattern flap; Cranial superficial epigastric axial pattern flap; Superficial brachial axial pattern flap; Genicular axial pattern flap; Reverse saphenous conduit axial pattern flap; Superficial temporal axial pattern flap; Caudal auricular axial pattern flap; and Lateral caudal axial pattern flap