Plexus Flap Research Articles

Single Pedicle Advancement Flap Models for Teaching Veterinary Reconstructive Surgical Techniques.

Reconstructive surgical techniques are used in both general and referral veterinary practice to facilitate closure of challenging wound defects. During veterinary studies, there are often limited opportunities for students to practice these techniques on live patients or cadavers. Surgical models, including suture pads and ovariohysterectomy models, have been successfully incorporated into veterinary teaching, providing students with additional practice. Models to simulate veterinary reconstructive surgical techniques are lacking. In the current study, a single pedicle advancement flap model was designed. The design consisted of a silicone model secured by a plate, providing tension. Fifth-year veterinary science students (n = 34) were surveyed to assess the model's impact on surgical technique and confidence. Students were also assessed to determine surgical technique using the models. It was hypothesized that students who had two additional practice sessions using the models (Trial group, n = 17) would show greater improvement in technique than students who had no practice sessions between assessments (Control group, n = 17). Students strongly agreed (median score 5/5) that using the model helped to reinforce the subdermal plexus flap technique and improved their confidence in performing a subdermal plexus flap. Students from both groups performed significantly better in the follow-up assessment compared to the initial assessment. No significantly greater improvement was observed in technique between the control and the trial groups. Results suggest that the students' reconstructive surgical technique improved after a single practice session and that the single pedicle advancement flap model can be used synergistically with other teaching methods.

Marginal excision of cutaneous mast cell tumors in dogs was not associated with a higher rate of complications or prolonged wound healing than marginal excision of soft tissue sarcomas.

To compare wound healing following planned marginal excision of cutaneous mast cell tumors (MCTs) with that of soft tissue sarcomas (STSs) and to identify risk factors for wound healing complications and delay in healing. 126 dogs that underwent intentional marginal excision of cutaneous MCTs (n = 77) or subcutaneous STSs (49). Medical records of included dogs were reviewed and signalment, tumor size, tumor location, skin closure type, time to healing, reported complications, histopathological grade, and surgical margins were recorded. These variables and outcomes (complication rate and time to complete healing) were compared between dogs in the MCT and STS groups. Potential risk factors for complications and delayed healing were analyzed. No significant difference between the groups was found in any of the variables. Wound healing complication rates were 29% (22/77) for the MCT group and 31% (15/49) for the STS group. The mean ± SD time to complete healing was 16.5 ± 7.5 days for the MCT group and 17.7 ± 9.3 days for the STS group. These outcomes did not differ significantly between groups. For both groups, the use of subdermal plexus flap reconstruction was associated with the development of complications and increased time to complete healing. Marginal excision of cutaneous MCTs was not associated with a higher rate of complication or prolonged wound healing, compared with marginal excision of STSs. The use of flap reconstruction in skin closure may delay healing and planned adjuvant therapy. Owners should be counseled regarding these risks and where appropriate and feasible, surgery without reconstruction should be considered.

Studies on reconstruction of large skin defects following mammary tumor excision in dogs

Aim:The main objective of the study was to describe the use of skin fold advancement flaps (SFAFs) and other reconstructive techniques for closure of large skin defects following mammary tumor excision in dogs.Materials and Methods:Twelve dogs underwent reconstruction of large ventral skin defects following mammary tumor excision with wide margins. Skin fold flaps (flank fold flap and elbow fold flap) were elevated from the flank and elbow region, respectively, and transposed and sutured onto the large ventral skin defect following mastectomy in all the dogs. In addition to the skin fold flaps, other reconstructive techniques such as undermining, walking sutures, and tension-relieving suture techniques were followed during surgery in the closure of large skin defects without skin tension and compromising limb mobility. The skin flap viability was assessed subjectively by gross observation of the flap such as color, temperature, capillary perfusion, and cosmetic appearance, and scoring (1-4) was done. Tissue samples were collected from a surgical site on days 3, 6, and 12 post-operatively for histopathological evaluation and healing status of the skin flap.Results:All the surgical wounds healed primarily, without any major complications and the skin flap remained healthy throughout the healing process post-operatively. Distal flap necrosis was noticed in one case and necrosis of skin flap between two suture lines was noticed in another case in which the necrotized distal portion healed by secondary intention after 7 days. The mean survival of subdermal plexus flap in the above cases was 98% which was a subjective evaluation based on surface area of the skin defect measured by Image’ J software and the flap dimensions. The average healing of skin flap in days was 14.91±0.86.Conclusion:The SFAFs along with other reconstructive techniques help in the reconstruction of large ventral skin defects following mastectomy in dogs without much compromising limb mobility.

Reconstructie van de schedel van een hond met een titanium mesh na het verwijderen van een multilobulair osteochondrosarcoom

Een elf jaar oude cavalier-king-charles-spaniël werd aangeboden met een grote massa centraal op het schedeldak. Met behulp van computertomografie werd de intracraniale uitgebreidheid van het letsel vastgesteld. Bioptname en histologisch onderzoek leidden tot de diagnose van een graad-1 multilobulair osteochondrosarcoom. Vermits dit een biologisch matig agressieve tumor is die traag groeit, de nabijgelegen weefsels wegdrukt in plaats van te invaderen en deze laaggradige tumor slechts bij 30% van de patiënten metastaseert, werd besloten tot chirurgische resectie. Een ruime partiële craniëctomie werd uitgevoerd, waarna het defect in het schedelbot werd gereconstrueerd met een specifiek daartoe bestemde titanium mesh. Het huiddefect werd gesloten met een lokale huidflap. De marges werden histologisch beoordeeld en waren vrij van tumorcellen. Volledige chirurgische resectie van deze tumor kan resulteren in een lange overlevingstijd. De beschreven hond was ruim zeventien maanden na de operatie nog steeds in leven, zonder aanwijzingen voor een lokaal recidief of metastasering.

Distally Based Perforator Propeller Sural Flap for Foot and Ankle Reconstruction

Distally based perforator propeller sural flaps that pedicled on an isolated perforator from the peroneal artery or posterior tibial artery are a versatile local reconstructive option for defects of the foot and ankle region. However, flap venous congestion is yet a difficult problem after operation. We hypothesize that containing some adipofascial tissues around the axial perforator can preserve some tiny venous return routes, improve venous drainage, and ultimately enhance flap safety in distally based sural flaps. A prospective case series of 12 patients undergoing distally based perforator sural flaps for foot and ankle coverage were included in this study from January 2008 to December 2010. There were 7 posterior tibial artery perforator flaps from the posteromedial sural region and 5 peroneal artery perforator flaps from the posterolateral sural region. After identifying the proper viable perforator during operation as the pivot point, the whole flap was designed in an eccentric propeller shape. The proximal larger blade was a fasciocutaneous flap, whereas the distal smaller blade was a subdermal vascular plexus flap, preserving at least a quarter area of adipofascial tissue intact around the perforator. Postoperatively, flap swelling was classified into a 5-grade assessment scale. Flap survival, complications, and patient functional recovery were evaluated. The proximal fasciocutaneous flap measured 4 × 8 to 6 × 18 cm (mean, 57.8 cm), and the distal subdermal cutaneous flap measured 2 × 2 to 4 × 4 cm (mean, 9.2 cm). The flaps were rotated 160 to 180 degrees. Postoperatively, flap swelling was noted under grade 2 in 9 cases, grade 3 in 2, and grade 4 in 1 with some distal superficial skin necrosis, which occurred in the largest flap in our series. All flaps survived uneventfully. After a mean of 13 months of follow-up, the wounds were cured successfully. All patients recovered walking and shoe wearing function. Keeping a quadrant adipofascial tissue around the distal pivot perforator to form a perforator-adipofascial-pedicle can preserve more venous return routes and relieve flap swelling. This technique should be recommended in distally perforator-pedicled propeller flaps because it enhances flap safety yet does not increase the difficulty of 180-degree rotation.

Pilot Study of the Suitability of Dorsal Vulval Skin as a Transposition Flap: Vascular Anatomic Study and Clinical Application

To identify the blood supply to the vulval fold and adjacent skin, and evaluate it as a transposition flap for closing perineal wounds in dogs. Prospective study. Five female canine cadavers and 2 cases referred for excision of mast cell tumors adjacent to the vulva. Dissection was performed to identify the vascular supply to the vulval fold in two cadavers following arterial injection of red latex and methylene blue, respectively. In three cadavers, barium sulfate mixed 1:1 with water was injected into the terminal aorta. The vulval fold and surrounding perineal skin was excised and radiographed. Transposition flaps using the vulval fold and adjacent skin were used to close skin defects in two dogs presented for wide excision of mast cell tumors situated ventro-lateral and dorso-lateral to the vulva, respectively. The vulval fold and adjacent skin was perfused bilaterally by branches of the ventral perineal and external pudendal arteries, which entered dorsally and ventrally, respectively. As incisions used to create a transposition flaps from the skin surrounding the vulval fold transect these vessels, the flap is dependent on the sub-dermal plexus for survival. There was 100% survival of transposition flaps in the 2 clinical cases and healing proceeded uneventfully with acceptable cosmetic and functional results. The vulval fold and surrounding skin can be used as a subdermal plexus flap to close large perineal defects in dogs. Availability of a defined local skin flap will improve treatment of diseases resulting in large perineal skin defects in female dogs.

Vacuum-assisted wound closure following urine-induced skin and thigh muscle necrosis in a cat

Vacuum-assisted closure (VAC) is a relatively new technique for wound management in dogs and cats. It was successfully used in this cat to treat severe urine-induced skin and thigh muscle necrosis, resulting from a traumatic urethral rupture. No complications were encountered with application of the VAC technique and production of a healthy granulation bed, suitable for wound reconstruction, was achieved after only five days of VAC treatment. The marked wound contraction (40.3%) obtained after eight days of treatment, was sufficient to allow closure of the defect using a simple, rotational subdermal plexus flap. This was a safe, effective and efficient treatment for a challenging wound in a difficult anatomical location.

Adnexal surgery in dogs and cats.

Abnormalities in eyelid position and function can lead to chronic irritation of cornea and conjunctiva. Corneal ulceration, vascularization and pigmentation are common consequences. Loss of vision, or loss of the globe may be the end result. The combination of ptosis and entropion of the upper eyelid is commonly seen in breeds with abundant forehead skin folds. Treatment options include surgical reduction of skin folds, suspending the brows, enforced secondary granulation of the upper eyelid, or a combination of procedures. Lid-shortening procedures reduce corneal exposure, improve functional blinking and reduce likelihood of traumatic proptosis. Although a lateral canthoplasty is technically easier to perform, a medial canthoplasty is the preferred method of eyelid shortening. An involuted lateral canthus with entropion is seen in certain dog breeds with a broad skull base and redundant facial skin. Surgical correction is by either applying traction to the lateral canthus, or by resection of the lateral canthal ligament. A combination of entropion, ectropion and macroblepharon may result in the presence of diamond shaped eyelids. Surgical correction involves the combination of several procedures. Upper eyelid agenesis is a congenital absence of part of the upper eyelid in cats. Treatment options include a skin-orbicularis flap from the lower eyelid with a conjunctival pedical graft, the transposition of the lower eyelid to the upper eyelid, cross lid flap and subdermal plexus flap, and subdermal collagen injection. Several techniques for reconstruction of upper and lower eyelid defects are described.