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Skin and Reconstruction > Axial and myocutaneous flaps > Flashcards

Axial and myocutaneous flaps Flashcards

1
Q

What distinguished an axial pattern flap from a subdermal plexus flap?

A

An axial pattern flap incorporates a direct cutaneous artery and vein, terminal branches of which supply blood flow and drainage for the subdermal plexus. This results in improved survival and ability to create a larger flap

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2
Q

How far can an axial pattern flap be safely rotated around its base?

A

180 degrees

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3
Q

What is the difference between peninsula and island axial pattern flaps?

A

Peninsula flaps maintain intact skin at their base, island flaps are incised around all of their edges.

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4
Q

What are the potential advantages and disadvantages of island and peninsula axial pattern flaps?

A

Peninsula: better protection of vasculature, may be less cosmetic (dog ears from rotation).

Island: more cosmetic but vascular pedicle is more exposed and may be damaged

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5
Q

Can axial pattern flaps be applied directly over bone, tendons and ligaments?

A

Yes

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6
Q

What is the overall survival rate of axial pattern flaps?

A

87-100%

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7
Q

What are important species differences between cats and dogs when it comes to axial pattern flaps?

A

Similar location of direct cutaneous vessels, but cats have a lower density of tertiary and higher order vessels. This translates to less cutaneous perfusion in cats.

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8
Q

Which is the easiest direct cutaneous artery to identify in an axial pattern flap?

A

Caudal superficial epigastric

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9
Q

Which is the hardest direct cutaneous artery to identify in an axial pattern flap?

A

Superficial cervical (omocervical flap)

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10
Q

What are the benefits of using of an interrupted skin closure for axial pattern flaps?

A

Allows for increased drainage, prevents complete wound dehiscence in cases of flap necrosis, permits more precise apposition and tension distribution.

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11
Q

Describe the boundaries of various axial pattern flaps

A

See table page 1459 Tobias

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12
Q

Does the omocervical or thoracodorsal axial pattern flap have a more robust blood supply?

A

The thoracodorsal

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13
Q

How frequently is tip necrosis observed when using thoracodorsal axial pattern flaps?

A

In up to 70% of dogs when used to repair forelimb defects.

Flap loss may result from excessive tension, pressure, or vascular compromise from rotation.

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14
Q

What are some complications reported with use of a thoracodorsal axial pattern flap?

A

Seroma formation, edema, distal bruising, infection, dehiscence, and distal flap necrosis.

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15
Q

Why are thoracodorsal axial pattern flaps particularly useful in cats?

A

Cats have excellent skin mobility and small leg to trunk ratio allowing the thoracodorsal axial pattern flap to reach the carpus

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16
Q

Is the dorsal or ventral branch of the deep circumflex iliac artery longer?

A

The ventral branch

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17
Q

What muscle is included in the caudal superficial epigastric axial pattern flap?

A

The supramammarius muscle, staying above the aponeurosis of the external abdominal oblique.

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18
Q

What is the maximum flap length of the caudal superficial epigastric flap?

A

The second mammary gland.

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19
Q

What is the clinical survival of caudal superficial epigastric flaps in dogs?

A

90%

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20
Q

The caudal superficial epigastric is a branch of which artery?

A

The external pudendal

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21
Q

What are some complications associated with the caudal superficial epigastric flap?

A

Seroma, bruising, flap edema, drainage and incisional dehiscence (30%).

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22
Q

Which mammary glands can the cranial superficial epigastric axial pattern flap include?

A

Glands 3, 4 and 5 (should be stopped just cranial to the prepuce in male dogs). Flap should be elevated below the panniculus muscle.

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23
Q

What is the reported survival rate of the cranial superficial epigastric axial pattern flap?

A

87-93% flap area survival.

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24
Q

Is the cranial or caudal superficial epigastric flap more robust?

A

The caudal. It has a longer vascular supply and the anatomic landmarks are less variable.

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25
Q

What are some complications associated with the cranial superficial epigastric flap?

A

Hyperemia, edema, infection, seroma, dehiscence, tip necrosis.

26
Q

The angularis oris artery is a branch of which artery?

A

Facial artery

27
Q

What underlying structures need to be avoided during development of an angularis oris axial pattern flap?

A

Facial nerve, parotid salivary duct, facial vein.

28
Q

What complications are reported with use of the angularis oris flap for maxillectomy repair?

A

Partial necrosis, nasal discharge, movement with respiration (usually resolves within 10 days).

29
Q

What thin muscle superficial to the temporalis muscle is elevated in a superficial temporal axial pattern flap?

A

Frontalis muscle

30
Q

Extension of a superficial temporal axial pattern flap to what level decreases survival?

A

Extension to the contralateral zygomatic arch (not recommended, 69% survival). Extension to the contralateral dorsal orbital rim has good survival (93-99%)

31
Q

What are reported complications of the superficial temporal axial pattern flap?

A

Seroma, necrosis, wound dehiscence.

32
Q

Which vessel does the caudal auricular axial pattern flap rely on?

A

The cleidomastoideus branches of the caudal auricular artery and vein

33
Q

How do the landmarks for the caudal auricular axial pattern flap differ in the dog and cat?

A

The dorsal flap is positioned slightly more midline in the cat (in dogs the width of the flap is the central third of the lateral profile centered over the wing of the atlas).

34
Q

What should be elevated along with the skin for the caudal auricular axial pattern flap?

A

The platysma muscle

35
Q

What is the mean reported survival of the caudal auricular axial pattern flap?

A

85% flap survival. Complications include seroma, edema, flap necrosis, alterations in hair color and direction of growth.

36
Q

What vessel is the superficial brachial artery a branch of?

A

Brachial artery

37
Q

Is the superficial brachial artery flap considered robust?

A

No - consider using other flaps if possible. May reach the carpus but usually not robust enough to extend to this level

38
Q

What vessel does the genicular artery originate from?

A

The saphenous artery

39
Q

What was the mean flap survival of the genicular artery axial pattern flap?

A

89%. The incision should converge so that the base is 2cm wider than the tip, and the flap should be kept as short as possible.

40
Q

What complications have been reported with use of a genicular axial pattern flap?

A

Dehiscence of the donor site, and necrosis of the flap tip.

41
Q

What defects are reverse saphenous conduit flaps most useful for?

A

Wounds on the distal aspect of the pelvic limb

42
Q

What vessels do the reverse saphenous conduit flaps rely on?

A

Relies on reverse flow through vascular anastomoses between branches of the cranial tibial and saphenous arteries and between tributaries of the medial and lateral saphenous veins

43
Q

What is the distal extent of the reverse saphenous conduit flap?

A

The anastomoses between the medial and lateral saphenous veins at the level of the hock

44
Q

What is a common clinical occurrence following placement of a reverse saphenous conduit flap?

A

Vascular congestion due to reverse venous flow. To maximize the chances of flap survival it is recommended to perform angiographic studies prior to flap dissection to ensure both the cranial and caudal saphenous branches are present (loss of one branch reduces chance of survival)

45
Q

The lateral caudal arteries and veins are branches of which vessels?

A

The caudal gluteal arteries and veins

46
Q

At what level is the tail amputated following creation of a dorsal or ventral lateral caudal axial pattern flap?

A

Between coccygeal vertebrae 2 and 3

47
Q

In an experimental study what was the survival of lateral caudal axial pattern flaps?

A

78%

48
Q

What is the vascular pattern to the latissimus dorsi muscle?

A

Type V (single dominant vascular pedicle and a segmental vascular pedicle). So long as the dominant vascular pedicle survives the muscle will survive.

49
Q

What is the dominant vascular pedicle of the latissimus dorsi muscle?

A

The thoracodorsal artery (the intercostal arteries at the caudodorsal border are the segmental vascular supply and can be sacrificed during flap elevation).

50
Q

What are the most common causes of axial pattern flap necrosis?

A

Typically caused by inadequate blood perfusion. This can be impacted by hematoma formation, excessive tension, inappropriate handling of the flap or incorrect landmarks, rotation beyond 180 degrees.

51
Q

What is the typical appearance of a flap at 6 days depending on whether the arterial or venous supply is primarily affected?

A

Venous: congested, cyanotic
Arterial: pale

52
Q

Is bleeding of an axial pattern flap when pricked centrally correlated with survival?

A

Yes, it is correlated with central but not peripheral survival. Laser Doppler flowmetry and fluoroscein have been investigated as additional methods to assess perfusion.

53
Q

What are some ways to salvage a failing flap?

A

Release the borders if they are under too much tension, culture if infection suspected, assess for excessive trauma, motion, compression, dehydration and anemia. Potentially consider vacuum assisted closure.

54
Q

According to Andries 2020 in vet surgery what three vessels might be used to develop axial pattern flaps in the caudal thigh region of cats?

A

Ventral and dorsal perineal, popliteal.

55
Q

According to Albernaz 2021 in Vet Surg, what were the three most common complications of angularis oris axial pattern flaps in cats?

A

Flap edema, suture dehiscence, distal tip necrosis

56
Q

In a study by Emmerson 2019 in JSAP, what was the average flap survival for a genicular artery axial pattern flap in dogs? What artery is the genicular artery a branch of? What were three minor complications reported?

A

Average flap survival was 99%.

The genicular artery is a branch of the saphenous.

Three minor complications (36% of dogs) were wound dehiscence, seroma formation and infection. Major complications in 14% of dogs.

57
Q

In a study by Milgram 2019 in JSAP, what reverse axial pattern flap was used for single staged reconstruction of a prepucial defect?

A

Superficial branch of the dorsal penile artery

58
Q

In a study by Puerta 2021 in JSAP, what percentage of superficial temporal axial pattern flaps had 100% survival? What major (1) and minor (3) complications occurred?

A

89% of flaps had 100% survival.

Major complications (5% of cases) included full thickness partial flap necrosis. Minor complications (21%) included partial thickness necrosis, edema, and wound discharge.

59
Q

In a study by Forster 2022 in JSAP, what percentage of dogs and cats experienced complications related to healing of caudal superficial epigastric axial pattern flaps? What were the 5 most common complications reported?

A

67% of dogs and 53% of cats experienced complications.

Dehiscence (30%), necrosis, seroma, edema, and post-operative infection were the most common complications in decreasing order of frequency (although edema was not reported in cats).

60
Q

In a study by Gaudio 2023 in JSAP, what was the complication rate following use of a cranial superficial epigastric flap in dogs? What were the 3 most common complications?

A

50% complication rate.

Reported complications were seroma, bruising, and necrosis. One flap required revision.

61
Q

In a study by Villedieu 2022 in JSAP, examining the use of superficial brachial axial pattern flaps in dogs what were the 5 most common post-operative complications in order of decreasing frequency? What percentage healed without open wound management?

A

Complications occurred in 100% of dogs and included partial dehiscence (44%), partial necrosis (38%), seroma formation (31%), edema (19%), complete flap necrosis (13%).

50% of flaps with complications healed without requiring additional surgery or open wound management.

Skin and Reconstruction (8 decks)

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