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Tobias full > Axial Pattern and Myocutaneous Flaps > Flashcards

Axial Pattern and Myocutaneous Flaps Flashcards

1
Q

How much can you rotate an axial pattern flap?

A

180 degrees

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2
Q

What are the two braod options when elevating an axial pattern flap?

A
  • Penisular flap - Intact skin at its base
  • Island flap - Skin incised along all edges and flap is rotated around vascular base
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3
Q

What is a composite flap?

A

An axial pattern flap composed of skin as well as muscle, bone or cartilage

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4
Q

What is the reported overall survival rate of axial pattern flaps?

A

87 - 100%

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5
Q

List some differences between cats and dogs in regard to skin anatomy and wound healing

A
  • Dogs have a much higher density of tertiary and higher order vessels than cats (less cutaneous perfusion to the uninjured skin of cats)
  • Granulation tissues takes half as long to form in cats and begins at the periphery
  • Removal of SQ reduces the rate of epithelialisation, especially in cats (recommended to preserve SQ with harvesting axial pattern flaps in cats)
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6
Q

Name the following axial pattern flaps

A
  • 1 = Caudal auricular
  • 2 = Omocervical
  • 3 = Thoracodorsal
  • 4 = Caudal superficial epigastric
  • 5 = Lateral genicular
  • 6 = Deep circumflex iliac
  • 7 = Lateral caudal
  • 8 = Superficial brachial
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7
Q

Describe the Omocervical axila pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on superficial cervical branch of the omocervical artery and vein (originates at level of prescap LN and courses cranially)
  • Caudal incision from acromion dorsally along scapular spine
  • Cranial incision parallel and equidistant from cranial edge of scapula
  • Can extend to contralateral scapulohumeral joint

Potential uses: Face, ear, cervical, shoulder, axillary defects

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8
Q

Describe the Thoracodorsal axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on cutaneous branch of thoracodorsal artery and vein
  • Cranial incision from acromion dorsally along scapular spine
  • Caudal incision parallel and equidistant from caudal shoulder depression
  • Can extend to contralateral scapulohumeral joint
  • Elevated under cutaneous trunci muscle

Potential uses: Thoracic, forelimb, shoulder, axillary defects

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9
Q

Describe the dorsal deep circumflex iliac axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on deep circumflex iliac artery and vein which exit lateral abdominal wall cranioventral to wing of ilium and divides into dorsal and ventral branch
  • Base of flap at ventral extent of cranial edge of ilium
  • Caudal incision midway between wing of ilium and greater trochanter extending dorsally
  • Cranial incision parallel and equidistant from wing of ilium
  • Can be extended to contralateral paralumbar or flank fold
  • Elevated below cutaneous trunci muscle

Potential uses: ipsilateral flank, lateral lumbar, pelvic lateromedial thigh, greater trochnater defects

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10
Q

Describe the ventral deep circumflex axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on the ventral branch, exiting at same point as dorsal branch but extending down lateral flank and craniolateral thigh
  • Landmarks for base and width identical to dorsal
  • Caudal incison runs ventrally in a line parallel to cranial border of femoral shaft
  • Cranial incision parallel
  • Can extend to proximal edge of patella

Potential uses: Lateral abdominal wall, pelvic, sacral

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11
Q

Describe the caudal superficial epigastric axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • External pudendal artery and vein exit caudal inguinal canal, provide ventral brance to labia/scrotum and arches cranially to form caudal superficial epigastric
  • Ventral midline incision
  • Parallel incision laterally and equidistant to teats
  • Can extend cranially to include 2nd mammary gland
  • Elevated below supramammarius muscle

Potential uses: Caudal abdominal, flank, inguinal, preputial, perineal, thigh, stifle defects

90% of dogs have complete flap survival

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12
Q

Describe the cranial superficial epigastric axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on short cutaneous braches of cranial superficial epigastric. Artery exits through rectus abdominis caudoventral to thoracic cage and 2-4cm lateral to midline
  • Ventral midline incision from just caudal to thoracic cage extending caudally
  • Lateral parallel incision equidistant from 3rd teat
  • Can extend to include mammary 3, 4 and sometimes 5
  • Elevated below panniculus muscle

Potential uses: Sternal defects

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13
Q

Describe the angularis oris axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on angularis oris artery and vein with branches of inferior and superior labial arteries
  • Based at labial commisure
  • Dorsal incision parallel to ventral zygomatic arch to level of vertical ear canal
  • Ventral incision parallel with ventral aspect of mandibular ramus
  • Can extend to wing of atlas but more commonly to vertical ear canal
  • Can also be created as a noncutaneous rectangular island flap based on the buccal mucosa

Potential uses: Palatal, facial, nasal defects

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14
Q

What important underlying structures may be encountered when elevating the angularis oris axial parrern flap?

A
  • Facial nerve (dorsal, ventral and auriculopalpebral branches)
  • Auriculotemporal nerve
  • Parotid salivary duct
  • facial vein
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15
Q

Describe the superficial temporal axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on superficial temporal artery
  • Based on caudal aspect of zygomatic arch caudally and lateral aspect of orbital rim cranially
  • Extends dorsally to maximal length at dorsal aspect of contralateral orbital rim
  • Thin frontalis muscle elevated with flap

Potential uses: Maxillofacial, eyelid defects

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16
Q

What nerve may need to be transected during elevation of superficial temporal axial pattern flap?

A
  • Rostral auricular nerve - does not effect eyelid function
17
Q

Describe the caudal auricular axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on sternocleidomastoideus branches of caudal auricular artery and vein
  • Based at palpable depression between vertical ear canal and wing of atlas
  • Flap is centered over wing of atlas with dorsal and ventral incisions running caudally and parallel to each other
  • Maxiumu length to spine of scapula
  • Platysma muscle is elevated with the flap
  • In cats, the dorsal incision is closer to dorsal midline

Potential uses: neck, facial, ear, dorsal head defects

18
Q

Describe the superficial brachial axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on superfical brachial branch of brachial artery
  • Base centered over proximal 1/3 of flexor surface of elbow
  • Lateral and medial incision lateral to each other and to the shaft of the humerus
  • Maximum length distal to greater tubercle
  • Fragile and easily fails, use as a last resort option

Potential uses: Antebrachial, elbow defects

19
Q

Describe the genicular axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on the genicular braches of the saphenous artery and saphenous vein
  • Genicular artery extends cranially over the medial aspect of the stifle and terminated over its craniolateral surface
  • Base of flap located 1cm proximal to patella and 1.5cm distal to tibial tuberosity
  • Incisions extend proximally, parallel to femoral shaft, converging to make base 2cm wider than tip
  • Maximum length distal to greater trochanter

Potential uses: medial stifle or tibial defects

20
Q

What is the reverse saphenous conduit flap dependant on?

A

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

21
Q

Describe the lateral caudal axial pattern flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on the left and right lateral caudal arteries and veins (branches of caudal gluteal)
  • Cranial border of flap is horizontal line where tail attaches to body
  • Dorsal or ventral midline incision
  • Elevated deep to dorsal fascia (tricky)
  • Tail amputated between caudal vertebrae 2-3
  • Can be splint along dorsal midline to form 2 flaps
22
Q

Describe the latissimus dorsi myocutaneous flap
what vessel is it base one, anatomical landmarks, maximum length, potential uses

A
  • Based on thoracodorsal artery
  • Direct cutanous artery through craniodorsal portion of latissiumus to the skin just dorsal to the scapula
  • Craniodorsal aspect is level with acromion and caudal to triceps m. Incised in a caudodorsal direction to head of 13th rib
  • Ventral border starts at thoracic limb skin fold at a point level with lower third of the humerus. Extends parallel to 13th rib
  • Dissection deep to latissimus dorsi

Potential uses: Defects which require more bulky reconstruction such as thoracic wall

23
Q

What is the reported outcome of thoracodorsal axial pattern flaps?

A
  • Experimental 98%
  • Clinically 70% partial tip necrosis
24
Q

What is the reported outcome of caudal superficial epigastric flaps?

A
  • 90% dogs have complete flap survival
  • 30% complication rate (seroma, brusining, oedema, drainage, dehiscense)
25
Q

What is the reported outcome of the superficial temporal axial pattern flap?

A
  • Mean flap area survival experimentally 93 - 99%
  • (decreased to 69% if extended to contralateral zygomatic arch - not recommended)
26
Q

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

A

85%

27
Q

What type of vascular pattern does the latissimus dorsi have?
What does this mean?

A
  • Type V vascular pattern
  • Has a single dominant vascular pedicle and a segmental vascular pedicle
  • Portions of a muscle with this vascular pattern will survive if the transfer is based on the dominant vascular pedicle (thoracodorsal artery for latissimus dorsi)

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