Is the caudal auricular axial pattern flap robust? A multi‐centre cohort study of 16 dogs and 12 cats (2005 to 2016)

Abstract

Objective: To determine the frequency and type of healing complications arising after the use of the caudal auricular axial pattern flap to close defects on the head in dogs and cats. Material and MethOds: Multi-centre retrospective cohort study. Centres were recruited by the Association for Veterinary Soft Tissue Surgery Research Cooperative. Medical records of 11 centres were reviewed, and data from all dogs and cats treated with a caudal auricular axial pattern flap were retrieved. The following data were recorded: signalment, reason for reconstruction, flap dimensions, anatomic landmarks used, histological diagnosis, flap healing and whether revision surgery was required. results: Twenty-eight cases were included: 16 dogs and 12 cats. Flap length: width ratio was approximately 3:1 and flap length extended to the scapular spine in most cases. Optimal wound healing occurred in five of 16 (31%) dogs and six of 12 (50%) cats. Wound dehiscence without flap necrosis occurred in one of 16 (6%) dogs and one of 12 (8%) cats. Wound dehiscence with flap necrosis occurred in 10 of 16 (63%) dogs and five of 12 (42%) cats. Revision surgery was performed in eight of 16 (50%) dogs and three of 12 (25%) cats.clinical significance: The caudal auricular axial pattern flap can provide full thickness skin coverage for large defects on the head in dogs and cats. Partial flap necrosis is a common complication, and revision surgery may be required in order to achieve final wound closure.

The use of near infrared fluorescence imaging with indocyanine green for vascular visualization in caudal auricular flaps in two cats

“…Margins of the caudal auricular axial pattern flap were marked as previously described with a 5-cm base and the flap extending to the cranial border of the scapular spine. [10][11][12] The ICG dye (Diagnostic Green; Aschheim-Dornach, Germany) was reconstituted according to manufacturer recommendations. Briefly, 10 mL of sterile water was mixed with 25 mg of ICG to form a 2.5-mg/mL solution.…”

“…10,11 Two recent articles in which use of a caudal auricular APF was described included a total of 15 cats, and had a high overall complication rate, with 47% of cats experiencing 25% to 50% flap necrosis and 33% of cats requiring revision surgery. 10,11 Landmarks described for the feline caudal auricular APF with positioning of the forelimb in relaxed extension and the spine of the scapula perpendicular to the trunk include: 1) the base centered over the lateral aspect of the wing of the atlas, 2) the dorsal border close to dorsal midline, 3) the ventral border equidistant and paralelle to the dorsal border, 4) the cranial margin just caudal to the scutiform cartilage of the pinna and in line with the vertical ear canal, and 5) the caudal margin in line with the spine of the scapula. [10][11][12] Although this flap is considered robust overall, the relatively high complication rate reported in the recent literature provides evidence that better intraoperative assessment of vessel location and flap viability is required.…”

“…10,11 Landmarks described for the feline caudal auricular APF with positioning of the forelimb in relaxed extension and the spine of the scapula perpendicular to the trunk include: 1) the base centered over the lateral aspect of the wing of the atlas, 2) the dorsal border close to dorsal midline, 3) the ventral border equidistant and paralelle to the dorsal border, 4) the cranial margin just caudal to the scutiform cartilage of the pinna and in line with the vertical ear canal, and 5) the caudal margin in line with the spine of the scapula. [10][11][12] Although this flap is considered robust overall, the relatively high complication rate reported in the recent literature provides evidence that better intraoperative assessment of vessel location and flap viability is required. 10,11 Current methods in addition to anatomic landmarks for APF planning include doppler ultrasound vessel identification, transcutaneous illumination, and various diagnostic imaging modalities; however, these techniques are not routinely employed and have intraoperative limitations.…”

“…[10][11][12] Although this flap is considered robust overall, the relatively high complication rate reported in the recent literature provides evidence that better intraoperative assessment of vessel location and flap viability is required. 10,11 Current methods in addition to anatomic landmarks for APF planning include doppler ultrasound vessel identification, transcutaneous illumination, and various diagnostic imaging modalities; however, these techniques are not routinely employed and have intraoperative limitations. 5,6,13 The use of ICG NIRF angiography may provide an alternative method for vessel identification in these cases.…”

Utilização de enxerto cutâneo no tratamento de ferida traumática grave associada à luxação metatarsofalangeana aberta: relato de caso

“…Na pele, quando a cicatrização por primeira intenção não é possível devido ao excesso de tensão tecidual (PAVLETIC, 2010), a melhor opção se torna a utilização de técnicas cirúrgicas reconstrutivas como retalhos e enxertos (MACPHAIL, 2015;PROOT et al, 2018), especialmente em casos de lesões nos membros, que devido ao processo de contração da ferida, pode ocasionar limitações articulares. Ademais, a contração exagerada pode atuar como um torniquete natural, podendo levar a distúrbios hemodinâmicos da região distal do membro e ocasionar dor e constante formação de edema (HANKS;SPODNIK, 2005;ZINGEL;SAKALS, 2017).…”