Outcome of caudal superficial epigastric axial pattern flaps in dogs and cats: 70 cases (2007‐2020)

Abstract

Objectives To describe the outcome and complications associated with the use of caudal superficial epigastric axial pattern flaps in dogs and cats. Material and Methods Multicentre retrospective review and descriptive study of clinical records of dogs and cats having undergone caudal superficial epigastric axial pattern flaps between 2007 and 2020. Data retrieved included signalment, aetiology of surgical defect, tumour type, presence/absence of clean surgical margins, presence/absence of post‐operative wound infection, use of peri‐ and post‐operative antibiotics, duration of anaesthesia, duration of surgery, presence and duration of hypothermia, presence and duration of hypotension, presence/absence of post‐operative surgical drain and length of caudal superficial epigastric axial pattern flap. The incidence of complications and outcomes were documented. Results Seventy cases met the inclusion criteria; 51 dogs and 19 cats. In dogs, 67% of cases developed complications (59% minor, 8% major) and 33% had uneventful wound healing. In cats, 53% of cases developed complications, (47% minor, 5% major) and 47% had uneventful wound healing. In dogs, the percentage of cases experiencing dehiscence, necrosis, seroma, oedema and post‐operative infection was 31%, 29%, 26%, 26% and 16% respectively. In cats, this was 26%, 16%, 11%, 0% and 5% respectively. A good overall outcome was seen in 77% of dogs and 79% of cats. A poor overall outcome was seen in 4% of dogs and 0% of cats. Clinical Significance Caudal superficial epigastric axial pattern flaps are traditionally thought more robust than other flaps, yet complication rates remain high, despite a high overall success rate.

Short‐term outcome and complications following cutaneous reconstruction using cranial superficial epigastric axial pattern flaps in dogs: six cases (2008‐2022)

“…Nevertheless, all flaps healed completely with only one requiring further surgical intervention. In the present study, the complication rate was lower than is reported following thoracodorsal (80%), caudal auricular (63%), genicular (63%), caudal superficial epigastric (67%) and superficial brachial (100%) APF (Aper & Smeak 2003, Emmerson et al 2019, Proot et al 2019, Forster et al 2022, Villedieu et al 2022. The reason for the lower complication rate is unknown, but it could be speculated that being the CrSE APF is generally shorter and smaller than other flaps, the risk of vascular embarrassment post-transposition might be lower.…”

“…Several APFs have been described in the literature and are named after the direct cutaneous artery that supplies each angiosome (Pavletic 1981, Kostolich & Pavletic 1987, Henney & Pavletic 1988, Smith et al 1991, Degner et al 1994, Fahie & Smith 1997, Anderson et al 2004, Saifzadeh et al 2005, Field et al 2015, Proot et al 2019, Forster et al 2022.…”

Chronic axillary wounds in cats: what do we know and how should we manage them?

“…For long-term resolution of an axillary wound, antimicrobial therapy is important, and particularly when reconstruction with a skin flap is planned, as infection is one of the most common complications observed. 23 As mentioned earlier, the reported microorganisms populating chronic axillary wounds are varied. While there are no specific guidelines regarding antimicrobial treatment of wounds in veterinary medicine, the following antimicrobial stewardship guidelines should be followed: < taking measures to prevent common diseases; < using evidence-based approaches when making decisions about antimicrobial drugs; < using antimicrobial drugs wisely and carefully.…”

“…For long-term resolution of an axillary wound, antimicrobial therapy is important, and particularly when reconstruction with a skin flap is planned, as infection is one of the most common complications observed. 23 …”

“…One of the most common complications associated with skin flaps is seroma formation, which may lead to infection. 23 For this reason, active suction drains are frequently placed in these patients. 37 While passive drains could, alternatively, be considered, these have a higher incidence of infection since this drain system is open, allowing bacteria to enter the wound, potentially leading to ascending infection; in addition, the active drains are more effective as they do not rely on gravity.…”