Versatility of the Angularis Oris Axial Pattern Flap for Facial Reconstruction

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.

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“…, Fahie & Smith , Losinski et al . ). The caudal auricular axial pattern flap was first described by Smith et al .…”

Section: Introductionmentioning

confidence: 97%

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

Proot

Jeffery

Culp

et al. 2018

J of Small Animal Practice

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“…Resections that involve the muzzle have traditionally been achieved by extending the extraoral incisions through the mucocutaneous junction of the lip and into the oral cavity, in many cases unnecessarily resecting the upper lip adjacent to the tumor ( 1 ). The resultant defect requires reconstruction of the lip with distally based upper lip/buccal advancement flaps or axial pattern flaps (superficial cervical, caudal auricular, superficial temporal, and angularis oris) ( 2 – 6 ). While axial pattern flaps are useful, and certainly have their place, they are not without substantial morbidity and potential complications.…”

Section: Discussionmentioning

confidence: 99%

“…Axial pattern flaps have greater potential to reach distant wounds and have a reported overall survival of 89–100% ( 5 , 8 – 12 ). However, distal ischemic necrosis has a reported frequency of up to 33% and remains a concern ( 2 ). The superficial cervical, caudal auricular, and superficial temporal axial pattern flaps are limited in their ability to reliably reach the nasal planum and may be prone to distal necrosis ( 1 – 6 ).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, because of the lack of oral mucosa, axial pattern flaps replace the normal oral mucosa of the oral cavity with hirsute skin, which creates additional complications ( 13 ). Of all the known axial pattern flaps for the oromaxillofacial region, the angularis oris axial pattern flap shows the most promise for reaching the nasal planum ( 2 ). However, to achieve this length, the flap must be dissected into an anatomically complex region.…”

Section: Discussionmentioning

confidence: 99%

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Composite Resection of Tumors of the Rostral Maxilla and Dorsolateral Muzzle Utilizing an Upper Lip-Sparing, Combined Approach in Dogs

Thomson

Soukup

2018

Front. Vet. Sci.

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Tumors of the rostral maxilla that involve both the oral mucosa and the dermis or subdermis of the dorsolateral muzzle provide unique challenges for the oromaxillofacial surgeon. Traditionally described approaches to such lesions may involve an intraoral incision that extends and involves the upper lip to envelope the involved dermis of the dorsolateral muzzle. However, such an approach unnecessarily resects upper lip tissue resulting in a large defect that likely requires advanced skin flaps or grafts for reconstruction. Such flaps are technically challenging and introduce potential for significance postoperative complications. In this article, we provide a detailed description a combined intra- and extraoral approach that allows for composite resection of tumors of the rostral maxilla that also involve the dorsolateral muzzle. The described technique allows for excellent intraoperative visualization and provides a superior cosmetic outcome that minimizes postoperative complications. In addition, we describe our experience utilizing the technique in three clinical cases.

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“…Other surgical options may include the use of hair bearing skin flaps such as the cutaneous angularis oris or a cutaneous lateral cheek flap. [6][7][8] Microvascular free tissue transfer of muscle flaps or myoperitoneal or rectus abdominis flaps have been described and provide a onestage method of intra-oral repair. 9 As specialized training is required to perform this procedure, it is not commonly employed.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Superior Labial Musculomucosal Flap in Dogs: An Angiographic Study and Case Report

Doyle

Degner

2019

Vet Comp Orthop Traumatol

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Objective The aim of this study was to evaluate the angiosome of the superior and inferior labial arteries within the superior and inferior labia and to describe superior and inferior labial musculomucosal axial pattern flaps that can be used for intra-oral wound reconstruction. This study also presents the clinical use of a superior labial musculomucosal flap in a dog. Materials and MethodsThe common carotid arteries of six canine cadavers were injected with barium sulphate. The skin of the face and labial mucosa was removed and radiographed to study the vascular supply of the superior and inferior labia. ResultsThe angiograms in all dogs demonstrated that the superior and inferior labial arteries were located within the musculomucosal layer of the labia. At the junction of the rostral and caudal half of the upper lip, extensive choke anastomoses joined the angiosome of the infra-orbital artery. The inferior labial artery perfused the caudal half of the lower labium and had extensive choke anastomoses with the middle and rostral mental arteries. Clinical Significance The musculomucosal flaps of the superior and inferior labia contain a rich arterial blood supply, which suggests that these flaps may survive in live dogs. The superior labial musculomucosal flap was successfully used to reconstruct a large cleft palate in a single clinical case.

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Versatility of the Angularis Oris Axial Pattern Flap for Facial Reconstruction

Abstract: Angularis oris axial pattern flaps provided hirsute, full-thickness skin coverage of a variety of large facial defects with minor complications, and should be considered when restructuring large defects of the rostral face or chin.

Cited by 30 publications

References 17 publications

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

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

Composite Resection of Tumors of the Rostral Maxilla and Dorsolateral Muzzle Utilizing an Upper Lip-Sparing, Combined Approach in Dogs

Evaluation of the Superior Labial Musculomucosal Flap in Dogs: An Angiographic Study and Case Report

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