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| USE OF RANDOM SUBDERMAL FLAPS TO REPAIR EXTENSIVE SKIN DEFECTS to dark purple to black over 1 to 6 days, ultimately leading to necrosis.1,2,6,7 References When necrotic skin is observed, evidenced by either the presence of a demarcation line between viable and nonviable skin, liquefactive necro- sis, or eschar, the necrotic skin should be debrided as soon as possible to encourage wound healing.2 COMPLICATIONS Complications associated with these procedures include:2,7 UÊ nviVÌion UÊ-iÀom>à UÊ ihiÃVinVi UÊ iVÀoÃiðÊÊ Seromas Seroma formation is more likely to occur if there is loose skin or dead space present, particularly in high- motion areas, such as the flank or axilla.2 The use of closed suction drains, bandages, and exercise restric- tion for 2 to 3 weeks post surgery decreases the risk of seroma formation.2,7 Dehiscence Some causes of dehiscence include excessive tension on the flap edges (due to inappropriate planning), infection, surgical trauma, or inadequate blood supply which causes necrosis.2,5,7 The risk of complications can be decreased by using good surgical technique and planning appropriately before performing surgery.7 CONCLUSION Skin defects can be difficult to correct without the aid of ancillary techniques, such as skin flaps. Local subdermal flaps can be performed in general practice if extreme care is used during the performance of the procedure and appropriate aftercare is instituted. More extensive wounds may benefit from advanced flaps, such as distant, axial pattern, and myocutaneous flaps, or free skin grafts; for these procedures, referral to a specialist is recommended. These types of wounds include those: UÊ oV>Ìi`Ê oÛiÀÊ Loni]Ê Ìin`onÃÉli}>minÌÃ]Ê oÀÊ l>À}iÊ arteries and veins UÊ nÛolÛi`ÊÜiÌhÊLo`ÞÊV>ÛiÌiià UÊ oÛiÀin}ÊmoÀiÊÌh>nÊÎä¯ÊovÊÌhiÊLo`ÞÊÃÕÀv>Vi UÊ oV>Ìi`ÊViÀVÕmviÀinÌi>llÞÊ>ÀoÕn`ÊiÝÌÀimiÌiið Another indication for referral is if the patient requires 24-hour care either due to its health status or a tendency to interfere with the bandage protecting the flap. ■ FIGURE CREDIT Figures 1 through 6 adapted from Pavletic MM. Atlas of Small Animal Reconstructive Surgery. Philadelphia: WB Saunders, 1999. 26 Today's Veterinary Practice May/June 2012 It is also important to recognize that regional plexus variations affect flap survival.1 1. Pavletic MM. Pedicle grafts. In Slatter D (ed): Textbook of Small Animal Surgery, 3rd ed. Philadelphia: WB Saunders, 2003, pp 292-321. 2. Hunt GB. Local or subdermal plexus flaps. In Tobias KM, Johnston SA (eds): Veterinary Surgery: Small Animal. St. Louis: Elsevier, 2012, pp 1243-1255. 3. Wardlaw JL, Lanz OI. Axial pattern and myocutaneous flaps. In Tobias KM, Johnston SA (eds): Veterinary Surgery: Small Animal. St. Louis: Elsevier, 2012, pp 1256-1270. 4. Bohling MW, Swaim SF. Skin grafts. In Tobias KM, Johnston SA (eds): Veterinary Surgery: Small Animal. St. Louis: Elsevier, 2012, pp 1271- 1290. 5. Pavletic MM. Atlas of Small Animal Reconstructive Surgery. Philadelphia: WB Saunders, 1999. 6. Hedlund CS. Surgery of the integumentary system. In Fossum TW (ed): Small Animal Surgery, 2nd ed. St Louis: Mosby, 2002, pp 134-228. 7. Hedlund CS. Large trunk wounds. Vet Clin Small Anim 2006; 36:847- 872. 8. Hunt GB, Tisdall PLC, Liptak JM, et al. Skin-fold advancement flaps for closing large proximal limb and trunk defects in dogs and cats. Vet Surg 2001; 30:440-448. 9. Hunt GB. Skin fold advancement flaps for closing large sternal and inguinal wounds in cats and dogs. Vet Surg 1995; 24:172-175. 10. Allen SW, Miller MA, Haas KM. Repair of a facial defect with an interpolation skin flap in a cat. JAVMA 1997; 210(9):1319-1321. 11. Schmidt K, Bertani C, Martano M, et al. Reconstruction of the lower eyelid by third eyelid lateral advancement and local transposition cutaneous flap after "en bloc" resection of squamous cell carcinoma in 5 cats. Vet Surg 2005; 34:78-82. 12. Szentimrey D. Principles of reconstructive surgery for the tumor patient. Clin Tech Small Anim 1998; 13(1):70-76. Dena L. Lodato, DVM, is a second-year small animal surgical resident at Mississippi State University College of Veterinary Medicine. Her clinical interests include recon- structive surgery, wound care, fracture repair, and physical therapy. Dr. Lodato received her DVM from Mississippi State University. After graduation, she completed a rotating internship at Louisiana State University School of Veterinary Medicine followed by a surgical internship at Louisiana Veterinary Referral Center in Mandeville, Louisiana. Jennifer L. Wardlaw, DVM, MS, Diplomate ACVS, is an assistant professor of small animal surgery in the Department of Clinical Sciences at Mississippi State University College of Veterinary Medicine. Her interests include arthritis, reconstructive surgery, wounds, nutraceuticals, and developmental orthopedic diseases. Dr. Wardlaw has spoken at numerous national meetings as well as published various research articles and book chapters. She received her DVM from University of Missouri and completed her internship, residency, and MS at Mississippi State University.