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T O day' S Ve T erinary Prac T ice | September/October 2016 | tvpjournal.com P rac T ica L T ec H ni QU e S F r OM TH e na V c in ST i TUT e Peer r eviewed 70 • KEY POINT: i n patients with skin defects caused by significant trauma, rule out trauma to other organ systems (eg, bladder rupture, diaphragmatic hernia). d o not rush reconstruction of an acute traumatic wound. r ather, focus first on appropriate early open wound care and patient stabilization. • Before any major reconstructive effort, limit contamination in a traumatic wound with appropriate antibiotic therapy, local wound management, and bandaging. SURGICAL TECHNIQUE Assess Skin Coverage 1. KEY POINT: Prior to surgery, ensure that the c S e axial vessel is healthy along its course by visual inspection of the area. i f trauma or skin loss is close to the inguinal ring or mammary chain, and vessel viability is questionable, color flow d oppler imaging or angiogram studies can help determine whether the axial vessel has been damaged. i f concerns exist regarding vessel viability, use the healthy contralateral mammary chain for skin transfer. 2. d etermine the approximate length of skin perfused by the caudal superficial axial vessel (angiosome) by measuring from the superficial inguinal ring to the region midway between the first 2 mammary glands (the most cranial extent of the skin nourished by this vessel) (Figure 1A). This length of skin is the same in both males and females. However, in males, one or more small branches of the c S e vessel supply the preputial skin. These branches must be carefully ligated to allow full rotation of the flap base in male animals. 3. Measure the distance from the base of the flap to the farthest point of the open wound. i prefer to add about 20% to the length of the skin flap needed to cover the defect because some length of the flap is lost as the flap is rotated into position and the flap can be expected to shrink somewhat. d etermine the feasibility of the flap to cover the defect on the basis of these initial measurements. 4. d etermine the maximum width of the flap by measuring from the abdominal midline to the nipple; then extend that measured length lateral to the nipple (Figure 1A). 5. i f a "paddle" of skin is needed to cover a large round defect broader than the maximal flap width, consider folding the terminal aspect of the flap in a For more information on wound management, visit tvpjournal.com and read: » Moist Wound Healing: The New Standard of Care (July/August 2015) » Helpful Tips for Managing Wounds in Veterinary Patients (November/ December 2013) » Unique Therapies for Difficult Wounds (July/August 2011). FIGURE 2. Anatomic course of the CSE vessel along mammary row. Reprinted with permission from Pavletic M. Atlas of Small Animal Wound Management and Reconstructive Surgery, 3rd ed. Hoboken, NJ: Wiley Blackwell, 2010, p 383. FIGURE 1. Schematic ventral view of a dog demonstrating CSE flap margins (dotted lines); the yellow region denotes range of skin defect coverage and arrows highlight the arc of flap rotation into various regions of the body ( a ). Lateral (B) and caudal (C) views, with skin defect coverage highlighted in yellow. 4 A 4 C 4 B