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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 72 Recipient Wound Preparation 1. Using aseptic technique, debride and lavage the wound if it is not fully covered with healthy granulation tissue. c ulture tissue removed from the wound bed, particularly if the wound is considered contaminated. • i f the flap is being used to reconstruct an open wound, irrigate the wound bed with an appropriate antiseptic solution and routinely clip and aseptically prepare the surrounding skin. • i f the wound is more chronic and skin wound edges are partially epithelialized, square off the wound edges and remove thin epithelialized tissue, extending the wound bed margins with a scalpel blade. 2. Sharply undermine the skin edges of the wound for several millimeters to create a free edge to which the flap will be sutured. c over the prepared recipient wound with moistened laparotomy pads as you begin flap (donor skin) preparation. Donor Skin Preparation 1. d raw the proposed flap dimensions with a sterile drawing pen (Figure 7 ). The medial border is located on the ventral abdominal midline from the pubis to a point between the first and second mammary glands. i n male dogs, the medial caudal border includes the skin just lateral to the base of the prepuce. 2. The lateral border of the flap should run parallel, and to an equal length, to the medial border (the midline). d raw the lateral borderline equidistant away from the nipple line as the distance measured from midline to the nipple line. e ssentially, the width of the flap is double the measurement from the midline to the nipple line. 3. Taper down the lateral skin margin toward the inguinal ring area, which makes the donor defect in the inguinal region easy to close after flap transfer. 4. a fter ascertaining the appropriate flap length, draw a line connecting the medial and lateral skin flap lines at the distal aspect of the proposed skin flap. c reate the shape of the distal end of the flap with rounded margins to facilitate closure of the cranial aspect of the donor defect without dog-ear formation. Incise & Undermine the Flap 1. Using a scalpel blade, incise skin along the borders of the drawn lines to outline the flap. Because the skin incision tapers caudally in the inguinal region, do not damage the nearby underlying c S e vasculature. 2. Starting at the distal aspect of the flap (the most cranial aspect), carefully and sharply undermine the subcutaneous tissue directly off the abdominal wall. i n the cranial most aspect, expect firm adherence of subcutaneous tissue to the underlying pectoral muscles. Undermining is easier as dissection progresses caudally because the subcutaneous tissues are loosely connected to the underlying fascia. a void using thumb forceps to grasp skin edges; rather, use skin hooks or digital manipulation to handle and retract the flap (Figure 8). 3. c over the donor skin edges and defect with moistened laparotomy pads as you undermine the flap. FIGURE 7. Large skin defect on caudal medial left thigh of a dog ( a ). The left limb is pulled upward, showing the medial thigh defect. Ink lines show proposed skin incision to create CSE flap (B); X is over the inguinal ring. The surgeon is drawing the course of the CSE vasculature in the middle of the left mammary chain. A B