Today's Veterinary Practice

SEP-OCT 2016

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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tvpjournal.com | September/October 2016 | T O day' S Ve T erinary Prac T ice 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 73 4. KEY POINT: Because undermining progresses toward the inguinal ring region, use extra caution as you bluntly dissect subcutaneous tissue around the base of the flap and pudendal epigastric trunk. c onsider leaving the inguinal fat pad (vaginal process) and connecting fat intact as long as the base of the flap can be rotated into position effectively. Create a Bridging Incision If Necessary 1. i f the base of the flap does not extend to include the skin defect, a bridging incision is necessary to allow a pathway for the flap to reach the recipient bed. 2. Make an incision through the skin and subcutaneous tissue directly between the base of the flap and recipient bed. d etermine where the flap base best sits within its rotated arc to decide where to create the bridging incision (Figure 9). 3. Undermine the skin adjacent to the bridging incision to allow for the width of the tapered skin flap base to comfortably fit within it. Transfer the Flap into the Recipient Bed 1. r otate the flap onto the wound. KEY POINT: The flap can be stretched somewhat to accommodate the wound defect, but do not allow tension or kinking of the c S e vessel if the flap is rotated 180 degrees or more. 2. e nsure the distal aspect of the flap is positioned in the distal most area of the open wound. Try multiple flap positions until you find the best location for the flap (Figure 10). 3. Once the best flap position is found, move the affected limb in multiple directions to ensure the flap is not under tension (especially for normal standing and walking limb positions). 4. i f the open wound is round and wide, and a "U turn" of the distal flap to create a "paddle" is planned, additional flap maneuvers may be neces - sary before beginning closure (Figure 6, page 71). 5. i f the flap does not fully cover the open wound, use other reconstructive options for closure. 6. While many surgeons prefer routine closed- suction drainage of these flaps to avoid seroma, i have found that drains are generally not necessary if atraumatic subcutaneous dissection and undermining were conducted and hemostasis was meticulous. i f drainage is elected, ensure there is a good seal around the wound edges during closure. d o not exit the closed suction drain through the flap; instead, exit it lateral to the flap (Figure 4, page 71). Suturing Wound Edges 1. KEY POINT: i prefer not to tack down or use walking sutures in the subcutaneous tissues to attempt to reduce motion and dead space under the flap and inguinal region. These sutures could inadvertently damage the blood supply to the flap. 2. Starting at the distal most aspect of the flap, use widely spaced interrupted hypodermal sutures FIGURE 8. The flap has been undermined and the surgeon is using Metzenbaum scissors to free tissue at the base of the flap. Proposed bridging incision (dotted line). Flap base is between two Xs. FIGURE 9. Electrotomy is used to create a bridging incision that connects the base of the flap with the defect. The edges of the separated bridging incision are delineated with dotted lines . FIGURE 10. The flap location is adjusted to fit within the defect.

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