ISSN 2398-2950      

Skin graft: pedicle

ffelis
Contributor(s):

Laura Owen


Introduction

  • Wound reconstruction, eg carcinoma external nose, following wide local excision, hemangiopericytoma, deficit following compartmental resection or reconstruction of a traumatic wound, utilizing skin flap(s) retaining its original vascular supply.

Uses

Conventional flaps

  • Vascularized solely by capillaries in subdermal plexus until neovasculization establishes a secondary blood supply from the receipient bed  Skin flap: vascular arrangement :
    • Advancement flaps.
    • Rotation flaps.
    • Transposition flaps.

Axial flaps

  • Vascularized by single direct cutaneous vessel (artery):
    • Caudal superficial epigastric for lower abdomen, groin and medial thigh.
    • Deep circumflex iliacs for lateral thigh and lumbar region.
    • Superficial omocervical for cranial shoulder and cervical region.
    • Thoracodorsal for thoracic, forelimb and axillary region.
    • Caudal auricular for head.

Advantages

Conventional flaps

  • Much loose skin in many cats.
  • Simple technique, applicable in many situations.
  • Avoids wound failure caused by primary closure under tension.

Axial flaps

  • Larger and more mobile than conventional flaps.
  • Blood supply preserved.
  • Can be combined with bone/muscle grafts.
  • Microvascular re-anastomosis, a specialized technique, can allow for complete detachment of skin and transposition to the recipient wound bed, where the direct cutaneous vessel is re-anastomosed to an artery there.

Disadvantages

Conventional flaps

  • Viability determined largely by pedicle base width and vascularity Skin flap: vascular arrangement .
  • Smaller and less mobile than axial flaps.

Axial flaps

  • Careful pre-operative planning and patient positioning to include axial vessel in reconstruction.
  • Technically more challenging.
  • Some techniques complex, eg microvascular anastomosis for orthotopic graft transfer.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good depending on site and extent of area to be repaired.

Further Reading

Publications

Refereed papers

Other sources of information

  • Pavletic M M (1992) Atlas of small animal reconstructive surgery. Philadelphia, J B Lippincott.

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