KÜRŞAT ÖZER, MURAT KARABAĞLI, Kemal UĞURLU

A New Flap Model in the Treatment of Non-Healing Elbow Wounds in Dogs: The Island Arterial Composite Flap Comprising the Skin Originating from the Thoracodorsal Artery, the Cutaneous Trunci Muscle and Fascia of the Latissimus Dorsi Muscle

Dirsek bölgesindeki doku kayıplı yaraların sağaltımında en çok kullanılan yöntem torakodorsal arter kökenli tüp flebi olmasına karşın, nekroz, dikişlerde açılma, gerginlik gibi dezavantajları bulunmaktadır. Bu nedenle çalışmamızda, torakodorsal bölgedeki deri, kutaneöz trunci kası ve latissumus dorsi kasının üzerindeki fasya dokusunun, kompozit ada arteriyel flebi olarak, dirsek bölgesindeki kronik yaraların rekonstrüksyonu için kullanılmasının sonuçlarının ortaya konması amaçlandı Dirsek bölgesinde doku kayıplı veya iyileşmeyen yarası bulunan 14 köpek çalışmanın materyalini oluşturdu. Öncelikle dirsek bölgesindeki kronik yara yenileştirildi. Daha sonra torakodorsal bölgedeki deri üzerinde, mevcut yaranın boyutuna göre değişen elips şeklinde bir ensizyon yapıldı. Torakodorsal arter pedikülü ortaya çıkarıldıktan sonra koltuk altında oluşturulan tünelden geçirilerek dirsek bölgesindeki yenileştirilmiş yara üzerine taşındı ve monoflament emilmeyen dikiş materyali ile basit ayrı teknikle dikilerek sonuçları değerlendirildi. Sonuç olarak torakodorsal arter kökenli deri, kas ve fasya ada arteriyel kompozit flebinin, dirsek bölgesindeki iyileşmeyen yaraların rekonstrüksiyonunda etkili bir yöntem olabileceği düşünüldü.

Köpeklerde İyileşmeyen Dirsek Yaralarının Sağaltımında Yeni Bir Flep Modeli: Torakodorsal Arter Kökenli Deri, Cutaneöz Trunci Kası ve Latissimus Dorsi Kası Fasyasını İçeren Ada Arteriyel Kompozit Flebi

In the treatment of wounds with tissue loss in the elbow region, despite the most frequently used method being the tube flap of thoracodorsal artery origin, this method has the disadvantages of necrosis, opening of sutures and tension. The aim of this study is to present the results of the island arterial composite flap, containing the skin of the thoracodorsal area, the cutaneous trunci muscle and fascia of the latissimus dorsi muscle, for the reconstruction of chronic wounds in the elbow region. The material of the study consisted of 14 dogs with either non-healing wounds or wounds with tissue loss in the elbow region. Firstly, debridement of the elbow defect was carried out. Next, an elliptical incision depending on the size of the defect was made in the thoracodorsal skin. Once the thoracodorsal artery and its pedicle were exposed, this was passed through the tunnel formed in the axillary region and placed over the debrided defect in the elbow region. It was sutured using non-absorbable monofilament suture material and simple interrupted sutures and the results were evaluated. In conclusion, the skin originating from the thoracodorsal artery, muscle and fascia island artery flap may be an effective method in the reconstruction of wounds in the elbow region.

PDF

___

Pavletic MM: Pressure sores. In, Pavletic MM (Ed): Atlas of Small Animal Wound Management and Reconstructive Surgery. 3rd ed., 216-221, Wiley- Blackwell, Ames Iowa, 2010.
Swaim S, Bohling M: Advances in small animal wound management. Vet Focus, 18 (1): 17-23, 2008.
Szentimrey D: Principles of reconstructive surgery for the tumor patient. Clin Tech Small Anim Pract, 13, 70-76, 1998. DOI: 10.1016/S1096- (98)80031-5
Aper R, Smeak D: Complications and outcome after thoracodorsal axial pattern flap reconstruction of forelimb skin defects in 10 dogs, 1989
Vet Surg, 32, 378-384, 2003. DOI: 10.1053/jvet.2003.50043
Pavletic MM: A comparison of the cutaneous trunci myocutaneous flap and latissimus dorsi myocutaneous flap in the dog. Vet Surg, 16, 283- , 1987. DOI: 10.1111/j.1532-950X.1987.tb00954.x
Done SH, Goody PC, Evans SA, Stickland NC: The thorax. In, Done SH, Goody PC, Evans SA, Stickland NC (Eds): Color Atlas of Veterinary Anatomy. Vol-3. 3rd ed., 195-261, Mosby Elsevier, London, 2014.
Pavletic MM: Introduction to myocutaneous and muscle flaps. Vet Clin North Am: Small Anim Pract, 20, 127-146, 1990. DOI:10.1016/S0195- (90)50007-8
Hedlund CS: Surgery of the integumentary system. In, Fossum TW (Ed): Small Animal Surgery, 2nd ed., 134-254, Mosby, China, 2002.
Pavletic MM: New techniques in small animal reconstructive surgery. Vet Quart, 19 (Suppl.-1): 25-27, 1997. DOI: 10.1080/01652176.1997.
Pavletic MM: Pedicle grafts. In, Slatter D (Ed): Textbook of Small Animal Surgery, 3rd ed., 292-321, Saunders, Philadelphia, 2003.
Disa JJ, Klein MH, Goldberg NH: Advantages of autologous fascia versus synthetic patch abdominal reconstruction in experimental animal defects. Plast Reconstr Surg, 97, 801-806, 1996. DOI: 10.1097/00006534- 00017
Ugurlu K, Hüthüt İ, Özçelik D, Ozer K, Sakiz D, Yıldız K, Baş L: Epithelialization process of free fascial flaps used in reconstruction of oral cavity mucosa defects in dogs. Plast Reconstr Surg, 113, 915-923, DOI: 10.1097/01.PRS.0000105625.27802.64
Ugurlu K, Karsidag T, Huthut I, Karsidag S, Ozer K, Sacak B, Akcal A: Bare dorsal thoracic fascial flap for esophageal defects: An experimental study with dogs. Surg Endosc, 26, 1682-1689, 2012. DOI 1007/s00464-011-2093-3
Bongartz A, Carofiglio F, Balligand M, Heimann M, Hamaide A: Use of autogenous fascia lata graft for perineal herniorrhaphy in dogs. Vet Surg, 34, 405-413, 2005. DOI: 10.1111/j.1532-950X.2005.00062.x
Battisti A, Polton G, Vries M, Friend E: Chest wall reconstruction with latissimus dorsi and an autologous thoracolumbar fascia graft in a dog. J Small Anim Pract, 56, 218-222, 2015. DOI: 10.1111/jsap.12270
Handerson ER, Friend EJ, Toscano MJ, Parsons KJ, Tarlton JF: Biomechanical comparison of canine fascia lata and thoracolumbar fascia: An in vitro evaluation of replacement tissues for body wall reconstruction. Vet Surg, 44, 126-134, 2015. DOI: 10.1111/j.1532-950X.2014.12247.x
White RAS: Management of specific skin wounds. Vet Clin North Am: Small Anim Pract, 36, 895-912, 2006. DOI: 10.1016/j.cvsm. 2006.04.004
Amsellem P: Complications of reconstructive surgery in companion animals. Vet Clin North Am: Small Anim Pract, 41, 995-1006, 2011. DOI:10.1016/j.cvsm.2011.05.005
Haar GT, Buiks SC, Delden MV, Reijntjes T, Sanchez RF, Kirpensteijn J: Skin tension. In, Kirpensteijn J, Haar GT (Eds): Reconstructive Surgery and Wound Management of the Dog and Cat. 12-13, Manson Publishing, London, 2013.
Sardinas JC, Pavletic MM, Ross JT, Kraus KH: Comparative viability of peninsular and island axial pattern flaps incorporating the cranial superficial epigastric artery in dogs. JAVMA, 207 (4): 452-454, 1995.
Wardlaw JL, Lanz OI: Axial pattern and myocutaneous flaps. In, Tobias KM, Johnston SA (Eds): Veterinary Surgery Small Animal. 1256- , Saunders, Missouri, 2012.
Sade C, Ugurlu K, Ozcelik D, Huthut I, Ozer K, Ustundag N, Saglam I, Bas L: Reconstruction of the urethral defects with autologous fascial tube graft ia a rabbit model. Asian J Androl, 9, 835-842, 2007. DOI: 1111/j.1745-7262.2007.00271.x
Remedios AM, Bauer MS, Bowen CV: Thoracodorsal and caudal superficial epigastric axial pattern skin flaps in cats. Vet Surg, 18, 380-385, DOI: 10.1111/j.1532-950X.1989.tb01105.x