1
|
Reingrittha P, Kittipibul K, Kulkittaya S, Jitprapaikulsarn S. U-Turn Design Metatarsal Artery Flap: Reliable Solution in Distal Forefoot Defect. Ann Plast Surg 2024; 93:94-99. [PMID: 38864419 DOI: 10.1097/sap.0000000000004012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND In distal forefoot defect, finding wound closure is challenging because of the distal site and small blood vessels involved. One possible resolution is the utilization of a metatarsal artery flap in a 'U-turn' design. This method offers several advantages, including its long length and a viable option for distal forefoot defect. METHODS Thirty-six patients with forefoot injuries from metatarsophalangeal (MTP) joint to distal interphalangeal (DIP) joint due to trauma were consecutively recruited and completed the study. Outcomes were analyzed descriptively, and risk prediction modeling for edge necrosis was performed. RESULTS The mean ± SD follow-up time was 27.3 months ±1.9. The median (IQR) MTP-to-DIP joint wound width and length were 1.8 (1.4, 3.0) and 3.2 cm (2.9, 6.2), respectively. The median (IQR) width, length, and width-to-length ratio flap dimensions were 3.6 (2.8, 6.0), 4.7 cm (4.3, 9.3), and 1.5 (1.2, 1.7), respectively. The mean ± SD operative time was 32.9 min ± 5.7. The median (IQR) intraoperative blood loss was 5.0 mL (4.0, 5.0). The mean ± SD hospital length of stay postoperatively was 4.0 days ±1.0. The mean ± SD Foot and Ankle Outcome Score and Foot Function Index were 64.1 ± 2.5 and 7.8% ± 3.3, respectively. All patients had good or excellent aesthetic satisfaction. Spontaneously resolving edge necrosis occurred in 13.9%. The mean ± SD time-to-start-ambulation was 1.7 weeks ±0.5. At the 2-year follow-up visit, all patients had reduced U-turn flap pivot point redundancy without shoe size impact, needing reoperation, or donor site morbidity. Edge necrosis was significantly associated with length-to-width ratio ( P = 0.014) but not with Foot and Ankle Outcome Score or Foot Function Index. CONCLUSIONS Metatarsal artery flap of U-turn design was reliable and was associated with a short recovery time, alternative resolution for forefoot area due to short operation time, minimal blood loss, short hospital length of stay, and excellent availability.
Collapse
|
2
|
Logothetou V, L'Eplattenier H, Shimizu N. Complications and influence of cutaneous closure technique on subdermal plexus flaps in 97 dogs (2006-2022). Vet Surg 2024; 53:546-555. [PMID: 38037259 DOI: 10.1111/vsu.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/17/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To determine the incidence and severity of complications for subdermal plexus flaps in dogs and compare the complications when using sutures or staples for cutaneous closure of subdermal plexus flaps. STUDY DESIGN Retrospective monocentric study. SAMPLE POPULATION Ninety-seven client-owned dogs. METHODS Dogs that underwent wound reconstruction using subdermal plexus flaps were retrospectively identified. Type of flap, cutaneous closure technique, complications and level of complication associated with their use were recorded. Follow-up was considered adequate if it was more than 10 days postoperatively or until a complication occurred. RESULTS Complications were seen in 52 dogs (53.6%), of which 13/18 (72.2%) of dogs had cutaneous closure with skin staples versus 39/79 (49.3%) with skin sutures. The location of the mass/wound on the head and use of an advancement flap was associated with lower incidence of complications (p < .001; p = .018 respectively). Location of the mass/wound on the proximal pelvic limb was associated with a low level of complications (p = .01) on univariable analysis only. On multivariable analysis, only an increased bodyweight was associated with an increased incidence of complications (p = .029). CONCLUSIONS Increased weight may be associated with an increased risk of complications with subdermal plexus flaps. No risk factor was found to be associated with the severity of complications. CLINICAL SIGNIFICANCE Overall incidence of complications for subdermal plexus flaps in dogs in this study was 53.6%. The number of dogs included in the study was not sufficient to assess if the skin closure technique affects the incidence of complications.
Collapse
|
3
|
Angelou V, Psalla D, Kazakos G, Marouda C, Chatzimisios K, Kyrana Z, Karayannopoulou M, Papazoglou L. Evaluation of Survival of Subdermal Plexus Skin Flaps in 8 Cats After Injection of Platelet Rich Plasma. Top Companion Anim Med 2023; 53-54:100770. [PMID: 36813229 DOI: 10.1016/j.tcam.2023.100770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/24/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
The aim of the present study was to evaluate the effect of platelet-rich plasma injection on the survival of experimentally developed subdermal plexus skin flaps in cats. Two flaps, 2 cm wide and 6 cm long were created bilaterally in the dorsal midline in 8 cats. Each flap was randomized to 1 of 2 groups: platelet-rich plasma injection and control. After flap development, the flaps were immediately placed back on the recipient bed. Then 1.8 mL of platelet-rich plasma was equally injected into 6 different parts of the treatment flap. All flaps were evaluated macroscopically daily and on days 0, 7, 14, and 25 by planimetry, Laser Doppler flowmetry, and histology. Mean flap survival on day 14 was 80.437 % (±22.745) for the treatment group and 66.516 % (±24,12) for the control group with no statistically significant difference between the 2 groups (P = .158). Histologically, a significant difference was found between the base of the PRP and the control flap in edema score on day 25 (P = .034). In conclusion, there is no evidence to support the use of platelet-rich plasma in subdermal plexus flaps in cats. However, the use of platelet-rich plasma may aid in reducing edema of subdermal plexus flaps.
Collapse
Affiliation(s)
- Vasileia Angelou
- Unit of Obstetrics and Surgery, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitra Psalla
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Kazakos
- Unit of Anaesthesiology and Intensive Care, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Marouda
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Chatzimisios
- Unit of Obstetrics and Surgery, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zacharenia Kyrana
- Department of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, Thessaloniki, Greeece
| | - Maria Karayannopoulou
- Unit of Obstetrics and Surgery, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lysimachos Papazoglou
- Unit of Obstetrics and Surgery, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
4
|
Castejón-González AC, Reiter AM. Oral and Maxillofacial Tumor Management - From Biopsy to Surgical Removal. Vet Clin North Am Small Anim Pract 2021; 52:235-270. [PMID: 34838252 DOI: 10.1016/j.cvsm.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The main objective of oral and maxillofacial (OMF) tumor resection is to get local control of the disease. Many OMF tumors can be cured with wide or radical surgery, whereas others might only achieve temporary local control of the disease by removing infection and the source of pain, thereby improving the quality of life of the patient while keeping masticatory function. The standard of care on managing OMF tumors includes the diagnosis and identification of the local and distant extension of the disease to establish an appropriate treatment plan tailored for each patient. In this article, we provide a practical review of the current information related to staging, biopsy, and main surgical techniques for OMF tumor removal.
Collapse
Affiliation(s)
- Ana C Castejón-González
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA
| | - Alexander M Reiter
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA.
| |
Collapse
|
5
|
Albernaz VGP, Oblak ML, Quitzan JG. Angularis oris axial pattern flap as a reliable and versatile option for rostral facial reconstruction in cats. Vet Surg 2021; 50:1688-1695. [PMID: 34293186 DOI: 10.1111/vsu.13686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 05/07/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate outcomes associated with the use of an angularis oris axial pattern flap (AOAPF) for rostral facial reconstruction in cats. ANIMALS Nine adult client-owned cats. STUDY DESIGN Short case series. METHODS Ten AOAPF were performed in nine cats after resection of a tumor. Wounds were located at the nose, infraorbital, supraorbital, frontal, eye, and ear canal region. Orbital exenteration (n = 3), pinnectomy (n = 2), nasal planum resection, total ear canal ablation (n = 2), and partial eyelid reconstruction (n = 3) were performed. RESULTS Short-term postoperative complications included flap edema (n = 10), suture dehiscence (n = 3), and distal tip necrosis (n = 3). All wounds resulting from minor complications healed by second intention in 5-15 days. Long-term complications included epiphora (n = 2), frequent grooming around the eyes (n = 2), and enucleation due to corneal ulcer secondary to impaired postoperative eyelid function (n = 1). Tumor recurrence occurred in 3 cases. CONCLUSION The AOAPF was a versatile and reliable option for rostral facial reconstruction in cats with acceptable long-term outcomes.
Collapse
Affiliation(s)
- Vinicius G P Albernaz
- School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
| | - Michelle L Oblak
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Juliany G Quitzan
- School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
| |
Collapse
|
6
|
Guerios SD, Serrano MA, Moore BA, Montiani-Ferreira F. Lip Commissure to Eyelid Transposition Flap to Correct Eyelid Agenesis in Cats in a Shelter Setting - a Case Series. Top Companion Anim Med 2021; 45:100557. [PMID: 34233226 DOI: 10.1016/j.tcam.2021.100557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Five cats were diagnosed with eyelid agenesis in a 6-month period at the Miami-Dade Animal Services, and a total of 9 blepharoplasties were performed using the lip commissure to eyelid transposition flap (LCET) technique. Eyelid agenesis affected 50%-80% of the superiolateral lid in all cats. Postoperatively, partial necrosis of the flap was observed in 4 and partial dehiscence was observed in 1 of the corrected eyelids, occurring where the buccal mucosa was sutured to the conjunctival mucosa. No cats with partial necrosis of the flap were known to have developed trichiasis due to scar tissue formed at the necrotic site. The single case in which dehiscence occurred developed slight trichiasis that may warrant further intervention to ensure permanent hair ablation. Eyelids were cosmetically acceptable and functional at final examination. Patients showed no evidence of initial discomfort at the surgical sites, nor discomfort or progression of corneal disease during the follow-up time. This case series documents a suitable technique to treat cat eyelid agenesis when referral to a specialist is not an option due to lack of resources, such as in shelters or low-cost veterinary clinics. The surgical technique, outcome and complications presented in this case series are evaluated, and discussed.
Collapse
Affiliation(s)
| | - Maria A Serrano
- Shelter Medicine, Miami-Dade Animal Services, Doral, FL, USA
| | - Bret A Moore
- Comparative Ophthalmology, University of Florida, Gainesville, FL, USA
| | | |
Collapse
|
7
|
Guzu M, Rossetti D, Hennet PR. Locoregional Flap Reconstruction Following Oromaxillofacial Oncologic Surgery in Dogs and Cats: A Review and Decisional Algorithm. Front Vet Sci 2021; 8:685036. [PMID: 34095284 PMCID: PMC8175653 DOI: 10.3389/fvets.2021.685036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Primary treatment of most oromaxillofacial tumors in dogs and cats is resective surgery. Management of malignant tumors may be very challenging as wide/radical free-margin surgical removal must be achieved while preserving vital functions. Removal of orofacial tumors may result in large defects exposing the oral cavity or creating a communication with the nasal, pharyngeal, or orbital cavities. Such defects require orofacial reconstruction in order to restore respiratory and manducatory functions. The veterinary surgeon must be familiar with reconstructive techniques in order to prevent the inability of closing the defect, which could lead to an insufficient resection. Small oral defects exposing the nasal cavity are best closed with local random mucosal flaps. Closure of large oral defects may be better achieved with a facial or major palatine-based axial-pattern flap. Small to moderate facial defects can be closed with local advancement or transposition skin flaps. Reconstruction of large facial defects often requires the use of locoregional axial pattern flaps such as the caudal auricular, the superficial temporal, or the facial (angularis oris) myocutaneous axial pattern flaps. Recent publications have shown that the facial (angularis oris) flap is a very versatile and reliable flap in orofacial reconstructive surgery. A surgical decision algorithm based on the size, nature, and location of the defect is proposed.
Collapse
Affiliation(s)
- Michel Guzu
- Dentistry and Oromaxillofacial Surgery Unit, Department of Surgery, ADVETIA Centre Hospitalier Vétérinaire, Vélizy-Villacoublay, France
| | - Diego Rossetti
- Department of Surgery, CHV ADVETIA, Vélizy-Villacoublay, France
| | - Philippe R. Hennet
- Dentistry and Oromaxillofacial Surgery Unit, Department of Surgery, ADVETIA Centre Hospitalier Vétérinaire, Vélizy-Villacoublay, France
| |
Collapse
|