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Surgeon’s Corner: Caudal Superficial Epigastric Skin Flap

Dr. Howard B. Seim, DVM, DACVS, Colorado State University

Surgery, Soft Tissue

|May 2013|Web-Exclusive

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Presentation

The patient has 2 significant degloving injuries on the caudal aspect of both extremities; the left extremity is more denuded than the right.

Surgery

On one extremity the surgeon has planned a caudal superficial epigastric flap to move skin into the denuded area. An incision is made to incorporate the entire mammary chain of the left caudal superficial epigastric blood supply. The surgeon is careful to elevate the skin flap by using an undermining technique and thus maintaining full-thickness dissection of the flap. Care is taken to avoid damage to any small vessels or branches of the caudal superficial epigastric artery and vein. A caudal incision is created to allow easier rotation of the base of the graft in order to maintain a tensionless closure and avoid unnecessary pulling on the neurovascular bundle. Tacking sutures are placed to hold the graft in place at the recipient site. A Jackson-Pratt drain is threaded up the SC area of the recipient site and exited at a point distant from the primary flap incision sites. This drain allows for active suction. The recipient and donor sites are then completely sutured. The immediate postoperative free range of motion on this grafted extremity provides for an excellent outcome. The opposite extremity is treated by undermining the medial and lateral aspects of the wound so that the skin is completely removed from the underlying SC tissue. A series of skin incisions are made to release the skin tension. The release incisions will gape upon wound closure, allowing the skin to be pulled to a relatively tensionless apposition. Although there is still some tension on the wound closure, the release incisions help dramatically to reduce the amount of tension.

Outcome

The dog is seen at the 1-month recheck appointment. The caudal superficial epigastric flap has been completely accepted and there is haired skin at the graft site. The range of motion in this extremity is excellent. The wound on the opposite extremity has completely closed and there is robust skin coverage over all previous defects.

This video was authored by Howard B Seim III, DVM, DACVS. Other surgical videos are available through VideoVet. Surgeon’s Corner is intended as a forum for those with specialized expertise to share their approaches to various techniques and procedures. As such, the content reflects one expert’s approach and is not subject to peer review.

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