Reconstruction Techniques of the Head

Restoration of oral cavity function and adequate cosmetic results are the goals of facial reconstruction. Primary closure can be achieved in most dogs due to their redundant lips and cheeks, even when major skin defects are present. The skin in cats, however, has less elasticity and may require flaps for closure of defects. Random subdermal flaps can be used for the side and caudal aspect of the head, incorporating a wide-based flap that is long enough to cover the defect with minimal tension. Skin should be undermined beneath the platysma muscle to retain blood supply to the subdermal area, and surgeons should be aware of the high risk of seroma formation in this area due to the vast array of lymphatic channels present. Three main axial pattern flaps have wide application to the face and head: (1) caudal auricular axial pattern flap for defects in the facial area (up to the lip in cats) and the dorsum of the head and ear, (2) angularis oris/labial axial pattern flap for cosmetic reconstruction of large facial and nasal defects in dogs, and (3) superficial temporal axial pattern flap for maxillofacial reconstruction of traumatic wounds or wounds resulting after excisional surgery or radiation therapy. Specific techniques for the repair of lip avulsions and lip fold pyoderma, as well as Estander full-thickness lip flaps for patients with extensive loss of lip tissue, are also covered in this presentation.

COMMENTARY: Wounds or defects in the head or face region are particularly challenging for the veterinarian due to lack of availability of local tissues and reconstruction difficulties around the orbit, nasal planum, and oral cavity. The direct cutaneous arterial supply of the canine and feline skin lends to the development of many specific axial pattern flaps, the most common of which are developed off the trunk and abdomen. The practitioner should keep in mind the available axial pattern flaps of the head and neck as possible reconstruction options for large head or facial wounds. In addition, the specific concepts regarding techniques to address wounds and conditions of the lower lip are good to revisit on occasion, particularly with regard to species and breed predispositions.

NAVC: Daniel Smeak, DVM, Diplomate ACVS/Wednesday, January 20 •10:10–11:00, Marriott