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1.
Objective— To compare short‐ and long‐term outcome and complications of chest wall reconstruction in dogs using autogenous, prosthetic, and composite autogenous–prosthetic techniques. Study Design— Historical cohort. Animals— Dogs (n=44) with spontaneous tumors arising from or involving the chest wall. Methods— Medical records were reviewed for dogs with rib and/or sternal tumors treated by chest wall resection and reconstruction. Signalment, preoperative clinical features, intraoperative findings and complications, reconstruction technique (autogenous muscle flap, prosthetic mesh, or composite autogenous–prosthetic technique), and short‐ (≤14 days) and long‐term (>14 days) postoperative complications were determined from the medical records and telephone contact with owners and referring veterinarians. Associations between chest wall reconstruction technique and postoperative complications were tested with Cox proportional hazards. Results— Chest wall defects were reconstructed with autogenous muscle flaps (29 dogs), prosthetic mesh (3), and a composite technique of prosthetic mesh and either autogenous muscle or omental pedicle flap (12). Early postoperative complications were recorded in 8 dogs (18.2%) and included seroma (5) and pleural effusion and peripheral edema (3). One dog had a late complication (2.3%) with a mesh‐related infection 767 days postoperatively. Overall, complications occurred in 10.3% of autogenous, 25.0% of composite, and 66.7% of prosthetic reconstructions. Chest wall reconstruction with Marlex mesh alone was associated with a significantly increased risk of postoperative complications compared with autogenous reconstruction (P=.027). Reconstruction of sternal defects (3), 2 of which were performed with Marlex mesh alone, was associated with a significantly increased risk of complications compared with lateral chest wall reconstructions (P=.037). Conclusions— Large chest wall defects can be reconstructed with autogenous and composite techniques, but prosthetic mesh should be covered with well‐vascularized autogenous muscle or omentum to decrease the risk of postoperative complications. Sternal defects should be reconstructed with rigid techniques. Clinical Relevance— Chest wall reconstruction with autogenous muscle flaps or a combination of autogenous techniques with prosthetic mesh is associated with a low rate of infection and other complications.  相似文献   

2.
Anatomic and experimental evaluation of the feline latissimus dorsi muscle was performed to assess its potential use as a free muscle flap. In the anatomic study, nonselective angiography of the subscapular artery was performed in nine heparinized feline cadavers. The muscle dimensions and vascular anatomy of the dissected latissimus dorsi muscle were recorded. In the experimental study four cats underwent heterotopic transplantation of a partial latissimus dorsi flap, and three cats underwent orthotopic transplantation of a complete latissimus dorsi flap. The mean length and width of the latissimus dorsi muscle was 19.0 and 5.4 cm, respectively. The dominant vascular pedicle was the thoracodorsal artery and vein. The average length and diameter of the thoracodorsal artery was 2.7 cm and 0.6 mm, respectively. Minor vascular pedicles were provided by branches of the intercostal arteries. Numerous choke anastomoses existed between the two pedicle systems. Viability of muscle flaps based on subjective evaluation, angiography, and histopathology, was 66% and 100% in the heterotopic and orthotopic studies, respectively. Flap failure seemed to be caused by both arterial and venous thrombosis. The latissimus dorsi muscle flap met criteria required for application in microvascular reconstruction. The vascular pattern was appropriate and consistent. Donor site morbidity was low, whereas surgical accessibility was high. The muscle satisfied the physical criteria of a free flap. Long-term anastomotic patency and flap viability was shown.  相似文献   

3.
A latissimus dorsi muscle flap was used to reconstruct a proximal scapular defect in a cat after excision of a fibrosarcoma that had recurred after eight surgeries, radiation therapy, and chemotherapy. To obtain appropriate surgical margins, infraspinatus and supraspinatus myectomy and scapular spinous ostectomy were performed. The latissimus dorsi muscle flap was rotated into the defect and anchored to four holes placed in the cranial border of the scapula. The cat showed no lameness at 6, 21, 42, and 147 days after surgery. The latissimus dorsi muscle flap was successful for proximal scapular reconstruction in this cat.  相似文献   

4.
Latissimus dorsi and cutaneous trunci myocutaneous flaps of equal dimension and location were randomly elevated on opposite sides of the thorax in 10 dogs (group 1) and resutured to their respective bed. The procedure was repeated in four additional dogs (group 2); however, the short perforating branches of the thoracodorsal artery and vein were divided at the base of each cutaneous trunci myocutaneous flap, whereas the cutaneous pedicle and underlying cutaneous trunci muscle were divided in the latissimus dorsi myocutaneous flaps to determine subsequent skin survivability and the major source of circulation of each myocutaneous flap. There was little difference in the percentage of skin survival between the latissimus dorsi and cutaneous trunci myocutaneous flaps in group 1 dogs. Circulation to the "skin island" of group 2 latissimus dorsi myocutaneous flaps originated from intramuscular anastomotic connections between the major branch of the thoracodorsal artery entering the latissimus dorsi muscle and the proximal lateral intercostal arteries perforating the muscle. Ligation of the short perforating branches of the thoracodorsal artery resulted in partial skin necrosis in all group 2 cutaneous trunci myocutaneous flaps. Results from this study indicate that it is unnecessary to elevate the latissimus dorsi muscle for major skin flap elevation and survival. The thicker latissimus dorsi myocutaneous flap is more difficult to develop surgically and appears to have no clinical major advantage over the more mobile cutaneous trunci myocutaneous flap or the adjacent thoracodorsal axial pattern flap for closure of large skin defects within the radius of flap rotation.  相似文献   

5.
Objective— To describe a thoracic wall reconstructive technique using a latissimus dorsi myocutaneous flap after en bloc resection of primary rib chondrosarcoma and report outcome in 5 dogs.
Study Design— Retrospective study.
Animals— Dogs (n=5) with primary rib chondrosarcoma.
Methods— Medical records (2003–2005) were reviewed for signalment, staging investigations, surgical findings, complications, and outcomes. Owners and veterinary surgeons were contacted for outcome information.
Results— A latissimus dorsi myocutaneous flap provided an air-tight thoracic wall closure after chondrosarcoma resection. Paradoxical respiratory movement of the flap occurred; however, from physical examination and blood gas analysis (2 dogs), ventilation was adequate. All flaps survived, 1 had superficial skin necrosis distally and 2 had minor wound dehiscence. One dog without tumor-free margins died of tumor-related disease 56 days after surgery. Tumor recurrence did not occur in 4 dogs with tumor-free margins. One dog was euthanatized 10 months after surgery for unrelated disease; 3 dogs were alive at writing (median follow-up: 20 months; range, 18–27 months) and all had a satisfactory functional and cosmetic outcome.
Conclusions— Reconstruction of ventral thoracic wall defects using a latissimus dorsi myocutaneous flap yields a functional, cosmetic outcome.
Clinical Relevance— A latissimus dorsi myocutaneous flap can be used as a successful 1-stage reconstructive technique for ventral thoracic wall defects.  相似文献   

6.
Objective —To evaluate the outcomes and complications in a consecutive series of animals undergoing microvascular reconstructive procedures at two veterinary institutions. Study Design—Retrospective study. Animals or Sample Population—A total of 44 client-owned dogs and one red-necked wallaby. Methods —The medical records of all animals undergoing reconstructive microsurgical procedures at the Western College of Veterinary Medicine and Michigan State University were reviewed. Microvascular flap survival and related complications were described. Statistical analysis was performed to determine the significance of relationships between operative factors and outcome. Results —A total of 57 microvascular procedures were performed on 55 animals. Reconstruction was required after trauma in 42 animals, after ablative cancer surgery in 11 animals and for correction of congenital tissue aplasia in 1 animal. Donor tissues included the superficial cervical cutaneous, medial saphenous fasciocutaneous or musculofasciocutaneous, caudal superficial epigastric cutaneous, trapezius muscle or musculocutaneous, caudal sartorius muscle, latissimus dorsi muscle or musculocutaneous, cranial abdominal myoperitoneal, carpal footpad, digital footpad, and vascularized ulnar bone flaps. A total of 53 of 57 flaps (93%) survived. There was a significant relationship between flap failure and level of assistant surgeon experience (P < .05). Latissimus dorsi flaps were significantly more likely to fail when compared with pooled data from all other flap types (P < .01). Conclusions —The success of microvascular tissue transfer in this case series compares favorably with those reported in human reconstructive microsurgery. Both the primary and assistant surgeon should be practiced in microsurgical technique. Failure of latissimus dorsi flaps was not likely caused by an inherently deficient flap design, but was more likely attributed to the location and severity of trauma at the recipient site, the difficulty in isolating suitable recipient vessels for anastomosis or the absence of a trained assistant surgeon during these procedures. Clinical Relevance —This retrospective study documents the successful application of microvascular technique in a series of clinical cases requiring tissue reconstruction.  相似文献   

7.
This report describes a novel technique for abdominal wall reconstruction using an internal abdominal oblique muscle flap in an Australian kelpie. En bloc resection of a chondrosarcoma and biopsy scar centred on the 13th rib was performed to include full thickness thoracic wall (12th rib, extending caudally) and lateral abdominal wall (including the vascular pedicle of the external abdominal oblique muscle). The diaphragm was advanced to close the thorax. A flap using the caudal internal abdominal oblique muscle with the base dorsally was elevated and rotated 90° to fill the dorsal defect. The ventral defect was closed using the composite ventral abdominal muscles. The skin was closed primarily. The dog developed a self-resolving seroma. Twelve months postoperatively, the dog was able to engage in agility competitions. A viable muscle flap using the internal abdominal oblique muscle provides a useful alternative to previously described techniques for autogenous closure of a large abdominal wall wound.  相似文献   

8.
This study reports about follicular development on the surface of canine ovarian tissue after autografting under the fascia of the thoracolumbar muscle and about meiotic resumption of follicle-derived oocyte after maturation culture. After ovarian excision from a bitch, each ovary of the pairs was cut approximately into half. The hemi-ovaries were transplanted into the bitch of origin at three different body sites (under the fascia of the quadriceps femoris muscle and the thoracolumbar muscle, and in the deltoid muscle in the scapular region). All grafted ovaries were recovered from the bitch at 35 days post-transplantation. A visible antral follicle was observed on the surface of the ovary grafted under the thoracolumbar fascia. Histological examination revealed viable follicles at different stages of development irrespective of graft site. Most granulosa cells in the follicles at different stages of development expressed proliferating cell nuclear antigen (PCNA). A total of three oocytes were collected from an ovary grafted under the fascia of the thoracolumbar muscle, wherein an oocyte reached metaphase I after maturation culture. This is the first report to demonstrate follicular development and meiotic resumption of oocytes recovered from autografted canine ovarian tissues.  相似文献   

9.
Dissection and injection studies in canine cadavers and in anesthetized dogs were conducted to determine the feasibility of using the latissimus dorsi, gracilis, and rectus abdominus muscles as musculocutaneous free flaps. Lengths of vascular pedicles for the latissimus dorsi (2 +/- 0.8 cm), gracilis (1.8 +/- 0.8 cm), and rectus abdominus (1.9 +/- 0.9-cm cranial deep epigastric, 1.7 +/- 0.5-cm caudal deep epigastric), as well as arterial diameters (1.28 +/- 0.31-mm thoracodorsal for the latissimus dorsi, 1.10 +/- 0.33-mm muscular branch for the gracilis, 1.25 +/- 0.25-mm cranial deep epigastric and 1.26 +/- 0.32-mm caudal deep epigastric for the rectus abdominus) were considered satisfactory for microvascular transfer. Fluorometry demonstrated overlying cutaneous perfusion in all flaps based on their muscle vascular pedicles, with the exception of the rectus abdominus flap based on the caudal deep epigastric artery. In this instance, up to 20% of the cutaneous element had questionable or no perfusion.  相似文献   

10.
A 7‐year‐old Connemara stallion was presented with a 4 month history of blepharospasm, recurrent corneal ulcerations, mucopurulent ocular discharge, and keratoconjunctivitis sicca (KCS) in both eyes unresponsive to medical therapy. Ophthalmic examination revealed lackluster corneas, axial corneal scarring and pigmentation with associated neovascularization, and absolute KCS in both eyes. Computed tomography scan and endoscopic evaluation of the upper airway and guttural pouches revealed no structural abnormalities to indicate neurogenic KCS. The stallion was diagnosed with immune‐mediated dacryoadenitis as all other causes of KCS were excluded. Parotid duct transposition (PDT) was performed in the right eye followed by PDT in the left eye 4 weeks later. The right PDT was functional 2 years post‐operatively with significant improvement in ocular comfort and reduced corneal fibrosis and neovascularization. The left PDT developed a salivary‐cutaneous fistula over the left masseter muscle post‐operatively due to avascular necrosis of the distal parotid duct (PD). Surgical reconstruction of the PDT using an expanded‐polytetrafluoroethylene (e‐PTFE) tube graft, an e‐PTFE tube graft to autogenous caudal auricular vein graft, and an autogenous saphenous vein graft were all unsuccessful. Tear production in the left eye improved at 1 year post‐surgery as a result of long term lacrostimulant therapy, and a permanent PD‐cutaneous fistula was performed on the left PD at the level of the ventral mandible. Bilateral PDT in the horse is effective in resolving clinical signs associated with KCS; however, morbidity associated with avascular necrosis of the transposed PD may be significant and can result in surgical failure.  相似文献   

11.
A mare was presented for evaluation of a penetrating thoracic injury. Surgical exploration of the thoracic wound was performed, revealing diaphragmatic perforation and the presence of a foreign body lodged in the right dorsal colon. The foreign body was removed through the thoracic deficit, the colon repaired and the thoracic wound closed utilising a latissimus dorsi muscle flap. It can be concluded that successful management of thoracic wounds with concurrent abdominal viscera involvement is achievable if minimal contamination is evident. In addition reconstruction of large thoracic defects with primary muscle flaps is a viable option in the horse.  相似文献   

12.
The purpose of the anatomical study was to identify potential myoperitoneal microvascular free flaps, in dogs, that are based on a single artery and vein. The angiosomes of the right deep circumflex iliac artery and left phrenicoabdominal (cranial abdominal) artery were evaluated in six medium-sized canine cadavers. The right deep circumflex iliac artery and left phrenicoabdominal (cranial abdominal) artery were injected with a mixture of barium and latex (equal parts). The entire right and left transversus abdominis muscles were dissected from the abdominal wall and radiographed. The angiograms of the deep circumflex iliac artery showed poor arborization of the vessels within the transversus abdominis muscle in all six cadavers. The angiograms of the phrenicoabdominal (cranial abdominal) artery showed consistent filling of the vascular bed of the cranial half of the transversus abdominis muscle flap in all six dogs. The vascular pedicle lengths and the diameter of the arteries and veins of both the deep circumflex iliac and phrenicoabdominal (cranial abdominal) myoperitoneal free flaps were found to be acceptable for microvascular anastomosis. The deep circumflex iliac flap was unacceptable because of inadequate vascular perfusion. The cranial abdominal artery had a consistent, large branch that supplied the cranial half of the transversus abdominis muscle, thereby making a myoperitoneal flap supplied by this vessel a potentially useful free flap. An 8-year-old male, neutered, mixed-breed dog was evaluated for possible repair of a large defect of the hard palate. Previous operations, using local tissue flaps, had been unsuccessful. A myoperitoneal free flap, based on the right cranial abdominal artery, and consisting of the cranial portion of the transversus abdominis muscle, was used successfully to reconstruct the hard palate. Migrating epithelium from the edges of the wound covered the myoperitoneal flap by 10 weeks after surgery. Therefore, the cranial abdominal myoperitoneal free flap can be considered for reconstruction of intra-oral defects that cannot be repaired using conventional local flap techniques.  相似文献   

13.
A case of a traumatic scleral rupture with uveal herniation in a dog was treated with an autogenous fascia lata graft. Placement of the graft resolved the uveal prolapse and resulted in return of strength and a more normal structure. Fascia lata appears to be an effective scaffolding graft for the repair of scleral defects. It is cheap, easily harvested and large grafts may be obtained. Healing was rapid and the end result was a cosmetic, comfortable, fully functional eye.  相似文献   

14.
Total muscle mass increases about five-fold in fast (anterior latissimus dorsi: ALD) and slow (posterior latissimus dorsi: PLD) muscles and 30-fold in cardiac muscle between the 12th and 20th d of incubation. 2. Increase in muscle protein does not parallel the rise in muscle RNA. 3. The DNA concentration of the ALD muscle decreases while that of the heart and PLD muscle show an increase between 8 and 12 d and a steady decrease thereafter. 4. The increase in glycogen concentration is greater in heart than in ALD and PLD up to the 20th d; 1 d after hatching, ALD has more glycogen than PLD.  相似文献   

15.
In an anatomic and radiologic study of the clavicle of 50 adult dogs of 10 breeds, the clavicle had ossified in 96% of the dogs. The clavicles studied had various shapes, and each clavicle was attached to the caudomedial part of the clavicular intersection of the brachiocephalic muscle, to the mastoid part of the cleidocephalic muscle, and to 4 radiating bands of connective tissue fasciculi. One band was attached to the caudal border of the scapula and fascia deep to the latissimus dorsi muscle, 1 was attached to the manubrium of the sternum, and 1 each was attached to the epimysia of the superficial pectoral and sternocephalic muscles. We concluded that, during movements of the thoracic limb, the clavicle and the 4 fasciculated connective tissue bands associated with it stabilize the position of the brachiocephalic muscle with relation to the crest of the greater tubercle of the humerus. Also, the fasciculated band attached to the caudal border of the scapula provides protection for nerves from the brachial plexus and axillary blood vessels that supply the thoracic limb.  相似文献   

16.
A myofascial island flap for abdominal wall reconstruction was based on the lumbar component of the external abdominal oblique muscle and supplied by a major neurovascular pedicle consisting of branches of the cranial abdominal artery, cranial hypogastric nerve, and a satellite vein. The flap was elevated and sutured into a 10 cm x 10 cm body wall defect in five dogs. The dogs were observed for 26 to 28 days. Abdominal wall contour and function were preserved. All dogs developed seromas, two of which became infected. One dog developed a hernia at the dorsal margin of the flap, which was repaired. At necropsy, there was no evidence of dehiscence in any of the dogs. Loose adhesions of omentum to the inner surface of the flap occurred in four dogs. Results of histologic examination confirmed the clinical impression of flap viability. The myofascial island flap has a wide range of mobility over the ventral and caudal areas of the abdomen and lateral thoracic wall. It has potential clinical use for reconstruction of defects within its arc of rotation.  相似文献   

17.
An autogenous free vascular bone graft of the canine distal ulna was evaluated. The vascularity of the graft was based on a musculoperiosteal sheath supplied solely by the caudal interosseous artery and vein. Four autogenous heterotopic (ulna to tibia) vascular transfers were performed. Two avascular transfers were performed to provide baseline criteria from which the success of vascularized transfers could be assessed. Clinical lameness evaluation, serial radiographs, bone scintigraphy, and sequential fluorochrome bone labeling were performed after surgery in both vascular and avascular transfers. All dogs were free of lameness in the donor limb by the 26th postoperative day. Serial radiographs revealed rapid graft incorporation and hypertrophy in all vascularized grafts and severe bone resorption in nonvascularized grafts. Histology, microangiography, and evaluation of fluorochrome bone labels were performed 90 days after surgery to determine graft viability, incorporation and temporal remodeling patterns. Microangiography and fluorochrome assessment complemented the histological findings. Based on these findings the distal ulnar bone graft was determined to be both viable and structurally adequate for selected cases of long bone reconstruction.  相似文献   

18.
Bite wounds of the chest wall in small dogs can extend into the thorax and can be associated with severe damage to chest wall muscles, ribs, and lungs. Two major problems associated with the management of these wounds are lack of sufficient muscle tissue for chest wall reconstruction, and difficulty draining the extensive dead space created in the chest wall. We describe a simple method to overcome these problems. The bite wound areas were surgically explored and all devitalized soft tissue was debrided. The pleural cavity was explored, intrathoracic injuries repaired, and a thoracic drainage tube was placed. Ribs in the injured area were stabilized in anatomic position by means of heavy gauge sutures passed around pairs of adjacent ribs, thus creating a scaffolding for soft tissues. Viable muscle and subcutaneous tissues were apposed as much as possible and the skin closed over the defect. Eleven small dogs were treated using this technique. All dogs had severe injuries to the thoracic wall muscles and eight dogs had multiple rib fractures. There was no evidence of chest wall instability in any of the dogs after surgery. Nine dogs survived the injury and were reevaluated 3 to 32 months after surgery. All were clinically normal. One dog developed wound infection and pyothorax, caused by insufficient debridement of injured muscle tissue, and died 10 days after surgery. A second dog died 24 hours postoperatively of undetermined causes.  相似文献   

19.
The purpose of this study was to establish the normal percutaneous ultrasonographic appearance of anatomic structures within the equine sacroiliac region. Percutaneous ultrasonography was performed in a cranial-to-caudal direction in 10 normal adult live horses. The following structures were examined in detail: supraspinous ligament, lumbar and sacral spinous processes, thoracolumbar fascia and its caudal extension, tubera sacralia, ilial wings, dorsal and lateral portions of the dorsal sacroiliac ligaments, lateral part of the sacrum, and the lateral sacral crest. After ultrasonography, all animals were euthanized and detailed dissection of the lumbosacropelvic region was performed in six horses. Four lumbosacropelvic specimens were frozen and sectioned transversely for evaluation of cross-sectional anatomy. Gross anatomic findings were correlated with ante-mortem ultrasonographic images. On percutaneous ultrasonography, all horses had tubera sacralia with a mild-to-moderate roughened surface with occasional irregular hyperechoic mineralizations located within the apophyseal cartilage of younger horses. At the level of the tuber sacrale the caudal extension of the thoracolumbar fascia joined the dorsal portion of the dorsal sacroiliac ligament and assumed two different configurations relative to the dorsal portion of the dorsal sacroiliac ligament, with the predominant configuration of the thoracolumbar fascia located medial to the dorsal portion of the dorsal sacroiliac ligament. The less frequently encountered configuration had the thoracolumbar fascia positioned dorsal to the dorsal portion of the dorsal sacroiliac ligament. Caudal to the tuber sacrale the dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia consolidated to form a single, fused structure with a common insertion on the sacral spinous processes. A large variability in linear fiber pattern, echogenicity (small focal hypoechoic areas), ligament height, and cross-sectional measurements was identified in the fused dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia of normal horses. Diagnosing mild-to-moderate desmitis of the fused dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia based solely on ultrasonography may therefore be difficult. To correlate ultrasonography with histology, samples of a fused dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia with bilateral hypoechoic lesions were submitted for histology and revealed diffuse mild-to-moderate loss of fiber density, multifocal fibrocyte degeneration, and cartilagenous metaplasia with multifocal, mild myofiber mineralization, which was compatible with age-related changes. As controls, sections of ultrasonographically normal fused dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia from three horses demonstrated similar but milder histologic findings, which were considered normal.  相似文献   

20.
Severely comminuted diaphyseal fractures in 11 dogs were repaired with standard bone plates that spanned a fracture gap filled with autogenous cancellous bone graft. Five dogs had closed injuries, 4 dogs had open fractures, and 2 dogs had infected nonunion fractures for which previous attempts at internal pin fixation had failed. A second autogenous cancellous bone graft was performed in 3 of the dogs during the healing period. The technique was successful in all dogs. The technique was considered a versatile and relatively simple alternative, compared with meticulous small fragment reconstruction and cortical bone allografts.  相似文献   

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