Ultrasonographic and color-flow Doppler ultrasonographic assessment of direct cutaneous arteries used for axial pattern skin flaps in dogs

Jennifer A. Reetz Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010.

Search for other papers by Jennifer A. Reetz in
Current site
Google Scholar
PubMed
Close
 DVM, DACVIM
,
Gabriela Seiler Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010.

Search for other papers by Gabriela Seiler in
Current site
Google Scholar
PubMed
Close
 DrMedVet
,
Philipp D. Mayhew Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010.

Search for other papers by Philipp D. Mayhew in
Current site
Google Scholar
PubMed
Close
 BVM&S, DACVS
, and
David E. Holt Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010.

Search for other papers by David E. Holt in
Current site
Google Scholar
PubMed
Close
 BVSc, DACVS

Abstract

Objective—To describe a method for ultrasonographic and color-flow Doppler ultrasonographic imaging of the 4 direct cutaneous arteries commonly used for axial pattern skin flaps in dogs.

Design—Descriptive report.

Animals—20 clinically normal dogs.

Procedures—Dogs were manually restrained and fundamental and harmonic ultrasonographic and colorflow Doppler ultrasonographic examinations of the superficial cervical, thoracodorsal, deep circumflex iliac (cranial and caudal branches), and caudal superficial epigastric arteries were performed by a resident in diagnostic imaging. The level of confidence in locating these vessels was subjectively graded as high, moderate, or low.

Results—High-frequency fundamental and harmonic ultrasonography was important for maximizing image resolution, and color-flow Doppler ultrasonography was important for vessel identification. The superficial cervical artery was the most difficult vessel to identify; confidence in correct vessel identification was low or moderate. The thoracodorsal and deep circumflex iliac arteries were identified with a moderate or high level of confidence. The caudal superficial epigastric artery was the easiest vessel to identify; confidence in correct vessel identification was high. Except for the superficial cervical artery, the level of confidence in correct vessel identification improved over time as operator experience increased.

Conclusion and Clinical Relevance—Results suggest that the combination of fundamental ultrasonographic and color-flow Doppler ultrasonographic imaging is an easy and noninvasive method for identifying the 4 direct cutaneous arteries commonly used for axial pattern skin flaps in dogs. This method could be useful in planning axial pattern skin flaps, particularly in dogs with regional soft tissue trauma in which the integrity of the vessel is in question.

Abstract

Objective—To describe a method for ultrasonographic and color-flow Doppler ultrasonographic imaging of the 4 direct cutaneous arteries commonly used for axial pattern skin flaps in dogs.

Design—Descriptive report.

Animals—20 clinically normal dogs.

Procedures—Dogs were manually restrained and fundamental and harmonic ultrasonographic and colorflow Doppler ultrasonographic examinations of the superficial cervical, thoracodorsal, deep circumflex iliac (cranial and caudal branches), and caudal superficial epigastric arteries were performed by a resident in diagnostic imaging. The level of confidence in locating these vessels was subjectively graded as high, moderate, or low.

Results—High-frequency fundamental and harmonic ultrasonography was important for maximizing image resolution, and color-flow Doppler ultrasonography was important for vessel identification. The superficial cervical artery was the most difficult vessel to identify; confidence in correct vessel identification was low or moderate. The thoracodorsal and deep circumflex iliac arteries were identified with a moderate or high level of confidence. The caudal superficial epigastric artery was the easiest vessel to identify; confidence in correct vessel identification was high. Except for the superficial cervical artery, the level of confidence in correct vessel identification improved over time as operator experience increased.

Conclusion and Clinical Relevance—Results suggest that the combination of fundamental ultrasonographic and color-flow Doppler ultrasonographic imaging is an easy and noninvasive method for identifying the 4 direct cutaneous arteries commonly used for axial pattern skin flaps in dogs. This method could be useful in planning axial pattern skin flaps, particularly in dogs with regional soft tissue trauma in which the integrity of the vessel is in question.

Axial pattern skin flaps can be used for single-stage reconstruction of large wounds in dogs. Because the pedicle of such flaps incorporates a direct cutaneous artery and vein, the surviving flap length is approximately 50% greater than the length for similar flaps that rely on blood supply from the subdermal plexus alone.1–4 In some instances, the trauma that causes the initial wound also damages the area where these direct cutaneous vessels originate. Thus, it is important to assess the integrity of the direct cutaneous vessels before constructing an axial pattern flap to reconstruct a traumatic wound.

Patency of direct cutaneous vessels has traditionally been assessed by means of angiography. However, this requires use of general anesthesia and catheterization of the femoral artery. Preoperative Doppler ultrasonography has been used since the early 1990s in humans to plan skin flap reconstructive surgery,5 and a recent report6 described the use of ultrasonography to evaluate the integrity of the caudal superficial epigastric arteries prior to bilateral transposition of caudal superficial epigastric flaps to close a traumatic wound in a dog. The purpose of the present report was to describe a method for ultrasonographic and color-flow Doppler ultrasonographic imaging of the 4 direct cutaneous arteries commonly used for axial pattern skin flaps in dogs and describe results in 20 clinically normal dogs.

Technique

A standard ultrasound unita with a 10to 12-MHz linear transducer that had harmonic ultrasound capabilities (up to 14 MHz) was used. Hair was not clipped from the regions of interest prior to ultrasonographic examination, but large amounts of alcohol and ultrasound coupling gel were used. Dogs were manually restrained without sedation in left lateral recumbency.

The 4 direct cutaneous arteries that were evaluated were the superficial cervical (ascending branch), thoracodorsal, deep circumflex iliac (cranial and caudal branches), and caudal superficial epigastric arteries. The region of each vessel was located on the basis of published landmarks1 and anatomic descriptions.7 In brief, with the forelimb in relaxed extension, the area of the superficial cervical artery (previously know as the omocervical artery) was located in the depression between the shoulder and neck in the area of the superficial cervical lymph node, cranial to the cranial border of the scapula. With the forelimb in the same position, the area of the thoracodorsal artery was located in the depression caudal to the caudal border of the scapula at the level of the dorsal portion of the acromion. With the hind limb in relaxed extension, the area of the deep circumflex iliac artery was located cranioventral to the wing of the ilium. Finally, with the hind limb flexed and abducted, the area of the caudal superficial epigastric artery was located in the inguinal region approximately 5 mm lateral to the ventral midline, lateral to the prepuce in male dogs, and medial to the mammary glands in female dogs.

The degree of confidence that the ultrasonographer had in locating each artery was subjectively graded as high, moderate, or low. A high level of confidence implied that a vessel was located within 1 to 3 minutes and that its identity was not in question. A moderate level of confidence implied that a vessel was located within 3 to 5 minutes and that the ultrasonographer felt fairly certain that the correct vessel was identified. A low level of confidence implied that > 5 minutes was spent locating a vessel and that the ultrasonographer was uncertain as to whether the correct vessel was identified.

Results

Ultrasonographic evaluations were performed in 20 clinically normal dogs of various ages and weights by a single individual (JAR) enrolled in a residency program in diagnostic imaging. Dogs were obtained from a research colony or were owned by staff members at the University of Pennsylvania School of Veterinary Medicine, and none of the dogs had any history or clinical evidence of trauma. Ultrasonographic evaluations were performed over a period of 1 year; each dog was evaluated only once. The research protocol was approved by the Hospital Protocol Review Committee and the Institutional Animal Care and Use Committee.

The 20 dogs that were evaluated consisted of 17 mixed-breed dogs, 2 Border Collies, and 1 Golden Retriever. Mean age was 4 years (range, 4 months to 10 years). Mean body weight was 17.1 kg (37.6 lb; range, 10 to 32 kg [22 to 70.5 lb]), but dog size subjectively did not appear to affect the ability to identify a particular artery. There were 3 castrated males, 4 spayed females, and 13 sexually intact females. Three dogs were overweight (body condition score, 6 or 7 on a scale from 1 to 10), whereas the remaining dogs were of normal body condition (body condition score, 4 or 5). Subjectively, image quality was reduced in the overweight dogs, but the ability to identify a particular artery was not affected.

Harmonic ultrasonography was primarily used to identify vessels because of its excellent resolution and minimization of near-field artifacts. However, vessels could also be imaged by means of color-flow Doppler ultrasonography at 12 MHz, and vessels were typically easier to locate with the use of color-flow Doppler ultrasonography, whether fundamental or harmonic imaging was used. In 1 dog that was consistently trembling, color-flow Doppler ultrasonography could not be used because of motion artifact.

In general, the superficial cervical artery was the most difficult artery to image. A longitudinal image of the artery could typically be obtained with the transducer angled approximately 45° caudodorsally to cranioventrally in the depression between the shoulder and neck (Figure 1). When a vessel was clearly located, it could typically be traced dorsally for several centimeters. The superficial cervical lymph node, which was the best landmark for this vessel, was identified in only 6 dogs, all of which were imaged in the last 3 months of the study. In dogs examined in the earlier part of the study, the artery was identified on the basis of its position relative to the scapula and its dorsal course. The artery was identified in 16 dogs with a moderate level of confidence. In the remaining 4 dogs, all of which were examined in the last 3 months of the study, the level of confidence that the vessel was correctly indentified was low. In these dogs, one of which had an identifiable superficial cervical lymph node, other arteries were detected in the region of examination, and it was not possible to definitively determine on the basis of anatomy or typical course which vessel was the superficial cervical artery. The superficial cervical vein was not clearly identified in any dog.

A longitudinal image of the thoracodorsal artery was obtained with the transducer positioned in the depression caudal to the scapula and angled approximately 60° to 65° caudodorsally to cranioventrally (Figure 1). When a vessel was identified, it could often be followed caudodorsally for several centimeters. The artery was identified in 16 dogs with a high level of confidence. In the remaining 4 dogs, the level of confidence was moderate because it took longer to locate the vessel. These 4 dogs were all examined in the earlier part of the study. The thoracodorsal vein was identified in only 3 dogs.

With the transducer aligned with the long axis of the dog and located just cranioventral to the wing of the ilium, the origin of the deep circumflex iliac artery at the abdominal aorta was easily identified (Figure 2). The cranial branch was usually found in cross-section, approximately 5 mm from the origin of the deep circumflex iliac artery, and could typically be followed dorsally for 1 to 2 cm. The caudal branch was more difficult to image than the cranial branch in 7 dogs, most of which were examined during the first 6 months of the study. With experience, it became easier to identify this branch at its origin and to follow it caudoventrally for 1 to 2 cm. The deep circumflex iliac artery was identified with a high level of confidence in 18 dogs and with a moderate level of confidence in 2 dogs. Corresponding cranial and caudal venous branches were not identified.

Figure 1—
Figure 1—

Diagram of the anatomic positions of the superficial cervical (1) and thoracodorsal (2) arteries in a dog. The rectangular outlines represent the approximate transducer position and alignment during ultrasonographic examination of the arteries. (Adapted from Pavletic MM. Canine axial pattern flaps, using the omocervical, thoracodorsal, and deep circumflex iliac direct cutaneous arteries. Am J Vet Res 1981;42:391–406. Reprinted with permission.)

Citation: Journal of the American Veterinary Medical Association 228, 9; 10.2460/javma.228.9.1361

Figure 2—
Figure 2—

Diagram of the anatomic positions of the deep circumflex and caudal superficial epigastric arteries in a dog. The rectangular outlines represent the approximate transducer position and alignment during ultrasonographic examination of the deep circumflex iliac (3) artery and its cranial (3a) and caudal (3b) branches and the caudal superficial epigastric artery (4). (Adapted from Pavletic MM. Canine axial pattern flaps, using the omocervical, thoracodorsal, and deep circumflex iliac direct cutaneous arteries. Am J Vet Res 1981;42:391–406. Reprinted with permission.)

Citation: Journal of the American Veterinary Medical Association 228, 9; 10.2460/javma.228.9.1361

The caudal superficial epigastric artery was easily identified with a high degree of confidence in 17 dogs. The vessel was identified coursing cranially just lateral to the midline with the transducer aligned with the long axis of the dog (Figure 2). In 1 dog that was tense and trembling, the artery was not identified, and in 2 dogs, there was difficulty in maintaining the position of the hind limb, which made identification of the artery difficult. When one of the latter dogs was positioned in dorsal recumbency, the artery was quickly identified. The caudal superficial epigastric vein was identified in 18 dogs.

Discussion

Results for dogs described in the present report suggest that the 4 direct cutaneous arteries commonly used for axial pattern skin flaps in dogs can be identified by use of fundamental and harmonic ultrasonography combined with color-flow Doppler ultrasonography. Although harmonic ultrasonography was not required for vessel identification, use of a highfrequency linear transducer was essential. Good knowledge of the regional anatomy aided vessel identification, and the ability to identify vessels improved with experience. All but the superficial cervical artery could be identified with a moderate to high level of confidence. This technique is a relatively easy, noninvasive, and inexpensive method of assessing the integrity of the direct cutaneous arteries and could potentially be helpful when planning an axial pattern flap in a clinical case.

All of the dogs in the present report were examined with both fundamental and harmonic ultrasonography. Harmonic ultrasonography is a more advanced technology and would typically be available only in academic institutions and large referral facilities. Importantly, we found that the vessels could be adequately examined without the use of harmonic frequencies, which is important for most practitioners and specialists. Because of the relatively small diameter of these vessels and their superficial location, we believe that a 10to 12-MHz linear transducer is best for obtaining diagnostic information. However, a 7.5-MHz linear transducer was used successfully in a previous report.6 With superficial vessels, such as the caudal superficial epigastric artery, a stand-off pad could be used to minimize the effects of near-field artifacts on image quality. Although not necessary in every instance, color-flow Doppler ultrasonography greatly facilitated vessel identification. Unless an artery is seen pulsating, it can be difficult to differentiate a small vessel from parallel hyperechoic connective septa in the subcutis.8 It is possible that good visualization of these arteries would be difficult in clinical cases with regional soft tissue trauma, regardless of the type of ultrasonography used. Use of ultrasonography in such instances in human medicine has been well described.5,9 However, because use of ultrasonography for this purpose in dogs has been reported only once,6 its use in veterinary medicine requires further study.

Movement of the dogs during examination made vessel identification more difficult and time-consuming in some cases. For example, in the 1 dog in which color-flow Doppler ultrasonography could not be used, the caudal superficial epigastric artery was not identified. Sedating the dog would likely have made vessel identification easier and faster in these instances. Although sedation can alter hemodynamic status, which could then affect quantitative parameters such as blood flow velocity or vessel cross-sectional diameter, its effect on visualization of the direct cutaneous vessels is likely minimal.10–12

The fact that the hair was not clipped prior to examination could have affected image quality. Subjectively, however, image quality was not significantly affected because of the large amounts of alcohol and coupling gel used. Because color-flow Doppler ultrasonography was generally needed for vessel identification, particularly when fundamental ultrasonography was used, it is possible that clipping the hair could have improved image quality enough that color-flow Doppler ultrasonography would not have been necessary.

The presence of subcutaneous fat between the transducer and a region of interest can decrease the ability to visualize structures as a result of increased beam attenuation secondary to scattering of the ultrasound beam.13 This likely contributed to lesser image quality in dogs that were overweight in the present report. However, size of the dog did not appear to affect vessel visualization. On the other hand, none of the dogs weighed < 10 kg (22 lb), so it is not known whether vessel identification would be more difficult in smaller animals.

Because proficiency in ultrasonography is operator dependent and has a steep learning curve, identifying direct cutaneous vessels is likely to be difficult for novice ultrasonographers. Having a solid background in the fundamentals of ultrasonography and a basic knowledge of color-flow Doppler ultrasonography is considered important by the authors for success in this technique. A good knowledge of regional anatomy is also important. It is possible that vessel identification in this study would have been facilitated by recent exposure to surgical or anatomic dissection of the regions and vessels of interest.

For the thoracodorsal and deep circumflex iliac arteries, a learning curve in vessel identification was found in the present study. In general, the level of confidence increased and the time involved decreased as the study progressed. In contrast, during examination of the region of the superficial cervical artery in 4 dogs examined in the later part of the study, visualization of multiple vessels near the superficial cervical lymph node made it difficult to identify the correct artery. One possible reason for this could have been the presence of anatomic variations in the vasculature. Also, it is possible that this vessel is more difficult to locate than originally thought and that vessels were incorrectly identified earlier in the study.

To maximize success in vessel identification in clinical cases, it would be beneficial for clinicians to have experience locating these arteries in clinically normal dogs. The authors would recommend that 5 to 10 dogs be examined to develop confidence in identification of the thoracodorsal and deep circumflex iliac arteries and that more than 10 dogs be examined to develop confidence in identification of the superficial cervical artery. However, confidence in identification of the caudal superficial epigastric artery could be gained by examination of 5 or fewer dogs.

Identification of the corresponding veins was not a primary objective of the present study, but visualization of the veins was recorded. Preservation of venous outflow from axial pattern flaps is considered important for flap survival.3,4,14,15 In a previous report,6 the caudal superficial epigastric artery and vein were both identified and patency was established. However, the direct cutaneous veins could not be identified in many dogs in the present study, with the exception of the caudal superficial epigastric vein. The location of these veins relative to the arteries is not well described, and there is only 1 study3 describing angiography of these vessels in dogs. However, it is generally accepted that the corresponding veins course parallel to the arteries.16 Thus, the reason why we were generally unable to visualize the veins is unknown, although it could have been related to the slower blood flow in the veins, which may have been missed because settings for color-flow Doppler ultrasonography were more appropriate for arterial blood flow, with a relatively higher baseline or pulse-repetition frequency. The use of power Doppler ultrasonography may have aided in vein identification because of its increased sensitivity to low-volume flow.17 Also, the pressure of the transducer may have caused collapse of the thin-walled veins. It is possible that visualizing the veins in clinical cases is not essential, as their integrity could be assumed if normal corresponding arteries are identified.

Performing additional imaging studies such as angiography in the early phase of the study would have been helpful in locating arteries and confirming vascular anatomy. However, the dogs used in this study were either privately owned or part of another research project, so further evaluation was not possible. Selective angiography is considered one of the best methods for identifying vascular patterns,18 but is an invasive and expensive procedure that requires general anesthesia. Magnetic resonance angiography, which is primarily used in human medicine, is less invasive but is still expensive and was not available at the time of this study. However, in individual clinical cases, it may not always be necessary to definitively identify the correct artery. If several arteries of similar sizes are imaged in the region where a particular direct cutaneous artery is expected, it may be safe to assume that the integrity of the direct cutaneous artery is intact. In human medicine, cutaneous flaps are often based on much smaller terminal musculocutaneous arteries, and it has been suggested that a larger solitary perforating artery could be used in planning the flap if vascular anomalies or anatomic variations are present.10

a.

Logiq 9, General Electric Medical Systems, Milwaukee, Wis.

References

  • 1

    Pavletic MM. Axial pattern flaps. In: Pavletic MM, ed. Atlas of small animal reconstructive surgery. 2nd ed. Philadelphia: WB Saunders Co, 1999;217240.

    • Search Google Scholar
    • Export Citation
  • 2

    Pavletic MM. Vascular supply to the skin of the dog: a review. Vet Surg 1980;9:7780.

  • 3

    Pavletic MM. Canine axial pattern flaps, using the omocervical, thoracodorsal, and deep circumflex iliac direct cutaneous arteries. Am J Vet Res 1981;42:391406.

    • Search Google Scholar
    • Export Citation
  • 4

    Pavletic MM. Caudal superficial epigastric arterial pedicle grafts in the dog. Vet Surg 1980;9:103107.

  • 5

    Taylor GI, Doyle M, McCarten G. The Doppler probe for planning flaps: anatomical study and clinical applications. Br J Plast Surg 1990;43:116.

    • Search Google Scholar
    • Export Citation
  • 6

    Mayhew PD, Holt DE. Simultaneous use of bilateral caudal superficial epigastric axial pattern flaps for wound closure in a dog. J Small Anim Pract 2003;44:534538.

    • Search Google Scholar
    • Export Citation
  • 7

    Evans HE. The heart and arteries. In: Evans HE, ed. Miller's anatomy of the dog. 3rd ed. Philadelphia: WB Saunders Co, 1993;586681.

    • Search Google Scholar
    • Export Citation
  • 8

    Diana A, Preziosi R, Guglielmini C, et al. High-frequency ultrasonography of the skin of clinically normal dogs. Am J Vet Res 2004;65:16251630.

    • Search Google Scholar
    • Export Citation
  • 9

    Hallock GG. Evaluation of fasciocutaneous perforators using color duplex imaging. Plast Reconstr Surg 1994;94:644650.

  • 10

    Braun U, Fohn J. Duplex ultrasonography of the common carotid artery and external jugular vein of cows. Am J Vet Res 2005;66:962965.

    • Search Google Scholar
    • Export Citation
  • 11

    Smith BT, Mattoon JS, Bonagura JD, et al. Pulsed-wave Doppler ultrasonographic evaluation of hepatic veins during variable hemodynamic states in healthy anesthetized dogs. Am J Vet Res 2004;65:734740.

    • Search Google Scholar
    • Export Citation
  • 12

    Lee SW, Hankes GH, Purohit RC, et al. Comparative study of ultrasonography and arteriography of the carotid artery of xylazine-sedated and halothane-anesthetized goats. Am J Vet Res 1990;51:109113.

    • Search Google Scholar
    • Export Citation
  • 13

    Penninck DG. Artifacts. In: Nyland TG, Mattoon JS, eds. Small animal diagnostic ultrasound. 2nd ed. Philadelphia: WB Saunders Co, 2002;1929.

    • Search Google Scholar
    • Export Citation
  • 14

    Islamoglu K, Tetik G, Ozgentas HE. Effect of the delay phenomenon on survival of rat island skin flaps with total venous occlusion. J Reconstr Microsurg 2003;19:473476.

    • Search Google Scholar
    • Export Citation
  • 15

    Bilgin-Karabulut A, Ademoglu E, Aydin I, et al. Protective effects of vitamins A and E pretreatment in venous ischemia/reperfusion injury. J Reconstr Microsurg 2001;17:425429.

    • Search Google Scholar
    • Export Citation
  • 16

    Evans HE. Veins. In: Evans HE, ed. Miller's anatomy of the dog. 3rd ed. Philadelphia: WB Saunders Co, 1993;682716.

  • 17

    Loh N, Ch'en IY, Olcott E, et al. Power Doppler imaging in preoperative planning and postoperative monitoring of muscle flaps. J Clin Ultrasound 1997;25:465471.

    • Search Google Scholar
    • Export Citation
  • 18

    Tsukino A, Kurachi K, Inamiya T, et al. Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg 2004;113:241246.

    • Search Google Scholar
    • Export Citation

Contributor Notes

Supported by the Commonwealth of Pennsylvania.

The authors thank Patty O'Donnell for technical assistance.

Address correspondence to Dr. Reetz.
  • Figure 1—

    Diagram of the anatomic positions of the superficial cervical (1) and thoracodorsal (2) arteries in a dog. The rectangular outlines represent the approximate transducer position and alignment during ultrasonographic examination of the arteries. (Adapted from Pavletic MM. Canine axial pattern flaps, using the omocervical, thoracodorsal, and deep circumflex iliac direct cutaneous arteries. Am J Vet Res 1981;42:391–406. Reprinted with permission.)

  • Figure 2—

    Diagram of the anatomic positions of the deep circumflex and caudal superficial epigastric arteries in a dog. The rectangular outlines represent the approximate transducer position and alignment during ultrasonographic examination of the deep circumflex iliac (3) artery and its cranial (3a) and caudal (3b) branches and the caudal superficial epigastric artery (4). (Adapted from Pavletic MM. Canine axial pattern flaps, using the omocervical, thoracodorsal, and deep circumflex iliac direct cutaneous arteries. Am J Vet Res 1981;42:391–406. Reprinted with permission.)

  • 1

    Pavletic MM. Axial pattern flaps. In: Pavletic MM, ed. Atlas of small animal reconstructive surgery. 2nd ed. Philadelphia: WB Saunders Co, 1999;217240.

    • Search Google Scholar
    • Export Citation
  • 2

    Pavletic MM. Vascular supply to the skin of the dog: a review. Vet Surg 1980;9:7780.

  • 3

    Pavletic MM. Canine axial pattern flaps, using the omocervical, thoracodorsal, and deep circumflex iliac direct cutaneous arteries. Am J Vet Res 1981;42:391406.

    • Search Google Scholar
    • Export Citation
  • 4

    Pavletic MM. Caudal superficial epigastric arterial pedicle grafts in the dog. Vet Surg 1980;9:103107.

  • 5

    Taylor GI, Doyle M, McCarten G. The Doppler probe for planning flaps: anatomical study and clinical applications. Br J Plast Surg 1990;43:116.

    • Search Google Scholar
    • Export Citation
  • 6

    Mayhew PD, Holt DE. Simultaneous use of bilateral caudal superficial epigastric axial pattern flaps for wound closure in a dog. J Small Anim Pract 2003;44:534538.

    • Search Google Scholar
    • Export Citation
  • 7

    Evans HE. The heart and arteries. In: Evans HE, ed. Miller's anatomy of the dog. 3rd ed. Philadelphia: WB Saunders Co, 1993;586681.

    • Search Google Scholar
    • Export Citation
  • 8

    Diana A, Preziosi R, Guglielmini C, et al. High-frequency ultrasonography of the skin of clinically normal dogs. Am J Vet Res 2004;65:16251630.

    • Search Google Scholar
    • Export Citation
  • 9

    Hallock GG. Evaluation of fasciocutaneous perforators using color duplex imaging. Plast Reconstr Surg 1994;94:644650.

  • 10

    Braun U, Fohn J. Duplex ultrasonography of the common carotid artery and external jugular vein of cows. Am J Vet Res 2005;66:962965.

    • Search Google Scholar
    • Export Citation
  • 11

    Smith BT, Mattoon JS, Bonagura JD, et al. Pulsed-wave Doppler ultrasonographic evaluation of hepatic veins during variable hemodynamic states in healthy anesthetized dogs. Am J Vet Res 2004;65:734740.

    • Search Google Scholar
    • Export Citation
  • 12

    Lee SW, Hankes GH, Purohit RC, et al. Comparative study of ultrasonography and arteriography of the carotid artery of xylazine-sedated and halothane-anesthetized goats. Am J Vet Res 1990;51:109113.

    • Search Google Scholar
    • Export Citation
  • 13

    Penninck DG. Artifacts. In: Nyland TG, Mattoon JS, eds. Small animal diagnostic ultrasound. 2nd ed. Philadelphia: WB Saunders Co, 2002;1929.

    • Search Google Scholar
    • Export Citation
  • 14

    Islamoglu K, Tetik G, Ozgentas HE. Effect of the delay phenomenon on survival of rat island skin flaps with total venous occlusion. J Reconstr Microsurg 2003;19:473476.

    • Search Google Scholar
    • Export Citation
  • 15

    Bilgin-Karabulut A, Ademoglu E, Aydin I, et al. Protective effects of vitamins A and E pretreatment in venous ischemia/reperfusion injury. J Reconstr Microsurg 2001;17:425429.

    • Search Google Scholar
    • Export Citation
  • 16

    Evans HE. Veins. In: Evans HE, ed. Miller's anatomy of the dog. 3rd ed. Philadelphia: WB Saunders Co, 1993;682716.

  • 17

    Loh N, Ch'en IY, Olcott E, et al. Power Doppler imaging in preoperative planning and postoperative monitoring of muscle flaps. J Clin Ultrasound 1997;25:465471.

    • Search Google Scholar
    • Export Citation
  • 18

    Tsukino A, Kurachi K, Inamiya T, et al. Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg 2004;113:241246.

    • Search Google Scholar
    • Export Citation

Advertisement