Axial pattern flap case series highlights tradeoff between reach and risk: full analysis

A newly published Journal of Small Animal Practice case series is putting fresh clinical detail around an uncommon reconstructive technique: the omocervical axial pattern flap. Reviewing six cases from 2016 through 2024, investigators reported that the flap was used in four dogs and two cats to close defects after mass removal, scar revision, chronic inflammation, and trauma. All six patients developed postoperative complications, but only one required revision surgery, and the authors said the technique remained effective for selected defects in the orofacial, cervical, shoulder, and axillary regions. (pubmed.ncbi.nlm.nih.gov)

The finding is notable less because it overturns existing practice than because it fills in a sparse evidence base. The omocervical flap has been part of veterinary reconstructive surgery since at least 1981, when early canine work described its potential reach for facial, pinna, neck, shoulder, forelimb, axillary, and thoracic defects. Later reports expanded its use in specific scenarios, including a 2005 feline case in which an omocervical flap was used to repair a chronic axillary wound after other options were limited. (pubmed.ncbi.nlm.nih.gov)

In the new series, half of the defects followed mass removal, while the remaining cases involved scar revision, chronic inflammation, or trauma. Minor complications occurred in five of six cases and included skin irritation, hematoma formation, dehiscence, infection, and necrosis; one case developed major flap necrosis that needed surgical revision. That 100% complication rate sounds stark, but the authors’ interpretation was more measured: most events were manageable with conservative treatment, and the flap still provided usable coverage in anatomically difficult regions. (pubmed.ncbi.nlm.nih.gov)

That framing is consistent with the broader axial flap literature. A 73-case study published in 2015 found postoperative complications in 89% of dogs and cats undergoing axial pattern flap reconstruction, yet long-term outcome was still rated excellent or good in most patients. And more focused feline data suggest the same general tradeoff between complication frequency and clinical usefulness. In a retrospective series of 14 cats treated with lateral caudal axial pattern flaps for caudodorsal trunk defects, 50% had postoperative complications, most commonly partial flap dehiscence, seroma, and edema. Still, 57.1% healed without complications and the remaining 42.8% had only minor complications, leading the authors to describe the flap as a reliable option for feline trunk reconstruction. In other words, complication-prone doesn’t necessarily mean unsuccessful, especially when the surgical team plans for intensive postoperative monitoring and timely wound management.

While direct expert reaction to this paper was limited in publicly accessible sources, recent reconstructive surgery literature points to growing interest in better flap planning and perfusion assessment. The references attached to the new paper include a 2024 study on near-infrared fluorescence angiography with indocyanine green for evaluating direct cutaneous arteries used in canine axial pattern flaps, suggesting the field is looking for more objective ways to assess vascular reliability before or during surgery. That’s an inference from the paper’s reference list and adjacent literature, rather than a stated conclusion of the case series itself. (pubmed.ncbi.nlm.nih.gov)

Why it matters: For veterinary professionals, this paper is a reminder that omocervical flaps remain a viable option for selected head, neck, shoulder, and axillary defects, particularly when local closure is impossible and alternative axial flaps may not be ideal. But it also reinforces the need for careful case selection, frank preoperative conversations with pet parents about complication risk, and a postoperative plan that accounts for dehiscence, infection, hematoma, edema, seroma, and distal necrosis. In referral and specialty settings, the practical value may be less about proving the flap is “low risk” and more about clarifying the kinds of complications teams should expect and manage. (pubmed.ncbi.nlm.nih.gov)

The study’s limitations matter, too. With only six cases and a retrospective design, it can’t establish comparative performance against thoracodorsal, superficial brachial, or other axial pattern flaps. It does, however, add species-specific and indication-specific detail to a part of the literature that still relies heavily on older technique papers, isolated case reports, and mixed-flap retrospective reviews. The same is true across feline reconstructive surgery more broadly: even the larger cat-only flap series remain small, retrospective, and technique-specific, which makes it hard to generalize complication rates from one flap type or body region to another. (pubmed.ncbi.nlm.nih.gov)

What to watch: The next step will likely be larger multicenter comparisons, ideally with standardized reporting on flap dimensions, defect location, complication grading, and revision thresholds, plus possible adoption of perfusion-imaging tools to improve flap design and intraoperative decision-making. More cat-specific outcome series would also help determine whether the complication profile seen with one axial flap, such as the lateral caudal flap used for caudodorsal trunk defects, translates to other flap choices or simply reflects the anatomy and indications of that individual technique. (pubmed.ncbi.nlm.nih.gov)