Successful Treatment of a Metacarpal Trophic Ulcer Utilizing a Neurovascular Island Flap

Abstract

A 4-year-old, neutered male, soft coated wheaten terrier mixed-breed dog was presented for evaluation of a nonhealing ulcer of the metacarpal pad of 10 to 12 weeks' duration. A diagnosis of an ulnar nerve deficit and secondary trophic ulceration was made. The ulcer was repaired using a neurovascular island flap. Postoperatively, a fiberglass clamshell splint was used to protect the healing flap. The flap healed successfully and developed a highly keratinized epithelium much like a normal footpad.

Pedicled Instep Flap and Tibial Nerve Reconstruction in a Cynomolgus Monkey[Macaca fascicularis]

“…The absence of sensitivity to the sole of foot was confirmed later when the tibial nerve (N) was found severed. Trophic ulceration of digital pads has been described in veterinary medicine [ 3 – 5 ]. It is well established that in clinical practice wound healing is delayed in denervated skin areas even without additional hindering factors such as pressure and/or impaired vascularization (i.e., diabetes).…”

“…The medial plantar artery and parts of the N. plantaris medialis are included in the neurovascular pedicle of the flap. Neurovascular free and island flaps have been applied successfully in veterinary medicine in order to replace injured canine foot pads [ 3 , 5 , 11 ]. In human patients Wan et al could demonstrate at 6 months to 1 year after sensate medial plantar flap transposition that the sensation of the recipient area retained the quality of the donor site, thereby surpassing the sensation of the contralateral normal heel [ 12 ].…”