The concept of complete local excision of all visible tumor followed by, or concurrent with, chemotherapy or radiation therapy for treatment of presumed micrometastasis has achieved marked acceptance in human oncologic therapy and is being applied in veterinary medicine. This multimodality treatment plan includes surgery as an integral component especially for large, aggressive neoplasms. The goal of the operative plan for oral neoplasms in cats and dogs is most commonly curative resection or palliation. A surgical procedure which offers the greatest possibility of cure, restores or maintains function, and has an acceptable cosmetic result is often required in veterinary medicine. With these goals in mind, reconstruction following resective surgery generally maximizes available oral tissues for primary wound closure. Dehiscence of the reconstructed wound may be related to suturing tissues under excessive tension, however this may not be the originating problem in all cases of dehiscence. Oronasal communication with clinical signs of rhinitis occurs in patients with dehiscence of the reconstructed maxillary defect. A phone call follow-up within 5 to 7 days of the maxillectomy will be predictive of wound dehiscence if the owner reports that the patient is sneezing, snorting, or has a nasal discharge especially after eating or drinking. Oral examination proves diagnostic based on visual evidence of an oronasal communication or periodontal probing into the nasal cavity with or without epistaxis.

The clinician would prefer to correct the problem immediately (and so would the owner), however the timing for revision surgery is paramount to a successful outcome following the second procedure. Therefore, it is recommended to wait 2 to 3-weeks before the revision procedure to allow resolution of acute inflammation and the development of fibroplasia in tissues around the defect. For axial-pattern flaps, the most detrimental complication following wound reconstruction is devitalization of the flap apex, or end. Because of the nature of axial-pattern flap utilization, partial-flap necrosis occurs at an area where the flap is most important. This is particularly problematic in oral and maxillofacial reconstruction where second-intention healing following flap necrosis and wound dehiscence is not a viable management option.

Clinical signs of flap necrosis include a demarcated discolored (black/purple) area, palpably decreased temperature of the discolored area, decreased hair growth in the devitalized area, and wound dehiscence with drainage of a serosanguineous or purulent fluid if there is concurrent infection. The clinician should be deliberate when deciding when to revise the flap. Early intervention may result in even more tension applied to the flap and continued flap necrosis. It is advisable to wait 4 to 7 days until flap viability is ascertained and the risk of further devitalization is minimal. Another advantage of deliberate management is the improved blood flow to the base of the flap at the time when flap revision is performed. Generally, the revision of a devitalized flap is successful, taking advantage of the increased blood flow and redundant skin present at the base of the flap.