11. Plastic Surgery

Question 1

how do you avoid tension when closing a wound?

Answer 1

undermining technique

Question 2

what are the advantages of local flaps?

Answer 2

-can match skin color, texture, hair growth, and thickness

Question 3

what are the disadvantages of local flaps?

Answer 3

vascular compromise

must be handled w/ care

Question 4

what is a V-Y flap?

Answer 4

-advancement flap

with a V shaped incision –> sides of V are advanced –> closed wound resembles a Y

Question 5

what are the indications for a V-Y flap?

Answer 5

• excision of skin lesion
• scar tissue
• joint contracture
• skin contracture

Question 6

what is the Y-V flap?

Answer 6

(advancement flap)

• Y shaped skin incision
• V portion advanced
• closed wound resembles a V

Question 7

what are indications for a Y-V flap?

Answer 7

• release tension at right angle to Y-V

- scar tissue

Question 8

what is a Z-skin plasty?

Answer 8

(rotational flap)

• Z skin incision
• transpose arms of Z to lengthen skin and relieve tension
• lengthens along longitudinal axis and shortening along transverse axis

Question 9

the amt of lengthening achieved by Z-skin plasty is based on the angle of the triangles and the length of the central arm. if the angle is 30 deg, how much lengthening is achieved?

Answer 9

25% increase

Question 10

the amt of lengthening achieved by Z-skin plasty is based on the angle of the triangles and the length of the central arm. if the angle is 45 deg, how much lengthening is achieved?

Answer 10

50% increase

Question 11

the amt of lengthening achieved by Z-skin plasty is based on the angle of the triangles and the length of the central arm. if the angle is 60 deg, how much lengthening is achieved?

Answer 11

75% increase

Question 12

the amt of lengthening achieved by Z-skin plasty is based on the angle of the triangles and the length of the central arm. if the angle is 75 deg, how much lengthening is achieved?

Answer 12

100% increase

Question 13

what is a split-thickness skin graft composed of?

Answer 13

epidermis and portion of dermis

Question 14

what is a full-thickness skin graft composed of?

Answer 14

epidermis and all of dermis

Question 15

thinner grafts have what characteristics?

Answer 15

• take better
• contract more
• more hyperpigmentation
• more susceptible to trauma

Question 16

describe the stages of skin graft healing.

Answer 16

1. plasmatic imbibition
2. inosculation
3. venous and lymphatic drainage

Question 17

what happens in plasmatic imbibition phase of graft healing? what is the time scale?

Answer 17

(48 hrs)

-nutrition (skin graft drinks nutrition from the granular bed)

Question 18

what happens in the inosculation phase of skin graft healing? what is the time scale?

Answer 18

(4-7 days)

capillary growth and budding

Question 19

what happens in the venous and lymphatic drainage phase of skin graft healing?

Answer 19

(day 6)

-venous and lymphatics drain

Question 20

what are some complications that occur with skin grafts?

Answer 20

• hematoma
• infection
• seroma
• shearing