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spring 24: surgery > 18 skin > Flashcards

18 skin Flashcards

1
Q

where is subdermal plexus

A

within and deep/superficial to panniculus (cutaneous trunci)- areas without panniculus: within the deep SQ and areolar tissue

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2
Q

wound closure should be — to tension lines

A

parallel

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3
Q

how to undermine is panniculus present

A

deep to the muscle

  • preserves direct cutaneous vessels
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4
Q

how to undermine if no panniculus

A

undermine DEEP to SQ, just superficial to muscle fascia

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5
Q

what type of tension relieving sutures

A

cruciates
far-far-near-near
far-near-near-far
walking suture
stent/bolster

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6
Q

how does skin stretching techniques work

A

mechanical creep
stress relaxation

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7
Q

what is mechanical creep

A

superhelices of collagen fibers straighten and realign in parellel orientation

  • skin stretches/elongates
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8
Q

what is stress relaxation

A

elastic fibers break/ lose eleasticity

  • skin loses tendency to recoil after load removed
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9
Q

benifits of vacc to close wound

A

decrease edema
increased blood flow
increased early cytokine levels
stimulate formation of granulation tissue

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10
Q

subdermal or local skin flap blood supply

A

from subdermal plexus and collateral circulation from remaining cutaneous attachment

  • random- no known direct cutaneous artery or vein like there is in an axial pattern flap

keep 2:1 length to width to minimize rsk of necrosis
full thickness

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11
Q

single releasing incision also called

A

bipedicle advancement flap

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12
Q

transposition flap

A

rectangular flap within 90 degree of long axis of defect

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13
Q

interpolation flap

A

rectangular flap with NO common edge shared with defect- must cross intract skin

  • bridging incision
  • tube
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14
Q

skin fold flaps are used in what areas

A

elbow fold (axillary) and flank fold (inguinal) flap

  • useful for upper limb and trunk defect
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15
Q

delay phenomenon

A

training the flap to use vascular supply from pedicle
* cut flap but suture back into original place
* then come back later and do actual surgery

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16
Q

axial pattern flap blood supply

A

flaps with known direct cutaneous artery/vein

  • can have bigger flaps but only rotate up to 180
17
Q

when to use skin graft

A

last resort

  • recipient bed needs to be healthy and well perfused
  • no infection
  • immobilized
18
Q

4 stages of engraftment

A
  • adherence (fibrin links then fibrous tissue) until day 10
  • plasmatic imbibition (peak at 2-3 days)- absorbs nutrients from wound bed
  • inosculation (first within 2-3 days, normal blood flow by 5-6 days)- anastomosis of pre-exsiting vessels
  • vascular ingrowth (peak 5-7 days)
19
Q

adherence for graft occurs

A
  • adherence (fibrin links then fibrous tissue) until day 10
  • plasmatic imbibition (peak at 2-3 days)- absorbs nutrients from wound bed
  • inosculation (first within 2-3 days, normal blood flow by 5-6 days)- anastomosis of pre-exsiting vessels
  • vascular ingrowth (peak 5-7 days)
20
Q

plasmatic imbibition for graft

A
  • adherence (fibrin links then fibrous tissue) until day 10
  • plasmatic imbibition (peak at 2-3 days)- absorbs nutrients from wound bed
  • inosculation (first within 2-3 days, normal blood flow by 5-6 days)- anastomosis of pre-exsiting vessels
  • vascular ingrowth (peak 5-7 days)
21
Q

inosculation for graft

A
  • adherence (fibrin links then fibrous tissue) until day 10
  • plasmatic imbibition (peak at 2-3 days)- absorbs nutrients from wound bed
  • inosculation (first within 2-3 days, normal blood flow by 5-6 days)- anastomosis of pre-exsiting vessels
  • vascular ingrowth (peak 5-7 days)
22
Q

vascular ingrowth for graft

A
  • adherence (fibrin links then fibrous tissue) until day 10
  • plasmatic imbibition (peak at 2-3 days)- absorbs nutrients from wound bed
  • inosculation (first within 2-3 days, normal blood flow by 5-6 days)- anastomosis of pre-exsiting vessels
  • vascular ingrowth (peak 5-7 days)
23
Q

how to prepare full thickness graft

A

epidermis and entire dermis
* then defatted until dermis with cobblestone appearance
* more durable and usually better hair growth
* survival rate may be lower then split thickness

24
Q

post op care for graft

A
  • bandage for 21 days
  • immobilize for 10-14 days
  • ecollar
  • activity restriction

spring 24: surgery (22 decks)

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