18 skin Flashcards
where is subdermal plexus
within and deep/superficial to panniculus (cutaneous trunci)- areas without panniculus: within the deep SQ and areolar tissue
wound closure should be — to tension lines
parallel
how to undermine is panniculus present
deep to the muscle
- preserves direct cutaneous vessels
how to undermine if no panniculus
undermine DEEP to SQ, just superficial to muscle fascia
what type of tension relieving sutures
cruciates
far-far-near-near
far-near-near-far
walking suture
stent/bolster
how does skin stretching techniques work
mechanical creep
stress relaxation
what is mechanical creep
superhelices of collagen fibers straighten and realign in parellel orientation
- skin stretches/elongates
what is stress relaxation
elastic fibers break/ lose eleasticity
- skin loses tendency to recoil after load removed
benifits of vacc to close wound
decrease edema
increased blood flow
increased early cytokine levels
stimulate formation of granulation tissue
subdermal or local skin flap blood supply
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
single releasing incision also called
bipedicle advancement flap
transposition flap
rectangular flap within 90 degree of long axis of defect
interpolation flap
rectangular flap with NO common edge shared with defect- must cross intract skin
- bridging incision
- tube
skin fold flaps are used in what areas
elbow fold (axillary) and flank fold (inguinal) flap
- useful for upper limb and trunk defect
delay phenomenon
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