9: Plastic Surgery - Smith

Question 1

what are relaxed skin tension lines?

Answer 1

• natural lines of wrinkling of skin

- incisions should be made parallel to RSTL

Question 2

what are langer lines/cleavage lines?

Answer 2

• determined by making skin biopsies and determining direction of collagen
• cut in direction of lines

Question 3

define angiosome

Answer 3

blocks of tissue that are fed by source arteries

Question 4

how many angiosomes in foot?

Answer 4

six( distinct angiosomes in foot originating from three* main arteries and their branches with direct arterial-arterial connections

Question 5

angiosome location

• heel
• instep
• lateral midfoot and forefoot
• lateral anterior upper ankle
• plantar heel
• anterior ankle and dorsum of foot

Answer 5

• calcaneal branch post tib
• medial plantar a
• lateral plantar a
• anterior perforating
• calcaneal branch
• ant tib/ dorsalis pedis

Question 6

“skiving”

Answer 6

cutting skin on angle

• incisions should be made perpendicular to skin with counterpressure
• incisions should be through the dermis in an even stroke

Question 7

should there be tension on a wound closure?

Answer 7

nope!

- undermining and mobilization techniques can help make the skin more mobile

Question 8

advantages and disadvantages of using a local flap

Answer 8

+ match skin color, texture, hair growth and thickness

- vascular compromise, handle with care

Question 9

V-Y flap (gives longitudinal length)

Answer 9

• advancement flap
• v shaped incision
• sides of v advanced
• closed wound resembles a Y
• can be used for skin contractures (also joint contracture MPJ, scar tissue, excision of skin lesion)

Question 10

Y-V flap (gives perpendicular to incision length)

Answer 10

• advancement flap
• Y shaped incision
• V portion advanced
• closed wound resembles a V
• used to release tension at right angle to y-v, scar tissue

Question 11

V-Y island flap

Answer 11

move an entire V to cover an excised area closing the apex of V to create a Y shape

Question 12

Z skin plasty

Answer 12

• rotational flap
• z skin incision
• transpose arms of z to lengthen skin and relieve tension
• lengthen along longitudinal axis and shortening along transverse axis

Question 13

what determines amount of lengthening in z skin plasty

Answer 13

based on angle of the triangles and the length of the central arm

30 degrees - 25% increase
45 - 50
60 - 75
75 - 100

Question 14

split thickness vs. full thickness skin graft

Answer 14

split = epidermis and portion of dermis
full = epidermis and all of dermis (better color, sensation, etc, but the complications are riskier)

Question 15

thinner grafts in comparison to thicker grafts

Answer 15

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

Question 16

15 scalpel blade thickness =

Answer 16

0.015 inch

Question 17

why mesh a skin graft?

Answer 17

• prevention of hematoma and seroma
• better contact b/w graft and wound
• coverage of larger wound
• crisscross scar

Question 18

purpose of stent dressing with xeroform and saline soaked cotton balls

Answer 18

prevents motion or shearing of graft

Question 19

3 phases of skin graft healing ***

Answer 19

• plasmatic imbibition (48 hrs, nutrition)
• inosculation (capillary growth and budding, 4-7 d)
• venous and lymphatic drainage (6th d)

*** why we need strict elevation 5-7 days and elevation

Question 20

bacteria that produce enzymes that eat graft

Answer 20

pseudomonas and beta-hemolytic strep

Question 21

4 common skin graft complications

Answer 21

• hematoma
• infection
• seroma
• shearing