Advanced Wound Reconstruction Flashcards
Classification of flaps
Blood supply- free graft vs flap
Composition- skin, muscle, nerve, bone
Location- local v distant
Subdermal plexus flap (random)
Vascularized. Terminal branches of direct cutaneous arteries. In panniculus and subcutis
Axial pattern flaps
Vascularized- supplied by a named direct cutaneous aa or vv.
Island arterial flap. Free vascularized skin flap
Non-vascularized flaps
(free grafts). Full or partial (split) thickness. Meshed v non Specialized epithelium (pads)
Composition
Cutaneous flaps
Composite flaps: mycocutaneous, osteomyocutaneous, neurovascular
Location
Subdermal plexus flaps: local flaps (advancement and rotational)
Distant- subdermal plexus based on distant tissue. (Direct v indirect)
Axial pattern flaps
Defined blood supply, infection resistant, durable full thickness skin, instant closure, radiation resistant
Doesn’t reach distal extremities, large donor site closure, discomfort
Axial pattern principles
Dissect deep to panniculus or subcutis. Trans-illluminate. Bridging incision, tacking sutures, closed suction drainage.
Caudal superficial epigastric flap
Axial flap
Midline to second to last mammary gland.
Caudal 4 glands (dog) vs three (cat)
Coverage: flank, lateral thigh, stifle, inguinal, perineal. Extends to mid tibia in dogs v hock in cats
Thoracodorsal flap
Dorsal: midline to lateri dolenti. Cranial: scapular spine, Caudal: scapular border. Ventral: acromion
Coverage: shoulder, axilla, cranial thorax. Extends to mid antebrachium in dog v carpus in cats
Therapy for questionable axial flaps
Dextrans, vasodilators, negative pressure, leeches
Free skin grafts- thickness
Partial- higher % survival, poor hair growth, special equipment, painful donor site
Full- No special equipment, good survival, some hair growth, donor site closed
Free skin grafts types
Mesh, punch, pinch, stamp, strip
Mesh is the most common (prevents fluid accumulation, increase area by up to 3x
Free skin graft post op
Immobilize for 2 weeks. Don’t peek for 3 days. Bandage change every 3-5 days
Free graft recipent
Recipient beds- fresh muscle with fascia removed. Granulation tissue
Inappropriate beds- bone, tendon, fascia, infected, irradiated
