Chapt 79: Skin Graft

Question 1

different sizes of split thickess skin graft

Answer 1

thin: 0.008 to .012 “
intermediate: 0.013-0.016”
thick: 0.017-.02

Question 2

the graft that will llkely take

Answer 2

STSG: there are more blood vessels in the superficial dermis thats transected which could aid in revasc. and has less tissue to support with blood supply

Question 3

graft with greater contraction

Answer 3

STSG- less dermis

Question 4

graft prone for hyperpigmentation

Answer 4

STsg

Question 5

more durable graft

Answer 5

full thickness

Question 6

better cosmetic

Answer 6

full thickness

Question 7

common complications for STSG

Answer 7

hematoma(most common)/seroma

infection-2nd most commonn: Group A strep, pseudomonas will prevent graft from adhering

shearing forcess
poor vascularity of exposed bones/tendons

Question 8

survival rate or STSG vs FTSG

Answer 8

5 days-Stsg, FTSG: 3 days

so if seroma or hematoma is present on STSG, it may still survive

Question 9

common donnor sites for FtSG

Answer 9

flexor creases: poplitea fossa, inguina area, gluteal fold

“pinch” area- sinus tarsi

Question 10

3 phases of skin graft healing

Answer 10

plasmatic phases/imbibition: 24-48 hr
capillary budding, graft still ischemic - passively absorbs nutrients in wound bed by diffusion

inosculation: (48-72 hrs): capillary budding in contact with graft

angiogenesis/reorganization: day 5-new blood vessels grow into graft, graft become vascularized

Question 11

what consists of a skin flap

Answer 11

skin and subq transferred or rotated to restore tissue defect; has some of its own vascular supply

Question 12

where on the flap retains vasculairty

Answer 12

base of flap: pedicle

Question 13

what type of graft has better function

Answer 13

thicker graft

Question 14

in order for the graft to “take”, what is important?

Answer 14

absence of motion, infection, hemostasis, stent dressings (dressing designed for skin graft to hold graft in place, apply pressure, and absorb fluid): adap6tic, saline soaked gauzed, fluff, held by tie-over sutures securing of graft.

requires a vascular recipient site, cannot be placed over bone or tendon which has less vascularity

Question 15

isograft

Answer 15

graft of tissue between two individuals who are genetically identicial

Question 16

xenograft

Answer 16

a graft of tissue from one species used on another species

Question 17

what is the ratio of the full thickness skin graft in order for adequate closure

Answer 17

3:1 length to width: elliptical incision

Question 18

common donor sites for STSG

Answer 18

anterior/lateral thigh, upper inner arm, gluteal region, dorsum of foot

Question 19

limberg flap orientation

Answer 19

longitudinal axis is parallel to the line of minimal skin tension

Question 20

for z plasties, how should the lines be placed

Answer 20

diagonal lines should be the same length as the scar

Question 21

how much length will 45 deg and 60 deg z plasty get

Answer 21

45 deg: 50% length; 60 deg:75%

good for linear scar contractures

Question 22

what are the consequences if angles are less than 45 or more than 60 for z plasties

Answer 22

45 deg results in impaired blood flow to flaps

>60 deg: severe tension, extreme lengthening

Question 23

V-Y plasty placement

Answer 23

apex of V placed at the point of maximal tension

Question 24

V-Y plasty good for what type of contractures and allows for how much lengthening

Answer 24

V-Y are useful for lengthening contractures or in reducing contracted digits across the MPJs. Commonly treats overlapping 5th digits.
good for unidirection skin lengthening technique

20% increase in length

Question 25

the cincinnati incision is common for what procedure

Answer 25

soft tissue release for club foot

Question 26

indications for skin flap

Answer 26

1. Areas with poor vascularity (bare bone or tendon)
2. Reconstruction for full thickness
3. bad bony prominences

Question 27

rotational flap

Answer 27

semi-circular flap (ideally 1/2 circle) that is rotated pivot towards adjacent defect. Donor site is closed or grafted

Question 28

. Z-Plasty

Answer 28

1. Transposition of 2 triangular flaps
2. Make transverse central incision parallel to the contracted skin
3. Arms of Z are EQUAL (all arm lengths are aequal) with flap to tip angle 60 Degrees (can give about 75% increase in length)

Question 29

V-Y Plasty for skin lengthening

Answer 29

1. Apex of V is proximal in foot - distal skin is advanced

2. Entire V may be undermined beneath superficial fascia for exposure

Question 30

random pattern flap vs axial pattern flap

Answer 30

random pattern flap: lack a primary artery and vein and rely on perfusion of dermal-subdermal vessel from the pedicle of the flap (length to base ratio should be 1:1)

axial pattern flaps contain a primary artery and vein that are incorporated into pedicle of he flap. therefore, perfusion depends on axial artery rather than the width of the pedicle and cutaneous perfusion

Question 31

Rotational vs transpositional vs interpolational flaps vs advancement flaps

Answer 31

rotational flap: semicircular and rotated about a pivot point

transpositional flap rotated about a point but are linear dimensions such as squares and rectangles

interpolational flaps are rotated about a pivot point but flap must pass over or under intact tissue between donor and recipient sites. The defect is not immediately adjacent to defect

advancement flap: fixed point that are stretched as donor tissue into recipient bed (ie bipedicle flap or V to Y flap)

Question 32

For a Y-V approach, what direction does the lengthening occur?

Answer 32

lengthening occurs perpendicular to the stem of the Y because the flap is advanced in direction of the apex

Question 33

what type of flap is a a limberg flap? advantages to this flap

Answer 33

This is a random pattern, transpositional flap in a shape of rhombus.

advantages to this flap is that it preserves a large amount of normal skin adjacent to the deficit that would otherwise been excised with a standard elliptic flap

Question 34

disadvantage of limber procedure

Answer 34

skin must be mobile to prevent excessive tension across the flap and obtain closure to donor site.

Question 35

common donor sites for free vascularized flaps

Answer 35

latissimus dorsi, rectus abdominis, groing, gracilis, serratus anterior , radial forearm fasciocutaneous flap

Question 36

what types of flaps can be used to cover chronic osteomyelitis to increase blood perfusion to the area and availability of systemic antibiotics

Answer 36

Free muscle flaps

Question 37

what is the most common disadvantage /complication causing free flap failure

Answer 37

microvascular techniques is needed for reanastomosis because VENOUS or Arterial thrombosis are MAJOR causes of free flap failure

technical skill and instrumentation needed

Question 38

when are muscle flaps useful

Answer 38

covering soft tissue defects when bulk, padding, and vascularity are needed to cover a wound

Question 39

what is a common complication of a reverse sural artery flap

Answer 39

venous congestion