Chapter 37 - Soft Tissue Coverage

Question 1

what is the benefit of thicker STSG?

Answer 1

less contration, bc contains more dermis

Question 2

how do STSG maintain nutrition status?

Answer 2

diffusion from wound bed

Question 3

what cell type do STSG contain?

Answer 3

keratinocytes

Question 4

when doe revascularization begin for STSG?

Answer 4

d2-3

Question 5

what is the maximum length to width ratio for ransom pattern flaps

Answer 5

2:1

Question 6

hallmark of random pattern flap?

Answer 6

no named vessel in the pedicle

Question 7

Hallmark of an axial pattern flap?

Answer 7

named vessel in the pedicle

Question 8

what is an island local flap?

Answer 8

area of skin detached from all of its host attachments except for the artery that is perfusing it

Question 9

when to use an island local flap?

Answer 9

coverage of the dorsum of the hand proximal to the MCPJ

Question 10

groin flap pedicle

Answer 10

superficial circumflex iliac a

Question 11

lat dorsi flap pedicle

Answer 11

thoracodorsal a (a branch of the subscapular a)

Question 12

Flaps to use by location of the defect: fingertip

Answer 12

Dorsal: 1. v-y advancement

Volar:
1.cross finger flap (if. >30yo)
2. thenar flap (if <30 yo)
3. FTSG
4. reverse cross finger (for nail bed sterile matrix and eponychial fold losses)
5. Digital island artery

Question 13

Flaps to use by location of the defect: volar proximal finger

Answer 13

cross finger flap (if >30yo)
axial flap from long finger

Question 14

Flaps to use by location of the defect: Dorsal Proximal finger and MCP

Answer 14

Reverse cross finger
axial flap from long finger

Question 15

Flaps to use by location of the defect: volar thumb

Answer 15

moberg advancement if <2cm
FDMA if >2cm
Neurovascular island flap >4cm

Question 16

Flaps to use by location of the defect: dorsal thumb

Answer 16

first dorsal metacarpal a

Question 17

Flaps to use by location of the defect: first web space

Answer 17

z-plasty

Question 18

Flaps to use by location of the defect: Dorsal hand

Answer 18

groin flap

Question 19

v-y advancement flap

Answer 19

indicated for volar fingertip issues

Question 20

digital island artery flap

Answer 20

indications:
straight or dorsal oblique finger tip lacerations
volar oblique finger tip lacerations

Question 21

cross finger flap

Answer 21

indications: volar proximal finger lesions in patients >30
requires a FULL thickness skin graft

Question 22

reverse cross finger flap

Answer 22

indications: dorsal fingertip lesions in patients >30
requires stsg or FTSG

Question 23

thenar flap

Answer 23

indications: volar oblique finger tip lacerations to index or middle finger in patients < 30 years
advantages of eventual improved cosmesis compared to cross finger flaps

Question 24

Moberg advancement flap

Answer 24

indication - thumb pulp <2cm

Question 25

First dorsal metacarpal artery/kite flap

Answer 25

indications: dorsal thumb lacs, volar thumb lacs if >2cm

Question 26

what must be present for a thumb microsurgery?

Answer 26

a stable/functioning CMC joint
if no functional CMC joint - pollicization of the index ray