Chapter 37 - Soft Tissue Coverage Flashcards
what is the benefit of thicker STSG?
less contration, bc contains more dermis
how do STSG maintain nutrition status?
diffusion from wound bed
what cell type do STSG contain?
keratinocytes
when doe revascularization begin for STSG?
d2-3
what is the maximum length to width ratio for ransom pattern flaps
2:1
hallmark of random pattern flap?
no named vessel in the pedicle
Hallmark of an axial pattern flap?
named vessel in the pedicle
what is an island local flap?
area of skin detached from all of its host attachments except for the artery that is perfusing it
when to use an island local flap?
coverage of the dorsum of the hand proximal to the MCPJ
groin flap pedicle
superficial circumflex iliac a
lat dorsi flap pedicle
thoracodorsal a (a branch of the subscapular a)
Flaps to use by location of the defect: fingertip
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
Flaps to use by location of the defect: volar proximal finger
cross finger flap (if >30yo)
axial flap from long finger
Flaps to use by location of the defect: Dorsal Proximal finger and MCP
Reverse cross finger
axial flap from long finger
Flaps to use by location of the defect: volar thumb
moberg advancement if <2cm
FDMA if >2cm
Neurovascular island flap >4cm
Flaps to use by location of the defect: dorsal thumb
first dorsal metacarpal a
Flaps to use by location of the defect: first web space
z-plasty
Flaps to use by location of the defect: Dorsal hand
groin flap
v-y advancement flap
indicated for volar fingertip issues
digital island artery flap
indications:
straight or dorsal oblique finger tip lacerations
volar oblique finger tip lacerations
cross finger flap
indications: volar proximal finger lesions in patients >30
requires a FULL thickness skin graft
reverse cross finger flap
indications: dorsal fingertip lesions in patients >30
requires stsg or FTSG
thenar flap
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
Moberg advancement flap
indication - thumb pulp <2cm
First dorsal metacarpal artery/kite flap
indications: dorsal thumb lacs, volar thumb lacs if >2cm
what must be present for a thumb microsurgery?
a stable/functioning CMC joint
if no functional CMC joint - pollicization of the index ray
