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5: Skin and Reconstruction > Chapter 78 Local or Subdermal Plexus Flaps > Flashcards

Chapter 78 Local or Subdermal Plexus Flaps Flashcards

1
Q

In six month old dos, what percentage does skin contribute to total body weight?

A

12%

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2
Q

What is reported skin thickness in haired skin

A

0.5 - 5 mm

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3
Q

What is the difference between a simple and a mixed cutaneous artery?

A

Simple cutaneous artery runs between muscles, with insignificant branching to muscles.

Mixed cutaneous artery runs through muscles, with appreciable muscular branching

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4
Q

What anatomical level do the superficial, middle and deep plexus correlate with?

A

In dermis:

  • Superficial plexus is sub-papillary
  • Middle plexus is cutaneous

In hypodermis:

  • Deep plexus is subcutaneous
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5
Q

How do subdermal plexus flaps receive their blood supply?

A

From collateral connections to deep(/subcutaneous) plexus

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6
Q

What percentage of fibre content does collagen account for in skin?

A

90%

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7
Q

What is meant by ‘delay phenomenon’?

What does Pavletic recommend as ideal schedule for delay of tubed flaps?

A

Enhanced survival by staged flap development

e.g. incise but dont elevate, partially divide pedicle of an flap (e.g. cut halfway across base), temporarily occlude one pedicle

Pavletic re tubes flaps: Day 18 divide half of base of pedicle (the one thats far from the target wound), day 21 divide other half

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8
Q

What percentage of normal blood flow remains in a single pedicle flap after initial elevation?

And a bipedicle flap?

What does blood flow rise to in delayed flaps after 3 weeks?

A

10% in single pedicle

40% in bipedicle

120-150% (after re-elevation drops to 90% of normal)

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9
Q

List 5 factors that contribute to the delay phenomenon

A
  • Altered sympathetic tone
  • Dilation of choke vessels (link adjacent vascular territories)
  • Re-orientation of vessels
  • Neovascularisation
  • Altered tissue metabolism
  • (Possibly ischaemic preconditioning too)
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10
Q

What local treatment has been shown to increase perfusion (n.b. not vascularity) of subdermal plexus flaps

A

Autologous PRP

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11
Q

List the 7 categories of subdermal plexus flap

A
  1. Advancement
  2. Transposition
  3. Rotation
  4. Interpolation
  5. Plasty
  6. Distant
  7. Composite
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12
Q

What are recommendations re length:width ratio of advancement flaps?

A

Lenght shouldnt exceed twice width.

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13
Q

List a disadvantage of advancement flap

A

Tension transferred to wound edge. Rotation or transposition better to avoid this

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14
Q

Define an interpolation flap and give an example

A

Flap had no common edge with defect i.e. have to make bridging inscision or tube

e.g. lip to lid flap

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15
Q

What is the difference between distant direct vs distant indirect flap?

A

Distant direct is application fo flap to donor site directly i.e. straight away

Distant indirect is by delayed transfer e.g. delayed transfer tubed flap

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16
Q

What three flaps are irotating flaps?

A

Rotation, transposition and interpolation

17
Q

List the three types of plasty

In terms of tension, wht does Z and v-Y plasty achieve?

A

H, Z and V–>Y (and ?M plasty)

Z and V-Y plasty rotate long axis of wound up to 90 degrees transferring tension and reducing elastic recoil

18
Q

What is a composite flap?

Give an example

A

Incorporate underlying structures with the skin

e.g.labial advancement, lip to lid, lat dorsi myocutaneous flap

19
Q

What anatomical structure needs to be incised to allow scrotum to be expanded and used as a flap?

A

Tunica dartos

20
Q

What subdermal plexus flap has been reported for reconstruction of prepuce w penile exposure?

A

BIpedicle subdermal plexus (+ free buccal mucosal flap)

21
Q

What subdermal plexus flap can be created from the pes?

A

Phalageal fillet

22
Q

Breifly outline steps of lip to lid flap

A
  1. Make parallel incisions at 45 degrees to line between medial-lateral canthus. incisions directed towards commisure w caudal incision ending just rostral to commisure.
  2. Incise buccal mucosa in a longitudinal plane (parallel with lip margin) at least 5mm proximal to lip margin.
  3. Gently dissect flap from buccal and gingival mucosa attachments
  4. Close oral defect
  5. Bridging incision from lateral eye wound margin to rostral flap incision
  6. Suture buccal mucosa to conjuntiva (6/0 - 7/0 multifilament, positioned to avoid abrasion of corneal - contact lens if worried)
  7. Suture flap skin margins
  8. Close donor site
23
Q

List 4 ‘additional’ steps to a distant direct flap, to ensure success

A
  • Test animal tolerance by bandaging limb in poition first
  • Leave small hole open for drainage
  • Suture rest of limb to trunk in places
  • Banage whole area
24
Q

What are the 4 main complications after subdermal plexus flap?

A
  • Infection
  • Seroma
  • Dehiscence
  • Necrosis

Potential causes for dehiscence: infection, trauma, poor blood supply, flap necrosis or tension (if lack of others then likely tension)

25
Q

What is the specific morbidity (%) for flap procedures before/after radiation/

  • Dehiscence
  • Flap necrosis
  • Infection
A
  • Dehiscence: 62%
  • Flap necrosis: 35%
  • Infection: 27%
26
Q

List 4 causes of flap necrosis

A
  • Inadequate vascularity
  • Damage to subdermal plexus
  • Thrombosis of subdermal plexus
  • Decreased perfusion/oxygenation
27
Q

What additonal therapy has been associated with improved flap survival?

And improved flap perfusion?

A

Improved survival: Hyperbaric oxygen

Improved perfusioon (n.b. not vascularity): Autologous PRP

28
Q

Re Jones & Lipsomb, JAVMA 2019, what was the:

  • Overall complication rate?
  • Major complication rate?
  • Most common complication?
  • How does the outcome compare to axial pattern flaps?
  • And skin grafts in dogs?
  • Skin grafts on cats?
A
  • Overall complication rate 51%
  • Major complication rate 16% (i.e. good-excellent outcome in 84%)
  • Most common complication dehiscence

(N.B. Mean time to complication 7d, higher complication rate when used on wounds (v.s. scar neoplasia), higher complication rate when used on trunk/upper limb vs head (highest complication rate with inguinal/axilla flap.)

Good-excellent outcome for:

  • Axial pattern flaps 64%
  • Canine skin grafts 38%
  • Feline skin gafts 77%

5: Skin and Reconstruction (8 decks)

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