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Small Animal Surgery > Cutaneous Surgery > Flashcards

Cutaneous Surgery Flashcards

1
Q

What are the 4 major layers of the skin?

A
  1. epidermis
  2. dermis
  3. hypodermis/adnexa/SQ
  4. hair follicles in dermis and hypodermis
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2
Q

What is the blood supply like to the skin? What do branches form?

A

vessels run parallel to the skin

  • superficial subpapillary plexus - epidermis
  • middle plexus - cutaneous
  • deep plexus - SQ
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3
Q

What are 3 major differences between dogs and cats’ skin?

A
  1. incision breaking strength is significantly less in cats
  2. granulation tissue occurs earlier in dogs (and they produce more)
  3. contraction and epithelialization occurs faster in dogs
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4
Q

What does granulation tissue look like?

A

nodular, bright red and made up of capillaries and fibroblasts

  • necessary for proper healing
  • no exudate, no bacterial growth
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5
Q

How is tension determined at surgery sites? How are incisions made?

A

pull of collagen and elastin fibers in dermal and hypodermal tissues

parallel to tension lines - heal better/faster and are more aesthetic

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6
Q

What is shear? In what 5 areas is this commonly seen?

A

forces (motion) acting on wound edges in mobile area

  1. axilla
  2. inguinal
  3. over joints
  4. tail base
  5. foot pads
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7
Q

In what 2 ways can shear be prevented?

A
  1. external coaptation
  2. confinement

decrease movement!

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8
Q

What 3 things does the viscoelasticity of skin allow?

A
  1. initial pliability
  2. tendency to return go original shape
  3. adapt when prolonged stress is applied
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9
Q

What are the 7 Halsted’s Principles?

A
  1. gentle tissue handling
  2. meticulous hemostasis
  3. preservation of blood supply
  4. strict aseptic technique
  5. minimum tension on tissues
  6. accurate tissue apposition
  7. obliteration of dead space
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10
Q

What is the simplest tension-relieving procedure? What 2 things does this allow?

A

undermining - use of scissors or scalpel to separate the skin from underlining tissue

  1. preservation of direct cutaneous vessels
  2. preservation of the deep subdermal plexus by undermining panniculus muscles
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11
Q

What is required for undermining? What muscle is undermined?

A

healthy periwound skin

under cutaneous trunci muscle, containing panniculus muscle

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12
Q

What are some examples of tension-relieving sutures?

A
  • strong subcutaneous
  • far-near-near-far, near-far-far-near
  • walking sutures
  • horizontal and vertical mattress
  • stent or Bolster sutures
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13
Q

How can stress on skin be reduced with strong subcutaneous sutures? How are the bites placed? What does this result in?

A

including the subdermal layer in closure

into the more superficial fibrous layer of hypodermal tissue and NOT into loose, fatty SQ

edges should kiss

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14
Q

How are stent (Bolster) sutures placed? What is avoided?

A
  • preplace stent sutures and leave them untied
  • perform a primary suture line with 2 layer closure
  • tie the stent sutures under moderate tension supported by a bandage or other “bolster”
  • remove 3-4 days post-op

use of buttons or red rubber

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15
Q

Far-near-near-far:

A
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16
Q

How are walking sutures placed?

A
  • move skin across a defect
  • obliterate dead space
  • distribute tension over the wound surface
  • place sutures without penetrating the skin surface no closer than 2-3 cm
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17
Q

What are 2 techniques for stretching the skin?

A
  1. pretensioning suture (+ bandage changing)
  2. intraoperative skin stretching
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18
Q

What is negative-pressure wound therapy?

A

the placing of a coarse, open cell foam in or around a wound defect with the drainage tubing placed above the foam, which is then covered by an occlusive dressing to create a complete seal

subatmospheric pressure is then applied

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19
Q

In what 5 ways does negative-pressure wound therapy aid in healing?

A
  1. improves wound perfusion
  2. reduces wound edema
  3. stimulates granulation tissue formation
  4. decrease bacterial colonization
  5. removes excess exudate produced by the wound
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20
Q

What is thought to cause the stimulation of granulation tissue formation seen in negative-pressure wound therapy?

A

stress and strain created in the extracellular matrix, which alters proliferative response —> strain related to use of open cell foam

  • increase in wound healing and neovascularization on histology
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21
Q

What additional use has negative-pressure wound therapy been utilized for? What effect is unknown at the moment?

A

adjunct treatment to the application of skin grafts on wound surfaces

decreased wound microbial burden

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22
Q

In what cases is negative-pressure wound therapy especially helpful? What makes its use challenging?

A

patients with very large and contaminated wounds

specialized equipment is needed and the negative pressure must be maintained
(+ many unknowns that require additional studies)

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23
Q

What are dog ears? How are they most commonly managed?

A

puckering of the skin that can occur after surgical wound closure

  • small ones will usually resolve on their own during healing
  • larger ones should be resected on both sides in the shape of a triangle and apposed
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24
Q

What are relaxing incisions? When are they most commonly used?

A

multiple small incisions placed adjacent to the wound in a parallel and staggered fashion to take tension off of the primary incision line

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25
Q

Relaxing incisions:

A
26
Q

Relaxing incision:

A

the incision is left open, but healthy tissue will heal much faster than the wound

27
Q

How are crescent-shaped defects corrected?

A

the longes portion of the wound is brought to the middle of the suggested incision line and sutured, then the following sutures are placed by cutting the distance in half

  • distributes tension evenly
28
Q

How is a triangular defect closed?

A
29
Q

How are rectangular defects closed?

A

work the corners in

30
Q

How are circle defects closed?

A

begin with direct apposition, then excise the resulting dog ears and completely close

31
Q

What is the best way to close a circular defect without forming dog ears?

A

turn it into an ellipse shape and close with direct apposition

32
Q

What is the difference between a skin flap and a skin graft?

A

FLAP = blood flow is maintained or immediately re-established when a skin segment is moves to a new position

GRAFT = blood supply is severed and new vessels must grow from recipient site

33
Q

What are the 2 classifications of pedicle flaps?

A
  1. subdermal plexus - capillary bed blood supply from the base
  2. axial pattern - direct cutaneous vasculature that travel further than plexi
34
Q

What must be contained within a pedicle flap to ensure the blood supply is there?

A

panniculus muscle

35
Q

Where is the blood supply based on in local flaps? What are the 2 types?

A

subdermal plex

  1. moves about a pivot point - rotation, transposition
  2. no rotation - single pedicle/bipedicle advancement
36
Q

Rotation flap:

A
37
Q

How are rotational flaps made? What does the back cut do?

A
  • make an arching incision 2.5 times the width of the defect
  • undermine deeply and advance it
  • if tension is present, incrementally lengthing arching incision until it is relieved

increases mobility, but also increases risk of vascular compromise

38
Q

Rotation flap:

A
39
Q

Multiple rotation flap:

A
40
Q

What are transpositional flaps? How does its angle from the wound affect its length?

A

three-sided flaps made up of donor skin in a different axis from the wound

larger angle = shorter effective length (60-90 degrees most common)

41
Q

Transpositional flap:

A

axillary and inguinal regions have a lot of extra skin - good candidates for donor skin

42
Q

What is a single pedicle advancement flap? When is it most commonly used?

A

donor skin used only on one side of the subdermal flap - flap can only be up to 3x larger than width

when simple undermining and advancement would result in excessive tension or distortion of surrounding tissue

43
Q

Single pedicle advancement flap:

A
44
Q

H-plasty:

A

(usually, if there’s enough skin to do this the skin can just be undermined and advanced)

45
Q

What is an axial pattern flap?

A

transposition flaps that incorporate a direct cutaneous artery and vein

  • the course of direct cutaneous vessels are very predictable, allowing large flaps incorporating those vessels to be constructed without the length limitations of subdermal plexus based
46
Q

What are the 2 most commonly performed axial pattern flap?

A
  1. thoracodorsal caudal
  2. caudal superficial epigastric
  • omocervical
  • deep circumflex iliac
  • genicular branch of saphenous
  • superficial caudal auricular lateral
47
Q

Caudal superficial epigastric axial pattern flap:

A
48
Q

How does flap design of caudal superficial epigastric axial flaps differ in females and males?

A

FEMALE - can extend into caudal thoracic mammary glands

MALE - more tenuous cranial to the abdominal mammary glands

49
Q

What are the 2 options for caudal superficial epigastric axial flaps in females?

A
  1. ipsilateral - increases distance flap can extend and risk of kinking vessels
  2. contralateral - shorter distance and less risk of kinking vessels
50
Q

Caudal superficial epigastric axial flap:

A
51
Q

What is a bridging incision?

A

the incision that connects donor sites to the wound

52
Q

What is “tubing” the flap? What is the point?

A

using a portion of an axial flap and suturing it into a tube to maintain blood supply

avoids making a bridge incision, but will require a second surgery to cut it free after it has healed in the wound bed (14-21 days)

53
Q

What are the 5 most common complications associated with using skin flaps?

A
  1. flap edema
  2. seroma
  3. infection
  4. partial dehiscence
  5. vessel thrombosis with flap loss (necrosis)
54
Q

What are 4 options for managing compromised flaps?

A
  1. assess vascular integrity
  2. vasoactive drugs - blood thinners
  3. hyperbaric oxygen
  4. leeches - exude anticoagulants and consume clots
55
Q

What are the 3 most common techniques for distal flaps?

A
  1. pouch flap - paw stays at donor site during recovery
  2. single pedicle
  3. direct flap
56
Q

Pouch flap:

A
57
Q

What are 4 types of skin grafts?

A
  1. autograft - graft from same patient
  2. allograft - graft from a donor of the same species
  3. xenograft - graft from a species that is different from the recipient
  4. isograft - graft from a donor who is genetically identical to the recipient

(no blood supply - uses granulation tissue)

58
Q

What are 3 types of skin grafts?

A
  1. full thickness
  2. partial thickness
  3. mesh
59
Q

How are mesh grafts made?

A

graft placed on a cutter that creates full-thickness openings —> increases surface area and allows drainage

60
Q

How are paw pad grafts prepared?

A
  • ensure there is a healthy granulation bed at the wound
  • cut out rectangular segments from other pads
  • tack grafts into the granulation bed
61
Q

How should grafts be secured/protected following surgery?

A

covered with nonadherent pad and gentamycin/mupirocin ointment, followed by a standard soft padded bandage

  • outside bandage can be changed as needed for discharge, but do not remove nonadherent pad until 3 days post-op

Small Animal Surgery (34 decks)

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