exam 2 material

Question 1

should your incision be parallel or perpendicular to tension lines

Answer 1

parallel

Question 2

T/F: skin sutures are not for tension relief

Answer 2

true. they are for apposition only

Question 3

what can be used for tension relief

Answer 3

far-near-near-far, far-far-near-near stents, bolsters, skin stretching, cruciate

Question 4

what is mechanical creep

Answer 4

elongation of skin with a constant load over time

Question 5

where should you undermine? what do you need to preserve?

Answer 5

deep to cutaneous trunci/platysma/sphincter colli muscles, down to the muscle fascia, preserve the subdermal plexus

Question 6

describe walking sutures

Answer 6

strong bites of dermis parallel to direction of pull. be judicious with number used as it can compromise blood supply

Question 7

what is a bipedicle flap

Answer 7

a single relaxing incision. allows you to close the primary wound/incision and the relaxing one heals by second intention

Question 8

what are mesh relaxing incisions

Answer 8

1 cm incisions 1 cm from the wound edge, rows spaced 1 cm apart. be very judicious with use b/c risk of skin necrosis

Question 9

what dimensions need to be maintained for a subdermal plexus flap

Answer 9

base should be slightly wider than with of flap

Question 10

what are single pedicle flaps

Answer 10

subdermal plexus flaps with 2 skin incisions in equal length to defect. simply advance the flap to cover the defect

Question 11

what are bipedicle flaps

Answer 11

subdermal plexus flaps with incision parallel to long axis of defect. flap length no more than 2x width of defect. may or may not close the flap incision

Question 12

what are subdermal plexus rotation flaps

Answer 12

used in an area of tight skin with loose skin nearby. cut a semicircle near the defect and pull like a fan to cover it

Question 13

what are transposition flaps

Answer 13

1 border adjacent to defect. width of flap=width of defect. cut the flap on 3 borders and move it over to cover the defect

Question 14

what are skin fold flaps

Answer 14

skin rotated in from areas with a lot of extra skin like the flank fold or the elbow fold

Question 15

what is the blood supply to axial pattern flaps? what is the benefit of these?

Answer 15

direct cutaneous artery and vein. can be longer and larger and rotated up to 180 degrees

Question 16

what are peninsular flaps

Answer 16

axial pattern flaps with intact skin at the base. this leaves a dog ear in the skin but reduces risk b/c vessels are protected

Question 17

what are island flaps

Answer 17

axial pattern flaps with skin cut all the way around where the vessels are completely exposed

Question 18

where can axial pattern flaps be used

Answer 18

thoracodorsal, caudal superficial epigastric, omocervical. need to know anatomy and exactly where the vessels are

Question 19

what is a reverse saphenous flap

Answer 19

axial pattern flap on the distal limb that is flipped upside down

Question 20

how are free skin grafts different from flaps

Answer 20

they are completely removed from the body and moved elsewhere

Question 21

what is the blood supply to free skin grafts

Answer 21

the wound bed

Question 22

what is the process of engraftment (healing of a skin graft)? describe the stages

Answer 22

• adherence - fibrin strands become fibrous adhesion
• plasmacytic imbibition - 1st 24-48 hours, donor tissue receives nutrients thru absorption of plasma from wound bed via capillary action
• inosculation - vascular network is established btwn cut vessels
• vascular ingrowth/revasculatization - vessels are connected

Question 23

what are the types of free skin grafts? which is not suitable in cats? which is ideal?

Answer 23

• split thickness unmeshed - not for cats
• full thickness unmeshed
• full thickness mesh
• split thickness mesh - ideal (b/c can take smaller donor section and required less vasculature than full thickness)

Question 24

what is important for healing of grafts

Answer 24

no movement in the site!

Question 25

T/F: ice packs should be applied after reconstructive surgery

Answer 25

false! may apply heat packs