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Flaps and grafts Flashcards

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1
Q

What does interpolated mean in a flap?

A

A two stage procedure.

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2
Q

What are two ways to locate the supratrochlear artery?

A

2cm from the midline or the medial border of the eyebrow.

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3
Q

At what time interval do you take down a paramedian flap?

A

3wks

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4
Q

Ipsilateral paramedian pedicle flaps do what.

A

Increase rotational torsion and longer pedicle to reach the defect.

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5
Q

What is a paramedian interpolated flap best for.

A

Large defects on the nose usually 2 cm or greater

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6
Q

T or F vascularity of the nasal ala as a recipient bed tends to be poor so the risk of composite graft necrosis is high?

A

False

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7
Q

If a composite graft becomes necrotic it should be debrided.

A

False

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8
Q

How much larger should a composite graft be over the size of the defect.

A

5 to 10 %

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9
Q

what are the four stages of graft healing?

A
  1. imbibition 24-48 hrs passive diffusion 2.inosculation day 2-5 attachment of vessels 3.neovascularization 7-10 days new capillary growth 4. Vasomotor normalization. 12-18 months
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10
Q

What is a mercedes flap?

A

advance from three directions looks like a mercedes logo.

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11
Q

What is the maximum size of a composite graft?

A

1 cm or less

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12
Q

How much larger should a composite graft be than the defect size?

A

5 to 10%

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13
Q

What is an interpolation flap?

A

a two stage procedure with a pedicle.

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14
Q

List four interpolation flaps.

A
  1. Paramedian forehead flap 2. a postauricular mastoid flap to ear 3.Melolabial from cheek to nose 4.cheek to ear
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15
Q

only one of the interpolation flaps has an axial blood supply which one is it?

A

the paramedian forehead flap using the supratrochlear artery.

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16
Q

How do you locate the supratrochlear artery.

A

2 cm from the midline of the glabella or the medial edge of the eyebrow. There is a supratrochlear notch in the orbit which is palpable and pedicle should be centered.

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17
Q

What are the sizes of a split thickness skin grafts.

A

Thin .15 - .3mm Intermediate .3mm to .45mm Thick .4mm to . 6mm

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18
Q

What do all rotation flaps have?

A

a pivot point

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19
Q

What type of flap is a mustarde flap.

A

a rotation flap for the eyelid upper cheek.

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20
Q

What is the standard pivotal restraint in a rotation flap?

A

Length of flap is 4x the width of the defect.

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21
Q

what is a dorsal nasal flap?

A

a rotational flap from the glabella to the nasal tip. an upside down V is cut in the glabella and the flap is rotated on the nasal tip.

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22
Q

What is the largest defect that should be repaired on the nasal tip with a dorsal nasal flap?

A

2cm

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23
Q

Where is the pivot point in a mustarde flap.

A

at the tip of the triangle of good skin removed below the defect.

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24
Q

a bilobe flap can be used up to what size.

A

1.5 cm

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25
Q

What makes up a bilobed flap?

A

two 45 degree rotations that make a 90 degree total rotation.

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26
Q

what type of flap is a bilobed flap.

A

a transposition flap

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27
Q

what type of flap is a rhomboid flap

A

transposition flap

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28
Q

The Rieger flap is also known as what.

A

The dorsal nasal flap.

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29
Q

Name three transposition flaps

A

bilobed, rhombic and banner

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30
Q

What is a banner flap

A

like a bilobed but only one lobe.

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31
Q

What is the definition of a transposition flap?

A

pick up flap and transpose over intervening tissue.

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32
Q

How much angle of rotation is in a rhomboid flap.

A

60 degrees

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33
Q
A
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34
Q

What is the name of the blade to harvest split thickness skin grafts.

A

Weck blade

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35
Q

What type of flap is this?

A

advancement flap

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36
Q

What type of flap is this?

A

o to z

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37
Q

What type of flap is an O to Z flap

A

A double rotation flap

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38
Q

With each of these z plasty angle how much % length gain do you get.

  1. 30 degree angle
  2. 45 degree angle
  3. 60 degree angle
A
  1. 25% gain
  2. 50% gain
  3. 75% gain
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39
Q

What type of flap is this?

A

Rieger Flap

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40
Q

In a bilobe flap what are the angles of rotation.

A

two 45 degree angles of rotation in an arc for a total of 90 degrees

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41
Q

Draw the diagram for a Rhomboid flap

A
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42
Q

What type of flap is this?

A

Tenzel flap

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43
Q

Tenzel flaps can be used to repair how much of the eyelid?

A

up to 60%

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44
Q

What type of flap is a tenzel flap considered?

A

A rotation flap like a mustarde flap.

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45
Q

In a rotation flap the length of flap to width of defect is what ratio.

A

4 to 1

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46
Q

What limits rotation flaps mobility?

A

Pivotal restraint

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47
Q

How can you improve flap mobility in a rotation flap.

A

Longer arc length and backcut

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48
Q

What is the name of this planned flap?

A

Spiral flap

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49
Q

What are spiral flaps best used for?

A

small defects on the nose to recreate the alar groove

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50
Q

what is the typical defect size on the nose for a spiral graft.

A

.5cm to 1.5 cm

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51
Q

What are two advantages split thickness skin grafts have over Full thickness grafts.

A

Able to cover large areas.

May work better on poorly vascularized wound beds.

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52
Q

What is a tertiary intention?

A

A delayed closure after a wound has been left open for a period of time.

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53
Q

what is primary intention?

A

Any wound closure immediately.

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54
Q

What is a dufourmentel flap

A

a modified rhombic flap

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55
Q

How much does a z plasty increae the scar length at each angle 30 degree 45 degree and 60 degree

A

25% 50% 75%

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56
Q

What angle to you need in a z - plasty to increse the length by 75 %

A

60 degree

57
Q

what angle do you need to increase scar lenght by 50% in a z plasty

A

45 degree

58
Q

if you want to increase scar length by 25% in a zplasty what angle do you use

A

30 degree

59
Q

what type of flap is a z plasty

A

transposition

60
Q

how do you make a z plasty

A

three equal incisions to make 2 eqilateral triangles which are then transposed

61
Q

The increase in the length of a scar in a z plasty is in what arm?

A

The middle arm

62
Q

small angle flaps in a z plasty carry what risk

A

increase in tip necrosis

63
Q

large angle flaps increase risk of what in a z plasty

A

tissue cones and tension

64
Q

after a full thickness skin graft after how many weeks post surgery can it be evaluated for dermabrasion

A

6 weeks

65
Q

What is the name of this flap

A

nasolabial rotation flap

66
Q

at what level do you undermine on the cutaneous lip?

A

at the level of the muscle below the sub Q fat

67
Q

At what level do you undermine in the cheek?

A

subQ fat

68
Q

at what level do you undermine on the nose?

A

submuscular just above the periosteum or cartilage.

69
Q

where do you undermine on the forhead.

A

just above the frontalis muscle.

70
Q

where do you undermine on the scalp

A

Subgaleal space.

71
Q

what are the first cells to migrate into a wound?

A

Neutrophils.

72
Q

what white blood cells stimulate angiogenesis and collagen production.

A

Macrophages

73
Q

What cells arrive late in the wound healing process and aid in maturation of the scar.

A

lymphocytes

74
Q

in the maturation phase (remodeling) of wound healing Collagen III is replaced by what?

A

Collagen I which is more crosslinked

75
Q

What are the three phases of wound healing

A

inflammatory(6hrs to 10 days)

Proliferative 1day to 14

Maturation 10 days to one year

76
Q

what monofilament polyglyconate (Glycolic acid) suture has the best tensil strength at one month

A

maxon

77
Q

an interpolation flap is also known as a what

A

tissue importation flap

78
Q

what is the most common Defect reconfiguration flap

A

island advanment flap

79
Q

what are examples of tissue reorientation flaps

A

Rombic

Bilobed

Melolabial fold flap

Spears flap

80
Q

What type of flap is this?

A

a banner flap

81
Q

what is an abbe flap

A

a cross lip interpolation flap from one lip to the other with blood supply from the labial artery

82
Q

If absorbable braided sutures such as vicryl are used as epidermal sutures they may last up to 4 weeks before dissolving if you don’t do what?

A

hydrate them with ointment

83
Q

Tie over bolsters does what for post op pain increase, decrease, no change

A

increase

84
Q

what type of grafts have the highest failure rate.

A

composite

85
Q

what can you do to a split thickness skin graft to increase survival

A

do meshing

86
Q

what type of graft has the worst textural and color mismatch

A

Split thickness skin graft

87
Q

Why is there more scaling and crusting over a split thickness skin graft

A

loss of adenexal structures lead to xerosis

88
Q

how much should you oversize a eyelid graft

A

100 to 200%

89
Q

one week post graft placement what color should it not be?

A

white

90
Q

What closure is best over a convex surface.

A

S-plasty

91
Q

a single tangent flap is known as what

A

burrow’s flap

92
Q

a bilateral single tangent flap is also know as what?

A

AT to T or O to T

93
Q

A Bilateral double Tangent flap is known as what?

A

H flap

94
Q

A Double Tangent Flap is known as what

A

U flap

95
Q

What is the eponym for this flap

A

Rieger Flap

96
Q

of the two absorbable mono filament sutures with long 6 mo absorbtion time Polydioxanone (PDS) and Maxon (Glycolic acid) which has the strongest tensile strenth at one month

A

Maxon

97
Q

What is the best monofilament subQ non absorbant suture for a running stich?

A

Prolene

98
Q

what two nonabsorbable sutures have poor knot security?

A

nylon and prolene

99
Q

both horzontial and vertical mattress sutures can be used in areas of what?

A

High tension

100
Q

in a suborbital defect which is more likely to show pincushing a graft or island flap

A

Island flap

101
Q

what has the highest cure rate for chondrodermatitis

A

surgery

102
Q

what % of the lower eyelid margin can be closed with a direct closure?

A

30%

103
Q

Which causes the least tissue injury when sutureing but most difficult to pierce the skin.

conventional cutting

reverse cutting

Tapered (rounded)

A

tapered (rounded)

104
Q

Between conventional cutting and reverse cutting needles which one is least likely to cause the suture to cut through the wound edge.

A

reverse cutting the cutting edge is on the reverse side facing away from the wound edge.

105
Q

what split thickness skin graft is most commonly used in derm surgery

A

medium

106
Q

in a flap the primary tension vector is what?

A

the direction of the force that counteracts the movement of the flap

107
Q

What two features of a suture are directly porportional to the knot security

A

coefficient of friction and

configuration (monofilament or multifiliment)

108
Q

what does capillarity mean with sutures.

A

the ablility to absorb.

multifilament absorb better than monofilament

109
Q

what is the USP size of a suture

A

the diameter required to give a certain tensile strength

110
Q

name a suture with low memory

A

silk

111
Q

Name a suture with good elasticity

A

Novafil

112
Q

which type of sutures have good pilability

A

braided

113
Q

What type of rhoboid flap is this?

A

limberg

114
Q

What type of rhoboid flap is this?

A

dufourmental

115
Q

What type of rhoboid flap is this?

A

Webster 30 degree angle

116
Q

how much of the upper and lower lip can be removed safely for a wedge excision

A

up to 33% of upper and 50% of lower.

117
Q

when would you consider a wedge excison closure over a locoregional flap on the eyelid?

A

when the defect is deep and involving the tarsal plate.

118
Q

what types of flaps are tissue reconfiguration flaps

A

Rombic flaps, bilobed,

119
Q

What is the maximum width to length ratio of this flap

and according to Bolognia which letter should be sewn up first?

A

4 to 1

Letter A

120
Q

what are some things that can be done to help with hypergranulation tissue.

A

steroids

Betablockers such as timolol

no occlusive dressings

remove foreign bodies

pulse dye laser

silver, iodine,aluminum chloride, gentian violet/methylene blue

121
Q

at what level of the skin will you get scar formation if the defect reaches that level

A

In the superficial dermis.

122
Q

what type of defect do you get wound contration

A

full thickness defects not partial thickness

123
Q

besides wound edge where else can you get reepitheliazation from?

A

adenexal structures if they are present.

124
Q

Hydrolysis breaks down all absorbable sutures except for what?

A

Gut

125
Q

What type of process breaks down gut sutures

A

proteolysis

126
Q

where do you get the most wound contraction concave or convex surfaces

A

concave

127
Q

what is a good superficial suture technique for areas of high tenison that are cosmetically sensitive?

A

running subcuticular

128
Q

in a full thickness skin graft when does sensory innervation begain

A

2 to 4 week but it may be months or 2 years for full innervation

129
Q

In a full thickness skin graft when do you get full vascularzation

A

4 to 7 days

130
Q

Spiral flaps are good for small nasal defects that straddle the what?

A

alar groove

131
Q

what is the wound strength at these intervals

1 wk

2 wks

one month

one year

A

<5%

10%

30-40%

80% max

132
Q

a tip stitch is also known as what

A

half buried horozontial stitch

133
Q

in a bilobed flap what should the angle be between each lobe of the flap

A

45 degrees both together create a 90 degree rotation

134
Q

identify each of the dressings

A

A. Tegaderm film permeable to gas and water vapor not wound fluids - see through

B. DuoDerm Hydrocolloid draws water makes gel (oder plus yellow/brown)

C. Gelfoam

D: Alginate (Maxorb) oder plus yellow brown

E. Hydrogel (Skintegrity) mostly water prone to infections use antibiotics before exudates

F.Vaseline Gause (Xeroform)

135
Q

what artery does the Abbe flap use as it’s blood supply?

A

the labial artery

136
Q

What are the first cells in the inflammatory phase in a wound.

A

Platelets

They attract other lymphocytes

137
Q

at what level do you undermine in the forehead area?

A

below the deep SMAS and the periosteum, but not in the superficial SMAS where sensory nerves tend to run.

138
Q

wound contraction peaks at what day from fibroblasts turning into myofibroblasts

A

14 days

Derm Surg questions (26 decks)

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