Flaps and Grafts Flashcards
Tissue that’s transferred WITHOUT an intact blood supply and relies on the ingrowth of new vessels.
Graft
Tissue transferred WITH ITS OWN BLOOD SUPPLY.
Flap
A flap that’s supplied by a named artery and vein..
Axial flap
What does “pedicle” mean?
Blood supply
Tissue is immediately adjacent to or near the primary defect.
Local flap
The tissue is not immediately adjacent to or near the site, but with pedicle sufficiently long to reach the primary defect.
Regional flap
Flaps with the pedicle distant enough not to streatch the the face or neck.
An example is a free flap.
Distant flap
Types of distant flaps.
Pedicled
Free
Flaps physically detached from their native blood supply and then reattached to vessels at the recipient site.
Free flap
A flap that has an unnamed blood supply.
Random flap
An advantage of an axial pattern flap.
You don’t have to obey the length to width ratios, the flap dimensions can be as long as the axial vessel.
This flap depends on the subdermal/subcutaneous plexus fused from perforators at the base of the flap.
Random pattern flaps.
Disadvantage of a random pattern flap.
Have to obey the 3:1 length to width ratio to ensure flap survival.
Length to width ratio of a flap if it’s not an axial pattern flap.
3:1
Types of pedicled flaps.
1) Advancement flaps
2) Transposition flaps
3) Rotation flaps
Epidermis is made of what kind of epithelium?
Keratinizing stratified squamous
Mnemonic for layers of the epidermis.
Come Lets Get Some Beers
Predominant cell type of the epidermis.
Keratinocyte (80%)
Layer of the epidermis that has the keratinocytes.
Basal
Thickness of the epidermis.
.075 - .15 mm
This is attached to the epidermis by the basement membrane.
Dermis
Components of a pilosebaceous unit.
1) Hair shaft
2) Sebaceous glands
3) Follicle
Where does epithelialization occur in full and split thickness grafts?
At the wound edges around the pilosebaceous unit.
Layers of the dermis
1) Papillary
2) Reticular
Thinnest dermis is found where?
Eyelid
Thickest dermis is found where?
Back
Thickness of the dermis as we age (after 5th decade).
Decreases
Men or women have thicker dermis?
Men
What are these indications for?
- Cutaneous defect not amenable to primary closure or local flap.
- Surface coverage of a vascularized (pedicled or free) myofascial flap.
- Large mucosal defects not amenable to primary closure.
- Tumor surveillance
- Older patients (better match).
- Temporary coverage.
Grafts
When you can’t do primary closure or local flaps, what is indicated?
Graft
Grafts are contraindicated when…
1) Vessels at the wound bed are exposed.
2) Exposed bone, cartilage, tendon.
3) No soft tissue wound bed.
4) Avascular defects
Thickness graft where you take the epidermis and some dermis.
Full thickness
Thickness graft where you take some epidermis.
Split thickness
Which has a greater survival rate: Full or Split Thickness skin graft?
Split
Does full or split thickness skin graft have a longer healing time?
Full thickness
Advantages of a FULL thickness skin graft:
1) Texture and pigmentation closer to normal skin compared to Split Thickness.
2) Less contour irregularities.
3) Durability in areas of friction is concern.
4) No special harvest equipment.
5) Less contracture.
6) Donor site heals primarily.
True
Indications for full or split thickness skin grafts?
1) Very large defects
2) Non-mobile site
3) Esthetics are not a concern
4) Visceral lining (oral) reconstruction.
Split thickness
Advantage of full or split thickness skin graft?
- Less tissue that requires revascularization.
- Can be used when revascularization is a concern.
Split thickness
Disadvantages of full or split thickness grafts?
1) Poor color and texture match with normal skin.
2) Contracts more
3) Patchy appearance to face
4) Donor site concerns:
- Takes 3 weeks to heal.
- Significant discomfort
- Sites always have color and texture changes that are unesthetic.
Split Thickness
The first flap based on a known axial blood supply.
Deltopectoral flap
Restore function and have bacteria resistance.
Flaps
Do NOT have function or bacterial resistance.
Grafts.
Name the flap:
1) Complete detachment with devascularization from the donor site.
2) Revascularization of the flap with microvascular anastomoses between flap pedicle vessels and recipient site vessels to nourish the flap with new arterial and venous drainage.
3) Intervening period of flap ischemia.
Free Flap (Distant flap)
Qualities of which flap?
1) No lymph drainage
2) Denervated with respect to the sympathetic NS.
3) Usually only a single feeder artery and vein.
Free flap
This tissue procedure RESTORES form and function.
Free flap
A composite free flap/tissue transfer includes:
Skin
Fascia
Muscle
Bone
Advantages of a free flap:
- Wide variety of tissue types can be oriented in many configurations to improve inset.
- Large amount of composite tissue.
- Defect size of little consequence.
- Can be harvested from almost any region of the body to match tissue characteristics.
- Fewer surgical stages and reduced time to complete rehabilitation vs. regional reconstructions.
- Potential for sensory and motor innervation
Magnification for tissue preparation.
x4 or x6
Magnification for vessel anastomosis.
x10
Artery that supplies the fibula.
Peroneal artery
Two of these run parallel to the peronealartery in the fibula.
Venae comitantes
