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***Soft tissue > Grafts > Flashcards

Grafts Flashcards

1
Q

different sizes of split thickess skin graft

A

thin: 0.008 to .012 “
intermediate: 0.013-0.016”
thick: 0.017-.02

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2
Q

STSG vs FTSG have better take

A

STSG: there are more blood vessels in the superficial dermis thats transected which could aid in revasc. and has less tissue to support with blood supply

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3
Q

graft with greater contraction

A

FTSGs have a greater amount of dermis and elastin, primary contracture is more significant in FTSG than STSG.

Secondary contracture is the shrinkage of the skin graft in the wound bed over time, caused by myofibroblasts. Secondary contracture is greater for STSGs than FTSGs,

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4
Q

graft prone for hyperpigmentation

A

STSG

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5
Q

more durable graft

A

full thickness

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6
Q

better cosmetic

A

FTSG

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7
Q

common complications for STSG

A

hematoma(most common)/seroma

infection-2nd most commonn: Group A strep, pseudomonas will prevent graft from adhering

shearing forcess

poor vascularity of exposed bones/tendons

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8
Q

survival rate or STSG vs FTSG

A

5 days-Stsg, FTSG: 3 days

so if seroma or hematoma is present on STSG, it may still survive

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9
Q

common donnor sites for FtSG

A

flexor creases: groin, poplitea fossa, inguina area, gluteal fold
“pinch” area- sinus tarsi

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10
Q

3 phases of skin graft healing

A

plasmatic phases/imbibition: 24-48 hr
capillary budding, graft still ischemic - passively absorbs nutrients in wound bed by diffusion

inosculation: (48-72 hrs): capillary budding in contact with graft

angiogenesis/reorganization: day 5-new blood vessels grow into graft, graft become vascularized

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11
Q

where on the flap retains vasculairty

A

base of flap: pedicle

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12
Q

what type of graft has better function

A

thicker graft

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13
Q

in order for the graft to “take”, what is important?

A

absence of motion, infection, hemostasis, stent dressings (dressing designed for skin graft to hold graft in place, apply pressure, and absorb fluid): adaptic, saline soaked gauzed, fluff, held by tie-over sutures securing of graft, wound vac

requires a vascular recipient site, cannot be placed over bone or tendon which has less vascularity

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14
Q

isograft

A

graft of tissue between two individuals who are genetically identicial

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15
Q

xenograft

A

a graft of tissue from one species used on another species

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16
Q

what is the ratio of the full thickness skin graft in order for adequate closure

A

3:1 length to width: elliptical incision

17
Q

common donor sites for STSG

A

anterior/lateral thigh, upper inner arm, gluteal region, dorsum of foot

18
Q

limberg flap orientation

A

longitudinal axis is parallel to the line of minimal skin tension

19
Q

how much length will 45 deg and 60 deg z plasty get

A

45 deg: 50% length; 60 deg:75%

good for linear scar contractures

20
Q

what are the consequences if angles are less than 45 or more than 60 for z plasties

A

45 deg results in impaired blood flow to flaps

>60 deg: severe tension, extreme lengthening

21
Q

V-Y plasty placement, and length of the arm of the V

A

apex of V placed at the point of maximal tension; apex usually proximal in foot and distal skin is advanced

the arms of the V should be 1.5x the length of the wound/contracture/scar

Entire V may be undermined beneath superficial fascia for exposure

22
Q

V-Y plasty good for what type of contractures and allows for how much lengthening

A

V-Y are useful for lengthening contractures or in reducing contracted digits across the MPJs. Commonly treats overlapping 5th digits. Good for unidirection skin lengthening technique

20% increase in length

23
Q

the cincinnati incision is common for what procedure

A

soft tissue release for club foot

24
Q

indications for skin flap

A
  1. Areas with poor vascularity (bare bone or tendon)
  2. Reconstruction for full thickness
  3. bad bony prominences
25
Q

rotational flap

A

semi-circular flap (ideally 1/2 circle) that is rotated pivot towards adjacent defect. Donor site is closed or grafted

26
Q

what type of flap is a Z-Plasty? length of arms?

A
  1. Transposition of 2 triangular flaps
  2. Make transverse central line parallel to the contracted skin
  3. Arms of Z are EQUAL (all arm lengths are equal) with flap to tip angle 60 Degrees (can give about 75% increase in length)
27
Q

random pattern flap vs axial pattern flap

A

random pattern flap: lack a primary artery and vein and rely on perfusion of dermal-subdermal vessel from the pedicle of the flap (length to base ratio should be 1:1) (ie. local cutaneous flap)

axial pattern flaps contain a primary artery and vein that are incorporated into pedicle of the flap. therefore, perfusion depends on axial artery rather than the width of the pedicle and cutaneous perfusion. (ie muscle flap)

28
Q

Rotational vs transpositional vs interpolational flaps vs advancement flaps

A

rotational flap: semicircular and rotated about a pivot point

transpositional flap rotated about a point but are linear dimensions such as squares and rectangles

interpolational flaps are rotated about a pivot point but flap must pass over or under intact tissue between donor and recipient sites. The defect is not immediately adjacent to defect

advancement flap: fixed point that are stretched as donor tissue into recipient bed (ie bipedicle flap or V to Y flap)

29
Q

For a Y-V approach, what direction does the lengthening occur?

A

lengthening occurs perpendicular to the stem of the Y

30
Q

what type of flap is a a limberg flap? advantages to this flap

A

This is a random pattern, transpositional flap in a shape of rhombus.

advantages to this flap is that it preserves a large amount of normal skin adjacent to the deficit that would otherwise been excised with a standard elliptic flap

31
Q

disadvantage of limberg procedure

A

skin must be mobile to prevent excessive tension across the flap and obtain closure to donor site.

32
Q

common donor sites for free vascularized flaps

A

latissimus dorsi, rectus abdominis, groin, gracilis, serratus anterior , radial forearm fasciocutaneous flap

33
Q

what types of flaps can be used to cover chronic osteomyelitis to increase blood perfusion to the area and availability of systemic antibiotics

A

Free muscle flaps

34
Q

what is the most common disadvantage /complication causing free flap failure

A

microvascular techniques is needed for reanastomosis because VENOUS or Arterial thrombosis/congestion are MAJOR causes of free flap failure

technical skill and instrumentation needed

35
Q

when are muscle flaps useful

A

covering soft tissue defects when bulk, padding, and vascularity are needed to cover a wound

36
Q

Indication for Abductor digiti minimi muscle flap

A

lateral malleoli wound

***Soft tissue (3 decks)

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