Grafts & Flaps Flashcards
What is reconstructive surgery?
restoration of form & function to those who have congenital & acquired deformities
- following trauma
- resection of a tumor
- congenital anomalies
What is aesthetic surgery?
- reshape the normal structure to improve patient’s appearance
- outcome parameter is the patient’s goals & satisfaction
- abdominoplasty (tummy tuck)
- mammoplasty
What is the reconstructive ladder?
1- secondary intention 2- primary intension 3- tertiary intension 4- split skin graft 5- full thickness graft 6- tissue expansion 7- random flap 8- axial flap 9- free flap
What are the types of grafts?
AUTOGRAFT: from same person
ISOGRAFT: identical twins
ALLOGRAFT: from man to man
XENOGRAFT: from animal to man
what are the requirements for skin grafting?
- good blood supply (GRANULATION TISSUE)
- no infection
- no necrotic tissue
What are the types of skin grafts?
PARTIAL THICKNESS: SSG or Thiersch graft
FULL THICKNESS: Wolfe graft
after wide excision in malignancy, removal of full epidermis + part of the dermis from the donor was required. What is this procedure called?
Partial thickness graft
What are the indications of a partial thickness graft?
- well granulated ulcer
- clean wound or defect
- after surgery to cover defect created
What are the contraindications for a partial thickness graft?
- infected wound
- can’t be done over, BONE, TENDON, CARTILAGE, or JOINT
What are the steps of taking a partial thickness graft?
- Donor area is dressed for 10 days
- Recipient area is scraped well & the graft is placed after making window cuts in it to prevent seroma
- graft is fixed & tie-over dressing in placed
What are the disadvantages of a partial thickness skin graft?
- contracture
- seroma & hematoma can prevent graft take up
- infection
- loss of hair growth
- blunting of sensation
- dry scaling of skin due to nonfunctioning sebaceous glands (anhidrosis)
- graft failure
- can’t be used on soles of hand & feet
What are the advantages of using partial thickness grafts?
- technically easier
- wide area can be covered
- graft take up is better
- donor area heals on its own
What do we use to remove the epidermis + full dermis, and what are the locations we could graft it at?
SCALPEL BLADE used to remove full thickness
used in:
- face
- eyelid
- over joints
- hands & fingers
What do we use to remove the epidermis + full dermis, and what are the locations we could graft it at?
SCALPEL BLADE used to remove full thickness
used in:
- face
- eyelid
- hands & fingers
What are the most common donor areas for a full thickness graft?
- post auricular
- supraclavicular
- groin crease
What are the advantages of full thickness grafts?
- good color match (especially for face)
- sensations are felt better than partial
- functions of sebaceous glands & hair follicles are retained better
- functional & cosmetic results are better
What are the disadvantages of a full thickness graft?
- used only in small areas
- wider donor area has to be covered with SSG to close the defect
- can not be used to cover ulcers
What is a flap are what are its parts?
transfer of donor tissue with its blood supply to the recipient area
parts: base, pedicle, tip
What are the indications of flaps?
- cover wider deeper defects
- cover bone, tendon or cartilage
- if skin graft repeatedly fails
What are the advantages of skin flaps?
- good blood supply & take up
- gives bulk, texture, & color to the area
- allows required movements in recipient area
- cosmetically better
What are the disadvantages of flaps?
- long term hospitalization
- infection
- kinking, rotation & flap necrosis
- staged procedure
What is the classification of flaps?
PATTERN OF BLOOD SUPPLY
COMPONENTS
SITE OF INSERTION
What are the types of flaps based on pattern of blood supply?
RANDOM
- subdermal plexus of blood vessels
- rectangular flap has to have 1:1 or < 1.5:1 ratio so flap necrosis doesnt occur
AXIAL
- superficial vascular pedicles pass along their long axis (main artery is used)
- anatomically known blood vessel is supplying it
- long lengthy flap
What are the types of flaps based on their components?
CUTANEOUS
- forehead flap
- deltopectoral flap
FASCIOCUTANEOUS
- radial forearm flap
MUSCLE
- gracilis (sphincter or face reconstruction)
MYOCUTANEOUS
- latissimus dorsi
OSTEOMYOCUTANEOUS
What are the types of local flaps?
ROTATIONAL FLAP
- rotated laterally
TRANSPOSITIONAL FLAP
- square rotated laterally but may need SSG to cover it
Z-PLASTY
- lengthens contracted scar
What is a free flap & what are its disadvantages?
- vascular pedicle is cut & anastomosed with recipient site vessels
DISADVANTAGES
- complex surgical technique
- failure involves total loss of all transferred tissue
What is an island flap?
- flap has long pedicle that is rotated and buried underneath skin bridge
What is a saltatory flap?
mobilizing the flaps in stages from distant donor area towards recipient area
- requires many staged surgeries & long term hospitalization
What is a Waltzing flap?
flap is moved from donor area & attached adjacent to the recipient defect area
- later in 2nd stage it is moved towards the defect formally
- reduces the tension on the flap & increases success rate
What are the most commonly used flaps?
- deltopectoral flap
- latissimus dorsi muscle
- groin flap
- pectoralis major myocutaneous flap
- transverse rectus abdominis muscle flap (TRAM)
Where is the deltopectoral flap used & what is its blood supply?
- in neck & lower face
- 2nd perforator of internal mammary artery
What is the blood supply of latissimus dorsi flap?
myocutaneous flap using thoracodorsal artery
What artery is used in groin flaps?
superficial circumflex iliac artery
Where is the pectoralis major myocutaneous flap used?
island flap used to cover defects over CHEEK/NECK/PHARYNX/INTRAORAL lesions
What is the blood supply used in TRAM flaps & what do they cover?
- if superior pedicle: superior epigastric vessels (cover chest wall defect or postmastectomy area)
- if inferior pedicle: inferior epigastric vessels (cover groin & thigh defects)
