KEY NOTES CHAPTER 1: GENERAL PRINCIPLES (D) Geometry of local flaps. Flashcards

0
Q

What is the best orientation for a surgical incision?

A

Parallel to RSTL / rhytid.
Perpendicular to LMEs.
Parallel to direction of hair growth.
Pinch test.

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1
Q

What are Langer’s lines and what did Borges describe?

A

Langer (19th century) made circular awl wounds in cadavers which resulted in elliptical defects due to skin tension.
Borges termed:
RSTL - parallel to rhytids, perpendicular to underlying muscle fibres.
LME - parallel to underlying muscle fibres, perpendicular to RSTLs.

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2
Q

What is a z-plasty?

A
Transposition of 2 adjacent triangular flaps.
Purpose:
1. increase length of scar.
2. break up straight line scar.
3. realign scar.
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3
Q

How much does a z-plasty elongate a scar by?

A
30 deg - 25%
45 deg - 50%
60 deg - 75%
75 deg - 100%
90 deg - 125%
Angles of flaps need not be equal but length of limbs do.
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4
Q

How do you design a z-plasty?

A
  1. Draw desired orientation of resultant scar (dotted).
  2. Draw line of original scar (bold).
  3. Draw 2 possible z plasty flaps, use ones with acute angle at apex of flap (not obtuse).
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5
Q

Draw a 4 flap plasty.

A

CADB

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6
Q

Draw a 5 flap plasty.

A

BACED

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7
Q

When is a W-plasty used?

A

To break up linear scar to improve aesthetics, does not lengthen scar.

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8
Q

What different types of local flaps are there?

A
  1. Advancement
    - Simple e.g. Moberg
    - VY e.g. Atasoy, Venkataswamy / Evans step advancement (blood supply comes from deep tissue through a subset pedicle
    - Keystone - trapezoidal flaps used to close elliptical defects, blunt dissection maintains perforators, lateral deep fascial margin is incised to increase mobilisation, 2 ends of donor site are closed as VY advancements.
    - bipedicled (e.g. von Langenbeck mucoperiosteal flap, posterior auricular bipedicle flap)
    - Burrow’s triangle excision / Z plasty
  2. Pivot flaps with SSG of donor site
  3. Transposition flaps with direct closure of donor site e.g. rhomboid, Dufourmentel
  4. Interpolation flaps - flap raised from local bridge and pedicle is passed under / over skin bridge
  5. Rotation
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9
Q

Design a keystone flap

A

.

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10
Q

Design a Limberg (rhomboid) flap

A

.

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11
Q

Design a rotation flap

A
  • flap circumference should be 5-8x diameter of defect

- can design back cut, donor site closes directly by tissue redistribution

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12
Q

Design a MacGregor flap

A

.

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13
Q

Design a bilobed flap

A

Esser (1918) - 2 flaps designed 90 degrees to each other

Zitelli - 45 degrees

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