Lec 20: Principles of Reconstructive Surgery

Question 1

why do we do reconstructive sx

Answer 1

• close defects that occur secondary to trauma
• correct/improve congenital abnormalities
• after removal of cancers

Question 2

why is it important to select the appropriate technique

Answer 2

to prevent complications and avoid unnecessary cost

Question 3

what can large or irregular defects be closed with?

Answer 3

relaxing incisions or “plasty” techniques

Question 4

large defects or those on extremities may require that tissue be mobilized from other sites. what are two examples of this?

Answer 4

pedicle flaps, grafts

Question 5

pedicle flaps are tissues that are _____ detached from the donor site and _____ to cover a defect.

Answer 5

partly ; mobilized

Question 6

grafts involve the ____ of a segment of ___ to a distant (recipient) site.

Answer 6

transfer ; skin

Question 7

what is hirudiniasis?

Answer 7

attachment of leeches to skin, only recc. for tissues w impaired venous circulation

Question 8

leeches produce a ____ that mimics venous outflow.

Answer 8

small bleeding wound

Question 9

what are some considerations we need to have in reconstructive surgery?

Answer 9

• location of wound
• elasticity of surrounding tissue
• regional blood supply
• character of wound bed

Question 10

apposing incision edges under too much tension can cause ______ and _____.

Answer 10

incisional discomfort ; pressure necrosis

Question 11

incisional discomfort and pressure necrosis caused by apposing incision edges under too much tension can in turn result in sutures _____ and ____ or ____ dehiscence.

Answer 11

“cutting out” ; partial ; complete

Question 12

methods of reducing tension include…
- undermining _____ edges
- selecting appropriate _____ _____.
- using relief _____.
- skin _____.
- tissue _____.

Answer 12

wound ; suture patterns ; incisions ; stretching ; expansion

Question 13

how should we always position the animal for surgery?

Answer 13

so that mobile skin is NOT pinned against the table or immobilized

Question 14

if methods do not allow for primary apposition, wounds may be allowed to heal by…

Answer 14

secondary intention or may be reconstructed with flaps or grafts

Question 15

true or false: incision should be made perpendicular to tension lines

Answer 15

FALSE - they should be made parallel to tension lines

Question 16

traumatic wounds should be closed in the direction that…

Answer 16

prevents or minimizes tension

Question 17

wound edges should be manipulated before closure to determine….

Answer 17

which direction the suture line should run to minimize tension

Question 18

if tension is minimal, a wound should be closed in the direction of its (long or short) axis

Answer 18

long

Question 19

the direction of closure should prevent or minimize the creation of…

Answer 19

“dog ears” or “puckers”

Question 20

perpendicular or oblique incisions gape and require ___ sutures than parallel skin tension lines.

Answer 20

more

Question 21

how do you undermine skin adjacent to a wound?

Answer 21

by using scissors to separate the skin or panniculus muscle from underlying tissue

Question 22

what is the simplest tension relieving procedure?

Answer 22

undermining skin adjacent to a wound

Question 23

undermining skin adjacent to a wound releases skin from underlying attachments so that its full _____ potential can be used.

Answer 23

elastic

Question 24

skin should be undermined ____ to the panniculus muscle to preserve subdermal plexus and direct cutaneous vessels which run parallel to the skin surface.

Answer 24

DEEP

Question 25

skin can be prestretched hours to ____ before surgery to aid in closure with less tension at the time of the procedure

Answer 25

days

Question 26

what tools can be utilized for skin stretching?

Answer 26

pre-suturing, adjustable sutures, skin stretchers, and skin expanders

Question 27

inflatable tissue expanders work by...

Answer 27

being inflated in subcutaneous tissue to stretch overlying skin. expanders have an inflatable bag and reservoir (pump to given pressure/volume at intervals)

Question 28

what type of skin stretching and expansion technique is depicted in the image?

Answer 28

presuturing

Question 29

what type of skin stretching and expansion technique is depicted in the image?

Answer 29

skin stretchers

Question 30

what type of skin stretching and expansion technique is depicted in the image?

Answer 30

inflatable tissue expanders

Question 31

what type of skin stretching and expansion technique is depicted in the image?

Answer 31

adjustable sutures

Question 32

____ pattern flaps are preferable to tissue expanders for large wound reconstruction.

Answer 32

axial (this is usually a referral level surgery)

Question 33

what suture patterns can we utilize to relieve tension?

Answer 33

subdermal sutures, walking sutures, external tension relieving sutures

Question 34

what is the standard tension relieving suture for the skin?

Answer 34

vertical mattress

Question 35

placing padded material beneath the suture loops is called ____.

Answer 35

stenting

Question 36

placing sutures close together on the convex side of the defect and farther apart on the concave side can help prevent _____.

Answer 36

dog ears

Question 37

outlining with an _____ incision, removing redundant ___, and apposing skin edges in a linear or curvilinear fashion can help prevent dog ears.

Answer 37

elliptic ; skin

Question 38

dog ears may be corrected by incising the center of the dog ear to form two _____. one _____ should be excised and the other used to fill the _____. OR both ______ may be excised and the edges apposed, creating a _____ suture line.

Answer 38

triangles ; triangle ; defect triangles ; linear

Question 39

thin skin is less likely to form ____ than thick skin.

Answer 39

dog ears

Question 40

many dog ears ____ without excision.

Answer 40

flatten

Question 41

we can correct/prevent dog ears at the end of suture lines by using _____ suture spacing.

Answer 41

unequal

Question 42

we can correct/prevent dog ears at the end of suture lines by _____ an ______ segment of skin.

Answer 42

resecting ; elliptic

Question 43

we can correct/prevent dog ears at the end of suture lines by resecting one large ____ of skin.

Answer 43

triangle

Question 44

we can correct/prevent dog ears at the end of suture lines by resecting __ smaller triangles of skin.

Answer 44

two

Question 45

where would we use relaxing incisions?

Answer 45

distal extremities, around eyes/anus, to cover tendons, ligaments, nerves, vessels or implants.

Question 46

before a tumor is removed, skin tension and elasticity should be assessed, but excessive tumor ________ should be avoided.

Answer 46

manipulation

Question 47

direction of skin tension lines, shape of excision, and closure method should be ______ prior to surgery.

Answer 47

planned

Question 48

a _____ area should be clipped and aseptically prepared for surgery, especially if there is a chance that skin flaps may be needed for closure.

Answer 48

LARGE

Question 49

excision of skin tumors should include - the ____ - previous ____ sites - ____ margins of normal tissue in _____ dimensions.

Answer 49

tumor ; biopsy ; wide ; 3 (length/width/depth)

Question 50

if the tumor is benign, it should be removed along with __ cm of normal tissue.

Answer 50

1

Question 51

if the tumor is malignant, it should be removed along with a margin of ___ to ___ cm for a complete local excision.

Answer 51

2 ; 3 (remember, these margins are taken in all dimensions, including the deep margin through the fascia if possible)

Question 52

margin of distance should be greater for more aggressive, infiltrative tumors like....

Answer 52

mast cell tumors, melanomas, squamous cell carcinomas, soft tissue sarcomas, feline mammary adenocarcinomas, hemangiopericytomas, infiltrating lipomas.

Question 53

______ dense fibers like, cartilage, tendon, ligaments, fascia, are _____ to neoplastic invasion and therefore are often spared during resection.

Answer 53

collagen ; resistent

Question 54

excision of infiltrative or aggressive tumors should still extend at least one _____ layer below the detectable tumor margins.

Answer 54

fascial

Question 55

for poorly localized tumor or those with high grade malignancy, we should consider _____ tumor excision.

Answer 55

radical (removal of an entire compartment or structure, amputation or lobectomy)

Question 56

local tumors most often reoccur due to the ______ ______ for the original tumor being inadequate.

Answer 56

surgical margins

Question 57

be sure to ___ tumor borders.

Answer 57

mark

Question 58

what is the image depicting? A. advancement flaps B. rotational flaps C. transposition flaps D. interpolation flaps E. tubed pedical flaps

Answer 58

A ; v to y plasty

Question 59

what is the image depicting? A. advancement flaps B. rotational flaps C. transposition flaps D. interpolation flaps E. tubed pedical flaps

Answer 59

B

Question 60

what is the image depicting? A. advancement flaps B. rotational flaps C. transposition flaps D. interpolation flaps E. tubed pedical flaps

Answer 60

C

Question 61

what is the image depicting? A. advancement flaps B. rotational flaps C. transposition flaps D. interpolation flaps E. tubed pedical flaps

Answer 61

E

Question 62

axial pattern flaps include a direct cutaneous ____ and ____ at the base of the flap.

Answer 62

artery ; vein

Question 63

axial pattern flaps have better ______ than pedicle flaps with a circulation from the subdermal plexus alone.

Answer 63

perfusion