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Surgery I > Lec 20: Principles of Reconstructive Surgery > Flashcards

Lec 20: Principles of Reconstructive Surgery Flashcards

1
Q

why do we do reconstructive sx

A
  • close defects that occur secondary to trauma
  • correct/improve congenital abnormalities
  • after removal of cancers
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2
Q

why is it important to select the appropriate technique

A

to prevent complications and avoid unnecessary cost

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3
Q

what can large or irregular defects be closed with?

A

relaxing incisions or “plasty” techniques

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4
Q

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

A

pedicle flaps, grafts

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5
Q

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

A

partly ; mobilized

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6
Q

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

A

transfer ; skin

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7
Q

what is hirudiniasis?

A

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

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8
Q

leeches produce a ____ that mimics venous outflow.

A

small bleeding wound

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9
Q

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

A
  • location of wound
  • elasticity of surrounding tissue
  • regional blood supply
  • character of wound bed
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10
Q

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

A

incisional discomfort ; pressure necrosis

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11
Q

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

A

“cutting out” ; partial ; complete

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12
Q

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

A

wound ; suture patterns ; incisions ; stretching ; expansion

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13
Q

how should we always position the animal for surgery?

A

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

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14
Q

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

A

secondary intention or may be reconstructed with flaps or grafts

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15
Q

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

A

FALSE - they should be made parallel to tension lines

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16
Q

traumatic wounds should be closed in the direction that…

A

prevents or minimizes tension

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17
Q

wound edges should be manipulated before closure to determine….

A

which direction the suture line should run to minimize tension

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18
Q

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

A

long

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19
Q

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

A

“dog ears” or “puckers”

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20
Q

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

A

more

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21
Q

how do you undermine skin adjacent to a wound?

A

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

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22
Q

what is the simplest tension relieving procedure?

A

undermining skin adjacent to a wound

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23
Q

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

A

elastic

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24
Q

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

A

DEEP

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25
Q

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

A

days

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26
Q

what tools can be utilized for skin stretching?

A

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

27
Q

inflatable tissue expanders work by…

A

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

28
Q

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

A

presuturing

29
Q

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

A

skin stretchers

30
Q

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

A

inflatable tissue expanders

31
Q

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

A

adjustable sutures

32
Q

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

A

axial (this is usually a referral level surgery)

33
Q

what suture patterns can we utilize to relieve tension?

A

subdermal sutures, walking sutures, external tension relieving sutures

34
Q

what is the standard tension relieving suture for the skin?

A

vertical mattress

35
Q

placing padded material beneath the suture loops is called ____.

A

stenting

36
Q

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

A

dog ears

37
Q

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

A

elliptic ; skin

38
Q

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.

A

triangles ; triangle ; defect

triangles ; linear

39
Q

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

A

dog ears

40
Q

many dog ears ____ without excision.

A

flatten

41
Q

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

A

unequal

42
Q

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

A

resecting ; elliptic

43
Q

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

A

triangle

44
Q

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

A

two

45
Q

where would we use relaxing incisions?

A

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

46
Q

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

A

manipulation

47
Q

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

A

planned

48
Q

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

A

LARGE

49
Q

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

A

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

50
Q

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

A

1

51
Q

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

A

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

52
Q

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

A

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

53
Q

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

A

collagen ; resistent

54
Q

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

A

fascial

55
Q

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

A

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

56
Q

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

A

surgical margins

57
Q

be sure to ___ tumor borders.

A

mark

58
Q

what is the image depicting?

A. advancement flaps
B. rotational flaps
C. transposition flaps
D. interpolation flaps
E. tubed pedical flaps

A

A ; v to y plasty

59
Q

what is the image depicting?

A. advancement flaps
B. rotational flaps
C. transposition flaps
D. interpolation flaps
E. tubed pedical flaps

A

B

60
Q

what is the image depicting?

A. advancement flaps
B. rotational flaps
C. transposition flaps
D. interpolation flaps
E. tubed pedical flaps

A

C

61
Q

what is the image depicting?

A. advancement flaps
B. rotational flaps
C. transposition flaps
D. interpolation flaps
E. tubed pedical flaps

A

E

62
Q

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

A

artery ; vein

63
Q

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

A

perfusion

Surgery I (10 decks)

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