Muscle Flaps, Omental Flaps and Free Skin Grafts Flashcards
Why is it difficult to close distal extremity wounds? (4)
- There is often too much skin tension to allow primary closure;
- There is not enough loose skin to allow the use of local skin flaps;
- Many animals will not tolerate immobilisation of a limb for a distant direct flap to be successful;
- Most axial pattern flaps are not long enough to extend beyond the carpus or tarsus.
What muscle flap can be used to repair a thoracic wall defect?
Latissimus Dorsi
What is a myocutaneous flap?
Skeletal muscle and the overlying skin are elevated simultaneously
How useful are myocutaneous flaps in cats/dogs? why?
Myocutaneous flaps are less useful in dogs and cats, who have an abundance of loose skin for random flaps and direct cutaneous arteries that can be incorporated into axial pattern flaps.
How are muscle flaps typed?
Type I - Type V
What is a type I muscle flap?
There is one dominant vascular pedicle. Type I muscles can be elevated and pivoted on this pedicle.
What is a Type II muscle flap?
There is one dominant vascular pedicle near the origin or insertion, with a minor pedicle supplying the muscle belly. Type II muscles are likely to survive following ligation of the minor pedicle as long as the major pedicle is intact.
What is a type III muscle flap?
There are two dominant pedicles supplying approximately half the muscle belly. Ligation of one vascular pedicle may or may not compromise the part of the muscle belly it supplie
What is a type IV muscle flap?
Smaller segmental vascular pedicles supply the muscle between its origin and insertion. Survival is inconsistent following muscle elevation.
What is a type V muscle flap?
There is one dominant vascular pedicle at the muscle’s insertion, with segmental pedicles entering near its origin. The muscle would survive as long as its dominant pedicle were intact. Survival based on the segmental pedicles would be less consistent.
Latissimus Dorsi Flap:
The origin of the muscle is the superficial leaf of the lumbodorsal fascia and the insertion is an aponeurosis medially on the triceps muscle.
What is the muscle type?
V
External abdominal oblique flap
A) Where does the costal component of muscle originate from?
B) Where does lumbar component originate?
A) Segmentally from ribs 4-5 to rib 13
B) thoracolumbar fascia along the iliocostalis muscle.
Greater Omentum:
A) Where does it arise from?
B) Extend to?
A) Greater curvature of stomach
B) Level of urinary bladder
What is the pocket between the ventral and dorsal leaf of greater omentum?
Omental bursa (or lesser peritoneal cavity)
What is the single opening to the omental bursa?
Epiploic foramen
Epiploic foramen is bordered by what:
A) Ventrally?
B) Dorsally?
A) Portal Vein
B) Cd vena cava
What is the other term for the splenic portion of omentum?
Gastrosplenic ligament
What is contained in the veil portion of the omentum?
L lobe of pancreas
How can the omentum be lengthened?
- Incising the dorsal lead at attachment to pancreas
- Inverted L incision in left side of omentum caudal to gastrosplenic ligament
Why might we want to lengthen the omentum?
- use for thoracic wall
Nutrition of a graft occurs by..?
Plasmatic imbibition
Three stages of graft nutrition?
Plasmatic imbibition
Inosculation
Re-vascularisation
What do full thickness grafts comprise of?
Epidermis and whole dermis
What does parital thickness graft comprise of?
Epidermis and part dermis
Can you remember the three causes of graft separation and failure?
Movement
Infect
Fluid accumulation
What first layer of bandage for skin graft?
Non adhesive
What is the earliest a bandage should be changed after graft placement?
48 hours
Why is it safer to wait 72 hours for bandage chaneg after graft placement?
Critcal period for re-vasc
