Plastics Flashcards
the most ideal approach for WOund Care, SKin Grafts, and Flaps
simple primary closure
- free tissues
- tissues containing their own blood supply
- Grafts
- Flaps
Classification
According to biologic relationships:
- Autogenous or Autografts-
- Heterogenous-
- Homogenous/Isografts-
- Zoografts-
- Autogenous or Autografts- same indiviual
- Heterogenous- from a different body
- Homogenous/Isografts- from animals of the same species
- Zoografts- different species
Classifications
- According to components
- Simple grafts-
- Compound grafts-
- Simple grafts- includes one component (eg. Fascial or Mucosal graft)
- Compound grafts- more than one component (eg. Osseocutaneous graft)
Classifications
According to Anatomical division
- Thin Split Thickness Skin Graft
- Full Split Thickness Skin Graft
- Thin Split Thickness Skin Graft
+/ = 5mm skin graft (epidermis and superficial dermis - Full Split Thickness Skin Graft
+/>5mm skin graft (epidermis and 1/3 to ¾ of dermis)
Uses of Graft
- For large skin or tissue loss after trauma or after excision of tumor
- To act as lining to prevent cosmetically unacceptable contraction
- Serve as a biological dressing
General considerations of Graft
- Potential healing ability
- Recipient bed
- Potential healing ability
+ Age- younger patient has better take
+ General health- DM
+ Nutrition - Recipient bed
+ Vascularity
+ Contamination
+ Contact between bed and graft
Process of grafts
- Stage of Plasmic Circulation 24-48 hrs
+ Nutrition comes from local exudation - Stage of Vascularization 18 hrs
+ Blood vessels grow out from the recipient bed - Stage of Organic Union
+ 4th-5th day- fibroblast formation
+ 10th day- permanent union
+ 14th-30th day- assumes normal appearance
+ 5th week- nerve grow into the area
Classification
Based of the distance in relation to the defect
- Local flaps-
- Distant flaps-
- Local flaps- raised from adjacent tissues
- Distant flaps-moved from areas far from the recipient
Classification
Based on Composition
- Simple-
- Compound-
- Simple- skin and some subcutaneous tissues
- Compound- carries another tissue such as bone or cartilage
Uses of Flaps
- To reconstruct a large defect
- To carry
- Limited to transplantation of skin
- Depends on the recipient site
- Cosmetic- may discolor
- Less adaptable to weight bearing
- Less able to survive on a bed with questionable nutrition
- Requires pressure dressing
- Cannot bridge defects
Grafts
- Can carry out other tissues
- Has own blood supply
- Better color
- More adaptable to weight-bearing
- Can be used on a bed with questionable nutrition
- No pressure dressing
- Can bridge defects
Flaps
- Cleft lip +/- cleft palate 2nd most frequently occurring congenital anomaly
- many associated syndromes
- Males > females 2:1
- Left > right
- 80% unilateral, 20% bilateral
- 3rd most common birth defect in the PH
- 5.6:10000 live births
Cleft deformity
▪ Less common (1:2000 live births)
▪ Females more affected (4:1)
▪ 20-30% are syndromic
Cleft palate alone
SUB UNITS OF THE LIP
- Columella
- Philtrum and phlitral ridges
- Cupid’s bow
- Mucocutaneous ridge
- Vermilion border
- Tubercle
Units of the PALATE
- Primary palate
- Secondary palate
- Uvula
- Muscularis uvulae
- Levator Veli Palatini
- Tensor Veli Palatini
Development:
- Lip
- Palate
- Lips- develop in 4-6 weeks AOG
- Palate- develop in 8-12 weeks AOG
From the Nasofrontal, Maxillary and Mandibular Prominences
Etiology of Cleft Deformity
- Genetic factor
- Exposure to alcohol and smoking
- Folic acid deficiency and Antagonists
- Maternal Diabetes Mellitus
- Phenytoin
- Retinoic acid derivatives
Classification of Lip Deformity
- Incomplete
- Complete
- Incomplete -only a portion of the lip is involved
- Complete -involves the entire thickness of the lip reaching up to the vestibule of the nose
Classification of Palate Deformity
- Incomplete
- Complete
- Incomplete –cleft not reaching the incisive foramen; only involves the secondary palate
- Complete -involves the primary palate
Caused by a mesodermaldeficiency of the muscles of the palate with intact overlying oral and nasal mucous membranes
Submucous clefts
Triad of Submucous clefts
a) Bifid uvula
b) Bluish midline streak (zona pellucida)
c) Loss of posterior nasal spine or frank notching of the posterior hard palate
Rule of 10s in Cleft Lip and Palate
- 10 lbs
- 10 weeks
- Hemoglobin of 10 g/dL
