Principles of Plastic Surgery Flashcards
stopped at 92
What is the definition of orthoplastics and microsurgery?
principles and practices of both specialists applied to a clinical problem either by a single provider or team of providers working in concert for the benefit of the patient
what is the stepwise approach of wound coverage?
direct closure->grafts->local flaps->distant flaps->tissue transfer
Where are the resting skin tension lines in the axis of muscles/tendons and joints
perpendicular to the long axis of muscles and tendons
parallel to the axis of joints at the level of the joints
Where is the ideal incision placed in relation to the RSTL
parallel
what does closing a surgical incision in layers do?
takes tension off the wound edges-dont make too many layers though to avoid tissue fibrosis etc
-leads to dec rate of deshicence and a prettier scar
what is the 3:1 rule?
the length to width ratio for which skin is able to be mobilized is 3:1.
what is apligraf made from?
human neonatal foreskin
- epidermal layer=human keratinocytes
- dermal layer: human fibroblasts in bovine type 1 collagen lattice
what does apligraf contain?
matrix proteins, cytokines
When do you use apligraf?
venous leg ulcers, diabetic ulcers,non-healed for 1 month for ulcers that havn’t responded to care
contraindications of apligraf?
infected wounds, exposed tendon or bone, allergy to bovine collagen or sensitivity to apligraf
how do you apply apligraph?
- debride wound
- saline
- fenestrate with 11 blade
- apply
- add dressing
- compression if needed
what is dermagraft?
cryopreserved human fibroblast derived dermal substitute
- single layer
- 6months shelf life
when do you use dermagraft
diabetic ulcers-full thickness, >6 weeks in duration
-venous leg ulcers
contraindications of dermagraft?
-infected wounds, exposed tendon or bone, sinus tracts, allergy or sensitivity
how to apply dermagraft?
- thawed from freezer
- debride
- apply
- apply non occlusive dressing (no petroleum)
- apply dressing
- offload pt
what is oasis?
- porcine submucosa
- 3d lattice scaffold
- not living tissue
indications of oasis?
chronic ulcerations
trauma
pvd
decubitus ulcerations
contraindications of oasis
infected wound
exposed tendon or bone
sensitivity/allergy to porcine
how to apply oasis
adequate wound debridement
- apply oasis
- saline
- dressing to keep moist
do not debride between applications
What is integra?
- bilayer wound care product
- bovine collagen and silicone
- semi-permeable silicone membrane
indications of integra?
- exposed tendon or bone
- diabetic, traumatic, vascular, venous, partial thickness, full thickness
contraindications of integra?
exposed wound, known hypersensitivity to product
what is the most commonly used free grafted tissue?
split thickness skin graft (STSG)
what type of STSG is this?
- excellent host incorporation
- contracts the most
- greatest change for hypopigmentation
- most susceptible to trauma
Thin graft .008 - .012
what type of STSG is this?
- less contracture
- more durable
Intermediate graft (0.012 - 0.016)
what type of stsg is this?
- less chance of incorporation-greater tissue demands
- durability and contraction are much improved
thick graft (0.016-0.020)
what type of stsg is this?
- placed through mesher-fenestrates the tissue
- expands to allow greater tissue coverage
- prevents seroma and hematoma from collecting beneath the graft
- interposed spaced heal by epithelial migration from the surrounding graft tissue
Meshed grafts
what is the difference between stsg and full thickness skin grafts?
-FTSG involves dermis AND portion of superficial fascia
when is FTSG indicated?
-coverage in WB area of flexion points
what are the donor sites of ftsg?
- popiteal fossa, inguinal fossa
- pedal donor sites: medial arch; sinus tarsi
advantages of ftsg?
permanent coverage, simple, low risk, can be applied to almost any area of the body
disadvantages of ftsg?
inc failure rate over tendon and bone, graft contracture, inc failure rate, infection, non healing donor site
What are the stages of skin graft healing?
- Plasmotic stage
- Inosculation stage
- Re-organization stage
- Re-innervation stage
What stage of skin graft healing is this?
- occurs 24-48 hrs following graft application
- a fibrin layer is formed between the graft and host bed which serves to anchor and allow diffusion of nutrients to the graft
plasmotic
What stage of skin graft healing is this?
- begins at 48 hrs
- revascularization of the graft occurs
- graft will demonstrate a pink hue during this stage
- lymphatic drainage will be established by the 4th to 5th day
inoscultation stage
What stage of skin graft healing is this?
- continues for months after grafting
- CT reorganizes and regulates vascular and lymphatic flow
re-organization stage
What stage of skin graft healing is this?
- occurs simultaneously with re-organization
- can take 1-2 yrs to complete
re-innervation stage
What are some reasons for graft failure?
lack of compression of the graft to the recipient site
-movement/shearing
-infection
seroma/hematoma
-Tissue harvested and applied whithin same individual
autograft
-tissue transferred between individuals of the same species
allograft/homograft
tissue harvested and applied within a set of identical twins
isografts
tissue transferred between different species
-function as biologic dressing and never incorporates into the host’s tissues
xenografts
what is a threedimensional anatomic unit of tissue fed by a source artery
angiosome
these link angiosomes to each other
- demarcate each angiosome
- provide indirect collateral flow
Choke vessels
what arteries make up the posterior tibial artery angiosomes
medial calcaneal
lateral and medial plantar
are incisions placed perpendicular to the joint to avoid scar contracture impeding mobility?
yes
DO skin flaps maintain vascular supply?
yes
what are the indications of skin flap use?
coverage for areas of poor vascularity
- reconstruction of full thickness deficits
- padding over boney prominences
- coverage of areas requiring operation at later date
- restoration of sensation to the area
What is the flap of a skin flap
-tongue of the tissue
what is the pedicle of a skin flap
-base or stem of the tissue
- derive blood supply from cutaneous dermal-subdermal plexus
- no axial arteries
- limited based on dimensions
- pedical must be wide enough to support the flap
- base should be at lease as wide as the flap is long
-random pattern cutaneous flap
- derive blood supply from cutaneous artery
- survival of these flaps are dependent on the dimensions of the artery and the length of the territory of the artery not on the width of the pedicle
- island flaps-no skin bridge
- free flaps; transferred from distant site
axial pattern-arterial flaps
- adjacent to the deficit
- either rotate on a pivot point or are advanced forward form their base to cover a defect
- include epidermis, dermis and subq tissue
- donor site is either closed primarily or skin grafted
local flaps
- flaps that rotate on a pivot point
- pivot about pedicle
- includes skin and subq tissue
rotational flaps
- rotate on pivot point
- usually rectangular or square with rounded edges
- movement is in an arc and can be rotated as much as 90 degrees
transposition flap
-rotate on a pivot point when defect has a rhomboid shape
limberg flap
