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Surgery > Principles of Plastic Surgery > Flashcards

Principles of Plastic Surgery Flashcards

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1
Q

What is the definition of orthoplastics and microsurgery?

A

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

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2
Q

what is the stepwise approach of wound coverage?

A

direct closure->grafts->local flaps->distant flaps->tissue transfer

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3
Q

Where are the resting skin tension lines in the axis of muscles/tendons and joints

A

perpendicular to the long axis of muscles and tendons

parallel to the axis of joints at the level of the joints

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4
Q

Where is the ideal incision placed in relation to the RSTL

A

parallel

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5
Q

what does closing a surgical incision in layers do?

A

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

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6
Q

what is the 3:1 rule?

A

the length to width ratio for which skin is able to be mobilized is 3:1.

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7
Q

what is apligraf made from?

A

human neonatal foreskin

  • epidermal layer=human keratinocytes
  • dermal layer: human fibroblasts in bovine type 1 collagen lattice
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8
Q

what does apligraf contain?

A

matrix proteins, cytokines

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9
Q

When do you use apligraf?

A

venous leg ulcers, diabetic ulcers,non-healed for 1 month for ulcers that havn’t responded to care

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10
Q

contraindications of apligraf?

A

infected wounds, exposed tendon or bone, allergy to bovine collagen or sensitivity to apligraf

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11
Q

how do you apply apligraph?

A
  • debride wound
  • saline
  • fenestrate with 11 blade
  • apply
  • add dressing
  • compression if needed
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12
Q

what is dermagraft?

A

cryopreserved human fibroblast derived dermal substitute

  • single layer
  • 6months shelf life
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13
Q

when do you use dermagraft

A

diabetic ulcers-full thickness, >6 weeks in duration

-venous leg ulcers

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14
Q

contraindications of dermagraft?

A

-infected wounds, exposed tendon or bone, sinus tracts, allergy or sensitivity

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15
Q

how to apply dermagraft?

A
  • thawed from freezer
  • debride
  • apply
  • apply non occlusive dressing (no petroleum)
  • apply dressing
  • offload pt
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16
Q

what is oasis?

A
  • porcine submucosa
  • 3d lattice scaffold
  • not living tissue
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17
Q

indications of oasis?

A

chronic ulcerations
trauma
pvd
decubitus ulcerations

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18
Q

contraindications of oasis

A

infected wound
exposed tendon or bone
sensitivity/allergy to porcine

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19
Q

how to apply oasis

A

adequate wound debridement

  • apply oasis
  • saline
  • dressing to keep moist

do not debride between applications

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20
Q

What is integra?

A
  • bilayer wound care product
  • bovine collagen and silicone
  • semi-permeable silicone membrane
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21
Q

indications of integra?

A
  • exposed tendon or bone

- diabetic, traumatic, vascular, venous, partial thickness, full thickness

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22
Q

contraindications of integra?

A

exposed wound, known hypersensitivity to product

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23
Q

what is the most commonly used free grafted tissue?

A

split thickness skin graft (STSG)

24
Q

what type of STSG is this?

  • excellent host incorporation
  • contracts the most
  • greatest change for hypopigmentation
  • most susceptible to trauma
A

Thin graft .008 - .012

25
Q

what type of STSG is this?

  • less contracture
  • more durable
A

Intermediate graft (0.012 - 0.016)

26
Q

what type of stsg is this?

  • less chance of incorporation-greater tissue demands
  • durability and contraction are much improved
A

thick graft (0.016-0.020)

27
Q

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
A

Meshed grafts

28
Q

what is the difference between stsg and full thickness skin grafts?

A

-FTSG involves dermis AND portion of superficial fascia

29
Q

when is FTSG indicated?

A

-coverage in WB area of flexion points

30
Q

what are the donor sites of ftsg?

A
  • popiteal fossa, inguinal fossa

- pedal donor sites: medial arch; sinus tarsi

31
Q

advantages of ftsg?

A

permanent coverage, simple, low risk, can be applied to almost any area of the body

32
Q

disadvantages of ftsg?

A

inc failure rate over tendon and bone, graft contracture, inc failure rate, infection, non healing donor site

33
Q

What are the stages of skin graft healing?

A
  • Plasmotic stage
  • Inosculation stage
  • Re-organization stage
  • Re-innervation stage
34
Q

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
A

plasmotic

35
Q

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
A

inoscultation stage

36
Q

What stage of skin graft healing is this?

  • continues for months after grafting
  • CT reorganizes and regulates vascular and lymphatic flow
A

re-organization stage

37
Q

What stage of skin graft healing is this?

  • occurs simultaneously with re-organization
  • can take 1-2 yrs to complete
A

re-innervation stage

38
Q

What are some reasons for graft failure?

A

lack of compression of the graft to the recipient site
-movement/shearing
-infection
seroma/hematoma

39
Q

-Tissue harvested and applied whithin same individual

A

autograft

40
Q

-tissue transferred between individuals of the same species

A

allograft/homograft

41
Q

tissue harvested and applied within a set of identical twins

A

isografts

42
Q

tissue transferred between different species

-function as biologic dressing and never incorporates into the host’s tissues

A

xenografts

43
Q

what is a threedimensional anatomic unit of tissue fed by a source artery

A

angiosome

44
Q

these link angiosomes to each other

  • demarcate each angiosome
  • provide indirect collateral flow
A

Choke vessels

45
Q

what arteries make up the posterior tibial artery angiosomes

A

medial calcaneal

lateral and medial plantar

46
Q

are incisions placed perpendicular to the joint to avoid scar contracture impeding mobility?

A

yes

47
Q

DO skin flaps maintain vascular supply?

A

yes

48
Q

what are the indications of skin flap use?

A

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
49
Q

What is the flap of a skin flap

A

-tongue of the tissue

50
Q

what is the pedicle of a skin flap

A

-base or stem of the tissue

51
Q
  • 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
A

-random pattern cutaneous flap

52
Q
  • 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
A

axial pattern-arterial flaps

53
Q
  • 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
A

local flaps

54
Q
  • flaps that rotate on a pivot point
  • pivot about pedicle
  • includes skin and subq tissue
A

rotational flaps

55
Q
  • 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
A

transposition flap

56
Q

-rotate on a pivot point when defect has a rhomboid shape

A

limberg flap

Surgery (9 decks)

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