Reconstruction

Question 1

Skin function

Answer 1

Hydration of tissues, defense against environment. Vitamin D production, sensory, storage, insulation

Question 2

Skin anatomy

Answer 2

Epidermis, dermis, and hypodermis (blood supply. Panniculus in the hypodermis). Superior blood supply than humans

Question 3

Panniculus muscle

Answer 3

Penetrate the dermis allowing voluntary movement. Not present on lower limbs
Critical landmark. Always dissect underneath

Question 4

Vascular supply

Answer 4

Direct cutaneous aa and vv. Terminate: deep, middle and superficial plexus.
Deep or subdermal plexus supplies the majority of blood

Question 5

Debridement

Answer 5

Get the fat and non-vital skin off. Goal is to facilitate healing

Question 6

Healing types

Answer 6

Primary, delayed primary, secondary, second intention

Question 7

Closing

Answer 7

undermine tissue edges and freshen wound edge. Interrupted suture approximation. Relieve tension as needed- closed suction egress (drains 3-4 days).
Trunk, upper extremities, and cervical region have extensive loose skin

Question 8

Tension lines

Answer 8

Result from gravitational and muscular forces.
Dictates how skin defects should be reconstructed/closed.
Incisions should be parallel.

Question 9

Needle selection

Answer 9

Swages on, tapered needles to take advantage of small diameter.
Reverse cutting needles for skin closure.

Question 10

Suture patterns

Answer 10

Cutaneous and reconstructive surgery can be classified as appositional or tension relieving

Question 11

Simple interrupted

Answer 11

Accurate apposition. Cosmetic, time consuming

Question 12

Cruciate

Answer 12

Good apposition. Some tension relieving properties. Efficient. Commonly used.

Question 13

Intradermal/subcuticular

Answer 13

Buried skin sutures. Cosmetic. No need for suture removal. Primarily apposition with some tension relief. May be less irritating to the patient. Time consuming

Question 14

Vertical and horizontal mattress

Answer 14

Tension relieving. Horizontal mattress can be combined with stents. May compromise blood supply.
Vertical mattress- may cause eversion of skin edges

Question 15

Walking sutures

Answer 15

Three main functions: advance and appose skin edges, decrease tension on closure, and close dead space.
Disadvantages: possible disruption of blood supply. Seroma/ abscess formation. Dimply appearance.

Question 16

Local skin mobilization

Answer 16

Undermining, relaxing incisions. Plasty incisions, local flaps

Question 17

Local or subdermal plexus flaps

Answer 17

Easiest flaps. Rely on subdermal plexus for blood supply. Length to width: 1.5
There is no secondary wound to address.
Single pedicle advancement flap. Bidpedicle advancement flap (Improved blood supply and greater tissue coverage). Rotation flap. Transpositional flap

Question 18

Rotational flap

Answer 18

Similar applications to those of a transpositional flap. Skin mobility to less than that of a transposition

Question 19

Transpositional flaps

Answer 19

More versatile than and single or double pedicle advancement flap.