Reconstruction and Closure

Question 1

Why is it important to ensure adequate margins before definitive reconstruction?

Answer 1

To simplify re-excision in cases where surgical margins are initially inadequate

Question 2

What are the options for surgical reconstruction after cutaneous tumor excision?

Answer 2

Secondary intent, primary closure, graft/composite, flaps (local, pedicled, tissue expansion, and free)

Question 3

What are ideal areas for split thickness grafts?

Answer 3

Large areas that are less cosmetically important

Question 4

What are the most common reasons for failure of full thickness skin grafts?

Answer 4

Hematoma, Seroma, and Shear - this is why bolster dressings are used

Question 5

What is the purpose of a tissue expander?

Answer 5

To allow for size matching of adjacent (and sometimes remote) skin to cover a defect inappropriate for grafting and to large to close primarily

Question 6

What is the difference between a free flap and a pedicled flap

Answer 6

Free flaps are removed from their innate blood supply and anastomosed to vasculature at the defect site while pedicled flaps retain their original blood supply