Reconstructive Surgery Flashcards
what is undermining?
clearing the sub Q attachments, preserving the vasculature, creating dead space to release some wound tension
what are the different kinds of tension relieving sutures?
strong subcutaneous sutures, far near near far, walking sutures, mattress sutures, stented sutures
describe the difference between acute skin stretching and chronic skin stretching
acute: constant load on the skin will re-arrange collagen organization and extrude water from the collagen molecule, not formation of new skin
chronic:consant load on the skin causes NEW collagen to form and allows for NEW SKIN
what is a pre-tension suture?
do a simple continuous suture but you pull it together slowly over time. you can do this before you excise as well, or after.
what is a meshed relaxing incision? what are they useful for? do you require a bandage?
multiple punctate relaxing incision: you place multiple parallel staggeed incisions placed 1cm from the wound edge, 5mm to 10mm in length and 1cm apart. keep going until you can close the main incision and leave the mesh holes to heal by second intention
useful for distal limb wounds
yes you require a bandage until all the little mesh holes have healed
what is a simple relaxing incision? when are they useful?
also called bipedicle flap, where you make an incision paralell to the long axis of the wound using a ratio of 4-1 for length and width/distance from primary wound. the relaxing incision is left open
useful for when you ave a wound near an orifice
what is a plastie?
a relaxed incision but you can close it, you manipulate the skin tension to allow for tension free closure of the primary incision line
list some plasties
V to Y
Z plasty
M plasty
are partial thickness skin grafts used in animals?
not very often, they are more commonly used in people. only time youd use it would be in horses
are partial thickness skin grafts used in animals?
not very often, they are more commonly used in people
what are the 3 I’s of graft survival? describe them
imbibition (drinking): the capillaries of the graft can suck up the fluid from the wound bed and has to survive a few days with just that to supply the graft
inosculation: the end of the capillaries in the graft and the wound bed start to touch each other due to the capillaries starting to grow in the graft
ingrowth: the blood vessels are actually crossing over and forming anastomoses with each other; the graft acts like a highway for new capillaries to form
how long does it take for a skin graft to heal (go through all 3 I’s)
3 weeks
what are the simple steps to preforming a skin graft?
do open wound management until there is a healthy granulation bed, debride any excessive granulation tissue and epithelialized edge, harvest the graft (making sure to measure twice and cut once), mesh the graft to make it a little bigger, get rid of all the excess fat and tissues, suture the graft in place, finally BANDAGE
what kind of bandage should you use on a skin graft? what other things should you use in a graft bandage?
a non adherent bandage for sure so you don’t rip the graft off
use petrolum based mesh for the contact layer or a tefla pad
apply a soft padded bandage and often a splint to avoid motion
sedate for the first bandage change
frequent bandage changes, at least 1 a week
for removing a bandage on a skin graft:
who should remove it?
should the patient be sedated?
how should layers be removed?
how should you remove the last layers?
what equipment do you need to use on yourself?
the person who placed it
YES
one at a time
soaked in saline to loosen exudate
sterile gloves when touching surgical site to avoid contamination
what 3 things disrupt a graft and the graft bed interface?
graft separation via seroma or hematoma
infection
motion
what are the differences between a local subdermal skin flap and an axial pattern flap?
local subdermal flaps have no diect cutaneous artery and depend on subdermal vascular plexi. they can be done anywhere on the body, but the blood suply is not as consistent
axial pattern flaps have direct cutaneous artery (direct blood supply), can only preform them in specific anatomical borders, more consistent blood supply
what is the most common local subdermal flap? what other kind is fairly common?
a simple advancement flap
rotational flaps
what are the 3 configurations of an axial pattern flap?
peninsular, island/tubed, composite (containing more than just skin)
what causes failure of an axial pattern flap?
inadequate blood supply or excessive tension on the flap edges. hematoma and seromas can cause excessive pressure and cut of blood supply
