Reconstructive Surgery

Question 1

What is the blood supply to the skin?

Answer 1

Bigger vessels found in the skeletal muscle (direct cutaneous artery and vein) feed the smaller vessels (deep or subdermal plexus) found in the panniculus muscle (hypodermis)

Question 2

You should avoid grasping skin at reconstructive sites with thumb forceps. What can you use instead to ensure gentle skin handling?

Answer 2

skin hooks
stay sutures

Question 3

Your incision and closure should be (parallel/perpendicular) to tension lines?

Answer 3

parallel

Question 4

T/F: skin sutures are used primarily for tension relief

Answer 4

false – they cannot tolerate tension. they should be used for apposition only in final layer.
tension relief should be occurring in deeper layers.

Question 5

Describe the difference between mechanical creep and biological creep.

Answer 5

• mechanical – elongation of skin due to a constant load over time; occurs quickly (ex. use of temporary towel clamps)
• biological – elongation of the skin over time as a result of placing stress on tissue (ex. pregnancy)

Question 6

which portion of an incision has the MOST tension?

Answer 6

middle/center
so you can use towel clamps to temporarily tack the incision together while suturing at the peripheral edges.

Question 7

what 5 factors go into decision making and planning for reconstructive surgery?

Answer 7

1. optimal wound environment (no infection, good blood supply)
2. optimal periwound status (minimal inflammation and necrosis, give wounds time)
3. wound factors (size, shape, anatomic location)
4. patient factors (species, breed, age, temperament, co-morbidities)
5. owner factors ($$$, compliance)

Question 8

What tension-relieving technique is described as the following:
separating the skin from the underlying tissue, preserving the subdermal plexus, going deep to cutaneous trunci/platysma/sphincter colli muscles to the muscle fascia.

Answer 8

undermining

Question 9

What is skin-stretching?

Answer 9

a tension-relieving technique that is characterized by placing temporary sutures to pre-stretch/relax the skin before or after surgery in order to get to a point where you can close larger wounds.

Question 10

what 5 patterns are considered tension-relieving suture patterns?

Answer 10

1. cruciates
2. far-near-near-far
3. far-far-near-near
4. mattress (horizontal and vertical)
5. walking sutures

Question 11

When doing walking sutures to relieve tension, in which directions should your bites of dermis be taken?

Answer 11

parallel to the direction of pull

remember with this pattern, you do not penetrate the skin.

Question 12

T/F: placing stents minimizes tension

Answer 12

true

Question 13

what is the purpose of a bolster?

Answer 13

it sits underneath of suture to relieve tension and protect the skin from suture injury.

Question 14

what are 2 relaxing/releasing incisions?

Answer 14

1. single-relaxing incision – bipedicle flap
2. mesh-relaxing incisions – 1 cm incisions that are 1 cm from the wound edge spaced 1 cm apart.

Question 15

What is important to maintain when performing a subdermal plexus flap?

Answer 15

Appropriate base which is slightly wider than the width of the flap
You also want to ensure the length of the flap is sufficient to cover the defect.

Question 16

what are 4 examples of subdermal plexus flaps?

Answer 16

1. advancement flaps (single-pedicle or bipedicle)
2. rotation flaps
3. transposition flaps
4. skin-fold flaps (flank fold or elbow fold)

Question 17

T/F: when performing a subdermal plexus advancement flap, you can do either single-pedicle flaps or bipedicle flaps.

Answer 17

true

Question 18

what flap is described below:
1 border must be adjacent to the defect and the width of the flap should be the width of the defect

Answer 18

transposition flap

Question 19

what are 2 types of skin fold flaps?

Answer 19

1. flank fold flap
2. elbow fold flap

Question 20

what is the blood supply for axial pattern flaps?

Answer 20

direct cutaneous artery and vein (larger vessels)

Question 21

Which of the following statements is FALSE about axial pattern flaps?
A. can be longer and larger relative to pedicle
B. can be rotated up to 180 degrees at base
C. survival rate 87-100%
D. two types are flank fold and elbow fold

Answer 21

D. two types are flank fold and elbow fold

the types listed are examples of skin fold flaps which are subdermal plexus flaps.

Two types of axial pattern flaps are peninsular flaps and island flaps

Question 22

Describe the process of engraftment that occurs with free skin grafts:

Answer 22

1. adherence (fibrin strands –> adhere graft to underlying wound bed)
2. plasmacytic inhibition
3. inosculation
4. vascular ingrowth/revascularization

Question 23

what are the 4 types of free skin grafts?

Answer 23

1. split-thickness unmeshed
2. full thickness unmeshed
3. split-thickness mesh
4. full thickness mesh

these are very delicate!

Question 24

what are a few reconstructive surgery complications?

Answer 24

1. necrosis (would most likely occur at tip of flap)
2. dehiscence
3. infection
4. seroma

Question 25

what 4 factors can contribute to complications in reconstructive surgery?

Answer 25

1. compromised blood supply (obstructed vasculature, inappropriate bandage pressures)
2. excessive tension
3. excessive motion
4. cold (do NOT apply ice to flaps post-op, it vasoconstricts and reduces blood supply)

Question 26

What is the blood supply to free skin grafts?

Answer 26

from the wound bed itself.

Question 27

T/F: split-thickness unmeshed grafts are NOT suitable in cats

Answer 27

true

Question 28

___________ flaps entail 2 skin incisions equal in length to the defect.

Answer 28

single-pedicle

Question 29

_________ flaps entail an incision parallel to the long axis of the defect. this flap length is no more than 2x the width of the flap base

Answer 29

bipedicle

Question 30

what is the blood supply to subdermal plexus flaps?

Answer 30

the subdermal plexus