Reconstructive Surgery

Question 1

What are two ways to gently hand skin?

Answer 1

Skin hooks and stay sutures

Question 2

Tension lines

Answer 2

Line where if you align your so closure you get the least amount of tension

Question 3

Where should you place your elipitical incision ideally>

Answer 3

In alignment/parallel to the tension lines

Question 4

What happens if you don’t minimize tension?

Answer 4

Dehiscence

Question 5

Explain creep

Answer 5

Mechanical creep happens when you elongate the skin with a constant load overtime (think about a pregnant belly)

Question 6

Undermining can help with tension relief by separating the skin deep to the ___ muscle from underlying tissue. Why would we not use this in cancer cases?

Answer 6

Cutaneous trunci/platysma/sphincter colli m

It may seed/spread cancer cells

Question 7

You may use __ to stretch skin prior to surgery so you’ll be able to close

Answer 7

Sutures

Question 8

What are some strong subcutaneous tension relieving sutures?

Answer 8

Cruciate pattern
Far-near-near-far
Far-far-near-near

Question 9

Name a few other tension relieving sutures

Answer 9

Mattress suture and walking sutures

Question 10

What is the blood supply to the skin?

Answer 10

The subdermal plexus from the direct cutaneous artery and vein

Question 11

Bolsters are essential a tie over bandage with __

Answer 11

Tension

Question 12

Relaxing/release incisions

Answer 12

Single relaxing incision or mesh relaxing incisions - be very judicious

Question 13

Subdermal Plexus Flaps blood supply is the ____ and maintains a good base that is wider than the flap.

Answer 13

Subdermal plexus

Question 14

Subdermal plexus advancement flaps 2 types

Answer 14

Single pedicle flaps: 2 skin incisions equal in length to defect

Bipedicle flaps: incision parallel to long axis of defect, flap length no more than 2x width of flap base

Question 15

Single pedicle advancement flaps are not meant for __ wounds

Answer 15

Large

Question 16

Explain a transposition flaps

Answer 16

1 border adjacent to defect is used to make the flap

Question 17

Axial pattern flaps blood supply is ___and can be longer and larger relative to the pedicle then can be rotated up to 180 degrees at the base. The overall survival rate is __. What are the 3 areas for axial pattern flaps?

Answer 17

Direct cutaneous artery and vein, 87-100%

Thoracodorsal, causal superficial epigastric, omnocervical

Question 18

Where is the skin flap most likely to necrose?

Answer 18

The tip bc the base has the most blood flow

Question 19

Explain free skin grafts.

Answer 19

The blood supply comes from the wound bed. The process of engraftment has adherence, plasmacytic inhibition, inosculation, vascular ingrowth/and revascularization.

Question 20

What are reconstruction complications?

Answer 20

Necrosis, dehiscence, Seroma, infection

Prevent compromised blood supply, excessive tension, motion and cold (do not ice flaps bc cold causes vasoconstriction)