Reconstructive Surgery Flashcards
What are two ways to gently hand skin?
Skin hooks and stay sutures
Tension lines
Line where if you align your so closure you get the least amount of tension
Where should you place your elipitical incision ideally>
In alignment/parallel to the tension lines
What happens if you don’t minimize tension?
Dehiscence
Explain creep
Mechanical creep happens when you elongate the skin with a constant load overtime (think about a pregnant belly)
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?
Cutaneous trunci/platysma/sphincter colli m
It may seed/spread cancer cells
You may use __ to stretch skin prior to surgery so you’ll be able to close
Sutures
What are some strong subcutaneous tension relieving sutures?
Cruciate pattern
Far-near-near-far
Far-far-near-near
Name a few other tension relieving sutures
Mattress suture and walking sutures
What is the blood supply to the skin?
The subdermal plexus from the direct cutaneous artery and vein
Bolsters are essential a tie over bandage with __
Tension
Relaxing/release incisions
Single relaxing incision or mesh relaxing incisions - be very judicious
Subdermal Plexus Flaps blood supply is the ____ and maintains a good base that is wider than the flap.
Subdermal plexus
Subdermal plexus advancement flaps 2 types
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
Single pedicle advancement flaps are not meant for __ wounds
Large
Explain a transposition flaps
1 border adjacent to defect is used to make the flap
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?
Direct cutaneous artery and vein, 87-100%
Thoracodorsal, causal superficial epigastric, omnocervical
Where is the skin flap most likely to necrose?
The tip bc the base has the most blood flow
Explain free skin grafts.
The blood supply comes from the wound bed. The process of engraftment has adherence, plasmacytic inhibition, inosculation, vascular ingrowth/and revascularization.
What are reconstruction complications?
Necrosis, dehiscence, Seroma, infection
Prevent compromised blood supply, excessive tension, motion and cold (do not ice flaps bc cold causes vasoconstriction)
