Reconstructive Surgery and Skin Flaps Flashcards
what is the most common cause of healing complications?
tension
what is static tension?
readily appreciable in relaxed tissues at closure
how does a vertical mattress suture protect from tension?
with some eversion
when should you use walking sutures?
when wound tension is too severe at the suture line
what are releasing incisions?
incisions made parallel to original wound to reduce tension and allow for closure at a difficult site: over boney protuberance, high motion
what does a V-Y plasty allow?
skin to be advanced toward the original incision
what is the common rule of thumb for random pattern flaps in length?
length < 2x width
how are advancement flaps raised?
parallel to lines of tension
what is a very good technique for defects around eyes?
single pedicle advancement flap
what are bipedicle advancement flaps used for?
cleft palate
elbow lesions
what is an axial pattern flap based on?
a direct cutaneous artery
do you want to close an incision parallel to tension lines?
yes
what is dynamic tension?
may only be apparent with functional assessments related to movement or eating
what can you do for wounds with mild tension?
undermine adjacent skin below deep vascular plexus and advance
what can you do for wounds with moderate tension?
vertical mattress sutures
walking suture
how much will it increase the wound length by making a round wound into and ellipse to close without dog ears?
30-50%
how much can you acutely and chronically stretch skin?
acutely 50%
chronically another 50%
what is blood supply of basic random pattern flaps based on?
random inclusion of blood vessels at the base of the flap from the sub-dermal plexus
how aree transposition flaps raised?
perpendicular to lines of tension
what should you suture for a single pedicle advancement flap?
only perimeter
not below flap
what are transposition skin flaps useful for?
areas where skin is less mobile
what vessels are commonly used for axial pattern flaps?
thoracodorsal
caudal superficial epigastric
