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Surgical Basics > Skin Flaps > Flashcards

Skin Flaps Flashcards

1
Q

What 4 things is it important to do when creating a skin flap?

A
  • use fine instruments when handling skin flaps;
  • use sharp dissection rather than blunt dissection when possible;
  • manipulate skin flaps with stay sutures to prevent crushing injury to their edges;
  • use moist swabs to prevent desiccation of the donor and recipient sites during flap creation and closure.
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2
Q

Define subdermal plexus flaps

A

full-thickness tongues of skin that are detached from skin adjacent to the wound along three of four quadrants and then advanced or rotated into the wound.

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3
Q

Define a local flap

A

Developed adjacent to recipient bed

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4
Q

Name types of local flaps (5)

A
  • Advancement
  • Rotational
  • Transposition
  • Interpolation
  • Skin fold
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5
Q

Define distant flap

A

Using skin that is distant to the recipient bed. The skin is then transferred to the recipient site directly (hinge flaps or pouch flaps) or indirectly (tubed flaps).

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6
Q

When are distant flaps used?

A

Closure of extremity wounds

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7
Q

What is different between skin vasculature of humans vs cats/dogs?

A

humans - via musculocutaneous arteries
dogs/cat - direct cutaneous arteries.

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8
Q

What is the blood suppled to random flaps via?

A

Deep dermal (subdermal plexus)

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9
Q

How do you preserve blood supply to flaps?

A

Undermine deep to panniculus muscle
- if this muscle isnt present - as close as poss to underlying fascia

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10
Q

What is the delay phenomenon?

A

If the skin is intimately associated with the deeper tissue, this too may need to be incorporated into the flap. Flap survival has been shown to be enhanced by staged development.

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11
Q

What size should a flap be?

A

Flaps should be large enough to cover the recipient site while allowing the donor site to be closed.
Flaps should have a base slightly wider than their width; if the base is too narrow the flap’s blood supply might be compromised.

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12
Q

The longer the flap is, the great the risk of..

A

vascular compromise to the flap’s extremities.

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13
Q

How many layers should a flap be closed in?

A

2-3

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14
Q

What must there be NONE of on the flap?

A

tension

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15
Q

Why must care be taken when using flaps on limbs? (2)

A
  • Ensure no excessive shearing force
  • Ensure movement doesnt distort
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16
Q

T or F
Flap survival has been shown to be enhanced by staged development

A

True

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17
Q

T or F
Flaps should be closed in two or three layers.

A

True

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18
Q

T or F
It is essential to guarantee there is some tension on the flap.

A

False

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19
Q

T or F
Dogs’ blood supply is via direct musculocutaneous arteries and veins.

A

False

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20
Q

T or F
There are strict guidelines to safe flap dimensions.

A

False

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21
Q

Advancement flap:
What is the flap length?

A

equal to wound length

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22
Q

Advancement flap:
What is the flap width

A

Equal to wound width

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23
Q

With an advancement flap how can the elastic reoil and tension which a transferred to wound edges be counteracted?

A

Pulling the skin around the flap in the opposite direction as the flap is advanced.

24
Q

What is a closure of a skin defect with 2 single pedicle advancement flaps?

A

H plasty

25
Q

What advancement flap has a theoretical advantage of?

A

Improved blood supply

26
Q

What shape wounds can rotation flaps close?

A

triangle

27
Q

How can rotation flaps be used to close rectangle wounds?

A

use of 2 flaps

28
Q

What flap is good over the greater trochanter area?

A

Rotation

29
Q

What is a major disadvantage of a rotation flap? Therefore what flap may be more appropriate

A

The size of the donor site that must be created in order to rotate into the recipient site
- transposition flaps

30
Q

What is the difference between transposition flaps and interpolation flaps?

A

Transposition flaps share a border with the recipient site; interpolation flaps do not and are connected by a bridging incision or are tubed.

31
Q

What does the success of transposition and interpolation flaps rely on?

A

Adequate elasticity along the long axis of the flap (usually perpendicular to the long axis of the wound).

32
Q

Name the two main skin fold flaps

A

Elbow skin flap
Inguinal skin flap

33
Q

What does the elbow skin fold flap close? (4)

A
  • Brachial
    -Elbow
  • Axillary
  • Sternal
34
Q

What does the inguinal skin fold flap close? (3)

A
  • Inguinal
  • Thigh
  • Stifle
35
Q

Complications of sub dermal flap. (3)

A
  • seroma
  • flap dehiscence
  • flap necrosis
36
Q

What should be done with seromas at a flap site?

A

surgically drained to allow adherence of the flap to the recipient site.

37
Q

What should be done with skin flap dehiscence/necrosis?

A

open wounds for a short period of time. Small defects can be left to heal by second intention.

38
Q

What does an axial pattern flap incorporate surgically?

A

a direct cutaneous artery and vein in their pedicle. This allows for creation of a larger flap with more consistent survival.

39
Q

?? flaps have intact skin at their base and are the most used type of axial pattern flap.

A

Peninsular

40
Q

??? flaps are attached only by their vascular pedicle. This allows a greater arc of rotation (up to 180°).

A

Island

41
Q

What needs to be identified and preserved for skin flaps?

A

direct cutaneous artery and vein supplying the flap

42
Q

Do you remember which flaps are only attached by their vascular pedicle?

A

Island flaps

43
Q

What defect for caudal auricular artery flap? (2)

A

Facial and pinnal

44
Q

What defect for cervical cutaneous branch of omocervical artery? (3)

A

Head
Neck
Shoulder axillary

45
Q

What defect for throacodorsal artery (4)

A

Thoracic
shoulder
FL
Axillary

46
Q

What defect for superficial brachial artery (2)

A

Antebrachial
Elbow

47
Q

What defect for cranial superficial epigastric artery?

A

Sternal

48
Q

What defect for caudal superficial epigastric artery? (5)

A

Flank
Thigh
Stifle
Perineal
Preputial

49
Q

What defect for genicular artery?

A

Lower limb *between stifle and tarsus *

50
Q

What defect for deep circumflex iliac artery (dorsal branch) (5)

A

Thoracic
Lateral abdo wall
Flank
Thigh
Greater trochanter

51
Q

What defect for deep circumflex iliac artery (dorsal branch) (3)

A

Lateral abdo wall
Pelvic
Sacral (as island)

52
Q

What defect for Lateral caudal arteries? (2)

A

Perineal
Caudodorsal trunk

53
Q

What defect of reverse saphenous conduit?

A

Metatarsal

54
Q

What is the thoracodoral artery axial pattern used for? (4)

A

Thoracic
Shoulder
Brachial
Axillary

55
Q

What is the caudal superficial epigastric arter axial pattern flap for? (5)

A

Flank
Thigh
Stifle
Perinea
Preputial

Surgical Basics (10 decks)

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