Skin Flaps Flashcards
What 4 things is it important to do when creating a skin flap?
- 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.
Define subdermal plexus flaps
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.
Define a local flap
Developed adjacent to recipient bed
Name types of local flaps (5)
- Advancement
- Rotational
- Transposition
- Interpolation
- Skin fold
Define distant flap
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).
When are distant flaps used?
Closure of extremity wounds
What is different between skin vasculature of humans vs cats/dogs?
humans - via musculocutaneous arteries
dogs/cat - direct cutaneous arteries.
What is the blood suppled to random flaps via?
Deep dermal (subdermal plexus)
How do you preserve blood supply to flaps?
Undermine deep to panniculus muscle
- if this muscle isnt present - as close as poss to underlying fascia
What is the delay phenomenon?
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.
What size should a flap be?
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.
The longer the flap is, the great the risk of..
vascular compromise to the flap’s extremities.
How many layers should a flap be closed in?
2-3
What must there be NONE of on the flap?
tension
Why must care be taken when using flaps on limbs? (2)
- Ensure no excessive shearing force
- Ensure movement doesnt distort
T or F
Flap survival has been shown to be enhanced by staged development
True
T or F
Flaps should be closed in two or three layers.
True
T or F
It is essential to guarantee there is some tension on the flap.
False
T or F
Dogs’ blood supply is via direct musculocutaneous arteries and veins.
False
T or F
There are strict guidelines to safe flap dimensions.
False
Advancement flap:
What is the flap length?
equal to wound length
Advancement flap:
What is the flap width
Equal to wound width
With an advancement flap how can the elastic reoil and tension which a transferred to wound edges be counteracted?
Pulling the skin around the flap in the opposite direction as the flap is advanced.
What is a closure of a skin defect with 2 single pedicle advancement flaps?
H plasty
What advancement flap has a theoretical advantage of?
Improved blood supply
What shape wounds can rotation flaps close?
triangle
How can rotation flaps be used to close rectangle wounds?
use of 2 flaps
What flap is good over the greater trochanter area?
Rotation
What is a major disadvantage of a rotation flap? Therefore what flap may be more appropriate
The size of the donor site that must be created in order to rotate into the recipient site
- transposition flaps
What is the difference between transposition flaps and interpolation flaps?
Transposition flaps share a border with the recipient site; interpolation flaps do not and are connected by a bridging incision or are tubed.
What does the success of transposition and interpolation flaps rely on?
Adequate elasticity along the long axis of the flap (usually perpendicular to the long axis of the wound).
Name the two main skin fold flaps
Elbow skin flap
Inguinal skin flap
What does the elbow skin fold flap close? (4)
- Brachial
-Elbow - Axillary
- Sternal
What does the inguinal skin fold flap close? (3)
- Inguinal
- Thigh
- Stifle
Complications of sub dermal flap. (3)
- seroma
- flap dehiscence
- flap necrosis
What should be done with seromas at a flap site?
surgically drained to allow adherence of the flap to the recipient site.
What should be done with skin flap dehiscence/necrosis?
open wounds for a short period of time. Small defects can be left to heal by second intention.
What does an axial pattern flap incorporate surgically?
a direct cutaneous artery and vein in their pedicle. This allows for creation of a larger flap with more consistent survival.
?? flaps have intact skin at their base and are the most used type of axial pattern flap.
Peninsular
??? flaps are attached only by their vascular pedicle. This allows a greater arc of rotation (up to 180°).
Island
What needs to be identified and preserved for skin flaps?
direct cutaneous artery and vein supplying the flap
Do you remember which flaps are only attached by their vascular pedicle?
Island flaps
What defect for caudal auricular artery flap? (2)
Facial and pinnal
What defect for cervical cutaneous branch of omocervical artery? (3)
Head
Neck
Shoulder axillary
What defect for throacodorsal artery (4)
Thoracic
shoulder
FL
Axillary
What defect for superficial brachial artery (2)
Antebrachial
Elbow
What defect for cranial superficial epigastric artery?
Sternal
What defect for caudal superficial epigastric artery? (5)
Flank
Thigh
Stifle
Perineal
Preputial
What defect for genicular artery?
Lower limb *between stifle and tarsus *
What defect for deep circumflex iliac artery (dorsal branch) (5)
Thoracic
Lateral abdo wall
Flank
Thigh
Greater trochanter
What defect for deep circumflex iliac artery (dorsal branch) (3)
Lateral abdo wall
Pelvic
Sacral (as island)
What defect for Lateral caudal arteries? (2)
Perineal
Caudodorsal trunk
What defect of reverse saphenous conduit?
Metatarsal
What is the thoracodoral artery axial pattern used for? (4)
Thoracic
Shoulder
Brachial
Axillary
What is the caudal superficial epigastric arter axial pattern flap for? (5)
Flank
Thigh
Stifle
Perinea
Preputial
