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Small Animal Surgery > Skin Flaps > Flashcards

Skin Flaps Flashcards

1
Q

Define a skin flap.

A

Blood flow is maintained or immediately re-established when skin segment is moved to new position.

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2
Q

Define a skin graft.

A

Blood supply is severed and new vessels must grow in from recipient site

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3
Q

What are the 2 general categories of skin flaps?

A

Type of blood supply

Distance from wound

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4
Q

What are 3 types of blood supply?

A

Subdermal plexus
Axial pattern flap
Revascularized

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5
Q

What are the 2 types of distance from wound?

A

Local

Distant

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6
Q

Where does the subdermal plexus originate?

A

In the cutaneous trunci muscle

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7
Q

Where is the blood supply usually based in a local flap?

A

Based in the subdermal plexus

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8
Q

What 2 types of local flap do not rotate around a pivot point

A

Single pedicle advancement flap

H-plasty (two single pedicle flaps advanced together)

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9
Q

What 2 types of local flap move about a pivot point?

A

Rotation flaps

Transposition flaps

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10
Q

What are 2 reasons for using a single pedicle flap?

A

When donor skin is available only on one side

When simple undermining and advancement would cause too much tension or distortion

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11
Q

How is a rotation flap made?

A

Arc incision ~2.5x width of defect, undermine flap and rotate to cover wound.

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12
Q

Why would you keep your skin flap thick?

A

To minimize destruction of blood supply

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13
Q

Why should you try to avoid tacking down the skin flap?

A

Because you may accidentally ligate the blood supply

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14
Q

What can you do to try and prevent dog ears?

A

Space suture further apart on the long side and closer together on the short side

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15
Q

How do you manage dog ears?

A

Small ones resolve during healing

Larger ones should be removed

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16
Q

How do you remove a larger dog ear?

A

At end of incision with dog ear, extend incision slightly and remove small flap from ONE side to suture the rest down together.

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17
Q

When might you use multiple rotation flaps?

A

If you can’t close the wound with just one.

Remember the cat butt picture.

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18
Q

What is a transposition flap?

A

3-sided flap from a different axis from the wound

19
Q

What do you need to remember about the length of a transposition flap?

A

The greater the angle from the wound, the shorter the flap length becomes

20
Q

How wide can you make a transposition flap and still have decent blood flow?

A

The flap can be 3x the width of the wound

21
Q

What is the most common degree of rotation with a transposition flap?

A

60-90 degrees

22
Q

What happens if your transposition flap is too short?

A

Too much tension through the middle of the flap and can interfere with blood supply.

23
Q

Why should you always draw out the skin flap before cutting?

A

So you don’t mess it up

24
Q

If you have a patient undergoing concurrent radiation or other therapies, why should you leave the sutures in longer?

A

Because the treatments will prolong healing

25
Q

What is an axial pattern flap?

A

Transposition flaps that incorporate a direct cutaneous artery and vein

26
Q

What is a benefit to using an axial pattern flap?

A

You can make the flap much longer because you’re bringing direct blood supply with it.

27
Q

What are 2 major axial pattern flaps that you can use?

A

Thoracodorsal

Caudal Superficial Epigastric

28
Q

Where does the thoracodorsal artery run?

A

Exits just caudal to the shoulder and follows parallel to the spine of the scapula.

NOTE: limb must be in neutral position

29
Q

How far can the thoracodorsal axial flap cover?

A

Mid-antebrachium in dogs with normal conformation.

To carpus and beyond in cats and short-legged dogs.

30
Q

How far can the caudal superficial epigastric axial flap cover?

A

Mid-tibial in female dogs with normal conformation (male dogs less likely)
Hock in cats and short-legged dogs (especially in females)

31
Q

What is 1 pro and 1 con to an ipsilateral caudal superficial epigastric axial flap in a female?

A

Pro: Increases distance flap can extend
Con: Increases risk of kinking vessels

32
Q

What is 1 pro and 1 con to an contralateral caudal superficial epigastric axial flap in a female?

A

Pro: Less risk of kinking vessels
Con: Shorter distance

33
Q

What does it mean to create a “bridging incision”?

A

Makes a communication between the base of the flap and the wound to avoid a second procedure (as you would have if you had to make a tube)

34
Q

What does it mean to “tube the flap”?

A

Avoids a bridging incision by suture the extra tissue into a tube fir removal later (usually 14-21 days)

35
Q

What are 5 complications of a skin flap?

A 
Flap edema
Seroma
Infection
Partial dehiscence
Vessel thrombosis with flap loss
36
Q

How do we deal with flap edema?

A

Usually just have owner deal with it. Vessels are just confused and figuring shit out.

37
Q

How do we deal with a seroma?

A

Put a drain in it.

38
Q

What flap complication do we worry about the most?

A

Vessel thrombosis because we can lose the entire flap.

39
Q

What 4 things can you do to manage a compromised flap?

A

Assess vascular integrity
Use vasoactive drugs
Hyperbaric oxygen
Leaches (can detect venous compromise because they won’t feed on arterial blood so can be used diagnostically)

40
Q

What are 3 ways to replace skin on the distal extremities?

A

Revascularized flap
Skin graft
Distant flap

41
Q

What are 2 types of distant flap?

A

Pouch flap

Single pedicle direct flap

42
Q

What is the difference between a pouch flap and a single pedicle direct flap?

A

One blood supply (single pedicle) vs. two (pouch flap)

43
Q

What 2 things must you make sure the patient can/will do before you opt for a distant flap?

A

Make sure patient can get up on 3 limbs

Make sure it will tolerate having limb bandaged

Small Animal Surgery (13 decks)

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