Skin Flaps and Grafts Flashcards
Skin Flap
Blood flow is maintain or immediately re-established when skin segment is moved to new position
Skin graft
Blood supply is severed and new vessels must grow in from recipient site
Skin Flap Classification
Type of Blood Supply
Distance from wound
Skin flap classification by type of blood supply
Subdermal Plexus
Axial pattern flap
Revascularized
Skin flap classification by distance from wound
Local
Distant
Axial Pattern Flap
Transposition flap that incooperate a direct cutaneous artery and vein allowing us to create large flaps for large areas
What tissue is included in a Subdermal Plexus Flap?
Epidermis
Dermis
Panniculus muscle
What tissues are included in a Subdermal Plexus Flap with no panniculus?
Epidermis
Dermis
Hypodermis
Local Flaps
Blood supply usually based on subdermal plexus
What are some Local flaps that do no rotate about a pivot point?
Single pedicle advancement flap
H-plasty
What are some local flaps that move about a pivot point?
Rotation flaps
Transposition flaps
Single Pedicle Advancement Flaps
Donor skin available on only one side
Subdermal plexus flap
Used when simple undermining and advancement would result in excessive tension or distortion of surround tissue
What is the maximum length for a single pedicle advancement flap?
3xs the width of the flap
H-plasty
Apposing single pedicle advancement flaps
Two smaller flaps lessens risk of vascular compromise
Rotation Flap Guidelines
Start by making the arcing incision 2 1/2 times the width of defect
If tension is present, incrementally lengthen arcing incision until the tension is relieved
What is a disadvantage of Rotation Flaps?
The back cut incision increases mobility of the flap but also increases the risk of vascular compromise
How do you prevent dog ears/puckering?
sutures spaced further apart on long side
Transposition Flap
Three-sided flap
Donor skin in different axis from wound
The greater the angle from the wound the shorter the effective length becomes
What are two popular Axial pattern flaps?
Thoracodorsal
Caudal Superficial Epigastric
Advantage of Ipsilateral flap in female
Increases distance flap can extend
Disadvantage of Ipsilateral flap in females
Increases risk of kinking vessels
Advantage of Contralateral flap in females
Less risk of kinking vessels
Bridging Incision
Incision that connects base of flap and recipient site and avoids having to tube flap over intact skin
“Tubing” the flap
Tubing the flap avoids making bridge incision but will require a second surgery to cut the flap free after it has healed in the wound bed usually 14-21 days
What are the considerations for the bridging incision?
the nipple will end up on the leg
What are the complications of flaps?
Flap edema Seroma Infection Partial dehiscence Vessel thrombosis with flap loss
What are the types of distant flaps?
Pouch flap: Bipedicle flap
Single pedicle direct flap
What are the indications for skin grafting?
Skin defects on the extremities
Extensive burn wounds
Adjunct to other reconstructive procedures
What are the grafts associated with Donor-Host Relationship?
Autograft
Allograft
Xenograft
Autograft
from another part of the body
What is the purpose for Cortical fenestration?
Speed granulation tissue formation over exposed bone
Cortical fenestration
Drill holes through near cortex into medullary cavity
Blood clots serve as matrix for granulation tissue to form a surface
When is granulation tissue ready for grafting?
Granulation tissue pink and glistening
surface smooth
Wound contracting and epithelial migration visible at wound margin
What are the skin grafting techniques?
Sheet: Full or Split thickness, Mesh, sieve, pie-crust
Punch: Seed, Pinch, or Stamp
Strip: tunnel
Full-thickness skin graft
Consists of epidermis and dermis
Included hair follicles and adnexal structures
What is the most common graft type in small animals?
Full-thickness skin graft
How do you prepare the recipient bed?
Lightly scrape with scalpel blade to remove surface debris and expose capillaries
Cover bed with moist sponges soaked in CHX solution while graft is being prepared
Harvesting Skin grafts
dissect graft from donor site deep to cutaneous trunci muscle
Remove cutaneous trunci muscle and superficial subcutaneous tissue prior to applying graft
What happens if you leave cutaneous trunci muscle on a graft?
will delay revascularization
Mesh graft
Sheet graft in which parallel rows of staggered slits are made
What are the advantages of Mesh grafts?
Allows expansion of graft to cover larger defects
Allows drainage of blood and serum from under graft
Allows graft to conform better to uneven surfaces
Punch (seed) grafts
Full-thickness plugs of skin placed in granulation bed
What is the advantage of Punch (seed) grafts?
Enhance epithelialization
What is the disadvantage of Punch (seed) grafts?
Poor cosmetic appearance
What is the postoperative care of skin grafts?
Apply antibiotic ointment and nonadherent dressing
Absorbent secondary layer
Splint or cast if over join
Change dressing in 24-48 hours
