Skin Flaps and Grafts

Question 1

Skin Flap

Answer 1

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

Question 2

Skin graft

Answer 2

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

Question 3

Skin Flap Classification

Answer 3

Type of Blood Supply

Distance from wound

Question 4

Skin flap classification by type of blood supply

Answer 4

Subdermal Plexus
Axial pattern flap
Revascularized

Question 5

Skin flap classification by distance from wound

Answer 5

Local

Distant

Question 6

Axial Pattern Flap

Answer 6

Transposition flap that incooperate a direct cutaneous artery and vein allowing us to create large flaps for large areas

Question 7

What tissue is included in a Subdermal Plexus Flap?

Answer 7

Epidermis
Dermis
Panniculus muscle

Question 8

What tissues are included in a Subdermal Plexus Flap with no panniculus?

Answer 8

Epidermis
Dermis
Hypodermis

Question 9

Local Flaps

Answer 9

Blood supply usually based on subdermal plexus

Question 10

What are some Local flaps that do no rotate about a pivot point?

Answer 10

Single pedicle advancement flap

H-plasty

Question 11

What are some local flaps that move about a pivot point?

Answer 11

Rotation flaps

Transposition flaps

Question 12

Single Pedicle Advancement Flaps

Answer 12

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

Question 13

What is the maximum length for a single pedicle advancement flap?

Answer 13

3xs the width of the flap

Question 14

H-plasty

Answer 14

Apposing single pedicle advancement flaps

Two smaller flaps lessens risk of vascular compromise

Question 15

Rotation Flap Guidelines

Answer 15

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

Question 16

What is a disadvantage of Rotation Flaps?

Answer 16

The back cut incision increases mobility of the flap but also increases the risk of vascular compromise

Question 17

How do you prevent dog ears/puckering?

Answer 17

sutures spaced further apart on long side

Question 18

Transposition Flap

Answer 18

Three-sided flap
Donor skin in different axis from wound
The greater the angle from the wound the shorter the effective length becomes

Question 19

What are two popular Axial pattern flaps?

Answer 19

Thoracodorsal

Caudal Superficial Epigastric

Question 20

Advantage of Ipsilateral flap in female

Answer 20

Increases distance flap can extend

Question 21

Disadvantage of Ipsilateral flap in females

Answer 21

Increases risk of kinking vessels

Question 22

Advantage of Contralateral flap in females

Answer 22

Less risk of kinking vessels

Question 23

Bridging Incision

Answer 23

Incision that connects base of flap and recipient site and avoids having to tube flap over intact skin

Question 24

“Tubing” the flap

Answer 24

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

Question 25

What are the considerations for the bridging incision?

Answer 25

the nipple will end up on the leg

Question 26

What are the complications of flaps?

Answer 26

``` Flap edema Seroma Infection Partial dehiscence Vessel thrombosis with flap loss ```

Question 27

What are the types of distant flaps?

Answer 27

Pouch flap: Bipedicle flap | Single pedicle direct flap

Question 28

What are the indications for skin grafting?

Answer 28

Skin defects on the extremities Extensive burn wounds Adjunct to other reconstructive procedures

Question 29

What are the grafts associated with Donor-Host Relationship?

Answer 29

Autograft Allograft Xenograft

Question 30

Autograft

Answer 30

from another part of the body

Question 31

What is the purpose for Cortical fenestration?

Answer 31

Speed granulation tissue formation over exposed bone

Question 32

Cortical fenestration

Answer 32

Drill holes through near cortex into medullary cavity | Blood clots serve as matrix for granulation tissue to form a surface

Question 33

When is granulation tissue ready for grafting?

Answer 33

Granulation tissue pink and glistening surface smooth Wound contracting and epithelial migration visible at wound margin

Question 34

What are the skin grafting techniques?

Answer 34

Sheet: Full or Split thickness, Mesh, sieve, pie-crust Punch: Seed, Pinch, or Stamp Strip: tunnel

Question 35

Full-thickness skin graft

Answer 35

Consists of epidermis and dermis | Included hair follicles and adnexal structures

Question 36

What is the most common graft type in small animals?

Answer 36

Full-thickness skin graft

Question 37

How do you prepare the recipient bed?

Answer 37

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

Question 38

Harvesting Skin grafts

Answer 38

dissect graft from donor site deep to cutaneous trunci muscle Remove cutaneous trunci muscle and superficial subcutaneous tissue prior to applying graft

Question 39

What happens if you leave cutaneous trunci muscle on a graft?

Answer 39

will delay revascularization

Question 40

Mesh graft

Answer 40

Sheet graft in which parallel rows of staggered slits are made

Question 41

What are the advantages of Mesh grafts?

Answer 41

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

Question 42

Punch (seed) grafts

Answer 42

Full-thickness plugs of skin placed in granulation bed

Question 43

What is the advantage of Punch (seed) grafts?

Answer 43

Enhance epithelialization

Question 44

What is the disadvantage of Punch (seed) grafts?

Answer 44

Poor cosmetic appearance

Question 45

What is the postoperative care of skin grafts?

Answer 45

Apply antibiotic ointment and nonadherent dressing Absorbent secondary layer Splint or cast if over join Change dressing in 24-48 hours