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RUSVM Small Animal Surgery 2017 > Skin Flaps and Grafts > Flashcards

Skin Flaps and Grafts Flashcards

1
Q

Skin Flap

A

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

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2
Q

Skin graft

A

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

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3
Q

Skin Flap Classification

A

Type of Blood Supply

Distance from wound

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4
Q

Skin flap classification by type of blood supply

A

Subdermal Plexus
Axial pattern flap
Revascularized

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5
Q

Skin flap classification by distance from wound

A

Local

Distant

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6
Q

Axial Pattern Flap

A

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

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7
Q

What tissue is included in a Subdermal Plexus Flap?

A

Epidermis
Dermis
Panniculus muscle

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8
Q

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

A

Epidermis
Dermis
Hypodermis

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9
Q

Local Flaps

A

Blood supply usually based on subdermal plexus

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10
Q

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

A

Single pedicle advancement flap

H-plasty

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11
Q

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

A

Rotation flaps

Transposition flaps

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12
Q

Single Pedicle Advancement Flaps

A

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

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13
Q

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

A

3xs the width of the flap

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14
Q

H-plasty

A

Apposing single pedicle advancement flaps

Two smaller flaps lessens risk of vascular compromise

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15
Q

Rotation Flap Guidelines

A

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

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16
Q

What is a disadvantage of Rotation Flaps?

A

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

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17
Q

How do you prevent dog ears/puckering?

A

sutures spaced further apart on long side

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18
Q

Transposition Flap

A

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

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19
Q

What are two popular Axial pattern flaps?

A

Thoracodorsal

Caudal Superficial Epigastric

20
Q

Advantage of Ipsilateral flap in female

A

Increases distance flap can extend

21
Q

Disadvantage of Ipsilateral flap in females

A

Increases risk of kinking vessels

22
Q

Advantage of Contralateral flap in females

A

Less risk of kinking vessels

23
Q

Bridging Incision

A

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

24
Q

“Tubing” the flap

A

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

25
Q

What are the considerations for the bridging incision?

A

the nipple will end up on the leg

26
Q

What are the complications of flaps?

A 
Flap edema 
Seroma
Infection 
Partial dehiscence
Vessel thrombosis with flap loss
27
Q

What are the types of distant flaps?

A

Pouch flap: Bipedicle flap

Single pedicle direct flap

28
Q

What are the indications for skin grafting?

A

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

29
Q

What are the grafts associated with Donor-Host Relationship?

A

Autograft
Allograft
Xenograft

30
Q

Autograft

A

from another part of the body

31
Q

What is the purpose for Cortical fenestration?

A

Speed granulation tissue formation over exposed bone

32
Q

Cortical fenestration

A

Drill holes through near cortex into medullary cavity

Blood clots serve as matrix for granulation tissue to form a surface

33
Q

When is granulation tissue ready for grafting?

A

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

34
Q

What are the skin grafting techniques?

A

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

35
Q

Full-thickness skin graft

A

Consists of epidermis and dermis

Included hair follicles and adnexal structures

36
Q

What is the most common graft type in small animals?

A

Full-thickness skin graft

37
Q

How do you prepare the recipient bed?

A

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

38
Q

Harvesting Skin grafts

A

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

39
Q

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

A

will delay revascularization

40
Q

Mesh graft

A

Sheet graft in which parallel rows of staggered slits are made

41
Q

What are the advantages of Mesh grafts?

A

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

42
Q

Punch (seed) grafts

A

Full-thickness plugs of skin placed in granulation bed

43
Q

What is the advantage of Punch (seed) grafts?

A

Enhance epithelialization

44
Q

What is the disadvantage of Punch (seed) grafts?

A

Poor cosmetic appearance

45
Q

What is the postoperative care of skin grafts?

A

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

RUSVM Small Animal Surgery 2017 (17 decks)

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