Skin grafts

Question 1

Name the four different types of skin flap

Answer 1

Rotational
Advancement
Transposition
Skin fold flaps

Question 2

What are the principles of a skin flap?

Answer 2

wider base than body
avoid narrowing
limit size
Go below the panniculus to maintain blood supply
Take from area of ample skin
avoid excess motion or stress at donor site

Question 3

What is the general technique to preform a skin graft?

Answer 3

pre-op assessment 
wide clip 
marker to outline flap
meticulous technique (avoid trauma to vessels/flap)
undermine below the panniculus/deep dermis
use stay sutures 
avoid tension/twisting
close recipient site
manage dead space drain vs sutures
close donor site

Question 4

What is an advancement flap?

Answer 4

flap parallel to line of least tension
flap stretched onto defect
loose skin adjacent to wound
prone to dehiscene

Question 5

What is a rotational flap?

Answer 5

Skin rotates to close triangular defect
radius of rotation= length of the wound
arc 4 times wound width

Question 6

What is a Transposition flap?

Answer 6

Flap parallel to tension
rotated into defect
maximise width of base
length equal to pivot arc

Question 7

What is a skin fold flap?

Answer 7

Axillary or inguinal skin folds
Versatile large flap
sternal and groin areas

Question 8

What are the complications associated with skin flaps?

Answer 8

Dehiscence
Necrosis
seroma

Question 9

What are axial pattern flaps?

Answer 9

Very larger flaps more likely to survive maintain arteries
Direct cutaneous artery
superficial landmarks
flap dimensions depend on conformation

Question 10

What are the indications for axial pattern flaps?

Answer 10

Size
large wounds, flank, proximal limb, reconstruction after tumour removal
Vascularity
chronic non-healing wound, avascular wound
Tisses
coverage exposed bone provision of muscle bulk

Question 11

What are the advantages of an axial pattern flap?

Answer 11

Durable full thickness skin 
predictable blood supply 
normal hair growth 
mobility less of a problem 
much larger than subdermal flaps

Question 12

Why is planning important when creating an axial pattern skin flap?

Answer 12

Donor site
defect size and location
draw landmarks, vessel origin and flap outline in marker pen
Is drain placement necessary

Question 13

What is a meticulous technique?

Answer 13

Avoid trauma of the blood vessels and tip of flap

undermine below the panniculus muscle

Question 14

How is the axial pattern skin flap isolated?

Answer 14

Skin incisions start peripherally
stay sutures at the tip
Work from peripheral tip to ventral vessel
identify blood vessel as soon as possible

Question 15

List the big four types of axial pattern flaps

Answer 15

Thoracodorsal
omocervical
caudal superficial epigastric
deep circumflex illiac

Question 16

What are the thoracodorsal flap landmarks, artery it is supplied by and it use?

Answer 16

Thoracodorsal artery 
landmarks
Vessel-caudal shoulder depression 
cranial-scapular spine 
caudal- parallel to cranial border
Length-to midline/shoulder 
Use
shoulder forelimb elbow axilla, thorax, carpus (cat)

Question 17

What are the caudal epigastric flap landmarks, artery it is supplied by and it use?

Answer 17

Blood vessel
external pudendal, caudal superficial epigastric artery
Landmarks
Vessel-inguinal region
medial-ventral midline
lateral- parrallel to medial
Uses
caudal trunk, inguinal region, perineum, pelvic limb
(take pectoral fascai, incorporate base of the prepuce, mammary tissue remains functional)

Question 18

What post-op care is carried out for skin flaps?

Answer 18

aseptic technique 
bandage change always sedated 
immobilisation of the limb 
reduce dead space (via bandaging)
Analgesia

Question 19

What complications may occur with skin flaps?

Answer 19

flap necrosis 
recepient wound 
seroma
failure to adhere
dehiscence 
infection