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Plastic Surgery > Skin Grafts And Flaps > Flashcards

Skin Grafts And Flaps Flashcards

1
Q

What is the Reconstruction Ladder?

A

An approach to wound management with successively more complex methods of treatment

This concept emphasizes starting with the least complex method and progressively increasing complexity as appropriate.

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2
Q

What is a Free flap?

A

A complex surgical method involving tissue transfer without its original blood supply

Typically used in more advanced stages of reconstruction.

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3
Q

What is a Pedicle flap?

A

A flap of tissue that remains attached to its original blood supply during transfer

This method is less complex than a free flap.

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4
Q

What is a Random pattern flap?

A

A flap that relies on random blood supply rather than a defined vascular pedicle

Used in various reconstructive procedures.

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5
Q

Define Full thickness graft.

A

Tissue composed of epidermis and varying degrees of dermis, that does not carry its own blood supply

Survival requires the generation of new blood vessels from the recipient site bed.

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6
Q

Define Split thickness graft.

A

A graft that includes the epidermis and part of the dermis, allowing it to have a better chance of survival

These grafts are often taken from inconspicuous areas.

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7
Q

What is Delayed closure?

A

A technique where the wound is left open for a period before being closed surgically

This method can improve healing in certain cases.

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8
Q

What factors must be considered for Donor Site Selection?

A

Size, hair pattern, texture, thickness of skin, and colour

Facial grafts are best if taken from ‘blush zones’ above the clavicle.

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9
Q

What is Primary closure?

A

A method of closing a wound immediately after injury or surgery

This is the simplest form of wound closure.

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10
Q

What is Healing by secondary intention?

A

A healing process where the wound is left open and heals naturally from the edges inward

This method is often used for larger or contaminated wounds.

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11
Q

List the phases of skin graft ‘take’.

A
  • Plasmatic imbibition: diffusion of nutrition from recipient site (first 48 h)
  • Inoculation: growth of vessels from bed and graft toward each other (d 2-3)
  • Neovascular ingrowth: growth of new vessels which vascularize graft (d 3-5)

These phases are crucial for successful graft survival.

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12
Q

What are the requirements for graft survival?

A
  1. Well-vascularized bed (recipient site).
  2. Good contact between graft and recipient bed ( Staples, sutures, splinting, and pressure dressings- are used to prevent movement/ shearing of graft and hematoma or seroma formation ).
  3. Low bacterial count at recipient site (<105/cm3).
  4. coagulation begins as soon as graft is placed on bed.
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13
Q

What are common reasons for graft loss?

A
  • Hematoma/seroma
  • Infection
  • Mechanical force (e.g. shearing, pressure)

These factors can compromise the integrity and success of the graft.

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14
Q

Whats skin graft?

A

tissue composed of epidermis and varying degrees of dermis, that does not carry its own blood supply.
Survival requires the generation of new blood vessels from the (recipient site bed).

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15
Q

What is an autograft?

A

A graft from the same individual

Autografts are often preferred due to lower rejection rates.

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16
Q

What is an allograft?

A

A graft from the same species but different individual

Also known as a homograft.

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17
Q

What is a xenograft?

A

A graft from a different species

An example is a graft taken from porcine sources.

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18
Q

What are the two classifications of skin grafts by thickness?

A

Split Thickness Skin Graft and Full Thickness Skin Graft

These classifications impact healing and aesthetic outcomes.

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19
Q

What does a Split Thickness Skin Graft consist of?

A

Epidermis and part of dermis

This type of graft is more reliable in terms of take and survival.

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20
Q

What does a Full Thickness Skin Graft consist of?

A

Epidermis and all of dermis

It is less reliable but can provide better aesthetic outcomes.

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21
Q

How does the healing process differ between Split Thickness and Full Thickness Skin Grafts?

A

Split Thickness heals via dermal appendages; Full Thickness requires primary closure

This affects the donor site recovery time.

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22
Q

What is the rate of re-harvesting for Split Thickness Skin Grafts?

A

~10 times

This is faster on the scalp.

23
Q

What is the graft take reliability of Split Thickness Skin Grafts?

A

More reliable with better survival

This is due to shorter nutrient diffusion distance.

24
Q

What is the contraction difference between Split Thickness and Full Thickness Skin Grafts?

A

Less 1° contraction and greater 2° contraction for Split; Greater 1° contraction and less 2° contraction for Full

Thicker grafts tend to have less secondary contraction.

25
Q

What are the aesthetic outcomes of Split Thickness Skin Grafts?

A

Poor

Usually requires further procedures for improved aesthetics.

26
Q

What are the advantages of Split Thickness Skin Grafts?

A
  • Takes well in less favorable conditions
  • Can cover a larger area
  • Allows for extravasation of blood/serum
  • Large number of donor sites

They can also be meshed to cover greater areas.

27
Q

What are the disadvantages of Split Thickness Skin Grafts?

A
  • Contracts significantly
  • Abnormal pigmentation
  • High susceptibility to trauma

Requires well-vascularized beds for optimal outcomes.

28
Q

What are the uses of Split Thickness Skin Grafts?

A

Large areas of skin and granulating tissue beds

Ideal for areas requiring extensive coverage.

29
Q

What are the advantages of Full Thickness Skin Grafts?

A
  • Better color match
  • Can be used on the face and fingers
  • Resists contraction

They provide superior aesthetic results.

30
Q

What are the disadvantages of Full Thickness Skin Grafts?

A
  • Requires well vascularized bed
  • Lower rate of survival

They are thicker and have slower revascularization.

31
Q

What are the uses of Full Thickness Skin Grafts?

A

Sites where thick skin or decreased contracture is desired

Commonly used on the face for color matching.

32
Q
A

Humby knife

33
Q
A

Humby knife

34
Q

What is the definition of FLAPS?

A

Tissue of varying composition with a known blood supply, not dependent on neovascularization, may consist of skin, subcutaneous tissue, fascia, muscle, tendon, bone, or other tissues

FLAPS can include random, pedicled, or named blood supplies.

35
Q

What are the classifications of flaps based on?

A

Tissue composition, blood supply to skin, location of the donor site

Classifications include random, axial, local, regional, and distant.

36
Q

What are the indications for using flaps?

A

Replaces tissue loss due to trauma or surgery, provides skin and soft tissue coverage for subsequent surgery

Flaps are often used in reconstructive surgery.

37
Q

What are common complications associated with flaps?

A

Flap loss due to hematoma, seroma, infection, poor flap design, extrinsic compression, vascular failure/thrombosis, fat necrosis

Complications can arise from both free and pedicled flaps.

38
Q

What characterizes Random Pattern Flaps?

A

Blood supply by dermal and subdermal plexus with random vascular supply, limited length: width ratio

Adequate blood supply is necessary for flap viability.

39
Q

What factors influence flap choice?

A

Available tissue, type of tissue needed, location of reconstruction site, blood supply, ability to close donor site, surgeon preference

These factors ensure optimal outcomes in flap surgery.

40
Q

What is a rotation flap?

A

Semicircular tissue rotated around a pivot point for defect closure

Commonly used for sacral pressure sores, scalp, and cheek defects.

41
Q

What are the local causes of flap failure?

A

Hematoma, thrombosis, infection, tension, hypothermia, poor design

These factors are specific to the site of the flap and can directly affect its viability.

42
Q

What are the general causes of flap failure?

A

Radiotherapy, diabetes mellitus, vascular ischemia, hypertension, hypoproteinaemia, poor cardiovascular function, hypercoagulability

These factors can impact the overall health and healing ability of the patient, affecting flap success.

43
Q

What is a keloid?

A

A hypertrophic scar

Keloids are raised scars that occur when the body produces too much collagen during healing.

44
Q

What is partial necrosis in the context of flap complications?

A

Inadequate blood supply leading to tissue death in part of the flap

This can occur due to local or general causes affecting blood flow.

45
Q

What is contracture as a complication of flap surgery?

A

Tightening of the skin or underlying tissue, leading to restriction of movement

Contracture can occur as a result of scarring and may require surgical intervention.

46
Q

Fill in the blank: _______ is a cause of flap failure related to the design of the flap itself.

A

Poor design

A well-designed flap is crucial for its success and functionality.

47
Q

True or False: Hypertension is a local cause of flap failure.

A

False

Hypertension is classified as a general cause of flap failure.

48
Q

List three local causes of flap failure.

A
  • Hematoma
  • Thrombosis
  • Infection

These factors are critical to monitor post-surgery for flap viability.

49
Q

What is an Axial Pattern Flap?

A

A flap that contains a well-defined artery and vein

This type of flap allows for a greater length to width ratio of 5-6:1.

50
Q

What is a Free Flap?

A

Transplanting donor tissue by isolating and dividing a dominant artery and vein

Microsurgical anastomosis is performed between the flap’s vessels and the recipient’s vessels.

51
Q

What are common types of Free Flaps?

A
  • Muscle
  • Skin
  • Bone
  • Jejunum
  • Omentum
  • Fascia

These can be harvested for vascular supply to all tissue types.

52
Q

What characteristics indicate a Healthy Free Flap?

A
  • Colour: Pink
  • Temperature: Warm
  • Arterial Pulse (Doppler): Warm or cool
  • Turgor: Soft, but with some firmness
  • Capillary Refill: 2-5 s

Variation in colour may depend on the patient’s skin tone.

53
Q

What indicates Arterial Insufficiency in a Free Flap?

A
  • Colour: Pale
  • Temperature: Cool
  • Arterial Pulse (Doppler): none
  • Turgor: Decreased tissue firmness
  • Capillary Refill: >5 s

These signs suggest poor blood flow to the flap.

54
Q

What indicates Venous Insufficiency in a Free Flap?

A
  • Colour: Purple or blue
  • Temperature: Warm
  • Turgor: Increased firmness
  • Capillary Refill: <2 s

These signs suggest a problem with venous drainage from the flap.

Plastic Surgery (5 decks)

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