Skin Grafts And Flaps Flashcards
What is the Reconstruction Ladder?
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.
What is a Free flap?
A complex surgical method involving tissue transfer without its original blood supply
Typically used in more advanced stages of reconstruction.
What is a Pedicle flap?
A flap of tissue that remains attached to its original blood supply during transfer
This method is less complex than a free flap.
What is a Random pattern flap?
A flap that relies on random blood supply rather than a defined vascular pedicle
Used in various reconstructive procedures.
Define Full thickness graft.
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.
Define Split thickness graft.
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.
What is Delayed closure?
A technique where the wound is left open for a period before being closed surgically
This method can improve healing in certain cases.
What factors must be considered for Donor Site Selection?
Size, hair pattern, texture, thickness of skin, and colour
Facial grafts are best if taken from ‘blush zones’ above the clavicle.
What is Primary closure?
A method of closing a wound immediately after injury or surgery
This is the simplest form of wound closure.
What is Healing by secondary intention?
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.
List the phases of skin graft ‘take’.
- 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.
What are the requirements for graft survival?
- Well-vascularized bed (recipient site).
- 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 ).
- Low bacterial count at recipient site (<105/cm3).
- coagulation begins as soon as graft is placed on bed.
What are common reasons for graft loss?
- Hematoma/seroma
- Infection
- Mechanical force (e.g. shearing, pressure)
These factors can compromise the integrity and success of the graft.
Whats skin graft?
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).
What is an autograft?
A graft from the same individual
Autografts are often preferred due to lower rejection rates.
What is an allograft?
A graft from the same species but different individual
Also known as a homograft.
What is a xenograft?
A graft from a different species
An example is a graft taken from porcine sources.
What are the two classifications of skin grafts by thickness?
Split Thickness Skin Graft and Full Thickness Skin Graft
These classifications impact healing and aesthetic outcomes.
What does a Split Thickness Skin Graft consist of?
Epidermis and part of dermis
This type of graft is more reliable in terms of take and survival.
What does a Full Thickness Skin Graft consist of?
Epidermis and all of dermis
It is less reliable but can provide better aesthetic outcomes.
How does the healing process differ between Split Thickness and Full Thickness Skin Grafts?
Split Thickness heals via dermal appendages; Full Thickness requires primary closure
This affects the donor site recovery time.
What is the rate of re-harvesting for Split Thickness Skin Grafts?
~10 times
This is faster on the scalp.
What is the graft take reliability of Split Thickness Skin Grafts?
More reliable with better survival
This is due to shorter nutrient diffusion distance.
What is the contraction difference between Split Thickness and Full Thickness Skin Grafts?
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.
What are the aesthetic outcomes of Split Thickness Skin Grafts?
Poor
Usually requires further procedures for improved aesthetics.
What are the advantages of Split Thickness Skin Grafts?
- 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.
What are the disadvantages of Split Thickness Skin Grafts?
- Contracts significantly
- Abnormal pigmentation
- High susceptibility to trauma
Requires well-vascularized beds for optimal outcomes.
What are the uses of Split Thickness Skin Grafts?
Large areas of skin and granulating tissue beds
Ideal for areas requiring extensive coverage.
What are the advantages of Full Thickness Skin Grafts?
- Better color match
- Can be used on the face and fingers
- Resists contraction
They provide superior aesthetic results.
What are the disadvantages of Full Thickness Skin Grafts?
- Requires well vascularized bed
- Lower rate of survival
They are thicker and have slower revascularization.
What are the uses of Full Thickness Skin Grafts?
Sites where thick skin or decreased contracture is desired
Commonly used on the face for color matching.
Humby knife
Humby knife
What is the definition of FLAPS?
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.
What are the classifications of flaps based on?
Tissue composition, blood supply to skin, location of the donor site
Classifications include random, axial, local, regional, and distant.
What are the indications for using flaps?
Replaces tissue loss due to trauma or surgery, provides skin and soft tissue coverage for subsequent surgery
Flaps are often used in reconstructive surgery.
What are common complications associated with flaps?
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.
What characterizes Random Pattern Flaps?
Blood supply by dermal and subdermal plexus with random vascular supply, limited length: width ratio
Adequate blood supply is necessary for flap viability.
What factors influence flap choice?
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.
What is a rotation flap?
Semicircular tissue rotated around a pivot point for defect closure
Commonly used for sacral pressure sores, scalp, and cheek defects.
What are the local causes of flap failure?
Hematoma, thrombosis, infection, tension, hypothermia, poor design
These factors are specific to the site of the flap and can directly affect its viability.
What are the general causes of flap failure?
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.
What is a keloid?
A hypertrophic scar
Keloids are raised scars that occur when the body produces too much collagen during healing.
What is partial necrosis in the context of flap complications?
Inadequate blood supply leading to tissue death in part of the flap
This can occur due to local or general causes affecting blood flow.
What is contracture as a complication of flap surgery?
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.
Fill in the blank: _______ is a cause of flap failure related to the design of the flap itself.
Poor design
A well-designed flap is crucial for its success and functionality.
True or False: Hypertension is a local cause of flap failure.
False
Hypertension is classified as a general cause of flap failure.
List three local causes of flap failure.
- Hematoma
- Thrombosis
- Infection
These factors are critical to monitor post-surgery for flap viability.
What is an Axial Pattern Flap?
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.
What is a Free Flap?
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.
What are common types of Free Flaps?
- Muscle
- Skin
- Bone
- Jejunum
- Omentum
- Fascia
These can be harvested for vascular supply to all tissue types.
What characteristics indicate a Healthy Free Flap?
- 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.
What indicates Arterial Insufficiency in a Free Flap?
- 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.
What indicates Venous Insufficiency in a Free Flap?
- Colour: Purple or blue
- Temperature: Warm
- Turgor: Increased firmness
- Capillary Refill: <2 s
These signs suggest a problem with venous drainage from the flap.
