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Year 4 Small Animal Studies > Soft Tissue Surgery: Reconstructive Surgery > Flashcards

Soft Tissue Surgery: Reconstructive Surgery Flashcards

1
Q

What instruments are commonly and sometimes required for skin reconstruction?

A
  • Mayo or metzembaum scissors- sharp/blunt dissection of subcut
  • Needle holders- mayo-hegar olsen-hedar
  • Fine tissue forceps- adsone

Extra
* Skin hooks
* Sterile marker pens
* Ophthalmic instuments

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2
Q

What are the aims of skin reconstruction?

A
  • Square skin edges- not angled
  • Accurate tissue apposition- optimial healing
  • Slight eversion of the wound edges- appose the dermis
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3
Q

What are halsteads principles?

A
  • Gentle tissue handling
  • Meticulous haemostasis
  • Preservation of blood supply
  • Strict asepsis
  • Minimal tension
  • Accurate tissue apposition
  • Obliteration of dead space
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4
Q

How can skin tension be reduced for appositional sutures?

A
  • Tension-relieving technique
  • Appopriate positioning- realsing leg ties
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5
Q

What is undermining and advancing skin?

A
  • Sharp or blunt trauma of subcut
  • Avoid injury to subdermal plexus
  • Preserve direct cutaneous arteries- undermine panniculus muscle
  • Neck, trunk and abdomen

Panniculus muscle- skin twitch

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6
Q

Describe the process of walking sutures

A
  • Absorbable 2-3 metric sutures between dermis and subcut fascia
  • When tightened suture pulls skin towards the centre of the wound onto fascia
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7
Q

What are the following tension-relieving suture patterns?

A

A. Alternating wide and narrow
B. vertical matress
C. horizontal matress
D. far-near-near far
E. far-far-near,near

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8
Q
  1. What is the function of alternating wide and narrow simple interupted sutures
  2. What can occur if mattress sutures are poorly placed
  3. When should tension relieving sutures be removed?
A
  1. Relieve minor tension
  2. Ishaemic skin necrosis
  3. 3-4 days- leave appositional
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9
Q

What is the function of far-near sutures?

A

Provide simultaneous tension relief (outer loop) and apposition (inner loop)

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10
Q
  1. When are relaxing/releasing incisions useful?
  2. How is the incision closed?
A
  1. When the primary defect overlies a vital structure
  2. Primary or secondary intention
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11
Q

What is multiplle punctate relacing incisions?

A

Rows of staggered stab incisions on either side of the wound and progressively tighten a preplaced suture

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12
Q

What is a Z and V-Y plasty?

A

Z- plasty
* Involves making triangular flaps of skin and transposing them to relieve tension

V-Y plasty
* a V-shaped invision created perpendicular to the wound- Y- relieves tension over a relatively limited area

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13
Q

What does a fusiform incision cause?
How can they be dealt with?

A

Dog ear- Wound sides with different lengths

Suturing the wound spacing sutures further apart on longer side (A)

Suturing the wound by starting halfway

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14
Q

How are triangular and square defects closed?

A

Start at corners and proceed to centre

Or use transposition or advancement flap

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15
Q

How are Chevron-shaped (V) and circular defects sutured?

A

Chevron
* close in the shape of a y
* placed first in the stem

Circular
* Convert to linear with fusiform defect then 3 point closure
* Create flaps

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16
Q

What is a skin flap?

Pedicle graft

A

Flaps are sections of skin with an intact vascular supply that are moved close to wounds

17
Q

How are flaps planned?

A
  • Use donor sites with ample skin and without excessive tension or movement
  • Apporopriate flap for the shape of the wound
  • Avoid narrowing the pedicle
  • Undermine below panniculus
  • Use fine suture material with initial tacking sutures
  • Ensure recipient bed is either a fresh or surfical wound
18
Q

What is a subdermal plexus flap?
What are the different types?

A

Flaps with blood supplies from the subdermal plexus and attenuated branches of distand direct cutaneous arteries
* Rotation flaps- triangular defects
* Transpositional flaps- rectangular rotated into place over a wound
* Interpolation flaps: similar to transpositinal- do not share common border with wound
* Advancement flaps- unipedicle or bipedicle that use elasticity of skin

19
Q
  1. What are axial pattern flaps
  2. What is the difference between free and peninsular flaps?
A
  1. Flaps incorporating a specific, large, direct cutaneous artery and vein
  2. Free no attachment- peninsular attachment at the donor bed
20
Q

Why do flaps fail?

A
  • Arterial and/or venous occlusion- thrombi, torsion, stretching
  • Elevated interstitial pressure due to excessuve tension causing reduced circulation and necrosis
  • Pressure on the flap from underlying haematomas/seromas or tight dressings
  • Infection
21
Q

How can flap health be assessed subjectively and objectively?

A

Subjectively
* Colour- unreliable
* Temperature- same as surrounding skin
* Sensation- unreliable
* Hair growth- only if flap viable

Objectively
* Flurescin dye flurescence- non-flurorescent areas often dehisce

22
Q

How can a failing flap be salvaged?

A
  • Apply ointments- prevent desiccation
  • Debride nonviable tissue
  • Open wound managment followed by secondary closure or development of a second flap
23
Q

What are free skin grafts?
How do they survive?

A
  • Segments of skin completely deteched from the donor site
  • Absorb tissue fluid for 48 hours
  • Then develop a new blood supply
24
Q

What are the pros and cons of full and split thickness grafts?

A

Full thickness
* durable
* good hair growth
* good survival if meshed

Spit
* more viable
* less duable
* not in cats

25
Q

What are passive drains?

A
  • Rely on gravity and capillary action
  • Efficiency proportional to their surface area
  • Exit through seperate stab wound- distal wound
  • Inguinal/axillary- proximal end through second incision to avoid emphysma
26
Q

What are active drains?

A
  • Apply negative pressure
  • At least every 6 hours
27
Q

What layer would you undermine if you are freeing skin around a wonud on the flank?

A

Panniculus muscle

28
Q

What is the maximum length-width ratio for an unipedicile subdermal plexus flap?

A

3:1

blood supply not adequate above this

Year 4 Small Animal Studies (97 decks)

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