Wound reconstruction

Question 1

an elliptical incision of a round mass allows…

Answer 1

closure without deformity

Question 2

how do you class a flap?

Answer 2

1. Blood supply: random cutaneous vs. direct cutaneous artery
2. Location: distant or Local

Question 3

List 6 simple skin flap techniques

Answer 3

1. Advancement skin flaps
2. Rotation flap
3. Bipedicle advancement flap/ V-Y plasty
4. Transposition flap
5. Flank flaps
6. Z plasty

Question 4

Advantages of a single pedicle advancement flap

Answer 4

• no secondary defect

- utilises loose skin at wound edge

Question 5

what is the length the of arc in a rotation skin flap?

Answer 5

4x the defect

Question 6

in what locations are rotation skin flaps useful?

Answer 6

ears, eyelids, maxilla

Question 7

how many suture lines are there when using a bipedicle advancement flap?

Answer 7

2-3 - your initial incision + you extra tension releasing incision (potentially two if you do one on either side of the surgical site incision)a

Question 8

when the V-Y plasty useful?

Answer 8

eyes and ears

Question 9

what blood supplies a inguinal flap?

Answer 9

deep circumflex iliac a.

Question 10

blood supply of an axilla flap?

Answer 10

thoracodorsal a.

Question 11

when are axilla and inguinal ‘flank’ flaps useful?

Answer 11

proximal limb and trunk defects

Question 12

give two types of distant flaps?

Answer 12

single (hinge) and bipedicle (pouch) flaps

Question 13

describe how distant flaps are staged procedures

Answer 13

they require a 2 week period for cut down

Question 14

when are free skin grafts indicated?

Answer 14

Defects cannot be closed primarily with a local technique and where second intention healing is undesirable

Question 15

Graft acceptance depends on 3 things

Answer 15

1. Plasmatic imbibition
2. Inosculation
3. Revascularisation

Question 16

3 points of preparation of the graft bed

Answer 16

1. vascular
2. Smooth
3. free from infection

Question 17

when are seed grafts useful?

Answer 17

very good for highly mobile areas to reduce traction + footpad reconstruction

Question 18

describe the blood supply of axial pattern flaps

Answer 18

direct cutaneous artery from a known point of origin, known angiosome

Question 19

when are axial pattern flaps indicated?

Answer 19

• defects cannot be closed primarily with local technique

- where second intention healing undesirable

Question 20

advantages of axial pattern flaps

Answer 20

• reliable blood supply

- full-thickness, haired, vascular coverage

Question 21

limitations of axial pattern flaps

Answer 21

• secondary defect closure
• location of wound vs. artery
• landmark (technical difficulty?)

Question 22

4 axial pattern flaps in dogs

Answer 22

1. Cervical cutaneous branch omocervical A and V.
2. Thoracodorsal A. and V.
3. Deep circumflex iliac A. and V
4. Caudal superficial epigastric A. and V.