Wound Reconstruction

Question 1

What are the surgical techniques that can be used for wound closure?

Answer 1

Close edges, mobilise local skin, mobilise adjacent skin, mobilise distant skin, use free skin grafts, second intention healing.

Question 2

Can you give examples of some tension relieving techniques?

Answer 2

Maximise available skin, change local skin tension, change regional skin tension, mobilise location skin, increase local skin, distribute tension, overcome tension, remove tension.

Question 3

In management of tension, how can you maximise the available skin?

Answer 3

Patient positioning - allows loose skin to be pulled towards surgical site.

Question 4

In management of tension, how can you change local skin tension?

Answer 4

Use closure patterns that do this. E.g. 3 point closure Y wound, Z plasty, V-Y plasty.

Question 5

What type of skin flaps can be used in reconstruction of wound? (not grafts, flaps)

Answer 5

Local (advancement, transposition, rotational), Axial (e.g. Thoracodorsal, Caudal epigastric, Reverse saphenous conduit, distant direct subdermal plexus flaps)

Question 6

What type of areas are local advancement flaps limited to?

Answer 6

Areas with loose skin e.g. lateral flank, neck, portions of head.

Question 7

What is a local transposition flap? What is critical in the use of these flaps?

Answer 7

Rectangular flap created with 90 degrees of the long axis of the defect. Measurements are critical.

Question 8

What type of wound is a local rotation flap used in?

Answer 8

Usually a triangular defect, where an arc of skin sharing a common border with a triangular defect is used.

Question 9

For wounds in which areas would you consider the use of a thoracodorsal axial skin flap?

Answer 9

Often used in elbow injuries, and injuries of proximal forelimb.

Question 10

For wounds in which areas would you consider the use of a caudal epigastric axial skin flap?

Answer 10

Used for skin defects around proximal hind limb.

Question 11

For wounds in which areas would you consider the use of a reverse saphenous conduit axial skin flap? How does it work?

Answer 11

Takes skin from medial crus, used to cover a skin defect on distal metatarsal region. There is reversal of blood flow through arteries.

Question 12

For wounds in which areas would you consider the use of a distant direct subdermal plexus flap?

Answer 12

Distal limb injuries.

Question 13

What situations indicate the use of free skin grafts, and which do not?

Answer 13

Indication: distal limb injury, fresh wound, healthy granulation tissue.
Contraindications: exposed bone, tendon or ligament, infection or movement, chronic granulation tissue.

Question 14

Why is omentalisation of a wound good for wound reconstruction?

Answer 14

Blood supply, lymphatic drainage, angiogenic, haemostatic, tissue support etc.

Question 15

What types of wounds is omentalisation used in?

Answer 15

Diaphragmatic defections, prostatic abscessation, chylothorax, omentopexy.