Written Exam - Reconstructive Surgery

Question 1

when positioning an animal for reconstructive surgery/grafts, what should be considered?

Answer 1

access to any skin proposed to be used, clip & prep wide, & position patient to relieve tension

Question 2

what are 3 types of local flaps?

Answer 2

1. single pedicle advancement
2. transposition flap
3. rotation flap

Question 3

what is a local flap?

Answer 3

flap is formed in nearby loose, elastic skin

base of the flap maintains circulation to the skin

Question 4

what is local flap blood supply reliant on?

Answer 4

subdermal plexus

Question 5

when doing a local flap, what should be avoided?

Answer 5

donor locations where excessive motion & stress is present

Question 6

what are the general guidelines for local flaps?

Answer 6

create flaps with a base slightly wider than the body to avoid narrowing the pedicle & decreasing blood transfusion

limit the flap to the size required to cover the recipient area without excessive tension

consider 2 smaller flaps for a large wound

Question 7

what is an advancement flap?

Answer 7

skin moves forward, toward the wound

relies mainly on the stretch of skin

Question 8

what are transposition flaps?

Answer 8

flap used in small/medium wounds - usually rotated within 90 degrees of the wound with the length being no more than twice the width

Question 9

when are distant local tissue grafts used?

Answer 9

when there is sufficient local tissue present, elasticity of dog skin, & truncal/neck wounds

Question 10

what kind of flap is seen here?

Answer 10

distant direct flap

Question 11

what do you do about the delay phenomenon?

Answer 11

raise flap, vasculature reorganizes/grows, move skin

Question 12

what are axial pattern flaps reliant on?

Answer 12

pre-defined direct cutaneous artery & vein - has a blood supply that must move with them

Question 13

what is a distant flap?

Answer 13

constructed at a site distant to the wound - almost used exclusively for wounds on middle/lower extremities & may require less exacting surgical skill & post-op care than a free graft

Question 14

what are 2 examples of a direct distant flap?

Answer 14

hinge - 1 pedicle
puch - 2 pedicles

Question 15

what is a tube flap?

Answer 15

distant indirect flap - prevents infection, healing to the donor site, helps eventual transfer with a 2-3 week delay

flaps shrink during delay time - increase size of the flap to about 25% bigger than the recipient site

Question 16

what is required when using an axial pattern flap?

Answer 16

careful measurements & planning - must identify anatomical landmarks

Question 17

why are no sutures placed in the middle of an axial flap?

Answer 17

could accidentally ligate the vessel

Question 18

what is required when doing a free graft?

Answer 18

excellent bandaging & immobilization

Question 19

what are some examples of free graft variations?

Answer 19

punch, pinch, strip, stamp, split thickness

Question 20

how is a free graft variation prepared?

Answer 20

prepare the same as full thickness mesh - create donor, angle with angle of the fur

Question 21

how is a pinch graft done?

Answer 21

angled pocket with a stab incision (better for thin granulation beds) (punch is better for thick granulation beds, use derm biopsy)

apply pressure until hemorrhage is controlled, no suturing, & bandage

Question 22

when may you perform a foot pad reconstruction?

Answer 22

pad laceration, trauma, mass removals

Question 23

when are digital flaps used?

Answer 23

closure of distal extremity defects - careful dissection & removal of phalanges provides healthy skin to close defects

Question 24

what is another name for a digital flap?

Answer 24

phalangeal filet

Question 25

why is paw pad loss so bad? what can you do?

Answer 25

MC/Mt pads very serious - normal skin can’t withstand daily physical abuse

digital pad transfer, accessory carpal pad transfer, pad grafting

Question 26

what do you do for a lacerated paw pad?

Answer 26

lavage, debride, closure (SQ & skin) - pads don’t heal as well as other tissues

Question 27

what happens if you have complete loss of all of the MC/MT paw pad?

Answer 27

may require limb amputation

Question 28

what are some examples of axial pattern flaps?

Answer 28

caudal auricular, cranial epigastric, lateral tail