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Surgical skills > Skin flaps and grafts > Flashcards

Skin flaps and grafts Flashcards

1
Q

What is the difference between flaps and grafts?

A

flaps remain attached to the patient, grafts do not

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2
Q

What is the difference between flaps and axial pattern flaps?

A

Flaps may rely on just the subdermal plexus

axial pattern flaps rely on a specific cutaneous artery and thus can be longer (better blood supply)

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3
Q

Why do free grafts require a recipient bed with a good blood supply to survive?

A

because they do not have their own blood supply (unless attached via microvascular anastomosis)

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4
Q

What are most commonly used to cover wounds of distal extremities?

A

free grafts

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5
Q

When are flaps and grafts used?

A
  1. for wounds where the wound is not expected to heal in a satisfactory way by contraction and epithelialization
  2. primary closure of surgically created defects that cannot otherwise be closed
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6
Q

What is another name for a subdermal plexus flaps?

A

random pattern flaps

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7
Q

How do you increase the change of subdermal plexus flap survival

A
  1. the flap should be no more than twice as long as it is wide
    2.
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8
Q

How do you increase the change of subdermal plexus flap survival

A
  1. the flap should be no more than twice as long as it is wide
  2. the base should be wider than the tip
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9
Q

What is a requirement for using a flap?

A

the skin adjacent to the wound has to be loose and mobile

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10
Q

How are flaps classified?

A

according to their shape and the movement of the flap

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11
Q

What are 3 types of subdermal plexus flaps?

A
  1. rotation flaps
  2. pedicle advancement flaps
  3. skin fold advangement flaps
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12
Q

What are rotation flaps useful for?

A

good for dealing with triangular defects. Make 3x as long as base of triangle.

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13
Q

What are pedicle advancement flaps?

A

make incisions on a side of a defect, undermining and advancing the resultant defect
(can also do on both sides)

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14
Q

Why don’t you want to cut into the base of a flap?

A

because it compromises blood supply

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15
Q

What are 4 types of subdermal plexus flaps?

A
  1. rotation flaps
  2. pedicle advancement flaps
  3. skin fold advangement flaps
  4. transposition flaps
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16
Q

Why don’t you want to cut into the base of a flap?

A

because it compromises blood supply

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17
Q

What are transposition flaps?

A

flaps in which skin is lifted form one area where skin is plentiful to close the wound

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18
Q

Why do you leave dog ears with transposition flaps?

A

because if you cut them you could compromise blood supply

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19
Q

Why do you have to be careful not to rotate transposition flaps too much?

A

Because they can compromise blood supply

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20
Q

What are skin fold advancement flaps?

A

flaps that make use of loose skin present in the axilla and inguinal regions that can be moved into defects nearby

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21
Q

What is a filet technique?

A

cut off tail or toe to use skin

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22
Q

Why can you make axial pattern flaps longer than subdermal plexus flaps?

A

because they contain a cutaneous artery and vein (thus a known blood supply)

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23
Q

What are angiosomes?

A

regions that each artery supplies

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24
Q

How much can axial pattern flaps be rotated?

A

180 degrees

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25
Q

Why can be an issue with rotating axial pattern flaps?

A

the base can kink and choke of the artery and vein

26
Q

Why don’t you want to trim dog ears in a axial pattern flap?

A

you could trim away the artery

27
Q

What is a bridging incision?

A

An incision made between the defect and the flap that is made so you can suture the graft into it

28
Q

What are axial pattern flaps most often used for?

A

for closing big defects on the head, neck, trunk and proximal portion of the extremities

29
Q

What is a thoracodorsal flap?

A

it is based on the thoracodorsal artery that exits caudal to the scapula. can extend over to other side or a hockey stick shape

30
Q

What is a superficial omocervical flap?

A

based on the omoservical artery that emerges in front of scapula
used to r

31
Q

What is a superficial omocervical flap?

A

based on the omoservical artery that emerges in front of scapula
can reach up haw and used to fill cranial thorax/priximal forelimb defects.

32
Q

What is the caudal superficial epigastric flap?

A

flap based on a pedicle exiting inguinal ring and extends cranilally along mammary chain. can use to covery perineum and thighs

33
Q

What are factors to remember about axial pattern flaps?

A
  1. make sure skin in normal position
  2. clip and prep is huge
  3. make pattern, mark with sterile pen
  4. only one chance to cut!
  5. DON’T try to close dead space–place a drain!
  6. don’t close dead space
  7. can close donor site with walking and tacking sutures
34
Q

What are types of axial pattern flaps?

A
  1. thoracodorsal flap
  2. superficial cervical (omocervical) flap
  3. caudal superficial epigastric flap
  4. reverse saphenous conduit flap
35
Q

What kind of tissue are grafts placed onto?

A
  1. wound with healthy granulation tissue
  2. fresh wound

NOT

  1. bone
  2. open joints
  3. contaminated, infected wound
36
Q

When a graft is first transferred to a recipient wound, its survival depends on:

A
  1. plasmatic imbibition
  2. inosculation
  3. direct vessel ingrowth from the wound to the graft
37
Q

What is plasmatic imbibition?

A

graft drinking up fluid from the wound bed

38
Q

What is inosculation?

A

open blood vessels on the graft meet up with those in the recipient bed

39
Q

What are the stages of adherence of a graft?

A
  1. correct placement of graft and securement
  2. fibrin strand bridging
  3. fibroblasts produce collagen fibers (strong)
40
Q

What are two things that graft survival depends on?

A
  1. blood supply

2. adherences

41
Q

What are two general types of grafts?

A
  1. full thickness grafts

2. partial (split) thickness grafts

42
Q

What are full thickness grafts?

A

grafts composed of

  1. epidermis
  2. all attached dermis
43
Q

What are advantages of full thickness grafts?

A
  1. easy to harvest

2. produce good cosmesis

44
Q

how should donor sites for full-thickness grafts be chosen?

A

from areas that can close primarily without compromizing function (belly, thoracic wall-SA, belly, neck–LA)

45
Q

How can you make full-thickness grafts spread out over a wider area than the donor site?

A
  1. by perforating the graft “meshing” which also helps excess fluid drain
  2. by harvesting small pieces
46
Q

What are partial (split) thickness grafts?

A

composed of epidermis and only PART of the dermis

47
Q

Why is a thinner partial thickness graft less cosmetic

A

because the hair comes from the dermis

48
Q

What three versions do partial thickness grafts come in?

A

thin, intermediate and thick versions

49
Q

What is the advantage of a partial thickness graft?

A

The skin grows back on the donor site so not limited to a donor bed the size you ccan suture closed

50
Q

Why is partial thickness graft common in large animals?

A

because they don’ have much extraskin

51
Q

What is the biggest disadvantage of partial thickness grafts?

A

they are less cosmetic than full-thickness grafts because the hair follicles become disrupted during harvest so the hair that grows on the graft is thin or absent

52
Q

Why is the graft a last resort?

A

it is less robust and requires more intensive post op care

53
Q

What is the technique for garvesting full graft tissue??

A
  1. trace a template
  2. excise skin required
  3. remove ALL subQ tissue attached to dermis!!
  4. mesh graft
  5. wrap graft in moist sponge
54
Q

What is the technique for preparing a recipient bed for a ful lthickness graft in a non-fresh wound with granulation tissue?

A
  1. wash with chlorhexidine
  2. rinse with saline
  3. excise any excess granulation tissue
  4. excise epithelialized edges
  5. apply pressure so bleeding stops
55
Q

What are the steps of full-thickness skin grafting? (5)

A
  1. graft harvest and preparation
  2. recipient bed preparation
  3. graft implantation
  4. bandage and immobilize
  5. assessing the graft
56
Q

How should the graft be implanted?

A
  1. ensure correct orientation
  2. suture graft edge to wound edge
  3. ensure graft conforms to entire wound bed
  4. bandage and immobilize–nonadherent, splint if necessary to prevent movement
  5. don’t change bandage for first 3-5 days
57
Q

How do you assess the graft?

A

the graft will at first appear blanched, but as blood vessels move in it will slowly pink up
often parts will look very dark and tissue may die but if not obviously infected or dry then give it time!

58
Q

What are pinch grafts?

A

pick up a little skin and use thumb forceps to cut off. remove fat

59
Q

What are punch grafts?

A

use skin biopsy. little donor site morbidity

60
Q

How do you implant pinch and punch grafts?

A

by making a small incision in the granulation tissue in the recipient bed and placing the graft inside

61
Q

How do you implant pinch and punch grafts?

A

by making a small incision in the granulation tissue in the recipient bed and placing the graft inside. grafts will epithelialize and converge

62
Q

What are footpad grafts?

A

can graft the same way and harvest via punch grafts. suture on the periphery of the defect and protect with a bandage–the epithelial component sloughs and pale skin is left but will return to former appearnce

Surgical skills (23 decks)

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