Tension and plasties

Question 1

What is the problem with tension?

Answer 1

it can increase complications and delay healing

1. blood flow is compromised
2. tension in a distal limb can cause necrosis of the distal limb
3. tension pulls the wound apart or may not be able to close
4. can restrict movement near a joint

Question 2

What is never acceptable regarding tension?

Answer 2

it is never acceptable to have tension on the skin portion of the closure because it will always dehisce

Question 3

What affects tension?

Answer 3

1. species and breed
2. location on the body
3. size and shape of wound
4. wound orientation

Question 4

Which is more easy to close: a wound that is parallel to the kines of tension or one that is perpendicular?

Answer 4

one that is parallel

Question 5

How do lines of tension usually run on a dog? Thus what wounds are easier to close?

Answer 5

1. dorsal to ventral

2. easier to close wound on dorsal ventral axis than longitudinal

Question 6

Which is less harmful: pulling on tissue with hands or with towel clamps?

Answer 6

towel clamps

Question 7

What are 5 ways to manage tension on a wound?

Answer 7

1. undermining
2. walking sutures
3. skin stretching
4. releasing (relaxing) incisions
5. plasties

Question 8

What is undermining?

Answer 8

1. It is a way to manage tension, but it creates dead space, which needs to be closed.
2. Keep the cutaneous muscle with the top layer to maintain blood supply
3. undermine in plane you need to advance

Question 9

What are walking sutures?

Answer 9

They are sutures applied after undermining. They distribute tension more evenly through the wound closure and facilitate advancemnet of the undermined tissues.

Question 10

Why must walking sutures only be used when necessary?

Answer 10

because they increase the risk of infection and fix relatively mobile skin in place

Question 11

What are different methods of skin stretching?

Answer 11

1. presuturing
2. adjustable sutures
3. skin stretchers
4. tissue expanders

Question 12

What are different methods of skin stretching?

Answer 12

1. presuturing
2. adjustable sutures
3. skin stretchers
4. tissue expanders

Question 13

What is presuturing

Answer 13

performed 24 hours before surgery and tension sutures are used to fold up the skin

Question 14

What are adjustable sutures?

Answer 14

button or split-shot or clip that hold the suture in tension and can ev used to anchor one or both ends of intradermal suture line. every day it is tightened

Question 15

What are skin stretchers?

Answer 15

placed on either side of a defect and a cross piece is used to advance bit by bit each day

Question 16

What are tissue expanders

Answer 16

commercially available inflatable balloons that are placed beneath the skin near the site of a proposed defect. slowly inject saline into the ballon

Question 17

What are relaxing incisions?

Answer 17

incisions that are made to relieve tension on the wound closure. They are left open and heal by second intention. make sure to leave enough area that blood supply not compromized

Question 18

What are plasties?

Answer 18

incisional techniques that redistirbute tension away form a wound.

Question 19

When are plasties particularly important?

Answer 19

when they are located near a structure (eyelid, prepuce, anus) whose function will be disrupted if under tension)

Question 20

What is a V-Y plasty?

Answer 20

Close part of the pointed/rounded end so the final suture results in a Y. This relieves tension in the long axis and adds some tension in the perpendicular plane. Can do the opposite to get less tension in the perpendicular plane–sometimes done in pyloris

Question 21

What is z-plasty?

Answer 21

make a z shaped incision and switch the flaps. This moves the tension in a different direction

Question 22

What are Z-plasties often used for?

Answer 22

to release areas of skin that have contractures from healing of old wounds

Question 23

What is required for Z plasties to work well?

Answer 23

The Z top and base should be the same length as the centerline and the angle should be 60 degrees. The middle line is in orientation that want tension relief

Question 24

What is mechanical creep?

Answer 24

stretch out coiled colalgen fier helix and there is stress relaxation as the elastic fibers break down

Question 25

What is mechanical creep?

Answer 25

stretch out coiled collagen fiber helix and there is stress relaxation as the elastic fibers break down