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Flashcards in Tension and plasties Deck (25)
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What is the problem with tension?

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


What is never acceptable regarding tension?

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


What affects tension?

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


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

one that is parallel


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

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


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

towel clamps


What are 5 ways to manage tension on a wound?

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


What is undermining?

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


What are walking sutures?

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


Why must walking sutures only be used when necessary?

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


What are different methods of skin stretching?

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


What are different methods of skin stretching?

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


What is presuturing

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


What are adjustable sutures?

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


What are skin stretchers?

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


What are tissue expanders

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


What are relaxing incisions?

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


What are plasties?

incisional techniques that redistirbute tension away form a wound.


When are plasties particularly important?

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


What is a V-Y plasty?

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


What is z-plasty?

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


What are Z-plasties often used for?

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


What is required for Z plasties to work well?

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


What is mechanical creep?

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


What is mechanical creep?

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