Wound Reconstruction

Question 1

When making incisions should we cut parallel or perpendicular to perpendicular to skin incison lines?

Answer 1

• Should aim to cut parallel to these incision lines (think about the zebra analogy)

Question 2

Describe the blood supply to the skin and the clinical significance of it:

Answer 2

• Panniculus muscle is innervated by the deep or subdermal plexus
• Blood supply is associated with panniculus layer – it is an important landmark as subdermal plexus runs superficial and deep – hence skin should be undermined beneath the panniculus layer

Question 3

Briefly explain what is involved in undermining skin and when the technique should be used:

Answer 3

Uses:

• Used when there is a lot of mobile skin

Technique:

1. Involves blunt dissection of the skin (below the panniculus layer - allows for preservation of the blood supply)
2. Use a combination of walking sutures and tension relief techniques to bring the skin to apposition

Question 4

Name the technique that is shown below and suggest a potential issue with this style:

Answer 4

• Centripedal suturing technique - puts alot of tension in the centre (this is where it fails)
• The success to this technique relies on having no tension in the centre

Question 5

You are suturing up a dog and you get to the edge and you have “dog ears” as shown below what is a potential solution?

Answer 5

• Make a triangle or an ellipse at the end and then close it

Question 6

What are the two main methods of classifying a flap?

Answer 6

1. Blood supply - random cutaneous or direct cutaneous artery (axial pattern)
2. Location - local or distant

Question 7

Describe how a simple advancement flap is performed (include the blood supply in answer):

Answer 7

• Make incisions perpendicular to the incision - no secondary defect is created - involves a random cutaneous blood supply
• Utilises loose skin at the wound edge

Question 8

Name the type of flap that is shown below:

Answer 8

• 2 flaps = H-plasty

Question 9

What type of flap should be used for the defect below?

Answer 9

• Rotation skin flaps

Question 10

What is the name of the skin flap techhnique shown below and what blood supply does it use?

Answer 10

Single pedicle advancement flap:

• Random cutaneous blood supply (creates a secondary defect - close or heal by secondary intention)

Question 11

What is the name of the technique that is shown below?

Answer 11

An example of a bipedicle advancment flap

Question 12

What is the name of the technique that is shown below?

Answer 12

• Transposition flap

Question 13

What is the name of the technique that is shown below and what blood supply is used?

Answer 13

Axilla and inguinal “flank” flaps:

• Utilises a random blood supply - thoracodorsal a. (axilla) and deep circumflex iliac a. (flank)

Question 14

Explain the procedure that is involved in a distal skin flap:

Answer 14

• Area over lateral thorax is created, and skin is elevated ⇒ wound area of interest of the distal limb is placed next to flap and is sutured over the defect ⇒ limb is bandaged in this location + changed frequently
• Multiple procedures are required + time consuming to perform

Question 15

What is an axial pattern skin flap and what are the advantages and disadvantages of them?

Answer 15

• Skin flap that included a direct cutaneous artery and vein into its base
• Advantage is they cover large defects in one procedure and create a full thickness well vascularised flap
• Limitations: requires good knowledge of landmarks for flaps

Question 16

What are the stages of acceptance that are involved with skin grafts?

Answer 16

Question 17

When doing free skin grafts what are some important consideration for the preparation of the graft bed and the donor site?

Answer 17

Graft bed:

• Vascular
• Smooth surface
• Free from infection!!

Preparation of the donor site:

• Aseptic preparation

Question 18

What are the advantages and disadvantages of meshing the graft?

Answer 18

• Advantages: stops dead space filling up and separate from wound bed affecting success, allows stretching to fill a larger area
• Disadvantages: poor cosmetic appearance of the mesh

Question 19

What is the name of the graft shown below?

Answer 19

Free skin graft - seed grafts

Question 20

What are the two main types of axial pattern skin flaps?

Answer 20

• Omocervical
• Thoracodorsal