Reconstructive surgery (Yr4)

Question 1

what are halsteads principles of surgery?

Answer 1

gentle tissue handling
meticulous haemostasis
preservation of blood supply
strict asepsis
minimal tension
accurate tissue apposition
obliteration of dead space

Question 2

how can tension of wounds be managed?

Answer 2

undermining/advancing skin
walking sutures
tension relieving suture patterns
relaxing/releasing incisions (multiple puntate relaxing incisions, Z plasty)

Question 3

what are some tension relieving suture patterns?

Answer 3

alternative wide and narrow simple interrupted
vertical or horizontal mattress slightly further away from the tissue edge
far-near-near-far
far-far-near-near

Question 4

what can be used to avoid trauma in tension relieving suture patterns?

Answer 4

soft rubber tubing or buttons to prevent sutures cutting through the skin

Question 5

how should elliptical incisions be closed?

Answer 5

place sutures further apart along the long edge
progressively placing sutures halfway along each section
(both of these will prevent a dog ear)

Question 6

how should triangular, rectangular or square defects be closed?

Answer 6

start from the corners and proceed to the centre

Question 7

what are the desired features of a skin flap?

Answer 7

avoid narrow base or flap being too long (should not exceed 3:1 length:width ratio)
undermine below panniculus
should be slightly larger than the defect its covering

Question 8

what is the difference between a subdermal plexus flap and a axial pattern flap?

Answer 8

subdermal… get blood supply from subdermal plexus and distant direct cutaneous arteries
axial pattern… incorporate a specific large cutaneous artery or vein into the flap

Question 9

should a surgical drain be removed when no fluid is being produced?

Answer 9

should always produce a small volume of fluid so this typically means the drain is blocked