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Flashcards in Principles of wound reconstruction Deck (38)
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1
Q

elective incisional wound

A

shouldn’t present problem in closure is wound is closed the same direction it was made
closure in different orientation sometimes used in reconstruction e.g z-plasty

2
Q

elective excisional wound

A

can cause large skin deficit, can be a challenge to close
usually closed immediately following the excicion + plans for reconstruction needed prior to surgery for preparations to be made

3
Q

traumatic wounds

A

potential for contamination must be addressed

need plans for reconstruction before surgery

4
Q

options for wound closure

A

primary closure
delayed primary closure
secondary closure
second intention healin

5
Q

choice of technique for wound closure - factors

A
patients physical statues
wound contamination
soft tissue damage
vascularity of tissues
amount of adjacent tissue available for closure
6
Q

aim of wound reconstruction

A
complete + durable wound closure
wound healing in shortest possible time
minimal discomfort
minimal morbidity e.g adequate limb function
cosmetic appearance
7
Q

planning wound reconstruction

A

evaluate inherent elasticity of local skin
identify skin tension lines + their likely effect
position + importance of local structures
location of adjacent direct cutaneous arteries
previous surgical or traumatic wounds in the region
evaluation of viability + vascularity of local skin

8
Q

closure of edges

A

delayed/primary closure

9
Q

mobilisation of local skin

A

suture techniques

skin-streching

10
Q

mobilisation of adjacent skin

A

subdermal plexus flaps

axial pattern flaps

11
Q

mobilisation of distant skin

A

distant in/direct flaps

12
Q

use of free skin grafts

A

partial/full thickness graft

13
Q

second intention healing

A

contraction + epithelialisation

14
Q

tension relieving techniques

A

maximise available skin - patient positioning
change local skin tension - geometric closure patterns
change regional skin tension - skin-directing
mobilise local skin - undermine skin
increase local skin - skin stretching
distribute tension - walking sutures
overcome tension - tension sutures + stents

15
Q

excessive tension

A

compromised circulation
slow wound healing
dehiscence
distortion of anatomic areas

16
Q

effect of tension on closure of skin wounds

A

wounds made parallel to tension lines close + have minimal tension
wounds perpendicular to tension lines gape + have greater tension
wounds made at oblique angle to tension lines form rhomboid wound

17
Q

patient positioning

A

patient should be suitably positioned depending on the site of surgery
ease of access to loose, available skin

18
Q

management of dog-ears

A

raised areas of skin after wound closure

can be removed to improve cosmetics of the wound but flatten over 6-8 weeks naturally

19
Q

triangle wound

A

3-point closure - Y shaped

20
Q

square wound

A

centripetal closure - X shaped

21
Q

rectangular wound

A

centipetal closure - double Y shaped wound

22
Q

undermining skin edges

A

simplest technique to release tension
skin is relieved from underlying attachments - allow inherit elastic properties to be used
care taken to avoid trauma to subdermal plexus + direct cutaneous arteries

23
Q

planes for undermining skin - cutaneous muscle present

A

undermine below muscle

24
Q

planes for undermining skin - cutaneous muscle not present

A

undermine in loose fascia below

25
Q

planes for undermining skin - skin associated with muscle

A

undermine below muscle fascia`

26
Q

skin stretching - pre-suturing

A

vertical mattress tension sutures used to imbricate normal skin either side of a lesion
sutures removed after time+ lesion excised using extra skin to achieve wound closure
simple + cheap but needs 2 operations

27
Q

skin stretching - skin stretchers

A

externally applied, non-invasive, adjustable devices that can stretch skin adjacent to + distant from the wound
stretching not immediately next to the wound allows for more gains than pre-suturing
cables crossing the wound can also hold dressing in contact with the wound

28
Q

skin stretching - skin expanders

A

silicone elastomer bag connected by tube to self-sealing implantable injection port
put under skin and slowly expanded with sterile saline

29
Q

walking sutures

A

simple + effective adjunctive method
static effect distributes tension over wide area
dynamic effect moves skin towards wound edges

30
Q

tension sutures

A

overcome tension in a wound
can be sole suture pattern or secondary retention sutures
retention, stay or echelon sutures consist of second suture line at distance from primary incision to reduce tension

31
Q

tension-relieving incisions - relaxing or release incisions

A

incision created parallel to long axis of a wound to ease closure
incisions may be singe, 1 either side of wound, double, or multiple
if skin mobility allows, secondary defect may be closed primarily

32
Q

relaxing incision for primary closure

A

incision placed adjacent + parallel to primary wound to allow intervening skin to close the defect
indicated when allows primary closure of main wound
in some cases skin elasticity will allow closure of secondary wound also

33
Q

multiple puncate relaxing incisions

A

multiple stab incisions in staggered rows parallel to primary wound
release tension + allow primary wound closure
left to heal by 2nd intention
indicated primarily for closure of wounds on the extremities

34
Q

relaxing incision for skin flaps

A

tension may prevent skin flap from being used
incisions in flap or adjacent tissue may be used to relieve this tension
incisions in adjacent skin are preferred as vascularity of flap not compromised
careful to avoid regional direct cutaneous artery
other procedures(V-Y + Z-plasty) should also be considered

35
Q

advancement flaps

A

limited to areas where there’s lose skin
additional skin made available for wound closure by making use of skin elasticity - no new skin moved into the wound
these flaps developed so that they advance parallel to lines of skin tension
skin tension may cause dehiscence or distort recipient wound

36
Q

transposition flaps

A

rectangle flap made within 90 degrees of long axis of defect
1 long edge of the flap shared by defect to be closed
loss of length of flap + incr likelihood of dog-ear development with incr are of rotation
90 degree transposition most useful + 180 dgree is max possible
measurements critical for closure of both sites
90 degree flap aligned parallel to lines of greatest tension which aids development of larger flap + helps transverse closure of donor site

37
Q

rotating flaps

A

arc of skin which shares common border with triangle defect
if planned properly, no secondary donor site defect created
skin from stretching (advancement) + moving adjacent skin (transposition)
no advantage over transposition flap but good for triangle defects
length of incision needed approx 4x length required to rotate the flap to cover the defect
incision progressively developed with undermining until flap cover defect

38
Q

flank folds

A

loose skin of axilla + flank fold used for reconstruction in these regions
fold of skin can be left attached to the limb + used for reconstruction of the limb, or can be left on the flank + used on the flank