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Flashcards in 78 Subdermal plex flaps Deck (24):

delayed phenomenon as it enhances tissue perfusion

initially perfusion will decrease after elevating and apposing an intended flap (decreases 10-40%)in 3 weeks perfusion is actually increased to 120-150% of normalfactors: alteration of sympathetic tone, dilation of chock vessels, reorientation of vessels, changes in tissue metabolism and neovascularization


difference btwn angiogenesis and vasculogenesis

angiogenesis--growth of micro vessels from existing capillary bedvasculogenesis--development of new vessels in situ from bone marrow derived endothelial progenitor cells


guideline for length of advancement flap

should be as long or preferably longer than the length of the wound to closea relaxing incision parallel to the wound should be as long as the wound or 1.5 x the length of the wound


guideline for width of advancement flap

should not be too narrowavoid converging incisions (wider tip than base)create wide base that is slightly wider than the overall width of the flap


types of sub dermal plexus flaps

LOCAL (adjacent to wound bed)1. advancement flap--single or bipedicle2. rotation flap--skin fold flaps3. transposition flap4. interpolation flap5. plasty (H, Z, V-Y)6. composite flaps (incorporate underlying structures)DISTANT 1. direct distant (pouch or hinge)2. Indirect distant (delayed transfer of a tube flap)


types and difference of rotating flaps

rotating flaps all pivot around a point and include1. rotation flaps--semicircular incision away from pivot point2. transposition flaps--share a common border with defect3. interpolation flaps---lack border with defect and need a bridging incision or tubed


types of advancement flaps

1. single pedicle (two incisions perpendicular to wound)2. bipedicle (one incision parallel to wound)rely on inherent elasticity of local skin to stretch over the defect


what is an H plasty

two single pedicle flaps from opposing directionbenefit is that flap length is reduced to maintain blood supply


main disadvantage of an advancement flap

bc it relies on the skins inherent elasticity that main disadvantage is that elastic RETRACTION and innate tension will be transmitted across the wound


skin fold flaps

subdermal plexus flap (elbow and flank fold common)rotation flapmust preserve one of any four attachments for adequate blood supplyattached dorsal and ventral trunk; medial and lateral upper limbin close proximity of lateral thoracic artery (elbow) and deep circumflex iliac artery (flank)


scrotal flap

subdermal plexus flap advancement flapharvest post neutermaintain plexus on the side opposite of the wound defectincise tunica dartos to enable scrotum to expandclose inguinal and perineal defects


preputial reconstruction

subdermal plexus flapadvancement flap--bipedicle with buccal mucosa


phalangeal fillet

subdermal plexus flaptransposition flapdigit amputation (digit 1) removing bone but maintaining skin, digital pad and blood supply


labial flaps

subdermal plexus flapcomposite/advancement flaprich blood supply from inferior and superior labial arteriesincision parallel to lip margin, full thicknesscheck that commissure is not too tight


lip to lid flap

subdermal plexus flapcomposite (mucocutaneous)/interpolation flap (needs bridging incision)close proximity of angularis oris artery


complications of sub dermal plexus flap

1. infection2. dehiscence3. seroma4. necrosis


causes of dehiscence in sub dermal plexus flaps

infectiontensionsurgical trauma (keep moist, minimal manipulation)flap necrosis poor blood supply (previous surgical attempts)


ways to prevent seroma

closed suction drainssoft compressive bandagerestrict vigorous exercise


morbidity associated with sub dermal plexus flaps before or after radiation therapy

HIGH (higher if radiation before because destroys fibroblasts and blood supply)62% dehisce35% necrosis27% infection


why does flap necrosis occur

when metabolic requirements of the skin exceed the capacity of sub dermal plexus perfusion--insufficient # of vessels--damage to blood supply during manipulation--thrombosis--decreased perfusion/oxygenation--self trauma--bandagesusually apparent within 2-3 days post op


two options for devitalized skin

-liquefactive necrosis-eschar (scab) may not separate from underlying tissues for up to 4 weeks


option to improve survival of flaps with marginal vascularity

hyperbaric oxygen therapyhyper oxygenated blood may stimulate fibroblasts and enhance revascularization


staging procedures to increase blood supply (delay phenomenon) should be delayed how long

~ 3 weeks


three methods to move tubed pedicle flap

1. caterpillaring (doubling up on itself)2. waltzing (lateral alternating)3. tumbling (direct advancement--most common)

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