9: Plastic Surgery - Smith Flashcards Preview

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Flashcards in 9: Plastic Surgery - Smith Deck (21)
1

what are relaxed skin tension lines?

- natural lines of wrinkling of skin
- incisions should be made parallel to RSTL

2

what are langer lines/cleavage lines?

- determined by making skin biopsies and determining direction of collagen
- cut in direction of lines

3

define angiosome

blocks of tissue that are fed by source arteries

4

how many angiosomes in foot?

six**( distinct angiosomes in foot originating from three*** main arteries and their branches with direct arterial-arterial connections

5

angiosome location
- heel
- instep
- lateral midfoot and forefoot
- lateral anterior upper ankle
- plantar heel
- anterior ankle and dorsum of foot

- calcaneal branch post tib
- medial plantar a
- lateral plantar a
- anterior perforating
- calcaneal branch
- ant tib/ dorsalis pedis

6

"skiving"

cutting skin on angle
- incisions should be made perpendicular to skin with counterpressure
- incisions should be through the dermis in an even stroke

7

should there be tension on a wound closure?

nope!
- undermining and mobilization techniques can help make the skin more mobile

8

advantages and disadvantages of using a local flap

+ match skin color, texture, hair growth and thickness
- vascular compromise, handle with care

9

V-Y flap (gives longitudinal length)

- advancement flap
- v shaped incision
- sides of v advanced
- closed wound resembles a Y
- can be used for skin contractures (also joint contracture MPJ, scar tissue, excision of skin lesion)

10

Y-V flap (gives perpendicular to incision length)

- advancement flap
- Y shaped incision
- V portion advanced
- closed wound resembles a V
- used to release tension at right angle to y-v, scar tissue

11

V-Y island flap

move an entire V to cover an excised area closing the apex of V to create a Y shape

12

Z skin plasty

- rotational flap
- z skin incision
- transpose arms of z to lengthen skin and relieve tension
- lengthen along longitudinal axis and shortening along transverse axis

13

what determines amount of lengthening in z skin plasty

based on angle of the triangles and the length of the central arm

30 degrees - 25% increase
45 - 50
60 - 75
75 - 100

14

split thickness vs. full thickness skin graft

split = epidermis and portion of dermis
full = epidermis and all of dermis (better color, sensation, etc, but the complications are riskier)

15

thinner grafts in comparison to thicker grafts

- take better
- contract more
- more hyperpigmentation
- more susceptible to trauma

16

15 scalpel blade thickness =

0.015 inch

17

why mesh a skin graft?

- prevention of hematoma and seroma
- better contact b/w graft and wound
- coverage of larger wound
- crisscross scar

18

purpose of stent dressing with xeroform and saline soaked cotton balls

prevents motion or shearing of graft

19

3 phases of skin graft healing ***

- plasmatic imbibition (48 hrs, nutrition)
- inosculation (capillary growth and budding, 4-7 d)
- venous and lymphatic drainage (6th d)

*** why we need strict elevation 5-7 days and elevation

20

bacteria that produce enzymes that eat graft

pseudomonas and beta-hemolytic strep

21

4 common skin graft complications

- hematoma
- infection
- seroma
- shearing

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