9: Plastic Surgery - Smith Flashcards Preview

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

what are relaxed skin tension lines?

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


what are langer lines/cleavage lines?

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


define angiosome

blocks of tissue that are fed by source arteries


how many angiosomes in foot?

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


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



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


should there be tension on a wound closure?

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


advantages and disadvantages of using a local flap

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


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)


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


V-Y island flap

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


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


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


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)


thinner grafts in comparison to thicker grafts

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


15 scalpel blade thickness =

0.015 inch


why mesh a skin graft?

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


purpose of stent dressing with xeroform and saline soaked cotton balls

prevents motion or shearing of graft


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


bacteria that produce enzymes that eat graft

pseudomonas and beta-hemolytic strep


4 common skin graft complications

- hematoma
- infection
- seroma
- shearing

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