Advanced wound closure Flashcards
(15 cards)
What is a skin graft, and what does graft survival depend on?
A skin graft is a segment of epidermis and dermis completely removed from the body and transferred to a recipient site, rendering it temporarily without vascular or nervous supply. Graft survival depends on the re-establishment of vascular supply through engraftment (‘take’).
What are the indications for skin grafts in veterinary wound management?
Skin grafts are indicated for major skin loss, primarily to close distal limb defects where loose skin is insufficient, and occasionally for large trunk wounds. Patient and wound health must be optimised beforehand.
Name different types of skin grafts used in veterinary surgery.
Types include full thickness grafts, split thickness grafts, pinch/punch/seed island grafts, strip grafts, stamp grafts, and paw pad grafts.
What are common causes of skin graft failure?
Common causes include graft separation due to fluid accumulation, infection causing exudate accumulation or fibrin dissolution, and movement disrupting early vascular connections.
What are axial pattern flaps and why are they advantageous?
Axial pattern flaps include direct cutaneous vessels that support reliable blood flow to a defined tissue region (angiosome). Advantages include ability to close large defects, reliable survival, and one-stage procedures without special equipment.
List disadvantages and complications of axial pattern flaps.
Disadvantages: variable cosmesis, limited use on distal limbs, patient anatomy-dependent, technically challenging. Complications: infection, seroma/hematoma, dehiscence, flap tip necrosis, each requiring specific preventive and treatment measures.
What are examples of axial pattern flaps used in veterinary medicine?
Examples: angularis oris, superficial temporal, caudal auricular, thoracodorsal, deep circumflex iliac (dorsal and ventral), cranial/caudal superficial epigastric, genicular, reverse saphenous conduit, and more.
How should flap tip necrosis be monitored and managed?
Monitor subjectively by color and warmth, and objectively (rarely) with laser Doppler or fluorescein. Management includes debridement, tension relief, antibiotics if infected, and supportive nursing with movement restriction.
What are subdermal plexus flaps and how do they survive?
Subdermal plexus flaps are large, readily available skin flaps elevated deep to the subdermal plexus and used to fill a defect. They survive by maintaining vascular support through collateral connections to the adjacent skin’s subdermal plexus. Success depends on sound decision-making, cutaneous physiology, wound healing factors, and skin elasticity, mobility, and tension.
List the types of subdermal plexus flaps.
Types include: Advancement flap, Rotation flap, Transposition flap, Interpolation flap, Plasty, Distant flap, Composite flap.
What are common complications of subdermal plexus flaps and how can they be managed?
Complications include infection (managed via decontamination, debridement, and antibiotics), seroma (aspiration, dressings, drains), skin edge dehiscence (managed by reducing tension and improving flap adherence), and necrosis (caused by inadequate perfusion, managed by debridement and reassessment).
What are axial pattern flaps and their advantages?
Axial pattern flaps are skin flaps based on direct cutaneous vessels and can be either peninsular or island flaps. Advantages include the ability to close large defects, reliable blood supply, placement over bone/tendon/ligament, and higher survival compared to random flaps.
What are the complications of axial pattern flaps and their prevention/treatment strategies?
Complications include infection, seroma/hematoma, dehiscence, and flap tip necrosis. Prevention involves proper surgical technique, haemostasis, planning, and care. Treatment may require debridement, antibiotics, dressings, drains, and exercise restriction.
Describe the process and phases of skin graft engraftment.
Skin graft engraftment includes adherence, plasmatic imbibition, inosculation, revascularisation, and reinnervation. These phases re-establish circulation for nutrient delivery and waste removal, essential for graft survival.
What are the common causes of skin graft failure and how can they be prevented or managed?
Causes include fluid accumulation, infection, and movement. Prevention includes meshing, NPWT, drainage, appropriate bandaging, and infection control. Management may involve drainage, topical treatments, and limiting movement.
