Exam 2: Lecture 18: Principles of Reconstructive surgery Flashcards
Why is reconstructive surgery performed
- to close defects that occur secondary to trauma
- correct or improve congenital abnormalities
- or after removal of neoplasms
what is important to remember about reconstructive surgery
must select the appropriate technique or techniques to prevent complications and avoid unnecessary cost
what do we do to close large or irregular defects
we can use relaxing incisions or “plasty” techniques
what is a pedicle flap
tissues that are partly detached from the donor site and mobilized to cover a defect
what are grafts
involve transfer of a segment of skin to a distant site
what do we try to prevent during surgery
excessive tension, kinking, and/or circulatory compromise
what is hirudiniasis
attachment of a medical leech to the skin
when is hirudiniasis recommended
for tissues with impaired venous circulation
what is a significant risk of hirudiniasis
infection with aeromonas hydrophila
what are the 4 things we should consider when planning reconstructive surgery
- location of wound
- elasticity of surrounding tissue
- regional blood supply
- character of the wound bed (is there infection? is there granulation tissue?)
what happens if you appose incision edges under too much tension
it causes incisional discomfort and pressure necrosis that results in the suture cutting out and partial/complete incisional dehiscence
what are the 5 ways to reduce tension
- undermining wound edges
- selecting appropriate suture patterns
- using relief incisions
- skin stretching
- tissue expansion
T/F: animal is always positioned for surgery such that mobile skin is not pinned against the table or otherwise immobilized
true!! Use pads, flexing appropriate joints, avoiding excessive tension with table ties can accomplish this
how are tension lines formed
by the predominant pull of fibrous tissue within the skin
T/F: General lines of tension are mapped in animals and there are no variations
false! Variations based on breed, conformation, gender, and age
T/F: incisions should be made parallel to tension lines
true
what are the 4 things that are good to know about tension lines (sorry this is a long card)
- traumatic wounds should be closed in direction that prevents/minimizes tension
- wound edges should be manipulated before closure to determine which direction the suture line should run to minimize tension
- if tension is minimal, a wound should be closed in the direction of its long axis
- direction of closure should prevent/minimize created of “dog ears”, or puckers
T/F: parallel skin incision lines require more sutures for closure than perpendicular or oblique
FALSE! Perpendicular/oblique require more sutures for closure
how do you undermine skin adjacent to a wound
by using scissors to separate the skin or panniculus muscle or both from underlying tissues
what is this image showing
undermining skin adjacent to a wound
should we worry about bleeding during undermining
it is usually insignificant but excessive bleeding should be controlled with ligation or electrocoagulation
how do you prevent subdermal plexus injuries
by preserving as much blood supply as you can via an atraumatic surgical technique
what are some ways to use an atraumatic surgical technique
- cut skin with sharp scalpel instead of scissors
- avoid crushing instruments
- manipulate skin with brown-adson thumb forceps, skin hooks, or stay sutures
what things interfere with cutaneous circulation
- wound closure under excessive tension
- rough surgical technique
- division of direct cutaneous arteries
