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Flaps Flashcards

1
Q

Sartorius

A

Type four, superficial femoral artery and vein

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2
Q

Gastrocnemius muscle

A

Sural Arteries type one

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3
Q

Lateral arm flap

A

Posterior radial collateral
Pedicle is located through the lateral intermuscular septum between the brachialis and the lateral head of the triceps

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4
Q

Radial forearm flap pedicle

A

Between brachial radialis and FCR

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5
Q

Gracilis

A

Type two
Medial femoral circumflex
Superficial femoral

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6
Q

Rectus femoris

A

Lateral femoral circumflex artery

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7
Q

Groin flap

A

Superficial circumflex iliac

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8
Q

Gluteal Thigh flap

A

Inferior gluteal

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9
Q

What nerve provides sensation to the lateral arm flap

A

Posterior brachial cutaneous

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10
Q

Triangular space boundaries

A

Teres minor
Major
Long head of triceps

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11
Q

What does the saphenous artery originate from?

A

Genicular

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12
Q

Deltopectoral flap

A

First, second and third perforating branches of the internal mammary artery

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13
Q

Posterior thigh flap

A

Involves the biceps femoris, semi tendinosis and semimembranosus
Inf gluteal artery
Profunda femoris

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14
Q

Latissimus dorsi

A

Thoracodorsal
Type five

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15
Q

Soleus

A

Popliteal
Type 2

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16
Q

External oblique

A

Lateral cutaneous branches of the inferior eight posterior intercostal arteries

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17
Q

Quadrangular space

A

Long head of triceps
humerus
Teres minor
Teres major

Contains the posterior circumflex, humeral vessels, and axillary nerve

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18
Q

Pec major

A

Type V
Pectoral branch of thoracoacromial artery

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19
Q

Abductor digiti minimi

A

Deep Palmer artery from ulnar artery

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20
Q

Reverse sural flap

A

Median superficial sural artery
Distal perforating branches of the peroneal

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21
Q

Medial plantar perforator flap

A

Septum between abductor hallucis and flexor digitorum brevis

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22
Q

Soleus

A

The proximal muscle is supplied by branches of the perineal artery, and the distal muscle is supplied by the posterior tibial artery perforators

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23
Q
A
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24
Q

What is the salvage rate for flaps that require re-exploration for ischemia?

A

50 to 85%

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25
What is the maximum warm ischemia time tolerated by bone flaps?
Less than three hours
26
What is the maximum warm ischemia time tolerated by skin and fascio cutaneous flaps?
4 to 6 hours
27
What is the warm ischemia time tolerated by jejunal flaps?
Less than two hours
28
Mechanism of action of Papaverine
It is an opium alkaloid drug that inhibits phosphodiesterases leading to increase levels of cyclic AMP
29
How long before a pseudo intima forms at the anastomosis site
Five days
30
31
What does heparin do?
Inhibit antithrombin three which inhibits thrombin, and it also inhibits the conversion of fibrinogen into fibrin
32
How does aspirin prevent platelet aggregation?
Inhibits endothelial Cox pathway with subsequent blockage of thromboxane A2
33
What are risk associated with using streptokinase?
Bleeding and hematoma It is antigenic and can result in an allergic response Can also cause a lytic state which will cause diffuse bleeding when administered in high doses
34
What nerve provides sensation to the lateral arm
Posterior brachial cutaneous
35
The fibula and radial forearm Osteo cutaneous flap can provide how much length of bone
Fibula can provide 25 cm Radius can provide 10 cm
36
What is the source of free radicals in the ischemic flap?
Xanthene oxidize
37
What is the blood supply of the Delto pectoral flap?
First, second and third perforating branches of the internal mammary artery
38
Where does the gluteus maximus insert?
Greater trochanter of the femur
39
What are the boundaries of the quadrilateral space?
Teres minor superiorly Teres major inferior Humerus lateral Long head of triceps medial Posterior circumflex, humeral vessels and axillary nerve travel here
40
What is the blood supply of a nasolabial flap?
Angular artery from the facial artery
41
Blood supply of the Abductor digiti minimi flap
Deep Palmer artery from the ulnar artery
42
Blood supply to the reverse sural flap
Peroneal artery more distally and the posterior tibial artery
43
What is the origin of the TFL flap?
Anterior 5 cm of the outer portion of the iliac crust and ASIS
44
What is the course of the radial collateral artery to the lateral arm flap?
Through the lateral intermuscular septum between the brachialis and lateral head of the triceps muscle
45
Thoracodorsal perforator flap nerve branch
Lateral branch of intercostal nerve
46
What recipient vessel should not be used in breast reconstruction with an S gap flap
The axillary vessels because the pedal length is often insufficient
47
What is the benefit of a thoracodorsal flap over scapular and parascapular?
It is a longer pedicle and relatively thinner subcutaneous tissue
48
List the advantages of the medial sural artery perforator flap
Thin impliable Less hair bearing Long and sizable vascular pedicle Volume can be adjusted by the inclusion of part of the gastrocnemius muscle Plantaris tendon can be harvested at the same time Two team approach
49
What is the location of the deep circumflex iliac perforator artery
One to 2 cm above the iliac crust and 5 cm behind the ASIS
50
What perforator flaps can be harvested as a chimeric flap
ALT Thoracodorsal MSAP PAP
51
Describe the types of Venous flaps
Type one is unipedicled or a pure venous Type two has an inflow and outflow vein Type three the inflow has become arterialized and there is an outflow
52
What is pre-lamination
A flap is surgically altered by partial elevation, manipulation of the structure and incorporation of other tissue layers at the first stage to create a specialized composite flap This is how nasal reconstruction is done
53
What is pre-fabrication
A new dominant vascular pedicle is buried in the new flap territory and six weeks later the flap is elevated and based on the new pedicle
54
What metabolic factors act as vasodilators
Acidosis Hyperkalemia Hypoxia Hypercarpnia
55
Which antigens are the most immunogenic?
MHC In humans, these are HL A’s Class one are exposed on all nucleated cells Class two are only expressed on antigen presenting cells like lymphocytes, monocytes, macrophages, dendritic cells, endothelial cells, and activated T cells
56
Describe acute rejection
Within weeks to months following a transplant The donor APCs migrate to the host lymphoid tissue and activate T cells, which then migrate to the graft and mediate rejection
57
What tissue types are least antigenic
Cartilage and tendon are the least Bone is less than skin and muscle
58
What immunosuppressive medication’s have not been shown to impaired wound healing
Anti-lymphocytes such as lymphocyte immune globulin, ATG and monoclonal antibodies against T cell receptors such as basaliximab
59
What are the important viral serology to crossmatch?
CMV Hepatitis B Hepatitis C HIV EBV
60
What is graft versus host disease?
This happens in bone marrow recipients The graft views, the tissues of the recipient as foreign and the T cells attack
61
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Board Review (8 decks)

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