Grafts

Question 1

different sizes of split thickess skin graft

Answer 1

thin: 0.008 to .012 “
intermediate: 0.013-0.016”
thick: 0.017-.02

Question 2

STSG vs FTSG have better take

Answer 2

STSG: there are more blood vessels in the superficial dermis thats transected which could aid in revasc. and has less tissue to support with blood supply

Question 3

graft with greater contraction

Answer 3

FTSGs have a greater amount of dermis and elastin, primary contracture is more significant in FTSG than STSG.

Secondary contracture is the shrinkage of the skin graft in the wound bed over time, caused by myofibroblasts. Secondary contracture is greater for STSGs than FTSGs,

Question 4

graft prone for hyperpigmentation

Answer 4

STSG

Question 5

more durable graft

Answer 5

full thickness

Question 6

better cosmetic

Answer 6

FTSG

Question 7

common complications for STSG

Answer 7

hematoma(most common)/seroma

infection-2nd most commonn: Group A strep, pseudomonas will prevent graft from adhering

shearing forcess

poor vascularity of exposed bones/tendons

Question 8

survival rate or STSG vs FTSG

Answer 8

5 days-Stsg, FTSG: 3 days

so if seroma or hematoma is present on STSG, it may still survive

Question 9

common donnor sites for FtSG

Answer 9

flexor creases: groin, poplitea fossa, inguina area, gluteal fold
“pinch” area- sinus tarsi

Question 10

3 phases of skin graft healing

Answer 10

plasmatic phases/imbibition: 24-48 hr
capillary budding, graft still ischemic - passively absorbs nutrients in wound bed by diffusion

inosculation: (48-72 hrs): capillary budding in contact with graft

angiogenesis/reorganization: day 5-new blood vessels grow into graft, graft become vascularized

Question 11

where on the flap retains vasculairty

Answer 11

base of flap: pedicle

Question 12

what type of graft has better function

Answer 12

thicker graft

Question 13

in order for the graft to “take”, what is important?

Answer 13

absence of motion, infection, hemostasis, stent dressings (dressing designed for skin graft to hold graft in place, apply pressure, and absorb fluid): adaptic, saline soaked gauzed, fluff, held by tie-over sutures securing of graft, wound vac

requires a vascular recipient site, cannot be placed over bone or tendon which has less vascularity

Question 14

isograft

Answer 14

graft of tissue between two individuals who are genetically identicial

Question 15

xenograft

Answer 15

a graft of tissue from one species used on another species

Question 16

what is the ratio of the full thickness skin graft in order for adequate closure

Answer 16

3:1 length to width: elliptical incision

Question 17

common donor sites for STSG

Answer 17

anterior/lateral thigh, upper inner arm, gluteal region, dorsum of foot

Question 18

limberg flap orientation

Answer 18

longitudinal axis is parallel to the line of minimal skin tension

Question 19

how much length will 45 deg and 60 deg z plasty get

Answer 19

45 deg: 50% length; 60 deg:75%

good for linear scar contractures

Question 20

what are the consequences if angles are less than 45 or more than 60 for z plasties

Answer 20

45 deg results in impaired blood flow to flaps

>60 deg: severe tension, extreme lengthening

Question 21

V-Y plasty placement, and length of the arm of the V

Answer 21

apex of V placed at the point of maximal tension; apex usually proximal in foot and distal skin is advanced

the arms of the V should be 1.5x the length of the wound/contracture/scar

Entire V may be undermined beneath superficial fascia for exposure

Question 22

V-Y plasty good for what type of contractures and allows for how much lengthening

Answer 22

V-Y are useful for lengthening contractures or in reducing contracted digits across the MPJs. Commonly treats overlapping 5th digits. Good for unidirection skin lengthening technique

20% increase in length

Question 23

the cincinnati incision is common for what procedure

Answer 23

soft tissue release for club foot

Question 24

indications for skin flap

Answer 24

1. Areas with poor vascularity (bare bone or tendon)
2. Reconstruction for full thickness
3. bad bony prominences

Question 25

rotational flap

Answer 25

semi-circular flap (ideally 1/2 circle) that is rotated pivot towards adjacent defect. Donor site is closed or grafted

Question 26

what type of flap is a Z-Plasty? length of arms?

Answer 26

1. Transposition of 2 triangular flaps 2. Make transverse central line parallel to the contracted skin 3. Arms of Z are EQUAL (all arm lengths are equal) with flap to tip angle 60 Degrees (can give about 75% increase in length)

Question 27

random pattern flap vs axial pattern flap

Answer 27

random pattern flap: lack a primary artery and vein and rely on perfusion of dermal-subdermal vessel from the pedicle of the flap (length to base ratio should be 1:1) (ie. local cutaneous flap) axial pattern flaps contain a primary artery and vein that are incorporated into pedicle of the flap. therefore, perfusion depends on axial artery rather than the width of the pedicle and cutaneous perfusion. (ie muscle flap)

Question 28

Rotational vs transpositional vs interpolational flaps vs advancement flaps

Answer 28

rotational flap: semicircular and rotated about a pivot point transpositional flap rotated about a point but are linear dimensions such as squares and rectangles interpolational flaps are rotated about a pivot point but flap must pass over or under intact tissue between donor and recipient sites. The defect is not immediately adjacent to defect advancement flap: fixed point that are stretched as donor tissue into recipient bed (ie bipedicle flap or V to Y flap)

Question 29

For a Y-V approach, what direction does the lengthening occur?

Answer 29

lengthening occurs perpendicular to the stem of the Y

Question 30

what type of flap is a a limberg flap? advantages to this flap

Answer 30

This is a random pattern, transpositional flap in a shape of rhombus. advantages to this flap is that it preserves a large amount of normal skin adjacent to the deficit that would otherwise been excised with a standard elliptic flap

Question 31

disadvantage of limberg procedure

Answer 31

skin must be mobile to prevent excessive tension across the flap and obtain closure to donor site.

Question 32

common donor sites for free vascularized flaps

Answer 32

latissimus dorsi, rectus abdominis, groin, gracilis, serratus anterior , radial forearm fasciocutaneous flap

Question 33

what types of flaps can be used to cover chronic osteomyelitis to increase blood perfusion to the area and availability of systemic antibiotics

Answer 33

Free muscle flaps

Question 34

what is the most common disadvantage /complication causing free flap failure

Answer 34

microvascular techniques is needed for reanastomosis because VENOUS or Arterial thrombosis/congestion are MAJOR causes of free flap failure technical skill and instrumentation needed

Question 35

when are muscle flaps useful

Answer 35

covering soft tissue defects when bulk, padding, and vascularity are needed to cover a wound

Question 36

Indication for Abductor digiti minimi muscle flap

Answer 36

lateral malleoli wound