Grafts & Flaps Flashcards
(35 cards)
What is reconstructive surgery?
restoration of form & function to those who have congenital & acquired deformities
- following trauma
- resection of a tumor
- congenital anomalies
What is aesthetic surgery?
- reshape the normal structure to improve patient’s appearance
- outcome parameter is the patient’s goals & satisfaction
- abdominoplasty (tummy tuck)
- mammoplasty
What is the reconstructive ladder?
1- secondary intention 2- primary intension 3- tertiary intension 4- split skin graft 5- full thickness graft 6- tissue expansion 7- random flap 8- axial flap 9- free flap
What are the types of grafts?
AUTOGRAFT: from same person
ISOGRAFT: identical twins
ALLOGRAFT: from man to man
XENOGRAFT: from animal to man
what are the requirements for skin grafting?
- good blood supply (GRANULATION TISSUE)
- no infection
- no necrotic tissue
What are the types of skin grafts?
PARTIAL THICKNESS: SSG or Thiersch graft
FULL THICKNESS: Wolfe graft
after wide excision in malignancy, removal of full epidermis + part of the dermis from the donor was required. What is this procedure called?
Partial thickness graft
What are the indications of a partial thickness graft?
- well granulated ulcer
- clean wound or defect
- after surgery to cover defect created
What are the contraindications for a partial thickness graft?
- infected wound
- can’t be done over, BONE, TENDON, CARTILAGE, or JOINT
What are the steps of taking a partial thickness graft?
- Donor area is dressed for 10 days
- Recipient area is scraped well & the graft is placed after making window cuts in it to prevent seroma
- graft is fixed & tie-over dressing in placed
What are the disadvantages of a partial thickness skin graft?
- contracture
- seroma & hematoma can prevent graft take up
- infection
- loss of hair growth
- blunting of sensation
- dry scaling of skin due to nonfunctioning sebaceous glands (anhidrosis)
- graft failure
- can’t be used on soles of hand & feet
What are the advantages of using partial thickness grafts?
- technically easier
- wide area can be covered
- graft take up is better
- donor area heals on its own
What do we use to remove the epidermis + full dermis, and what are the locations we could graft it at?
SCALPEL BLADE used to remove full thickness
used in:
- face
- eyelid
- over joints
- hands & fingers
What do we use to remove the epidermis + full dermis, and what are the locations we could graft it at?
SCALPEL BLADE used to remove full thickness
used in:
- face
- eyelid
- hands & fingers
What are the most common donor areas for a full thickness graft?
- post auricular
- supraclavicular
- groin crease
What are the advantages of full thickness grafts?
- good color match (especially for face)
- sensations are felt better than partial
- functions of sebaceous glands & hair follicles are retained better
- functional & cosmetic results are better
What are the disadvantages of a full thickness graft?
- used only in small areas
- wider donor area has to be covered with SSG to close the defect
- can not be used to cover ulcers
What is a flap are what are its parts?
transfer of donor tissue with its blood supply to the recipient area
parts: base, pedicle, tip
What are the indications of flaps?
- cover wider deeper defects
- cover bone, tendon or cartilage
- if skin graft repeatedly fails
What are the advantages of skin flaps?
- good blood supply & take up
- gives bulk, texture, & color to the area
- allows required movements in recipient area
- cosmetically better
What are the disadvantages of flaps?
- long term hospitalization
- infection
- kinking, rotation & flap necrosis
- staged procedure
What is the classification of flaps?
PATTERN OF BLOOD SUPPLY
COMPONENTS
SITE OF INSERTION
What are the types of flaps based on pattern of blood supply?
RANDOM
- subdermal plexus of blood vessels
- rectangular flap has to have 1:1 or < 1.5:1 ratio so flap necrosis doesnt occur
AXIAL
- superficial vascular pedicles pass along their long axis (main artery is used)
- anatomically known blood vessel is supplying it
- long lengthy flap
What are the types of flaps based on their components?
CUTANEOUS
- forehead flap
- deltopectoral flap
FASCIOCUTANEOUS
- radial forearm flap
MUSCLE
- gracilis (sphincter or face reconstruction)
MYOCUTANEOUS
- latissimus dorsi
OSTEOMYOCUTANEOUS
