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Surgery M4 part 1 > Grafts & Flaps > Flashcards

Grafts & Flaps Flashcards

1
Q

What is reconstructive surgery?

A

restoration of form & function to those who have congenital & acquired deformities

  • following trauma
  • resection of a tumor
  • congenital anomalies
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2
Q

What is aesthetic surgery?

A
  • reshape the normal structure to improve patient’s appearance
  • outcome parameter is the patient’s goals & satisfaction
  • abdominoplasty (tummy tuck)
  • mammoplasty
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3
Q

What is the reconstructive ladder?

A 
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
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4
Q

What are the types of grafts?

A

AUTOGRAFT: from same person
ISOGRAFT: identical twins
ALLOGRAFT: from man to man
XENOGRAFT: from animal to man

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5
Q

what are the requirements for skin grafting?

A
  • good blood supply (GRANULATION TISSUE)
  • no infection
  • no necrotic tissue
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6
Q

What are the types of skin grafts?

A

PARTIAL THICKNESS: SSG or Thiersch graft

FULL THICKNESS: Wolfe graft

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7
Q

after wide excision in malignancy, removal of full epidermis + part of the dermis from the donor was required. What is this procedure called?

A

Partial thickness graft

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8
Q

What are the indications of a partial thickness graft?

A
  • well granulated ulcer
  • clean wound or defect
  • after surgery to cover defect created
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9
Q

What are the contraindications for a partial thickness graft?

A
  • infected wound

- can’t be done over, BONE, TENDON, CARTILAGE, or JOINT

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10
Q

What are the steps of taking a partial thickness graft?

A
  • 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
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11
Q

What are the disadvantages of a partial thickness skin graft?

A
  • 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
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12
Q

What are the advantages of using partial thickness grafts?

A
  • technically easier
  • wide area can be covered
  • graft take up is better
  • donor area heals on its own
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13
Q

What do we use to remove the epidermis + full dermis, and what are the locations we could graft it at?

A

SCALPEL BLADE used to remove full thickness

used in:

  • face
  • eyelid
  • over joints
  • hands & fingers
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13
Q

What do we use to remove the epidermis + full dermis, and what are the locations we could graft it at?

A

SCALPEL BLADE used to remove full thickness

used in:

  • face
  • eyelid
  • hands & fingers
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14
Q

What are the most common donor areas for a full thickness graft?

A
  • post auricular
  • supraclavicular
  • groin crease
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15
Q

What are the advantages of full thickness grafts?

A
  • 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
16
Q

What are the disadvantages of a full thickness graft?

A
  • 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
17
Q

What is a flap are what are its parts?

A

transfer of donor tissue with its blood supply to the recipient area

parts: base, pedicle, tip

18
Q

What are the indications of flaps?

A
  • cover wider deeper defects
  • cover bone, tendon or cartilage
  • if skin graft repeatedly fails
19
Q

What are the advantages of skin flaps?

A
  • good blood supply & take up
  • gives bulk, texture, & color to the area
  • allows required movements in recipient area
  • cosmetically better
20
Q

What are the disadvantages of flaps?

A
  • long term hospitalization
  • infection
  • kinking, rotation & flap necrosis
  • staged procedure
21
Q

What is the classification of flaps?

A

PATTERN OF BLOOD SUPPLY
COMPONENTS
SITE OF INSERTION

22
Q

What are the types of flaps based on pattern of blood supply?

A

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
23
Q

What are the types of flaps based on their components?

A

CUTANEOUS

  • forehead flap
  • deltopectoral flap

FASCIOCUTANEOUS
- radial forearm flap

MUSCLE
- gracilis (sphincter or face reconstruction)

MYOCUTANEOUS
- latissimus dorsi

OSTEOMYOCUTANEOUS

24
Q

What are the types of local flaps?

A

ROTATIONAL FLAP
- rotated laterally

TRANSPOSITIONAL FLAP
- square rotated laterally but may need SSG to cover it

Z-PLASTY
- lengthens contracted scar

25
Q

What is a free flap & what are its disadvantages?

A
  • vascular pedicle is cut & anastomosed with recipient site vessels

DISADVANTAGES

  • complex surgical technique
  • failure involves total loss of all transferred tissue
26
Q

What is an island flap?

A
  • flap has long pedicle that is rotated and buried underneath skin bridge
27
Q

What is a saltatory flap?

A

mobilizing the flaps in stages from distant donor area towards recipient area
- requires many staged surgeries & long term hospitalization

28
Q

What is a Waltzing flap?

A

flap is moved from donor area & attached adjacent to the recipient defect area

  • later in 2nd stage it is moved towards the defect formally
  • reduces the tension on the flap & increases success rate
29
Q

What are the most commonly used flaps?

A
  • deltopectoral flap
  • latissimus dorsi muscle
  • groin flap
  • pectoralis major myocutaneous flap
  • transverse rectus abdominis muscle flap (TRAM)
30
Q

Where is the deltopectoral flap used & what is its blood supply?

A
  • in neck & lower face

- 2nd perforator of internal mammary artery

31
Q

What is the blood supply of latissimus dorsi flap?

A

myocutaneous flap using thoracodorsal artery

32
Q

What artery is used in groin flaps?

A

superficial circumflex iliac artery

33
Q

Where is the pectoralis major myocutaneous flap used?

A

island flap used to cover defects over CHEEK/NECK/PHARYNX/INTRAORAL lesions

34
Q

What is the blood supply used in TRAM flaps & what do they cover?

A
  • if superior pedicle: superior epigastric vessels (cover chest wall defect or postmastectomy area)
  • if inferior pedicle: inferior epigastric vessels (cover groin & thigh defects)

Surgery M4 part 1 (47 decks)

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