integumentary system Flashcards
1
Q
surgically created wound with no infection encountered
A
clean wound
2
Q
a wound where aseptic technique is maintains and no structures normally containing bacteria were opened
A
clean wound
3
Q
what type of wound is a surgically created one where you then notice there is a hole in your glove
A
clean contaminated
4
Q
surgically created wound but hollow viscus normally containing bacteria is opened but no contents are spilled
Minor break in technique occurs
or organ

A
clean contaminated
5
Q
T/F
a traumatic wound falls under dirty?
A
false – it is contaminated
6
Q
a surgical wound where a hollow viscous is opened with gross spillage
A
contaminated
7
Q
a wound that contains pus or the contents of a perforated hollow viscous
A
dirty wound
8
Q
the risk on infection doubles every _____
A
70-90 minutes
rule of thumb is every hour
most people use 90 min
9
Q
what do you do if you anticipate a surgery lasting longer than 90 minutes
A
antibiotic prophylaxis
10
Q
three major risk factors of infection
A
duration of surgery
number of people in room
dirty surgical site
11
Q
incidence of surgical infections in clean procedures
A
0 - 4.4%
12
Q
incidence of surgical infections in clean contaminated procedures
A
4.5 - 9.5%
13
Q
incidence of surgical infections in contaminated procedures
A
5.8 - 28.6%
14
Q
incidence of surgical infections in dirty procedures
A
this implies there will be infection
15
Q
most common source of operative wound infection
A
patients endogenous flora – especially the skin
16
Q
with implants - how long can a post surgery infection occur
A
30 days to 1 year later = due to biofilms on the implants
17
Q
how long before surgery should prophylactic antibiotics be started
A
30-60 min
18
Q
T/F
antibiotic prophylaxis is continued throughout surgery but does not exceed 24 hours
A
true
19
Q
how frequently is antibiotic prophylaxis given intraoperatively
A
every 90-120 minutes
20
Q
levels for cefazolin antibiotic prophylaxis
A
22mg/kg IV
21
Q
what is therapeutic antibiotics based on
A
culture and sensitivity which may take 48-72 hours so start and reasses later
22
Q
time line to give therapeutic AB
A
start before surgery and continue 2-3 days post op
23
Q
what types of procedures may require therapuetic AB
A
contaminated and dirty
24
Q
four stages of wound healing
A
inflammatory
debridement
repair
maturation
25
what is the lag phase of wound healing
the first 3-5 days because inflammation and debridement predominate and the wounds have not gained appreciable strength
26
a protective response initiated by tissue damage
inflammation
27
T/F
| the inflammatory phase of wound healing lasts 3-7 days
false 0-5
28
first response to any injury
hemorrhage
29
inflammatory phase of healing is characterized by...
increased permeability of local blood vessels
recruitment if circulatory cells
release of growth factors and cytokines
activation of neutrophils and macrophages
30
what will initiate the debridement phase of wound healing
WBC leaking from blood vessels into wounds
31
in the inflammatory phase how long does vasocontriction last
5-10 minutes = until it forms a fibrin clot
32
first responders at the inflammatory stage
PMNs then macrophages then T lymphocytes
33
this "glues the wound together" in the inflammatory stage
fibrin clot in vasoconstriction
34
how long is the debridement phase of wound healing
2-5 days
35
where does the debridement phase occur
in the wound bed
36
T/F
| neutrophils and lymphocytes are the cells essential for wound healing
FALSE
monocytes are
they become macrophges in the wounds in 24-48 hours
37
job’s are to prevent infection & phagocytize organisms & debris
neutrophils
38
Major secretory cells synthesizing growth factors that participate in tissue formation &
remodeling
monocytes
39
these cells arrive about 6 hours after wounding
neutrophils
40
these cells arrive about 12 hours after wounding
monocytes
41
these cells initiate debridement
monocytes
42
Facilitate breakdown of bacteria, extracellular debris/necrotic material & they stimulate monocytes
neutrophils
43
what are the three major roles of macrophages during debridement
1. Secrete collagenases removing necrotic tissue, bacteria & foreign material
2. Secrete chemotactic & growth factors
3. Macrophages also recruit mesenchymal cells, stimulate angiogenesis & modulate matrix production in wounds
44
direct macrophages to injured tissue
chemotactic factors
45
an initiate, maintain & coordinate formation of granulation tissue
growth factors
46
basic fibroblast growth factor comes from
macrophages, MCs, and T lymphs
47
epidermal growth factor comes from
platelets and macrophages
48
KGF - aka growth factor 7 comes from
fibroblasts
49
platelet derived growth factor comes from
platelets, macrophages, and endothelial cells
50
transforming growth factor comes from
macrophages, hepatocytes
| lymphocytes, and plts
51
what do macrophages do in the repair phase
stimulate fibroblast and DNA proliferation
52
how long does the repair phase last
3-5 days up to 2-4 weeks
53
Capillaries infiltrate wound behind fibroblast
angiogenesis
54
originate from undifferentiated mesenchymal cells in surrounding
connective tissue
fibroblasts
55
collagen production maxes out when
2-3 weeks post injury
56
T/F
| decreased oxygen tension in the wound will improve fibroplasia
FALSE -- it needs increased oxygen tension
57
environment preferred by fibroblasts
slightly acidic and pxygen rich (20mmHg)
58
Combination of fibroblasts, new capillaries & fibrous tissue development results in
the formation of bright red, fleshy granulation tissue ~ 3-5 days after wounding
true
59
special fibroblasts used in would contraction
myofibroblasts
60
granulation tissue is formed at the edge of a wound at a rate of ....
0.4 to 1 mm per day
61
when does epithelialization occur with suture wounds
in 24-48 hours
62
with an open wound what is required in order for epithelialization to occur
granulation tissue as a scaffold
usually takes 4-5 days
63
migration of epithelial cells is guided by...
collagen fibers
64
T/F
| epithilialization occurs faster over dry tissue
FALSE - faster over moist tissue and will NOT occur of nonviable tissue
65
why do wet-to-dry bandages delay re-epithelialization
they debride newly formed tissue
66
this prevents epithelial migration and mitosis but interventions such as a hyperbaric oxygen chamber could help
anoxia
67
T/F
| contraction is dependent on epithelialization
false
68
this occurs simultaneously with granulation and epithelizalization
contraction
69
contraction progresses at this rate
0.6 - 0.8 mm/day
70
when is contraction terminated
when the wound edges meet
71
begins when adequate levels of collagen are reached
wound maturation (17-20 days or longer)
72
in wound maturation what type of collagen increases and what type decreases
type 1 increased
| type 3 decreased
73
wounds gain what percent of their final strength in the first 3 weeks of injury
20%
the most rapid is between days 7-14 due to collagen
74
T/F
| 100% strength of tissue is restored in maturation
false - wounds may only get back to 80% original strength
75
class of wound with minimal contamination that occurs within 0-6 hours
class 1
76
what is the "golden period"
insufficient microbial replication to cause infection and can manage with primary closure
77
class within 6-12 hours of wounding
class 2 -- possible to still be in the golden period
78
>12 hours of wounding
class 3 wound
microbial replication is at a critical level for infection
>10^5 bact/g tissue
79
Appositional closure after granulation tissue has developed
secondary closure
>3-5 days after wounding
80
healing by contraction and epithelialization or open wound management
second intention healing
81
Appositional closure before granulation tissue develops
delayed primary
within 3-5 days of wounding
82
wound mgmt good for class 2
delayed primary
83
good for class 1 and some class 2 wounds
primary closure - first intention
84
list the 8 fundamentals of wound management
```
patient assessment
prevent nosocomial contamination
aseptically clean and scrub
lavage
procure culture
debride
select closure method
provide drainage if needed
```
85
when assessing the patient what should be handled first
any life threatening problems
86
T/F
| use local anesthesia for wound evaluation and closure
TRUE
87
what is indicated for all wounds upon entry to a hospital
bandage - prevent nosocomial infections from entering wound site
88
T/F
| the best scrub for wounds is alcohol
false - it damages open tissue
NEVER USE IT
89
T/F
| aseptically scrubbing can be done before the patient is stabilized
false - often requires anesthesia or sedation
90
why do you scrub AROUND the wound not on it
the detergents in the scrubs cause irritation and toxicity and pain when in exposed tissue and could potentiate the infection
91
preferred lavage solution
Sterile isotonic saline or a balanced electrolyte solution (i.e. LRS)
92
why is lavage used on wounds
it loosens debris and softens necrotic tissue during bandage changes
acts as a surfactant to allow organisms to be easily rinsed from the wounds
93
T/F
| antiseptics have very little effect on bacteria in an established infection
TRUE
94
this is effective and less detrimental than distilled or sterile water even though it may cause some hypotonic tissue damage like cell swelling
tap water
95
lavage solution that could cause corneal toxicity
0.05 % Chlorhexidine solution with tris EDTA
96
ideal pressure of a lavage
7-8psi
97
Pressure of ___ psi adequately REDUCES bacterial contamination from wounds
1.6
but 7-8 to REMOVE
98
lavage pressures > ___ psi could cause barotrauma to the wound & be detrimental to the surrounding tissue
25
99
historic recommendation for lavage
Use of a 35-mL syringe & an 18ga needle
100
T/F
| size of needle is the most important factor in lavage
false - doesnt matter
101
gold standard lavage technique
1 L bag saline and cuff pressure of 300mmHg
102
minimally or moderately contaminated wounds
6-8 hours
103
what steps should be taken prior to wound culturing
clip, clean, and lavage
104
when is culturing preffered
during the initial debridement
105
what are the most common bacterial organisms involved in external wounds
coagulase positive staph and e coli
106
"go to choice" for antimicrobial
clavulanic acid potentiated with amoxicillin
107
these 2 antimicobials should only be used if cultured first
fluoroquinolones and
| aminoglycosides
108
this antimicrobial can cause cartilage damage in young dogs
fluoroquinolone
109
antimicrobial with a high gram negative affinity
aminoglycosides
110
T/F
| systemic is preferred over topical antibiotics for open wounds
false - topical is preferred
if applied in 1-3 hours it often will prevent infections
111
topical antimicrobial that has poor efficacy against pseudomonas
TAB
112
what is TAB
Bacitracin, neomycin & polymyxin = Effective against a broad spectrum of pathogenic bacteria commonly infecting superficial skin wounds
113
responsible for enhancing re-epithelialization of wounds but can retard wound contraction
zinc bacitracin
114
T/F
| TAB is highly absorbed and frequently causes systemic toxicosis
false -- poorly absorbed
115
T/F
| TAB is better for prevention than for treatment of infections
TRUE
116
drug of choice to treat burn wounds
Silver sulfadiazine (Silvadene 1% cream)
117
The process of removing dead/damaged tissue, foreign material & microorganisms from the wound
debridement
118
goal of debridement
obtain fresh clean wound margins &
| wound bed for primary or delayed closure
119
how are en bloc debrided wounds closed
primary closure
120
advantage of en bloc debridement
accelerated wound care
121
what is the danger of surgical debridement
removing too much viable tissue
122
muscle is debrided in layering technique until...
it bleeds and contracts with appropriate stimuli
123
why should contaminated SQ be liberally excised
it is easily devascularized and harbors bacteria
124
what species is SQ debridement a caution
CATS -- it will delay wound healing
125
Accomplished through creation of a moist wound environment to allow endogenous enzymes to dissolve nonviable tissue
autolytic debridement
126
Preferred over layered sx or bandage
| debridement in wounds w/ questionable tissue viability
autolytic debridement
127
this debridement is highly selective for ONLY devitalized tissue
autolytic
128
autolytic devridement is accomplished using these bandages
hydrophilic
occlusive
semi occlusive
129
a single maggot may consume this much necrotic tissue each day
75mg
130
maggots are applied at what density to the wound
5 - 8/cm^2
131
type of dressing that will cover maggots / wound in biosurical debridement
self adhesive hydrocolloid
132
how long are maggots applied for
two 48 hour cycles each week
133
T/F
| you will never be wrong to delay the closure of an open wound
TRUE
134
what type of drain is the penrose
passive
135
what type of drain is the gold standard of active drains
jackson pratt
136
Relies on concept of gravity dependent flow of fluid w/in dead space
penrose / passive drains
137
T/F
| penrose drains require fenestrated tubing
false
138
what is the tubing width for penrose drains
1/4 - 1 inch
139
remove a penrose drain in ____ days or there is a higher risk of environmental infection
5-7
140
how does fluid travel with a penrose drain
along the drain NOT inside of it
141
where should passive drains exit
at least 1cm from the incision
exiting through the primary incision incresaes the risk of wound dehiscence
142
T/F
| with a penrose drain, the owner can be instructed to change the bandage daily
FALSE - never rely on an owner
143
T/F
| timing of the passive drain removals is wound dependent
true
144
what to instruct an owner to do once the penrose drain is removed
warm compress 10-15 minutes every 4-6 hours for the next 48 hours to encourage the hole to seal
145
what does a double exit passive drain encourage
the chances of ascending infections
146
where does fluid travel in active drains
inside the drain - relies on fenestrated tubing
147
where is the drain exit normally located in an active drain
dorsal to the wound in a non dependent portion
148
presence of a drain in a wound reduces the number of bacteria needed to cause a clinical infection by what factor
10,000
149
fluid collection site for passive drains
bangage
150
fluid collection site for active drains
grenade
151
T/F
| you do not need a fully closed wound for an active suction drain
false - requires a fully closed wound
wound must maintain a seal in order for there to be negative suction into the grenade
152
type of debridement required prior to closure with a closed suction drain
aggressive en bloc
153
how much fluid does the body produce as a reaction to the active drain
1-2 ml/kg/day
154
when can an active drain be removed
below 5ml/kg/DAY and when less than or equal to 0.2mL/kg/hour of fluid produced
155
how long should the stoma be covered post active drain removal
24 hours
156
these active drains are great for the face or peritoneum
modified butterfly catheter
157
first step of open wound management
debridement
158
performed during the first 3-5 days after wound occurs by WBCs
autolytic depbridement
159
debridement that is the most selective
autolytic
160
macroscopically selective debridement
surgical
161
bandage therapy promotes what type of environment at the wound surface
acidic
prevents carbon dioxide loss and absorbs ammonia produced by the bacteria which will increase the oygen dissociation from hemoglobin and increase oxygen availability
162
T/F
| bandage therapy will decrease oxygen dissociation from Hbg and therefore decrease oxygen availability
FALSE - increases all
163
T/F
| primary bandage layer is the contact layer and is non sterile
FALSE -- contact layer and is STERILE
164
Directly touches the wound surface & should remain in contact w/ it during movement
primary layer / contact layer of bandage
165
what are common materials for the intermediate bandage layer
loose-weave, absorbent materials - they can be non-sterile at this layer
166
what determines the thickness of the secondary layer of a bandage
the amount of wound exudate it is expected to absorb, the occlusivity of the 10 dressing & the amount of protection & support needed
167
common materials of the tertiary layer of a bandage
porous surgical adhesive tape, elastic adherent or self adherent material and stokinette
168
why do we want the fluid from the secondary layer to be able to evaporate through the porous tertiary layer
it concentrates the exudate and decreases bacterial growth
169
contact layer that is impermeable to air and fluid
occlusive
170
most commonly used bandage in vet med
semi occlusive
171
allows air to penetrate and exudate to escape from the wound surface
semi occlusive
172
contact layer that is less likely to macerate adjacent normal tissue
semi occlusive
173
contact layer used on less exudative wounds to keep the tissue moist
occlusive
174
contact layer used for mechanical debridement
adherent
175
contact layer that may cause pain when removed and serves little purpose in the absence of nonviable tissue
adherent
176
These products are very absorptive; they create a moist environment to facilitate healing & reduce the frequency of bandage changes (usually once every 3 to 7 days)
non adherent
177
wet to dry
| and dry to dry are what
adherent bandages
178
telfa, adaptic, hydrogels, hydrocolloids are
non adherent bandages
179
T/F
wet to dry bandages are commonly used early in the course of wound mgmt and are indicated for when granulation tissue has developed
FALSE -
NEVER indicated with granulation tissue because they will rip it off on removal
180
wet to dry bandages provide this type of debridement on removal
NON selective mechanical
181
how often does a wet to dry bandage need changed
every 24 hours (48 hours max)
182
in a tie over bandage what must be used as the tertiary layer
water impervious layer
183
The process of creating a wound environment that optimizes the body’s inherent wound-healing abilities using specialized primary layers called moisture retentive dressings
moist wound healing
184
moisture retentive dressings are usually ___ and ____
non adherent and occlusive
185
dressings with an MVTR < ____ are moisture retentive
< 35 g/m2/hr
186
avg MVTR of hydrocolloid
11.2
187
avg MVTR of polyurethane film
13.7
188
avg MVTR of gauze
67.0
189
avg MVTR or polyurethane foam
33.4
190
which dressings are closest to the transepidermal water loss of skin
hydrocolloid and polyuthethane film
191
a measure of water movement through skin
TEWL - transepidermal water loss
192
transepidermal water loss for intact skin
4 -9 g/m2/hr
193
advantages to MHW
selective autolytic debridement
lower infection incidence
maintains proper moisture level and limits expansion of nectrotic tissue
a low oxygen tension = lower ph = lower infection
non adherrent doesnt hurt to remove
194
T?F
| low oxygen tension is a chemoattractant for WBC
TRUE
195
the "big 4" MRDs
calcium alginate
polyurethane foam
hydorcolloid
hydrogel
196
which MRD:
| high exudate
calcium alginate
197
which MRD:
| moderate exudate
hydrocolloid
198
which MRD:
| low exudate
hydrogel
199
what are MRD covered with
traditional 3 layer modified robert jones
200
how often is MRD changed in the inflammtory phase
every 2-3 days
201
how often is MRD changed once granulation tissue forms
change to hydrocolloid which is less absorptive and change every 5-7 days
202
ideal UMF rating for mauka honey
> 10+
203
what is manuka honey
antimicrobial/antifungal `
204
what area of wounds is manuka honey good for
foot wounds
205
osmolarity of manuka honey
high
206
environement created by manuka honey
acidic - deleterious for bacteria and fibroblasts
207
glucose oxidase produces
hydrogen peroxide
208
how thick should sugar layer be
1-2cm
209
high osmolarity draws what to the wound
lymph
210
what is negative pressure wound therapy
vacuum assisted closure - VAC
| collects wound exudate
211
open wound pressure for VAC
125 mmHg
212
indications for negative pressure wound therapy
ideal for large open and effusive wounds that are devoid of granulation tissue
chronic non healing wounds
213
bites account for what percent of all vet traumas
10-15%
214
all bite cases are considered what class
contaminated
215
most common pathogen cultured from bites
pasteurella multocida
216
common aerobic isolates from bites
staph
enterococcus
bacillus
e coli
217
common anaerobic isolates from bites
clostridium and corynebacterium
218
canine jaw can generate a force of
150-450 psi
219
human jaw force
150 - 200 psi
220
salt water croc jaw force
3700 psi
221
Puncture wounds of the surface often look innocuous but extensive damage to the underlying tissue is very
common
iceberg effect
222
large breed dog common bite location
neck and face
223
small breed dog common bite location
dorsum
224
what species has a more common risk of infections from bites: dogs or cats
cats
225
cats commonly get bite wounds in these locations
forelimbs, lateral aspect of the face & near the base of the tail
226
counts as abdomen & is common site of cavity compromise in BDLD encounters
dorsal flank
227
a must for penetrating abdominal wounds
immediate exploratory laparotomy
228
mortality rate of bite wounds
10% - most common in thoracic trauma cases
229
what is flail chest
loss of intrastructure in a penetrating thoracic BDLD biyte wound
sucking in of skin
230
size blade to lance abscess
15 or 11
231
most common cause of thermal injury
accidental burns in vet clinics - hot dogs and hot water bottles
232
burn 1st degree, involving the outermost epidermis
superficial
233
2nd degree burn, involving the epidermis & a portion of the dermis
partial thickness
234
3rd degree burn, involving full-thickness epidermis & dermis
full thickness
235
Dark brown, NON-painful, eschar burn
full thickness, third degree
236
4th degree burn and needs surgery and 2nd intention healing
extension beyond dermis
237
When you gently lift it you only see SQ & not dermis or epidermis
eschar split in 3rd degree burn
238
animals with partial thickness burns involving < ___% Total body surface area require minimal systemic supportive therapy
15%
if >20% needs systemic therapy
239
burns at >__% TBSA may warrant euthanasia
50%
240
best protection against wound colonization and infection in burns
topical silver sulfadiazine
aloe vera - faster reepithelialization
manuka honey
241
what joint involved in shearing
tarsocrural --Occur when the limb is caught beneath a car tire & then dragged
242
T/F
| elbow hygroma is typically bilateral and nonpainful
true
243
T/F
| do diagnostic FNA/cytology to confirm hygromas
FALSE
they are usually sterile and this will introduce bacteria
244
elbow hygroma is common in what age group
young large breed dogs (6-18 months)
245
treatment for elbow hygromas
prevention -- protect from repetetive trauma
246
if you discover a gun shot injury incidentally how should you treat
benign neglect
247
Transient rapid expansion or ballooning of the tissues adjacent to the course of the bullet, which can be up to 30 times the diameter of the bullet
cavitation
248
Sherman & Parrish Classification System TYPE 1
SQ and deep fascia penetration
249
Sherman & Parrish Classification System type 2
penetrating tissues below deep fascia
250
Sherman & Parrish Classification System type 3
deep central zone of tissue destruction usually surrounds halo of pellets
251
Sherman & Parrish Classification System
| type 1 wounds
typical of scattered pellets noted incidentally on radiographs
252
Sherman & Parrish Classification System type 2 and 3 wounds are the result of...
result of closer range impact with a greater concentration of pellets
253
T/F
| lead poisoning is common in gun shot wounds
false
254
what are Halsted's priciples
* Gentle tissue handling
* Meticulous control of hemorrhage
* Observe strict aseptic technique
* Preserve blood supply to tissues
* Eliminate dead space
* Appose tissues accurately w/ minimal tension
255
first prof of surgery
William stewart halsted
256
where did halsted go to school
johns hopkins
257
skin flap needed for wounds >___cm
5
258
this species has a lower cutaneous perfusion and early wound breaking strength aka they rely heavily on their SQ
cats
259
this breed has tight thin skin
greyhound
260
BCS >___ makes reconstruction more challenging
>7/9
261
T/F
| younger animals have less cutaneous perfusion and slower healing
FALSE - older animals
262
what will increase know volume and tissue reactivity by a factor of 1.5
adding 2 extra throws
263
minimum number of throws to finish continous pds
7
264
minimum number of throws to start continuous PDS
5
265
most common monofilament absorbable suture
polydioxanone - PDS
266
type of suture patterns for facial or IM
simple interrupted or continuous
267
#1 suture for facial/intramuscular closure
3-0 USP
268
suture for SQ closure
3-0 or 4-0
269
closure pattern for SQ
simple continuous
270
SQ suture types
Poligecaprone25(Monocryl),glycomer 631 (Biosyn) or PDS
271
minimum distance between staples in cutaneous closure
4.0 - 6.5 mm
272
do not allow this in contact with the SQ because it will incite a FB reaction
cyanoacrylate - tissue adhesive
273
types of suture used in the cutaneous closure
```
3-0
4-0
ALMOST NEVER 2-0
ethilon(nylon)
polypropylene (prolene)
```
274
this reduces skin closure time 3 to 4 fold
Staples
275
tension is reduced when closed ____ to the tension lines
parallel
276
where is the exception to closing parallel to tension lines
on the extremities you want to close perpendicular
277
what is the simplest technique to relieving tension
undermining the tissue using metzenbaum scissors
BLUNT technique and sharp are most commonly combined
278
when is blunt technique used
in the loose areolar hypodermal tissues in the truncal skin
279
when is sharp technique to undermine tissue used
extremities
280
what are the tension relieving suture patterns
vertical and horizontal mattress
far far near near
far near near far
281
which tension relieving suture patterns are more appositional than everting and therefore are preferred
far near near far
282
how do releasing incisions heal
second intention
283
ideal for large open wounds with surrounding skin that is pliable
walking suture
284
indicated for chronic defects surrounded by inelastic skin and for closing wounds near structures that would be distorted under tension such as the eye
V-Y plasty
**point of chevron incision made away from the defect
285
Used primarily to facilitate closure of nearby wound when there is sufficient laxity parallel to the wound to permit skin stretch in that direction or for cicatrix excision
Z-plasty
286
in a Z-plasty the central arm of the Z is performed ____ to the long axis of the wound which should reside ___cm away
perpendicular
>3cm away
287
used in fusion wounds where skin at one or both ends is limited
M-plasty
**think mouth and mammary
288
how to close fusiform shaped defects
rule of halves
| place a suture at the widest part and continue to divide each segment in half with subsequent sutures
289
how to close a crescent shaped defect
begin at the midpoint and divide each segment in half
| space the sutures father apart on the longer side of the wound
290
closure of a triangular shaped defect
close the defect as a Y and then use a half buried horizontal mattress stitch to close the central portion of the Y
291
closure of circular shaped defects
close by direct apposition -- leads to dog ears --- divide into 3 arcs
or convert to fusiform which is easier
292
what is NOCITA
post op analgesic
bupivacaine liposome injectable suspension
a single dose (5.3mg/kg) during closure of surgery could provide up to 72 hours of pain control
293
ideal length of a flap for subdermal plexus
1.5x the length of the wound
294
how many layers used in closure of a subdermal plexus flap
2-3
| generally buried SQ
295
pivotal flap that has curvilinear configuration and is designed immediately adjacent to the defect and are best used to close triangular defects
rotation
296
pivotal flap with a linear axis
transpositional
297
typical angle for a transpositioon flap
45 - 180 degrees (90)
298
pivotal flap with linear configuration
interpolation
299
classic flap for triangular shaped defects
rotation -
300
synonym for dog ear
burows triangle
301
the effective length of a pivotal flap moving through an arc of 180 degrees is reduced ___%
40%
302
Have better perfusion than pedicle flaps w/ a circulation from the subdermal plexus alone
axial pattern flaps
303
Most commonly used to facilitate wound closure after tumor resection or trauma
axial patten flaps
304
survival rate of subdermal compared to axial flaps
axial survival is 2x more bc more robust
305
axial pattern flap that is good for sternal defects
cranial superficial epigastric
306
axial pattern flap that is good for medial and lateral tibial defects
genicular
307
axial pattern flap that is good for major defect over the greater trochanter and lateral pelvic ares as well as the ipsilateral flank and lateral lumbar area
deep circumflex iliac
308
what percent of animals has PO complications from axial pattern flaps
89%
309
most common composite flap
myocutaneous -- muscle and skin together
310
flaps composed or skin with muscle, bone, or cartilage
composite flaps
311
properties of muscles that are conducive to composite flaps
Easy to access & elevate and have direct cutaneous arteries exiting the muscle surface to supply overlying skin
**Latissimus dorsi, cutaneous trunci, gracilis, semitendinosus, and trapezius muscles
312
Flat, triangular muscle overlying the dorsal half of the lateral thoracic wall
latissimus dorsi
good for chest wall defect
313
Facilitate repair of the diaphragmatic hernia muscle
transversus abdominus
314
muscle flap for Perineal hernia repair
internal obturator, superficial gluteal, semitendinosis
315
Caudal abdominal hernias & tibial defects muscles
pectineus and sartorius
316
muscles used for esophageal substitution
Intercostal, diaphragmatic, sternocephalicus, or sternothyroideus
317
used to reconstruct tibial defects
semitendinosus
318
Orbitonasal defects & complicated intraoral reconstruction
temporalis
319
elastic and long flap mm that is used to facilitate repair of defects in the abdominal wall or caudal thoracic wall
external abdominal oblique
320
_____ muscle flaps are used to repair prepubic tendon ruptures or femoral hernias when tissue trauma, retraction, and fibrosis preclude adequate anatomic reapposition
cranial and caudal sartorius muscle flaps
321
Used to cover soft tissue defects, contribute to circulation and drainage, enhance healing, control adhesion & combat infection
omental flap
