Reconstructive Sx

Question 1

When it comes to wound closure you should use

Answer 1

the simplest techniques possible

Question 2

What are the different methods of wound closure

Answer 2

1) Primary closure (1st intention healing)
2) Delayed primary closure
3) Secondary closure (3rd intention healing)
4) Second intention healing
5) Tension relieving
6) Local flaps
7) Axial pattern flaps
8) Skin grafts

Question 3

What are methods of tension relieving

Answer 3

-Undermining
-Walking Sutures
-Tension relieving suture pattenrs
-Stents
-Skin stretchers
-Releasing incisions
-Skin reconstruction: flaps and grafts

Question 4

where the segment of skin and SQ tissue with its vascular attachment is moved from one area of the body to another (local or distant)

Answer 4

Skin Flaps (pedicle grafts)

Question 5

What is another word for a skin flap

Answer 5

Pedicle graft

Question 6

Free skin and SQ tissue moved from one area of the body to another
no vascular attachment

survive the first 48 hours by absorbing tissue fluid from the recipient bed, ultimately reestablish a blood supply

Answer 6

Skin grafts

Question 7

How does pedicle grafts differ from skin grafts

Answer 7

Pedicle grafts maintain vascular attachment

Question 8

How do skin grafts survive the first 48 hours

Answer 8

by absorbing tissue fluid from the recipient bed, ultimately to reestablish a blood supply

Question 9

What are the different type of skin grafts

Answer 9

Meshed graft
Punch grafts

Question 10

What are the two methods of skin flaps

Answer 10

1) Subdermal Plexus Flaps: anywhere
2) Axial Pattern Flap: known artery and vein that perfuses the body

Question 11

Can subdermal plexus or axial pattern flaps be larger

Answer 11

Axial pattern flaps

Question 12

Can you use subdermal plexus flaps or axial pattern flaps anywhere

Answer 12

subdermal plexus flaps

they rely on the subdermal plexus which is everywhere in the body

Question 13

What does subdermal plexus flap rely on

Answer 13

random blood supply
the terminal branches of direct cutaneous arteries

associated with the panniculus muscle layer

Question 14

Is surviving area higher with subdermal plexus flaps or axial pattern flaps

Answer 14

Axial pattern flaps surviving area 50% greater than subdermal flaps of comparable dimension

Question 15

arterial pedicle flap

Answer 15

Axial pattern flap

Question 16

you should limit flap length to

Answer 16

size required to cover the recipient bed without creating tension

if too short = tension (less healing)

if too long = might not perfuse and will become necrotic

Question 17

What is really important when handling flaps

Answer 17

atraumatic tissue handling is essential

Question 18

when making a skin flap you need to undermine

Answer 18

deep to the cutaneous muscle

Question 19

The recipient bed of skin flap needs to be

Answer 19

1) Infection free
2) No necrotic tissue
3) Freshen edges of chronic wounds (if chronic debride and freshen the edges)

Question 20

pedicle grafts developed adjacent to recipient bed
where loose, elastic skin predominates

Answer 20

Local subdermal plexus flap

Question 21

pedicle grafts constructed at a distance from the recipient bed extremities

Answer 21

distance subdermal plexus flap

Question 22

What is the outome of subdermal plexus skin flap

Answer 22

51% complication rate (37% minor, 14% major)
mean time 1 week

good to excellent outcome in 84% of cases

Question 23

What are the common subdermal skin flaps

Answer 23

Advancement
Rotational
Transposition
Skin Fold Flaps

Question 24

When doing subdermal skin flaps, the base of the flap should never be

Answer 24

narrower than the body of the flap

ie the base hshould be widest part of the flap

Question 25

When doing subdermal skin flaps the flap length should be

Answer 25

1-3x the width of the base most of the time aim for about 1-3x the width of the base

Question 26

Rotational flaps work well for what shape of wound

Answer 26

triangular ensure the distance of semi-circle is 4x the height of the wound

Question 27

How do you do a rotational flap

Answer 27

cut a semi-circle that is 4x the wound triangle height to the edge of the flap base. then rotate the healthy tissue over the wound and suture

Question 28

How do you do a transposition flap

Answer 28

Ensure the width of the flap for 90 degree transposition (Width of wound) Ensure length of flap for 90 degree transpostion Pivot point to furthest point of wound

Question 29

In an advancement flap, why does the base have to be the widest part

Answer 29

because that is where your blood supply is coming from

Question 30

How do you do an advancement flap

Answer 30

from wound, draw lines (as wide as the wound fanning out so that the base it te longest cut and pull together to cuture

Question 31

How does a skin fold flap work

Answer 31

Flank and elbow skin folds: medial and lateral layers of skin separated by loose connective tissue Four attachements: medial and lateral attachements to limb Dorsal and ventral attachments to trunk Division of any 3 attachments Separation of medial and lateral skin layers

Question 32

In skin fold flap, it utilizes the four attachments which are

Answer 32

Medial and lateral attachments to the limb Dorsal and ventral attachments to the trunk

Question 33

What is required of distant subdermal plexus flaps

Answer 33

For extensive distal wounds Circumferential wounds Staged surgical procedures (2-3 weeks) Long-term bandaging -may not be tolerated in some dogs -Obese -Significant orthopedic or neurologic disease

Question 34

Axial Pattern flaps can be for

Answer 34

large defects single staged procedures can place over bone, tendons, and ligaments (more robust blood supply)

Question 35

What is the survivability of Axial Pattern flaps

Answer 35

87-100% overall survival 50% greater survival than subderman plexus (random) flaps

Question 36

What are the cons of Axial Pattern flaps

Answer 36

-Limited use on distal limbs -Variabilty in vascular anatomy (doppler, angiogram studies, ICG) : each animal is different -Questionable cosmetic results -Dirty cut? Tumor resection

Question 37

What are the different Axial Pattern flaps

Answer 37

1) Caudal superficial epigastric 2) Thoracodorsal 3) Omocervical 4) Superficial brachial 5) Deep circumflex iliac 6) Genicular 7) Caudal auricular 8) Lateral caudal 9) Superficial temporal 10) Reverse saphenous conduit

Question 38

What are general considerations for Axial Pattern flaps

Answer 38

-Meticulous planning -Delicate tissue handling (skin hooks, stay sutures) -Tension free closure for the flap -Healthy free closure for the flap -Healthy recipient bed (granulation tissue not required) -Two layer closure -Active suction drains

Question 39

What are the indications for thoracodorsal flap

Answer 39

-Thorax -Axillary -Shoulder -Elbow -Carpus (cat)

Question 40

What are the indications for caudal superficial epigastric flap

Answer 40

-Inner thigh defects -Flank -Stifle -Perineum -Preputial area -Tarsus (cat) very versatile

Question 41

What are the landmarks for caudal superficial epigastric flap

Answer 41

essentially a mastectomy uses a caudal superficial epigastric distance is twice the distance from midline to nipple take glands 5,4,3

Question 42

What are complications of flap

Answer 42

-Seroma -Brusing -Flap edema -Incisional dehiscence -Flap necrosis 90% of dogs with axial pattern flaps had complications