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VET 415: Clinical Foundations > Skin Reconstruction > Flashcards

Skin Reconstruction Flashcards

1
Q

what are the main vessels that supply/drain the subdermal plexus

A

direct cutaneous artery and vein

extends to the panniculus and branches out into the subdermal plexus –> middle plexus –> superficial plexus

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2
Q

where is the plane of dissection for skin flaps

A

underneath the panniculus muscle

do not want to cut above the panniculus because will cut into the subdermal plexus and cut off blood supply to flap

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3
Q

angiosomes

A

regions of skin that are supplied by the direct cutaneous arteries and veins

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4
Q

what is the goal of open wound management

A

transform the contaminated wound into a clean wound before closure

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5
Q

should you close contaminated wounds via primary closure

A

NO - must manage wound to clean before closure

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6
Q

surgical debridement

A

excising contaminated and necrotic tissue using a scalpel

freshen edges - ensure bleeding
lavage with sterile saline
clip, clean, flush

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7
Q

mechanical debridement

A

using a wide mesh gauze contact layer to wick away necrotic/foreign material away from the wound (debris gets removed with the bandage)

can be applied:
- wet to dry
- wet to wet
- dry to dry

can NOT use in place of surgical debridement

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8
Q

how often should wounds be assessed

A

minimum once daily to ID healthy granulation tissue, signs of infection, etc

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9
Q

1st intention healing

A

surgically bringing together the edges of the wound
- primary closure
- delayed primary closure

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10
Q

primary closure

A

suturing up a clean surgical wound

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11
Q

delayed primary closure

A

surgical closure BEFORE granulation tissue forms

used on mildly contaminated wounds
- debride and bandage for 1-3 days then surgically repair

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12
Q

2nd intention healing

A

natural healing via skin contraction and re-epithelialization

used on small wounds and long, thin wounds
- skin must be able to contract close enough to epithelialize
- does NOT work on circumferential wounds

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13
Q

3rd intention healing

A

surgical closure AFTER granulation bed forms
(“secondary closure”)

debride –> bandage –> form granulation tissue –> close with a graft

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14
Q

in what direction should you align the long axis of the wound to reduce tension

A

parallel to the natural lines of tension in that area

make elliptical cuts vertically from dorsal to ventral

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15
Q

what are adverse effects of wound tension

A
  1. dehiscence
  2. excess scar tissue
  3. increased post-op pain
  4. potential tourniquet effect
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16
Q

what is the main principle of tension reduction

A

using subcutaneous of tissues to remove tension at the skin margin

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17
Q

what are 5 methods of tension reduction

A
  1. patient positioning (place in most tense position before suturing)
  2. use interrupted tension relieving sutures
  3. undermine the skin
  4. walking sutures
  5. skin stretchers
18
Q

what is undermining the skin

A

freeing up the skin that you are trying to maneuver from the underlying muscle

19
Q

what are tension relieving sutures

A

interrupted cruciate sutures in the deep subcutaneous tissues
OR
mattress sutures

+/- incorporation of the panniculus

20
Q

skin stretchers

A

applies a tensile force across the skin to stretch the dermal collagen fibers

can be used pre or post op
best for large abdominal or thoracic wounds

21
Q

incisional plasty

A

making incisions adjacent to the wound to provide a small amount of tension relief

22
Q

local flaps

A

elevating a flap of skin adjacent to the defect that can be moved around to cover the defect

23
Q

what is the blood supply for local flaps

A

subdermal plexus

must dissect deep to the panniculus - do NOT want to incorporate the direct cutaneous vessels

24
Q

appropriate base to length ratio for local flaps

A

1:2 base to length

ensures blood supply can make it all the way to the end of the flap

25
Q

single pedicle advancement flap

A

flap created as wide as the widest point of the defect

extend the length of the defect from the widest part of the base –> elevate skin under panniculus muscle –> pull flap forward to cover entire defect –> place drain

26
Q

bipedicle advancement flap

A

same as a releasing incision (incisional plasty)

often used on limbs to close a primary defect from oncological resection

27
Q

transpositional flaps

A

skin is elevated adjacent to the flap and rotated up to 90 degrees to cover defect

used on caudal thigh

28
Q

rotational flaps

A

incise in a semicircular fashion from the margin of the defect –> elevate skin and start rotating flap –> keep rotating until the defect is covered

used on lateral thigh (uses inguinal/axillary skin)

best for triangular/square defects

29
Q

skin fold advancement flap

A

advancement flaps made from the axillary and inguinal folds

folds are attached in 4 places to the trunk and limbs: lateral, medial, distal, proximal

any 3 of the attachment sites can be cut to form a flap

30
Q

axial pattern flaps

A

incising an entire angiosome to cover a larger defect

31
Q

what is the blood supply for an axial pattern flap

A

direct cutaneous artery

must incorporate in the flap

32
Q

free skin graft

A

removing skin from one area of the body and moving it to another

33
Q

what is the blood supply for free skin grafts

A

NONE - must lay the skin graft over a healthy granulation bed to ensure regrowth of capillaries

34
Q

what are the stages of free graft nutrition

A
  1. plasmatic imbibition
    - first 2-3 days
    - absorbing nutrients from wound
  2. inosculation
    - first week
    - new capillary buds cross the wound bed to anastomose with vessels
  3. revascularization
    - 1-2 weeks
    - growth of new capillaries that pass into grafted tissue
35
Q

what are the 5 complications of wound reconstruction

A
  1. flap necrosis
  2. flap dehiscence
  3. seroma
  4. SSI
  5. contracture
36
Q

what causes flap necrosis

A

vascular supply does not reach entire flap causing areas of necrosis

37
Q

what is dehiscence

A

wound edges pull apart

can usually heal by second intention, may require closure

38
Q

seroma treatment

A

warm pack and compression

can drain but may increase infection risk

39
Q

signs of SSI

A
  • purulent discharge
  • swelling
  • redness
  • necrotic tissue

occurs within 14 days of surgery

treat with antibiotics

40
Q

signs of SS reaction

A
  • swelling
  • redness
  • centered around knots

NO discharge

VET 415: Clinical Foundations (16 decks)

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