Skin Reconstruction Flashcards
(40 cards)
what are the main vessels that supply/drain the subdermal plexus
direct cutaneous artery and vein
extends to the panniculus and branches out into the subdermal plexus –> middle plexus –> superficial plexus
where is the plane of dissection for skin flaps
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
angiosomes
regions of skin that are supplied by the direct cutaneous arteries and veins
what is the goal of open wound management
transform the contaminated wound into a clean wound before closure
should you close contaminated wounds via primary closure
NO - must manage wound to clean before closure
surgical debridement
excising contaminated and necrotic tissue using a scalpel
freshen edges - ensure bleeding
lavage with sterile saline
clip, clean, flush
mechanical debridement
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
how often should wounds be assessed
minimum once daily to ID healthy granulation tissue, signs of infection, etc
1st intention healing
surgically bringing together the edges of the wound
- primary closure
- delayed primary closure
primary closure
suturing up a clean surgical wound
delayed primary closure
surgical closure BEFORE granulation tissue forms
used on mildly contaminated wounds
- debride and bandage for 1-3 days then surgically repair
2nd intention healing
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
3rd intention healing
surgical closure AFTER granulation bed forms
(“secondary closure”)
debride –> bandage –> form granulation tissue –> close with a graft
in what direction should you align the long axis of the wound to reduce tension
parallel to the natural lines of tension in that area
make elliptical cuts vertically from dorsal to ventral
what are adverse effects of wound tension
- dehiscence
- excess scar tissue
- increased post-op pain
- potential tourniquet effect
what is the main principle of tension reduction
using subcutaneous of tissues to remove tension at the skin margin
what are 5 methods of tension reduction
- patient positioning (place in most tense position before suturing)
- use interrupted tension relieving sutures
- undermine the skin
- walking sutures
- skin stretchers
what is undermining the skin
freeing up the skin that you are trying to maneuver from the underlying muscle
what are tension relieving sutures
interrupted cruciate sutures in the deep subcutaneous tissues
OR
mattress sutures
+/- incorporation of the panniculus
skin stretchers
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
incisional plasty
making incisions adjacent to the wound to provide a small amount of tension relief
local flaps
elevating a flap of skin adjacent to the defect that can be moved around to cover the defect
what is the blood supply for local flaps
subdermal plexus
must dissect deep to the panniculus - do NOT want to incorporate the direct cutaneous vessels
appropriate base to length ratio for local flaps
1:2 base to length
ensures blood supply can make it all the way to the end of the flap
