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Flashcards in Wound Closure Deck (29)
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1
Q

Which layer of muscle must always be trasnected below when skin graftin?

A

Cutaneous trunci as contains deep subdermal plexus from direct cutaneous arteries and veins

2
Q

Which artery supplies the skin overlying the shoulder in the dog and cat?

A

Thoracodorsal artery

3
Q

What is an area of skin supplied by one direct cutaneous a. called?

A

Angiozone

4
Q

What factors may impact skin tension?

A
  • regional differences
  • breed
  • species
  • disease influence (eg. hyperadrenocorticism and Ehlos-Danois syndrome -> fragile skin)
5
Q

What are the 5 potential wound closure mechanisms?

A
  • 1* closure
  • delayed 1* closure
  • 2* closure
  • contraction and epithelialisation
  • reonstruction (this lecture)
6
Q

What 3 ways may dead space be managed? What must you be aware of?

A
  • suturing
  • bandaging
  • drains
    > be aware of compromising blood supply with sutures, bandages etc.
7
Q

Is 2* closure a valid way to close a wound?

A

Yes, most wounds would eventually close up with granulatin tissue etc.
1* closure used to speed up process if owner impatient etc.

8
Q

5 options to v wound tension

A
  1. maximise available skin (patient position)
  2. change local skin tension (geometric patterns)
  3. mobilise local skin (undermining deep to cutaneous trunci)
  4. increase local skin (stretching by pre-suturing or stretchers)
  5. remove tension (relaxing incision)
9
Q

What is a v-Y plasty used for?

A

U shaped flaps

10
Q

What is a Z plasty used for?

A

changing local skin tension - make Z incision with middle line parallel to line of tension (ie. across wound)

11
Q

How may skin be stretched?

A
  • velro or elastic straps

- re-adjust tension q6-8hrs for 2-4d

12
Q

What are local (random) subdermal plexus flaps? SDPF?

A

Cutting section of skin near wound to place over wound.

  • advancement
  • transposition/rotation around a central point
  • pie shaped incision rotated around centre
13
Q

What are distant SDPFs? What are the requirements of the wound site? When are these not indicated?

A
Full thickness grafts from distant sites - usually used for distal limbs
- fresh wound
- healthy granulation tissue 
- omentalised wound 
> not indicated for 
- exposed bone, tendon or ligament
- infection or movement
- chronic granulation tissue
14
Q

What are axial pattern flaps?

A

Flaps based on direct cutaneous artery position and angiozones

15
Q

Where does the thoracodorsal artery arise?

A

Depression between deltoid and triceps

16
Q

Can donor skin be folded over existing skin to make a bridge?

A

Yes, top layer will become reducndant and must be removed

17
Q

Where does the caudal superficial epigastric artery run?

A

Arises from inguinal ring and runs along the ventral abdomen under mammary glands.

18
Q

How many nipples do cats and dogs have? How many of them can be used in a caudal superficial epigastric axial pattern flap?

A

dogs 10
cats 8
all but most cranial nipple can be transplanted

19
Q

What should be remembered when performing skin grafting?

A

Hair will not grow same direction - cat may groom back

20
Q

What is the reverse saphenous conduit?

A
  • medial crus (hindleg)

- reversal of flow through dorsal metatarsal and plantar arteries via the saphenous

21
Q

What are compound or composite flaps?

A
  • myocutaneous latissimus dorsi flap for thoracic wall reconstruction
22
Q

What is a direct distant subdermal plexus flap?

A
  • distal limb wound sutured into flap on side of thorax

- requires 2 anaesthetics

23
Q

How do free grafts differ from subdermal plexus flaps?

A

Should be as thin as possible - cutaneous trunci not wanted

24
Q

What types of free skin graft are possible?

A
  • split v full thickness
  • full sheet or meshed
  • pinch or punch
  • line grafting
25
Q

What is homograft survival dependent upon?

A
  • adhesion
  • plasmatic imbibition
  • vascular ingrowth (inosculation)
  • maturation
26
Q

When are hand meshed grafts useful?

A

undulating or uneven surfaces

27
Q

What is required for 24hours after a free skin graft?

A

rigid dressing to prevent shear forces

28
Q

eg. of a passive dressing? pros and cons?

A

Silicone mesh

  • low/non-absorbant
  • expensive
  • soft
  • easy to apply
  • stick to dry skin
  • need 2* absorbant layer
  • reusable
29
Q

What should be done if the wound reconstruction fails?

A

manage as open wounds until they are healthy enough to undergo another reconstruction