Flashcards in Wound Closure Deck (29)
Which layer of muscle must always be trasnected below when skin graftin?
Cutaneous trunci as contains deep subdermal plexus from direct cutaneous arteries and veins
Which artery supplies the skin overlying the shoulder in the dog and cat?
What is an area of skin supplied by one direct cutaneous a. called?
What factors may impact skin tension?
- regional differences
- disease influence (eg. hyperadrenocorticism and Ehlos-Danois syndrome -> fragile skin)
What are the 5 potential wound closure mechanisms?
- 1* closure
- delayed 1* closure
- 2* closure
- contraction and epithelialisation
- reonstruction (this lecture)
What 3 ways may dead space be managed? What must you be aware of?
> be aware of compromising blood supply with sutures, bandages etc.
Is 2* closure a valid way to close a wound?
Yes, most wounds would eventually close up with granulatin tissue etc.
1* closure used to speed up process if owner impatient etc.
5 options to v wound tension
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)
What is a v-Y plasty used for?
U shaped flaps
What is a Z plasty used for?
changing local skin tension - make Z incision with middle line parallel to line of tension (ie. across wound)
How may skin be stretched?
- velro or elastic straps
- re-adjust tension q6-8hrs for 2-4d
What are local (random) subdermal plexus flaps? SDPF?
Cutting section of skin near wound to place over wound.
- transposition/rotation around a central point
- pie shaped incision rotated around centre
What are distant SDPFs? What are the requirements of the wound site? When are these not indicated?
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
What are axial pattern flaps?
Flaps based on direct cutaneous artery position and angiozones
Where does the thoracodorsal artery arise?
Depression between deltoid and triceps
Can donor skin be folded over existing skin to make a bridge?
Yes, top layer will become reducndant and must be removed
Where does the caudal superficial epigastric artery run?
Arises from inguinal ring and runs along the ventral abdomen under mammary glands.
How many nipples do cats and dogs have? How many of them can be used in a caudal superficial epigastric axial pattern flap?
all but most cranial nipple can be transplanted
What should be remembered when performing skin grafting?
Hair will not grow same direction - cat may groom back
What is the reverse saphenous conduit?
- medial crus (hindleg)
- reversal of flow through dorsal metatarsal and plantar arteries via the saphenous
What are compound or composite flaps?
- myocutaneous latissimus dorsi flap for thoracic wall reconstruction
What is a direct distant subdermal plexus flap?
- distal limb wound sutured into flap on side of thorax
- requires 2 anaesthetics
How do free grafts differ from subdermal plexus flaps?
Should be as thin as possible - cutaneous trunci not wanted
What types of free skin graft are possible?
- split v full thickness
- full sheet or meshed
- pinch or punch
- line grafting
What is homograft survival dependent upon?
- plasmatic imbibition
- vascular ingrowth (inosculation)
When are hand meshed grafts useful?
undulating or uneven surfaces
What is required for 24hours after a free skin graft?
rigid dressing to prevent shear forces
eg. of a passive dressing? pros and cons?
- easy to apply
- stick to dry skin
- need 2* absorbant layer