Reconstructive Surgery Quiz
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Questions and Answers

Which of the following factors can cause variations in tension lines in animals?

  • Breed
  • Conformation
  • Gender
  • All of the above (correct)

    • What happens when incisions are made across tension lines?

  • They heal faster
  • The incised skin edges separate (correct)
  • The incised skin edges come together
  • They result in more aesthetic results

    • Why should incisions be made parallel to tension lines?

  • To increase tension on the wound
  • To create more 'dog ears'
  • To promote faster and better healing (correct)
  • To make closure more difficult

    • What shape do incisions made at an angle to tension lines tend to take?

    <p>Curvilinear (C)</p> Signup and view all the answers

    What is a potential consequence of making incisions across tension lines?

    <p>Increased likelihood of dehiscence (B)</p> Signup and view all the answers

    What is the primary goal when closing traumatic wounds?

    <p>To prevent or minimize tension (D)</p> Signup and view all the answers

    What should wound edges be manipulated for before closure?

    <p>To determine suture direction to minimize tension (D)</p> Signup and view all the answers

    What is the purpose of undermining skin adjacent to a wound?

    <p>To release skin from underlying attachments (A)</p> Signup and view all the answers

    Reconstructive surgery is commonly performed for what purpose?

    <p>To close defects secondary to trauma (C)</p> Signup and view all the answers

    What is a key consideration in reconstructive surgery to avoid complications?

    <p>Selecting the appropriate technique (C)</p> Signup and view all the answers

    What are relaxing incisions or 'plasty' techniques (e.g., V-to-Y plasty, Z-plasty) used for?

    <p>To close large or irregular defects (B)</p> Signup and view all the answers

    What are pedicle flaps in reconstructive surgery?

    <p>Tissues partly detached and mobilized to cover a defect (A)</p> Signup and view all the answers

    What is a graft in the context of reconstructive surgery?

    <p>A segment of skin transferred to a distant site (A)</p> Signup and view all the answers

    Why is careful planning important in reconstructive surgery?

    <p>To prevent excessive tension, kinking, and circulatory compromise (B)</p> Signup and view all the answers

    Where can larger defects often be closed by advancing adjacent tissue?

    <p>The trunk (C)</p> Signup and view all the answers

    When are leeches recommended in the context of reconstructive surgery?

    <p>For tissues with impaired venous circulation (B)</p> Signup and view all the answers

    What tool is used to undermine skin and subcutaneous tissue?

    <p>Scissors (D)</p> Signup and view all the answers

    What generally controls hemorrhage & prevents seromas after undermining?

    <p>Skin tension and bandaging (C)</p> Signup and view all the answers

    Which instrument is recommended for manipulating skin to minimize trauma?

    <p>Brown-Adson thumb forceps (B)</p> Signup and view all the answers

    Cutting skin with which instrument ensures an atraumatic surgical technique?

    <p>Sharp scalpel blade (A)</p> Signup and view all the answers

    What directly interferes with cutaneous circulation?

    <p>Wound closure under excessive tension (D)</p> Signup and view all the answers

    What is a potential consequence of interfering with cutaneous circulation?

    <p>Skin necrosis (A)</p> Signup and view all the answers

    How long should you wait to truly evaluate blood supply/tissue effect on recently traumatized skin?

    <p>28-48 hours (C)</p> Signup and view all the answers

    What is the primary principle behind skin stretching and expansion techniques?

    <p>Utilizing the skin's ability to stretch (C)</p> Signup and view all the answers

    What is the purpose of placing padded material beneath suture loops in stenting?

    <p>To relieve tension on the suture line (B)</p> Signup and view all the answers

    Which of the following is a suture pattern that can relieve tension?

    <p>Vertical mattress (B)</p> Signup and view all the answers

    What is a potential risk associated with horizontal mattress sutures?

    <p>Impairing local cutaneous blood flow to the skin edges. (B)</p> Signup and view all the answers

    What are 'dog ears' in the context of suturing?

    <p>Puckers at the end of a suture line (C)</p> Signup and view all the answers

    How can 'dog ears' be prevented or corrected?

    <p>Using unequal suture spacing (D)</p> Signup and view all the answers

    Where should sutures be placed when using unequal suture spacing to avoid 'dog ears'?

    <p>Closer together on the convex side (D)</p> Signup and view all the answers

    Which type of skin is less prone to the formation of dog ears?

    <p>Thin elastic skin (B)</p> Signup and view all the answers

    What can be done if a 'dog ear' does not flatten on its own?

    <p>Excise triangles of tissue (D)</p> Signup and view all the answers

    What is the main purpose of a V-to-Y plasty?

    <p>To provide an advancement flap to cover a wound (D)</p> Signup and view all the answers

    What is the purpose of a Z-plasty?

    <p>To reduce tension on a wound and facilitate closure (D)</p> Signup and view all the answers

    The central member of the Z in a Z-plasty should be parallel to what?

    <p>The greatest lines of tension (C)</p> Signup and view all the answers

    What should be assessed before removing a skin tumor?

    <p>Skin tension and elasticity (D)</p> Signup and view all the answers

    When excising a benign tumor, how much normal tissue should ideally be removed?

    <p>1 cm of normal tissue (C)</p> Signup and view all the answers

    For aggressive tumors, what characteristic should the margin distance have?

    <p>Greater (C)</p> Signup and view all the answers

    Which tissue type is typically spared during tumor resection due to its resistance to neoplastic invasion?

    <p>Cartilage (B)</p> Signup and view all the answers

    What is indicated for poorly localized tumors?

    <p>Radical tumor excision (A)</p> Signup and view all the answers

    What is a common cause of local tumor recurrence?

    <p>Inadequate surgical margins (A)</p> Signup and view all the answers

    In relation to lines of tension, how is an advancement flap developed?

    <p>Parallel (C)</p> Signup and view all the answers

    Flashcards

    Methods of Reducing Tension

    Strategies used to minimize tension when closing a surgical wound.

    Surgical Incision Direction

    Guideline on how and why to make surgical incisions in a certain direction.

    Planning Tumor Removal

    Key considerations for effectively removing skin tumors.

    Recruiting Skin

    Methods to mobilize skin to close wounds under tension.

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    Dog Ears Correction

    Techniques to prevent puckering at wound closure sites.

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    Reconstructive Surgery Purpose

    Common reasons for performing reconstructive surgery: trauma, congenital issues, or tumors.

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    Flap and Graft Techniques

    Flaps are partially detached for coverage; grafts transfer skin to a new site.

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    Recipient Bed Considerations

    The condition of the recipient area affects the choice of reconstructive technique.

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    Tension Lines

    Lines on the skin along which tension is distributed; critical for incisions.

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    Incision Direction

    Incisions should be made parallel to tension lines for optimal healing.

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    Undermining

    The technique of using scissors to separate skin and subcutaneous tissue from underlying tissue before wound closure.

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    Healing and Aesthetics

    Incisions along tension lines heal better and result in less scarring.

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    Controlling Bleeding

    Bleeding during undermining is usually minor; control excessive bleeding with electrocoagulation or ligation.

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    Gaping Wounds

    Wounds made across tension lines can gape and require more sutures.

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    Atraumatic Technique

    Surgical approach to minimize damage to tissue; includes using sharp instruments and avoiding crushing tools.

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    Dog Ears

    Puckers formed at the ends of sutures when tension is not managed.

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    Cutaneous Circulation

    Preserving blood flow in skin is crucial for healing; avoid excessive tension or rough techniques.

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    Minimizing Tension

    Wound edges should be manipulated to find the direction of least tension.

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    Undermining Skin

    Technique of separating skin from underlying tissue to relieve tension.

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    Skin Necrosis

    Death of skin tissue due to interrupted blood supply, which can result from poor surgical technique.

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    Panniculus Muscle

    Layer beneath the skin that should be preserved during undermining.

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    Wound Dehiscence

    The reopening of a wound, often due to excessive tension or improper healing.

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    Skin Stretching

    Technique used in reconstructive surgery to allow skin to stretch beyond its normal elasticity for closure.

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    Skin Expanders

    Devices used in surgery to help stretch the skin prior to procedures for easier closure.

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    Stents

    Devices placed in wounds or openings to keep them open.

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    Vertical mattress suture

    A suture technique providing tension relief and stability.

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    Suture spacing

    The distance between sutures to control tension.

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    Padded material placement

    Using soft material beneath sutures to relieve tension.

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    Pulley sutures

    A technique involving 'far-near' patterns for tension relief.

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    Elliptic incision

    A curved incision method to reduce dog ears.

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    Skin elasticity

    The ability of skin to stretch and return to form.

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    Aggressive Tumors

    Tumors that require wider margins during excision due to invasiveness.

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    Tumor Invasion Characteristics

    Invasion depends on surrounding tissue type, such as fat and muscle being more susceptible.

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    Radical Tumor Excision

    Complete removal of tumors including entire compartments for high-grade malignancy.

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    Flap Types for Wound Closure

    Different flap techniques like advancement, rotational, and transposition to close wounds.

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    Surgical Margins Importance

    Adequate margins (>2-3 cm) are crucial to reduce tumor recurrence.

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    V-to-Y Plasty

    A surgical technique providing an advancement flap to cover a wound.

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    Z-Plasty

    A technique allowing wound closure by creating a Z-shaped incision to relieve tension.

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    Wound Closure Tension

    The stress on skin when closing a surgical wound, important for planning Z-Plasty.

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    Skin Tumor Removal

    Surgical excision of skin tumors considering margins of normal tissue.

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    Excision Margin Guidelines

    Benign tumors require 1 cm and malignant tumors require 2-3 cm margins for removal.

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    Study Notes

    CVM 737A - Introduction to Surgery

    • Course: Introduction to Surgery
    • Topic: Principles of Reconstructive Surgery - SA
    • Instructor: R. Randall Thompson, DVM, MSpVM (SA Surgery)
    • Location: DeBusk Veterinary Teaching Center
    • Date: January 16, 2025

    Learning Objectives

    • Learning Objective 1: List methods of reducing tension when closing a wound surgically.
    • Learning Objective 2: Summarize the direction surgical incisions should be made and why.
    • Learning Objective 3: Summarize the considerations made when planning the surgical removal of a skin tumor.
    • Learning Objective 4: Summarize the methods for recruiting skin to close wounds under tension.
    • Learning Objective 5: Illustrate methods used for preventing or correcting "dog ears" or puckers.

    Reconstructive Surgery

    • Common Purposes:
      • Close defects from trauma
      • Correct or improve congenital abnormalities
      • Following removal of neoplasms
    • Importance: Selecting appropriate techniques to prevent complications and unnecessary costs.

    Techniques for Closing Defects

    • Relaxing incisions (e.g., V-to-Y plasty, Z-plasty): Used for large or irregular defects.
    • Tissue mobilization: Necessary for large defects, especially on extremities, to mobilize tissue from other sites.
    • Pedicle flaps: Tissues partly detached from donor sites, mobilized to cover defects.
    • Grafts: Transfer a segment of skin from a distant (recipient) site.

    Reconstructive Surgery Considerations

    • Careful planning and atraumatic techniques to prevent:
      • Excessive tension
      • Kinking
      • Circulatory compromise
    • Factors Affecting Skin Availability:
      • Site on the animal
      • Breed differences
      • Limited skin mobility in extremities
    • Strategies for Tension Reduction:
      • Advancing adjacent tissue: A method for closing large defects.
    • Recipient bed character influences technique selection.
    • Local flaps, grafts, and distant flap transfers require vascular beds (healthy granulation tissue, muscle, periosteum, and paratendon).

    Hirudiniasis

    • Leech attachment to skin: Primarily for tissues with impaired venous circulation.
    • Medicinal Leech Species: Hirudo medicinalis.
    • Wound characteristics: Creates a small bleeding wound mimicking venous outflow.
    • Blood oozing: Occurs for 24-48 hours post-removal due to anticoagulants and vasodilators.
    • Infection risk: Aeromonas hydrophila infection.

    Tension Lines and Tension Relief

    • Wound location, surrounding tissue elasticity, regional blood supply, and wound bed character are key considerations
    • Planning is essential to minimize tension
    • Methods of reducing tension:
      • Undermining wound edges
      • Selecting appropriate suture patterns
      • Using relief incisions
      • Skin stretching
      • Tissue expansion
    • Positioning for surgery: Animal position prevents mobile skin from being pinned to the table. Secondary intention or flap/graft reconstruction may be utilized if primary apposition isn't achievable.

    Tension Lines

    • Formed by fibrous tissue within the skin.
    • Animal variations exist across breeds, conformation, gender, and age.
    • Incisions parallel to tension lines heal better, faster, and with more aesthetic results.
    • Incisions at an angle to tension lines, take on a curvilinear shape, requiring more sutures for closure and are more likely to dehisce.
    • Closed in the direction that prevents or minimizes tension.
    • Wound edges manipulated prior to closure to determine ideal suture line direction.
    • Minimally tense closure usually involves a longitudinal direction along the long axis.
    • Creating linear closure prevents "dog ears" (puckers) at suture ends.

    Prevention of "Dog Ears"

    • Vary suture spacing (unequal); more closely spaced on the convex side and further on the concave side of the defect.
    • Use elliptic incisions, remove redundant skin, and appose edges to minimize puckering.
    • Incising the dog ear to form triangles, excise one triangle, and use the other to fill the defect
    • Use a resection of one or two triangles of skin, depending upon defect size. Thin, elastic skin is less prone to forming "dog ears" than thick or inelastic skin.

    Relaxing Incisions

    • Used for closure around fibrotic wounds or important structures.
    • Practical for before radiotherapy, after extensive tumor excision, and on distal extremities, including around the eyes and anus.
    • Used for covering tendons, ligaments, nerves, vessels, or implants.
    • Simple relaxing incisions heal by contraction and epithelialization (25-30 days)
    • Some are suitable for primary closure after wound approximation.
    • Multiple punctate relaxing incisions are smaller, parallel, staggered skin incisions near a wound to allow tighter apposition. More cosmetic than single incisions but potentially less tissue relaxation and higher circulatory risk.

    V-to-Y Plasty / Z-Plasty

    • Used to provide tissue advancement flap cover for the wound.

    Skin Stretching and Expansion Techniques

    • Methods for stretching skin include:
      • Presuturing: Done 24 hours prior to procedure
      • Adjustable sutures
      • Skin stretchers.
      • Skin expanders (Inflatable)

    Surgical Pearls - Other Suture Patterns

    • Other suture patterns: Alternating wide and narrow bites with interrupted sutures, and pulley sutures (far-near-near-far or far-far-near-near).
    • Horizontal mattress, with or without rubber tubing stents, may be used..
    • These patterns allow for greater tension relief, however, care is needed to ensure minimal cutanious blood flow compromise during suture application.

    Removal of Skin Tumors

    • Excessive tension should be avoided during tumor removal procedures, emphasizing the need for careful assessment of skin tension and elasticity prior to tumor removal.
    • Plan the excision shape, closure method, and area before surgical intervention to guide skin preparation. A sufficiently large surgical area should be clipped and aseptically prepared for tissue flaps or closure.
    • Excisions should include the tumor, previous biopsy sites, and wide margins of normal tissue, ensuring complete removal across three dimensions.
    • Benign tumors require removal of just the tumor plus a 1cm margin of adjacent healthy tissue for excision
    • Aggressive malignant tumors require wider margins, typically 2-3cm or more, encompassing the full thickness of tissue.
    • The margin and invasive path of tumor influence excision extent and method of closure
    • Radical excision is necessary for tumors poorly defined, localized, or characterized by a high-grade malignancy.

    Skin Flaps for Wound Closure

    • Advancement flaps: Local subdermal plexus flaps, single-pedicle, bipedicle, H-plasty, and V-Y advancement flaps are used to slide skin over a defect.
    • Rotational flaps: Local flaps pivoted over defects, creating a curved incision to cover the defect.
    • Transposition flaps: Rectangular or local flaps brought to fill defects; they're often aligned parallel to lines of greatest tension for the defect.
    • Interpolation flaps: Similar to transposition flaps, but with an interposed segment between the donor and recipient beds. The segment is exposed and resected after wound healing; bridging incisions may increase the effectiveness of flap transfer by avoiding additional procedures.
    • Tubed pedicle flaps: Advanced technique using a multi-staged procedure to transfer an indirect, distant flap to the recipient wound location.

    Axial Pattern Flaps

    • Use a direct cutaneous artery and vein at the base of the flap. The arteries' branches supply the subdermal plexus, leading to consistently well-perfused flaps, which is an advantage over pedicle flaps.
    • Axial pattern flaps are elevated and transferred to cutaneous defects within their radial range. Specific and important vessels such as caudal auricular, omocervical, thoracdoral, caudal superficial epigastric, medial genicular, deep circumflex iliac vessels, and superficial lateral caudal/brachial/temporal are included in this category

    Skin Grafts

    • Advanced procedures that require specialized expertise.
    • May be full-thickness, split-thickness, sheet, mesh, or punch and strip technique varieties.

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    Related Documents

    Principles of Reconstructive Surgery - CVM 737A Lecture Notes PDF

    Description

    Test your understanding of key concepts in reconstructive surgery, including tension lines and incision techniques. This quiz covers factors affecting wound healing and the methods used to enhance surgical outcomes. Perfect for medical students or professionals looking to refresh their knowledge in this essential area of surgery.

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