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Plastics: Principles of Reconstruction - Coggle Diagram
Plastics: Principles of Reconstruction
Wound Healing
Haemostasis
Inflammation
Proliferation
Remodelling
Decision Making
Defect - what is it
Wound bed - will it accept a graft
Requirements - stability / fill dead space / controur - depending on site
Donor sites
⭐Reconstructive Ladder / Elevator
2 intention
Primary intention
Skin graft
Tissue
Skin Graft
Definition
Transfer of tissue independent of its BS
Stripped epitheliam layer that re-epithelialsied
Use
Burns
Wounds that need to heal quick
Unfavourable wound site
Process
Remove skin with dermatome
+/- Mesh
If explecting exudate
Expanding graft
+/- fenetration
Types
Full thickness
Bene
No contractures
Good cosmetic appearance - colour
More robust - less favourable site
can grow hair if you take follicles - syndactyly releases
Split Thickness
Contract less
Salvage
Back to theatre
Check thrombosis
Cut out and re-anastomosis
Flaps
Local Flaps
Definition
Transfer of tissue with inherent and defined blood supply
Use
Wound bed not suitable for graft
Types
z plasty
Pedicle Flap
Use
Mohs micrographic surgery nose
Defin
Vascular supple remains connect to flap throughout transfer
Gastrocnemius flap
Defect on knee
Just take muscle then skin graft
Lat Dorsi Flap
Breast reconstruction
Myocutaneous Flap
Muscle and
Use
Breast reconstruction
Eg
Latisamus dorsi flap
Free Flap
DIEP
Use
Breast recontruction
Deep inferior epigaastic artery perforator flap
Precursor: TRAM flap -
Anterolateral thigh flap
Radial Forearm Flap
Allen's test - ulnar needs to be sufficient
Floor of mouth
Split skin graft repairs the defect donor site
Tissue Expansion
USe
Breast
Limited skin available - head and neck
Prolonged, gradual stretching of skin by inserting a prosthesis
Burns
Anterolateral Thigh Flap
Z plasty
Cases
Breast
DIEP
Tissue Expansion
Burns
Skin cancer - Mohs surgery
Head and Neck
Floor of mouth
Radial forearm flap
Hair baring
Facia cutaneous flap
Othor / Trauma
Gasatrocnemius flap for knee
Gracillis flap
Composite Vascularised Allotransplants
Hand transplant
Complications
Free flaps
Up to 48hrs
Necrosis
Inadequate venous return
Most common cuase of failure
Purple
Fast CRT
Warm
Inadequate arterial supplu
Pale
Slow CRT
Cool
Nomecular
Skin grafts take
Flaps survive