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Surgical Derm Stuff
Exam 2
112
Veterinary Medicine
Professional
09/24/2016

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Cards

Term
From least to worst, which instruments cause the least amount of trauma?
Definition
-scalpel < scissors < CO2 < electroscalpel
Term
What instrument is better for repeated tissue manipulation?
Definition
-skin hooks or suture stays are better than tissue forceps
Term
What method do we use to decrease the risk of devascularization?
Definition
-dissect deep to the subdermal plexus
Term
What is primary skin closure?
Definition
-immediate direct closure
Term
What is delayed primary skin closure?
Definition
-delayed direct closure before onset of granulation tissue (<3-5 days)
Term
What is secondary skin closure?
Definition
-delayed direct closure after onset of granulation tissue (>3-5 days)
Term
What is second intention skin closure?
Definition
-indirect closure by onset of granulation tissue and epitheliazation
Term
What are our major concerns with closing wounds by second intention?
Definition
-aesthetically or funcitonally unacceptable
-slow
-costly
Term
What are our skin closure options?
Definition
-direct apposition
-plasty techniques
-pedicle flaps
-axial pattern flaps
-composite flaps
-grafts
Term
Technique to close skin depends on what?
Definition
-elasticity of surrounding tissue
-location of the defect
-size of defect
-regional blood supply
-wound healing factors: systemic and locak
Term
What decides tension lines?
Definition
-tension lines are formed by the predominant pull of fibrous tissue within the skin
-tension increases the risk of closure complications
Term
How do we change our surical plan to address the issues of tension?
Definition
-close wound parallel to skin tension lines
Term
What happens if we close wounds perpendicular to skin tension lines?
Definition
-delays in healing
-wider scar
-more tension: dehiscence, pain
-dog ears
Term
What is undermining? Why do we do it?
Definition
-seperation of the skin or panniculus muscle or both from underlying tissue by blunt and sharp dissection
-simplest technique the relieve tension and maximizes elastic potential of skin edges
Term
How do we undermine granulation tissue?
Definition
-separate granulation tissue at the edges from epithelium
-caution!!!! don't be too agressive!!!
Term
What is the purpose of walking sutures?
Definition
-moves skin across a defect
-obliterate dead space
-distribute tension over the wound surface
-stretches skin in small increments
-do not penetrate skin surface
-anchored in fascia and dermis
Term
What suture patterns do we use to help disperse pressure?
Definition
-cruciate
-horizontal/vertical mattress
-far-ear-near-far
Term
What is the purpose of relaxing incisions?
Definition
-made to allow apposition of skin edges
-heal by contraction/epitheliazation
Term
Where do we use relaxing incisions?
Definition
-legs, around eyes/enus, cover vital structures
Term
What are the differences between simple and multiple relaxing incisions?
Definition
-Simple: less cosmotic, more relief
-Multiple: more cosmetic, less relaxaation, higher risk of circulatory compromise
Term
What is a V-to-Y plasty? When is it commonly used?
Definition
-relaxing incision where you make a V next to the incision and sow it until it becomes a Y
-common iwth eyelid surgery
Term
What is a Z-plasy?
Definition
-lengthens or relaxes an incision
-cut Z next to the wond
Term
What are dog ears?
Definition
-puckers of skin at the end of the incision line
Term
How do ewe correct dog ears?
Definition
-outline with an elliptical incision, remove redundant skin, appose skin edges
-cut off the dog ear
Term
Why are circular defects difficult surgically?
Definition
-b/c of dog ears
Term
What do we do to fix circular irregular skin defects?
Definition
-convert to linear: used for small defects, correct dog ears
Term
How do we convert circular defects to ellipse?
Definition
-4:1 length to width ratio
-resects more skin than necessary!
Term
What is a combined V?
Definition
-cut V's 45 degrees from axis of tension
Term
What is a bow-tie?
Definition
-cut triangles 30 degrees from axis of tension
-abundant skin must be available around defect
Term
How do we close triangular defects?
Definition
-start at points of triangle and suture inward
Term
How are rotational flaps closed?
Definition
-semicircular/three quarter circular flap of skin rotated at a pivot point into the defect
Term
Describe a single rotational flap.
Definition
-used when skin is available only on one side ofthe defect or rotation of skin results in a defect/distortion of adjacent structures
Term
Describe a bilateral rotational flap.
Definition
-little skin is available on both sides of defect/
Term
How do we close a square or rectangle skin defect?
Definition
-start corners and work inward (skin must be available on all four sides of defect)
Term
What are advancement flaps?
Definition
-free a flap the same length as the wound and pull it over
Term
What is a rotational flap?
Definition
-flap becomes increasingly shorter with increased rotation
-width of the flap = width of defect
Term
Describe how we close fusiform/elliptical skin defects?
Definition
-place suture across widest part of defect
-divide each remaining segment in half with subsequent sutures
Term
How d we close crescentic skin defects?
Definition
-close beginnin at the midpoint, each remaining segment closed by dividing segments in half
-place sutures on concave side closer, further on convex side
Term
What are skin grafts?
Definition
-transfer of a segment of free dermis and epidermis to a distant recipient site
Term
What are full-thickness skin grafts?
Definition
-epidermis and dermis
Term
What is a partial-thickness skin grafts?
Definition
-epidermis and variable dermis
-cannot do in cats (too thin)
Term
What are the types of skin grafts?
Definition
-sheet or mesh (often preferred)
-punch, stamps, strip
Term
What are the advantages of mesh skin grafts?
Definition
-increased surface area
-better conformity
-fluid drainage
Term
What four factors are critical to graft surviaval?
Definition
-healthy vascular bed
-lack of motion
-contact between the bed and graft
-lack of infeciton
Term
What diagnostics are indicated by neoplastic masses?
Definition
-fine needle aspiration
-biopsy, biopsy, biopsy
Term
What are our major concerns with resection of a neoplastic masses?
Definition
-wide excision
-submit tissue for margins
-first attempt is the best attempt!
Term
What margins are needed for a lipoma, mast cell tumor, and a high grade sarcoma?
Definition
-lipoma: 0cm
-mast cell tumor: 1-2 cm
-high grade sarcoma: 3cm
Term
In which cases are vulvar folds an issue?
Definition
-fat dogs
-infantile, recessed vulva
-superficial dermatitis, urinary incontinence, recurrent urinary tract infections
-episioplasty
Term
In which breeds do we commonly see redundant skin folds at the tail? What complications does this cause?
Definition
-Brachycephalics, Schipperke, Manx cat
-tail fold pyoderma is a common secondary complication
Term
Ho do we surgically correct redundant skin folds at the tail?
Definition
-tail fold resection that commonly leads to lack of a tail
Term
What are some common issues with ear pinna?
Definition
-lacerations
-frost bite
-aural hematoma
Term
What are the three ways we fix pinna lacerations?
Definition
-skin
-skin + cartilage
-skin + cartilage + skin
Term
What diagnostics do we use for aural hematomas?
Definition
-collection of blood, serum, or both in the pinna
-exacerbated with shaking of the head
Term
What is the goal during repair of an aural hematoma? How do we do it?
Definition
-Goal: obliterate dead space
-incision and suture, CO2, laser
Term
What commonly exacerbates aural hematomas?
Definition
-shaking of the head
Term
What must you absolutely do during recovery of an aural hematoma repair?
Definition
-bandage and immobilize the ear
Term
What are the indications for a lateral ear canal resection?
Definition
-adjunct to medical management for otitis externa
-minimal hyperplasia of ear canal
-small neoplastic lesions of lateral aspcet of the vertical canal
Term
What are the purposes of a lateral ear canal resection?
Definition
-allows for increased drainage, aeration of canal, facilitates medication administration
Term
Do we still have to medicate the ear with a lateral ear canal resection?
Definition
-YES
Term
Do we use lateral ear canal resection for otitis media?
Definition
-NO, not for obstruction of the horizontal ear canal either
Term
What are the indicatiosn for a vertical ear canal resection?
Definition
-Vertical canal disease: tumor, toitis externa confined to the vertical ear canal
-Horizontal canal must be normal
-better cosmetic appearance than with lateral resection when abundant hyperplstic tissue is present in and around vertical ear canal
Term
What are the indications for a total ear canal ablation?
Definition
-chronic otitis externa with failure of medical management
-ossificaion, hyperplasia of entire canal
-neoplasia
Term
What must we also perform with a total ear canal ablation?
Definition
-MUST PERFORM A LATERAL BULLA OSTEOTOMY
Term
What are the indications for a ventral bulla osteotomy?
Definition
-allows increased exposure to tympanic cavity
-technique for choice for cats: neoplasia, nasopharyngeal polyps
-better drainage of bulla
-CATS HAVE TWO COMPARTMENTS THAT MAKE UP THEIR BULLA
Term
What is a caudectomy?
Definition
-amputation of a portion/all of the tail
Term
What are the indications for a caudectomy?
Definition
-Therapeutic: traumatic lesions, infection, neoplasia
-Cosmetic
Term
Describe an adult caudectomy.
Definition
-general anesthesia
-V-shaped incision, vessel ligation, tension free closure
Term
What is a onychectomy?
Definition
-removal of the 3rd digital phalanx of cats
Term
What are some alternatives to onychectomy?
Definition
-nail trims
-caps
-DDF tenectomy
-outdoor cat
Term
What are the three methods of onychectomy?
Definition
-Scalpel
-Resco nail clipper: better chance of leaving ungual crest
-CO2 laser: less blood
Term
What kind of suture is used for onychectomy? Postop care?
Definition
-absorbable, monofilament
-bandages for 24 horus and paper litter
Term
What are the complications of onychectomy?
Definition
-hemorrhage, infection
-claw regrowth, lameness from remaining bone
-pad injury, tissue necrosis
Term
What are the indications for a canine onychectomy?
Definition
-trauma
-tumor: SCC, melanoma, sarcoma
-infection
Term
Describe a puppy dewclaw removal.
Definition
-at age 3-5 days
-do local anesthesia
-silver nitrate stick or pressure for hemostasis
Term
What are the two types of adult dewclaw removal?
Definition
-defined bony articulation at metacarpophalangeal joint
-soft tissue attachment only
Term
What are some doubled dewclaw breeds?
Definition
-Great Pyrenees
-Briard
Term
What are the indications for digit amputation?
Definition
-neoplasia
-chronic infection: bacterial, fungal
-osteomyelitis
-severe trauma
Term
What are the primary weight-bearing digits?
Definition
-3rd and 4th digits
Term
What is the purpose of the footpads?
Definition
-absorb shock, standing, and abrasive forces
Term
Describe the basic wound management we use for footpad lacerations.
Definition
-irrigation
-two-layer wound closure, simple interrupted
-padded splint
Term
How do we treat interdigital pyoderma?
Definition
-treat underlying cause first
-fusion podoplasty is performed if medical management fials
Term
What are some common issues with ear pinna?
Definition
-lacerations
-frost bite
-aural hematoma
Term
What are the three ways we fix pinna lacerations?
Definition
-skin
-skin + cartilage
-skin + cartilage + skin
Term
What diagnostics do we use for aural hematomas?
Definition
-collection of blood, serum, or both in the pinna
-exacerbated with shaking of the head
Term
What is the goal during repair of an aural hematoma? How do we do it?
Definition
-Goal: obliterate dead space
-incision and suture, CO2, laser
Term
What commonly exacerbates aural hematomas?
Definition
-shaking of the head
Term
What must you absolutely do during recovery of an aural hematoma repair?
Definition
-bandage and immobilize the ear
Term
What are the indications for a lateral ear canal resection?
Definition
-adjunct to medical management for otitis externa
-minimal hyperplasia of ear canal
-small neoplastic lesions of lateral aspcet of the vertical canal
Term
What are the purposes of a lateral ear canal resection?
Definition
-allows for increased drainage, aeration of canal, facilitates medication administration
Term
Do we still have to medicate the ear with a lateral ear canal resection?
Definition
-YES
Term
Do we use lateral ear canal resection for otitis media?
Definition
-NO, not for obstruction of the horizontal ear canal either
Term
What are the indicatiosn for a vertical ear canal resection?
Definition
-Vertical canal disease: tumor, toitis externa confined to the vertical ear canal
-Horizontal canal must be normal
-better cosmetic appearance than with lateral resection when abundant hyperplstic tissue is present in and around vertical ear canal
Term
What are the indications for a total ear canal ablation?
Definition
-chronic otitis externa with failure of medical management
-ossificaion, hyperplasia of entire canal
-neoplasia
Term
What must we also perform with a total ear canal ablation?
Definition
-MUST PERFORM A LATERAL BULLA OSTEOTOMY
Term
What are the indications for a ventral bulla osteotomy?
Definition
-allows increased exposure to tympanic cavity
-technique for choice for cats: neoplasia, nasopharyngeal polyps
-better drainage of bulla
-CATS HAVE TWO COMPARTMENTS THAT MAKE UP THEIR BULLA
Term
What is a caudectomy?
Definition
-amputation of a portion/all of the tail
Term
What are the indications for a caudectomy?
Definition
-Therapeutic: traumatic lesions, infection, neoplasia
-Cosmetic
Term
Describe an adult caudectomy.
Definition
-general anesthesia
-V-shaped incision, vessel ligation, tension free closure
Term
What is a onychectomy?
Definition
-removal of the 3rd digital phalanx of cats
Term
What are some alternatives to onychectomy?
Definition
-nail trims
-caps
-DDF tenectomy
-outdoor cat
Term
What are the three methods of onychectomy?
Definition
-Scalpel
-Resco nail clipper: better chance of leaving ungual crest
-CO2 laser: less blood
Term
What kind of suture is used for onychectomy? Postop care?
Definition
-absorbable, monofilament
-bandages for 24 horus and paper litter
Term
What are the complications of onychectomy?
Definition
-hemorrhage, infection
-claw regrowth, lameness from remaining bone
-pad injury, tissue necrosis
Term
What are the indications for a canine onychectomy?
Definition
-trauma
-tumor: SCC, melanoma, sarcoma
-infection
Term
Describe a puppy dewclaw removal.
Definition
-at age 3-5 days
-do local anesthesia
-silver nitrate stick or pressure for hemostasis
Term
What are the two types of adult dewclaw removal?
Definition
-defined bony articulation at metacarpophalangeal joint
-soft tissue attachment only
Term
What are some doubled dewclaw breeds?
Definition
-Great Pyrenees
-Briard
Term
What are the indications for digit amputation?
Definition
-neoplasia
-chronic infection: bacterial, fungal
-osteomyelitis
-severe trauma
Term
What are the primary weight-bearing digits?
Definition
-3rd and 4th digits
Term
What is the purpose of the footpads?
Definition
-absorb shock, standing, and abrasive forces
Term
Describe the basic wound management we use for footpad lacerations.
Definition
-irrigation
-two-layer wound closure, simple interrupted
-padded splint
Term
How do we treat interdigital pyoderma?
Definition
-treat underlying cause first
-fusion podoplasty is performed if medical management fials
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