Soft Tissue Coverage ppt - D. Muslim

Soft-tissue coverage

Skin grafts:- Its transplantation of tissues which blood supply depend completely on recipient area flap:- Its transplantation of tissues which blood supply depend on donor vessels

Skin grafts

I - Partial-thickness skin grafts epidermis and a variable thickness of dermis. . II - Full-thickness grafts epidermis and all of the dermis; the donor site will not epithelialize and must be closed,. dermis.

split thickness skin graft

Full thickness skin graft
1.Donor site healed spontaneously.
1. Donor site should closed directly, Since no epithelium appendage remain for resurfacing
2. Good intake.
2. Intake less readily.
3. Have more 2ndry Contraction
3. Undergo less 2ndry contraction.
4. Less cosmetic result
4. Have better cosmetic result
5-used large area
5. Used small area

Partial thickness

Full thickness

III- Composite grafts consist of skin and some underlying tissue such as fat and cartilage. *donor sites must be closed directly.

IV-Skin-graft substitutesCadaver skin,collagen sponge used as temporary skin substitutestissue culture ( stem cell)Used for coverage of large defect when autologus skin

Skingun

Contraindication of skin graft:
1--Deadly, heavy contaminated wound.2--Area of poor vascular supply.(3—bare Tendon (denuded of paratenon.(4—bare Muscle (denuded of epimysium.(5—bare Cartilage (denuded of perichondrium.(6—bare Bone (denuded of periosteum

To reduce failure rate of graft should be

1---not take on bare bone, bare tendon or cartilage,. 2— fixation of The graft3--- elevation of Limbs.

4---Haemostasis. 5--- Skin grafts can be stored in a refrigerator at 4 C for 2 weeks for delayed application. 6 -- avoid infection excessive contamination with bacteria will prevent take. Streptococci at levels above 10 5 m.o/g of tissue will result in graft loss. 7-- do multiple small incisions 8--dressing

- Other tissues grafts

--Bone grafts The outer table of the skull, the ribs, and the iliac crest are preferred donor sites. --Cartilage grafts are commonly used in nasal and ear reconstruction. Cartilage is an avascular tissue; survival of transplanted chondrocytes depends entirely on diffusion of nutrients . --Vessels, Nerve, tendon, , fascia and cornea are also all in common use.

Terminology

Flaps
1- Random pattern flapsused for local repair of adjacent defects  rotation flap , or advancement flap (, V-Y plasty )or transposition (Z-plasty )2-Axial pattern flaps Skin flap containing an artery in its long axisThe forehead flap , the deltopectoral flap and groin flap 3- mayocutaneous flaps(pedicle) compound flap of skin and muscle with adequate vascularity Latissimus dorsi and rectus abdominis muscles are particularly useful in breast reconstruction. Gluteus maximus and tensor fascia lata flaps are used for pressure-sore closure. 4- Free tissue transfer toe transfer to reconstruct the thumb. 5- Tissue expansion a silicone balloon flap

Random pattern flaps

rotation flap
advancement flap
transposition
1- Random pattern flapsused for local repair of adjacent defects  rotation flap , or advancement flap (, V-Y plasty )or transposition (Z-plasty )

Random pattern flaps

2-Axial pattern flaps
Skin flap containing an artery in its long axis The forehead flap , the deltopectoral flap and groin flap

3- mayocutaneous flaps(pedicle
Delto-pectoral flap
TRMP
compound flap of skin and muscle with adequate vascularity Latissimus dorsi and rectus abdominis muscles are particularly useful in breast reconstruction. Gluteus maximus and tensor fascia lata flaps are used for pressure-sore closure.

4-Free flap

toe transfer to reconstruct the thumb

THE MOST COMMON DISEASES NEAD RECONSETRUCTION

TRUAMA TUMORS BREAST CONGENITAL THE MOST COMMON DISEASES NEAD COSMOTIC SURGERY RHINOPLASTY, BOTOKS .

trauma

Burn Hand Face

burn & reconstruction

burn usually involve wide area , can involve any part in body A--early problems of burn are1-ischarectomy (compartment syndrome ) 2- early sloughing of dead tissues 3- skin graft delay healing of wide areas -- B-late problems of burn are contracture , alopecia , depegmentation and hyperpegmentation ,

ischarectomy

Flame burn(sloughing)

Marked for full thickness burns

Injecting with dilute adrenaline

Shaving marked area

Split skin graft harvest (donor site - left thigh)

Homby knife

Electric dermatom

Graft mesher

Application of skin graft

Dressing – crepe

Contracture of joint and scar release
after healing with fibrosis , contraction of fibrous tissues may cause deformity and limitation of joint treatment is elongation of scar by advancement flap , V-Y plasty , Z – plasty –

axilla

neck

Soft Tissue Coverage