How do tension lines affect wound closure?
wounds parallel to tension lines will close with minimal tension
wounds perpendicular to tension lines will gape and have greater tension
8 ways to manage tension
1) maximise available skin
2) change local skin disease
3) change regional skin tension
4) mobilise local skin
5) increase local skin
6) distributes tension
7) overcome tension
8) remove tension
How can you maximise available skin?
patient positioning
how can you change local skin tension?
- local closure of small defects with a fusiform excision
- managing dog ears
- suture small wounds
- relieve tension
how can you mobilise local skin?
undermine skin edges so its inherent elastic properties can be used
how can you increase local skin?
- pre-suturing (stretch normal skin before surgery)
- skin stretchers
- skin expanders
how can you overcome tension?
suture patterns
skin stretchers post op
how can you remove tension?
- tension relieving incision
- relaxing incision for primary closure
- multiples relaxing incisions
What is an advanced skin flap?
- use local loose skin
- may have problems with tension / diehescence
- want base of flap wider than apex to allow adequate blood supply
What is a transposition flap?
- rectangular flap created at 90 degrees to the long axis of the defect
- may get dog ears (should go down on their own in 6-8 w)
What is a rotating flap?
- arc of skin sharing a common border with a triangular defect
- no secondary donor site
- combination of advancement and transposition
What is a flank fold?
loose skin of axilla and flank
What is an axial pattern flap?
take a big flap nd move it somewhere else and take blood supply with it
what is a distant direct subdermal flap?
for large or very distal limb wounds
