Provisionof Skin Cover

  • Provisionof Skin Cover

    In the combined injury of skin and skeleton, skin damage can vary from minimal up to extensive degloving. Where skin loss has been minor, but closure by direct suture can only be achieved under tension, a ‘relaxation incision’ is often recommended. The idea is that by making such an incision, tension will be reduced, and […]

  • Fixation Of The Fracture

    Fixation of the fracture is the responsibility of the orthopaedic surgeon, but in choosing the method he has also to ensure that his choice does not conflict with the needs of the soft tissue injury. The essence of the method used is that it should provide rigid fixation of the fracture, and the potential alternatives […]

  • Skin-Bone Injuries

    The fractures most often associated with skin loss involve the long bones, tibia and, much less frequently, ulna. Before the management of such an injury can usefully be discussed, it is necessary to have an understanding of the principles which underlie its treatment, for the detailed handling of the injury is the expression in practical […]

  • Trochantericsores

    The greater trochanter is the projection which determines the site of the trochanteric ulcer. Initially, the main cavity of the ulcer is the trochanteric bursa which overlies the projection and, if this alone is involved, permanent closure may be achieved without interfering with the bone. As the condition progresses the trochanter and neck of femur […]

  • Sacral Sores

    The appropriate type of flap depends on the shape of the ulcer. Frequently suitable is the bilateral flap of buttock skin based on the in-ferior gluteal fold , and this double flap is especially useful in the sacral pressure sore in the non-paraplegic patient. If the shape and extent of the ulcer make this flap […]

  • Additional Techniques

    Several techniques have been developed which do not fit readily into a neat classification, either because they are not strictly surgical, though they are used in a surgical context, or have been taken from other surgical disciplines because they offered a partial or complete solution to problems whose management by conventional plastic surgical methods was […]

  • Raising The Flap

    The flap, designed astride the intermuscular septum, is raised under tourniquet. Its breadth is limited to 6cm because of the need to close the secondary defect directly; its average length is 10 cm. As a first step, the line joining the lateral epicondyle and the deltoid insertion, representing the line of the intermuscular septum, is […]

  • Ulnar Forearm Flap

    The perforating system of the ulnar forearm flap passes from the ulnar vessels to the investing layer of fascia in the septum between flexor carpi ulnaris and flexor digitorum superficialis. The flap is generally sited towards the ulnar side of the forearm, but in other respects the techniques involved in its transfer are similar to […]

  • Radial Forearm Flap

    This flap, raised on the flexor aspect of the fore-arm, is perfused from the radial vessels. Their perforating branches supply the plexus of the investing layer of deep fascia, from which the blood is distributed to the overlying skin. The flap can be designed as a fasciocutaneous flap to transfer soft tissue alone, or in […]

  • Postoperative Management

    Free flaps are at their most vulnerable during the first 72 hours after operation, and most compli-cations arise during this period. Things can go wrong later, but they do so sufficiently rarely that the first 3 days can be regarded as the dan-ger period when observation should be most acute. Complications arising more than 3 […]