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Surgery tray instruments are listed in Appendix G. Consider adding skin hooks to gently handle the skin flaps. Have at least three fine (mosquito) hemostats to assist with hemostasis while developing large skin flaps.
Suggested suture removal times are listed in Appendix J, and a suggested anesthesia tray that can be used for this procedure is listed in Appendix F. All instruments can be ordered through local surgical supply houses.
Closure of skin defects that require minimal skin removal, or where skin may be under tension from a variety of directions.
Poor blood flow areas
Wounds best closed by other methods
Presence of cellulitis, bacteremia, or active infection
Pearl: Prep a wide area so that an undraped area is not inadvertently exposed if the drape slides a little.
PITFALL: Bleeding from the flap base will impede healing and promote flap necrosis.
PITFALL: Do not undermine the flap itself, because the blood supply for this flap comes from the pedicle beneath. If the pedicle is undermined for any reason, convert the procedure to a fusiform excision.
Pearl: The use of loupe magnification may assist the performance of this technique; a 4-0 to 5-0 suture will produce fewer suture marks.
PITFALL: Make sure to maintain the same depth in the dermis throughout each corner suture.
Pearl: The flap should be as wide as the greatest width of the amputation.
Pain, infection, and bleeding
Nonunion of skin edges
Tissue sloughing, usually due to excess tension or the blood supply being disrupted by undermining
Sensory changes, which often subside with time