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MD2 Surgery and Anaesthesia > Basic Plastic Surgery > Flashcards

Basic Plastic Surgery Flashcards

1
Q

What are the aims of wound management?

A

Early healing
Avoid infection
Minimise long-term scarring

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2
Q

How do you assess a wound?

A

Mechanism of injury
Extent of skin loss
Underlying structures
Any impairment of wound healing

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3
Q

What are some causes of wound healing?

A 
Arterial insufficiency
Venous insufficiency
Pressure
Infection
Diabetes
Nutritional deficiency
Radiation
Drugs; eg: steroids
Smoking
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4
Q

What are the principles of wound management?

A

Assessment of wound and patient
Tetanus prophylaxis
Debridement
Wound closure

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5
Q

What does debridement involve?

A

Physical removal of all dead tissue and foreign matter

Lavage to reduce bacterial count

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6
Q

What is the management for bite wounds?

A 
High risk of infection!
Thorough debridement
Antibiotics
Determine type of closure or secondary intention healing
Never suture close a human bite wound
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7
Q

How do pressure sores occur?

A

Impairment of blood supply due to pressure of body on wound > occludes vessels

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8
Q

What is the management for pressure sures?

A

Assess overall health
Pressure care
Debridement to healthy tissue
Skin graft/flap when underlying causes have been corrected and good pressure care in place

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9
Q

What is the aim of wound dressings?

A 
Debridement
Reduction of bacterial count
Maintenance of favourable environment
Protection/splinting of wound
Apply pressure to reduce bleeding
Reduce pain
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10
Q

What is negative pressure wound therapy?

A

Open cell sponge applied directly to wound
Clear, occlusive plastic dressing
Tubing connected to negative pressure pump
Removes fluid from wound

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11
Q

What is a hypertrophic scar?

A

Exaggerated normal remodelling response

Stays within margins of original wound

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12
Q

What is a keloid scar?

A

Extends beyond original wound

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13
Q

Which racial groups do hypertrophic and keloid scars affect?

A

Hypertrophic - all racial groups

Keloid - African and Asians most common

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14
Q

Which areas of the body do hypertrophic and keloid scars affect?

A

Hypertrophic - some areas more common

Keloid - any part

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15
Q

How do hypertrophic and keloid scars change over time?

A

Hypertrophic - improve

Keloid - progress

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16
Q

What is the response of hypertrophic and keloid scars to steroid injections, and pressure?

A

Hypertrophic - respond well

Keloid - less responsive

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17
Q

What is a graft?

A

Transferred tissue dependent on recipient site for nutrition

Develops vascular network from recipient bed

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18
Q

What is a flap?

A

Transferred tissue independent of recipient site for nutrition
Carries own vascular network

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19
Q

What is a split skin graft?

A

Harvest epidermis and part of dermis

Leaves wound like deep graze > heals > pale scar

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20
Q

What are the advantages of a full thickness skin graft compared to a split skin graft?

A

Less contraction
Better appearance
Better function

21
Q

Compare and contrast split skin and full thickness skin grafts

A 
Area
- Split skin: large area
- Full thickness: size limited by need to close donor site
Adnexal structures
- Split skin: none
- Full thickness: present
Contraction
- Split skin: significant
- Full thickness: less
Cosmetic appearance
- Split skin: poor
- Full thickness: better outcome
Ease of harvest
- Split skin: easier take
- Full thickness: needs optimal recipient bed
22
Q

What are the indications for a flap over a graft?

A

Bed not sufficiently vascularised to support graft
Need to cover prosthetic material
Better appearance

23
Q

What are the types of single stage local skin flaps?

A

Transposition
Rotation
Advancement

24
Q

What is primary skin closure?

A

Immediate

25
Q

What are different types of suture material?

A 
Prolene - non-dissolvable
Monocryl - dissolves in 8 weeks
- Used to suture in sub-cuticular areas
Cat gut
Vicryl
26
Q

What is a free flap?

A

Flap taken from one part of body to another part

Anastomose microvasculature

27
Q

What sort of rotation flap is used on the face for a small area?

A

Limberg

28
Q

What sort of advancement flap is commonly used on the forehead and back of the ear?

A

Double advancement H flap

29
Q

What is an island flap?

A

Cut out all the way around

Most commonly seen at nasolabial fold

30
Q

What sort of flap is a keystone flap?

A

Island flap

31
Q

What is healing by secondary intention?

A

Closed by dressings

32
Q

What is the proportion of different skin cancers?

A

BCC - 70%
SCC - 25%
Melanoma - 5%

33
Q

What are some of the subtypes of BCCs?

A 
Ulcerating
Nodular
Superficial
Multifocal
Morphoeic
34
Q

What is the treatment for BCCs?

A

Excision

2-3 mm margin

35
Q

Do BCCs metastasise?

A

No

36
Q

What factors contribute to poorer outcomes in melanoma?

A 
Nodular
Higher Clark's score
Male
Smokers
Truncal vs on periphery
Ulcerated
37
Q

What is the treatment for melanoma?

A

Excision
Clear margin has to be 10x depth
May also have sentinel node biopsy
Vemurafenib for secondary melanoma

38
Q

What are the Clark’s levels?

A 
I = in epidermis
II = invasion into papillary dermis
III = invasion to junction of papillary and reticular dermis
IV = invasion into reticular dermis
V = invasion into subcutaneous fat
39
Q

What is the vermilion line?

A

Line where mucosa of lip meets skin

40
Q

What is the technique to excise a skin lesion on the ear?

A

Below equator - remove as wedge and suture

Above equator - flap

41
Q

What area should you avoid when excising under the eye?

A

Ectropion, as pulls eye down > can’t control tear duct

42
Q

What are the possible causes of Dupuytren’s contracture?

A

Alcohol
FHx
Manual labour; eg: jackhammer

43
Q

What is Dupuytren’s contracture?

A

Fatty-fibrous change in palmar fascia > attaches to other structures on hand > contracts

44
Q

Which digits does Dupuytren’s contracture affect, in order of most to least common?

A 
4th
5th
Thumb
2nd
3rd
45
Q

What is the treatment for Dupuytren’s contracture?

A

If painless - do nothing
Limited fasciotomy - most common treatment
Radical fasciotomy - take out fascia of whole hand
Amputation

46
Q

What is a pilonidal sinus?

A

Abnormal nest of hair in blind-ended tract

47
Q

Where is a pinonidal sinus most commonly found?

A

Sacrum

48
Q

What is the treatment for pilonidal sinus?

A

Excision

Heal with secondary intention

MD2 Surgery and Anaesthesia (31 decks)

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