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MD2 Surgery and Anaesthesia > Basic Plastic Surgery > Flashcards

Basic Plastic Surgery Flashcards

(48 cards)

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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?

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A

Less contraction
Better appearance
Better function

21
Q

Compare and contrast split skin and full thickness skin grafts

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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?

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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?

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A

Transposition
Rotation
Advancement

24
Q

What is primary skin closure?

25
What are different types of suture material?
``` Prolene - non-dissolvable Monocryl - dissolves in 8 weeks - Used to suture in sub-cuticular areas Cat gut Vicryl ```
26
What is a free flap?
Flap taken from one part of body to another part | Anastomose microvasculature
27
What sort of rotation flap is used on the face for a small area?
Limberg
28
What sort of advancement flap is commonly used on the forehead and back of the ear?
Double advancement H flap
29
What is an island flap?
Cut out all the way around | Most commonly seen at nasolabial fold
30
What sort of flap is a keystone flap?
Island flap
31
What is healing by secondary intention?
Closed by dressings
32
What is the proportion of different skin cancers?
BCC - 70% SCC - 25% Melanoma - 5%
33
What are some of the subtypes of BCCs?
``` Ulcerating Nodular Superficial Multifocal Morphoeic ```
34
What is the treatment for BCCs?
Excision | 2-3 mm margin
35
Do BCCs metastasise?
No
36
What factors contribute to poorer outcomes in melanoma?
``` Nodular Higher Clark's score Male Smokers Truncal vs on periphery Ulcerated ```
37
What is the treatment for melanoma?
Excision Clear margin has to be 10x depth May also have sentinel node biopsy Vemurafenib for secondary melanoma
38
What are the Clark's levels?
``` 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
What is the vermilion line?
Line where mucosa of lip meets skin
40
What is the technique to excise a skin lesion on the ear?
Below equator - remove as wedge and suture | Above equator - flap
41
What area should you avoid when excising under the eye?
Ectropion, as pulls eye down > can't control tear duct
42
What are the possible causes of Dupuytren's contracture?
Alcohol FHx Manual labour; eg: jackhammer
43
What is Dupuytren's contracture?
Fatty-fibrous change in palmar fascia > attaches to other structures on hand > contracts
44
Which digits does Dupuytren's contracture affect, in order of most to least common?
``` 4th 5th Thumb 2nd 3rd ```
45
What is the treatment for Dupuytren's contracture?
If painless - do nothing Limited fasciotomy - most common treatment Radical fasciotomy - take out fascia of whole hand Amputation
46
What is a pilonidal sinus?
Abnormal nest of hair in blind-ended tract
47
Where is a pinonidal sinus most commonly found?
Sacrum
48
What is the treatment for pilonidal sinus?
Excision | Heal with secondary intention

MD2 Surgery and Anaesthesia (31 decks)

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