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MRCS A > Burns/Grafts/Organ Transplants > Flashcards

Burns/Grafts/Organ Transplants Flashcards

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1
Q

Mx simple wounds/lacerations

A

primary closure, clean and dress
wound considered ‘closed’ by 48 hours

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2
Q

what negative pressure are VAC sealed wounds usually set to

A

75-100mmHg

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3
Q

C/I VAC dressings

A

active exposure of vessel/bowel
ongoing infection
significant necrosis requiring further debridement

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4
Q

what are the 2 types of skin grafting?

A

Split thickness - does not contain whole dermis
Full thickness - contains whole dermis (+ transplanting hair follicles)

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5
Q

how are split thickness grafts Harvested?

A

dermatome or using a specialist blade (such as a Humby knife)

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6
Q

use of full thickness grafts

A

smaller areas with need for better cosmetic results

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7
Q

difference between skin grafts and flaps

A

flaps bring their own blood supply

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8
Q

what are ‘free flaps’

A

“Free” flaps describe a technique where tissue is raised with its blood supply, which is then completely detached and re-attached (anastomosed) to a new vessel at the donor site.

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9
Q

What is the reconstructive ladder?

A

1 Secondary intention
2 Primary closure
3 Delayed primary closure
4 Split thickness graft
5 Full thickness skin graft
6 Tissue expansion
7 Random flap
8 Pedicled flap
9 Free flap

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10
Q

acid vs alkali burn - which type of necrosis

A

acid = coagulative necrosis
alkali = liquefaction necrosis

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11
Q

Def major burn adult vs paeds

A

Adult = >20 TSBA
Paed = >10% TSBA
of partial or full thickness burn

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12
Q

why run a superficial burn under cold water for 20 minutes?

A

promotes re-epithelialisation

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13
Q

why is hypothermia a severe risk after a burns injury?

A

extensive heat loss and fluid loss from burn sites

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14
Q

superficial burn - deepest layer involved

A

epidermis

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15
Q

superficial burn - appearance

A

dry, blanching, erythema, painful

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16
Q

superficial burn - prognosis

A

heals 5-10 days without scarring

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17
Q

superficial partial thickness burn - deepest layer involved

A

upper dermis

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18
Q

superficial partial thickness burn - appearance

A

blisters, wet, blanching, erythema, painful

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19
Q

superficial partial thickness burn -prognosis

A

heals without scarring
<3 weeks

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20
Q

deep partial thickness burn - deepest layer

A

lower dermis

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21
Q

deep partial thickness burn - appearance

A

yellow/white
dry
non-blanching
reduced sensation

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22
Q

deep partial thickness burn - prognosis

A

heal in 3-8 w
scar likely if >3w healing time

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23
Q

full thickness burn - deepest tissue involved

A

SCT

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24
Q

full thickness burn - appearance

A

leathery
waxy white
non-blanching
dry
painless

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25
full thickness burn - prognosis
heals by contracture >8 w scars
26
ideal fluid for Burns resus
Hartmann's
27
Parkland formula adults
Initial 24hrs (Adults): 4mL (Hartmann’s) x Weight (kg) x %TBSA burned 50% first 8h 50% next 16hr
28
Parkland formula paeds
Initial 24hrs (Children): 3mL (Hartmann’s) x Weight (kg) x %TBSA burned 50% first 8hr 50% next 16hr
29
transfer to burns unit if:
>10-39% with inhalation injury Deep partial or full-thickness Site Specialised areas (hands, feet, face, perineum, genitals, over major joint) Non-blanching circumferential burns Any chemical, electrical, friction, or cold injury
30
electrolyte imbalances 2' to burns
hypernatraemia; subsequent hypokalaemia, hypomagnesaemia, hypocalcaemia, and hypophosphataemia
31
GI complications burns
paralytic ileus, Curling’s ulcer, and bacterial translocation
32
Why do you get a Curling's ulcer with burns?
significant reduction in plasma volume following the injury --> gastric mucosa ischaemia --> ulcer formation
33
Def contractures
abnormal contraction or stiffening of tissues, ---> decreased movement and range of motion
34
intrinsic vs extrinsic contracture
intrinsic = scarring within the affected area extrinsic = scarring outside the affected area
35
why excise the burn early?
to prevent post-burn hypertrophic scarring and contracture
36
Mx formed scars and contractures
do not attempt surgery until scars have matured techniques: excision and grafting, scar release and joint release, local and regional flaps, skin substitutes, and tissue expansion
37
medical Tx scars
intralesional corticosteroid injection, cryotherapy, laser treatment, radiotherapy 5-fluorouracil
38
2 main risks with electrical burns
arrhythmia and myoglobinuria
39
what are the 4 steps of graft take
haemostasis plasmatic inhibition (day 1-2) inosculation (day 2-3) re-innervation (2-4w)
40
graft take - haemostasis
normal physiological response to prevent XS bleeding
41
graft take - plasmatic inhibition
fl migrates to graft bed --> oedamatous but still avascular
42
graft take - inosculation
vascular network = slowly re-established
43
graft take - re-innervation
begins at w2-4 but sensation may take a few months to recover
44
which microbe is the common infection in grafts
Strep spp
45
how is harvest site closed in full thickness skin graft
as no epidermis left behind closed with sutures
46
full thickness graft to face - common donor sites (2)
post auricular + supraclavicular skin
47
full thickness graft to upper eyelid - common donor site
contralateral eyelid
48
full thickness graft to hand/flexural contractures - common donor site
flexural skin e.g. antecubital fossa
49
full thickness graft to palms/soles - common donor sites
thigh + abdominal skin
50
process of full thickness graft harvesting
harvested with scalpel epidermis + dermis taken all SCT fat = removed = 'de-fatting' with scissors to be sutured into place at donor site
51
what is a split-thickness graft
full epidermis with a variable thickness of dermis, leaving dermal remnants at the donor site to allow for re-epithelization
52
skin graft vs flap - which has the higher chance of failure
highest failure = full thickness graft then split thickness then flap
53
What is a pedicled flap
completely raised on a named vessel from the donor site and then transferred to the recipient site;
54
Free flap - deep inferior epigastric perforator - donor site + aa
lower abdomen (sparing rectus abdominis) deep inferior epigastric aa
55
Free flap - Transverse Rectus Abdominis Myocutaneous - donor site + aa
Skin, subcutaneous tissue, and part of the rectus abdominus deep inferior epigastric aa
56
Free flap - Latissimus Dorsi Myocutaneous Flap - donor siite + aa
Skin, subcutaneous tissue, and part of the latissimus dorsi subscapular aa
57
Free flap - Thoracodorsal artery perforator - donor site + aa
Skin and subcutaneous tissue of lateral back, sparing the latissimus dorsi thoracodorsal aa
58
Free flap - anterolateral thigh - donor site + aa
Skin and subcutaneous tissue of anterolateral thigh (can include vastus lateralis muscle) descending branch lateral circumflex aa
59
Keloid scar
XS collagen in the scar BEYOND the boundaries of the scar
60
drugs --> delayed wound healing (4)
Non steroidal anti inflammatory drugs Steroids Immunosupressive agents Anti neoplastic drugs
61
in wound healing, when do the fibroblasts --> myofibroblasts
usually after 6 weeks
62
wound management I+D abscess
packing with alginate
63
vasculogenesis vs angiogenesis
vascu = new angi = pre vasculogenesis - new vessels developing in situ from existing mesenchyme angiogenesis - vessels develop from sprouting off pre-existing arteries
64
Factors that increase the risk of abdominal wound dishiniscence
* Malnutrition * Vitamin deficiencies * Jaundice * Steroid use * Major wound contamination (e.g. faecal peritonitis) * Poor surgical technique (Mass closure technique is the preferred method-Jenkins Rule)
65
noradrenaline main receptor
a1
66
dobutamine main receptor
b1
67
binding to alpha receptors -->
vasoconstriction
68
binding to beta 1 receptors -->
incr cardiac contractility + HR
69
binding to beta 2 receptors -->
vasodilation
70
binding to D1 receptors -->
renal and spleen vasodilation
71
binding to D2 receptors -->
inhibits release noradrenaline
72
causes of increases FRC (3)
Erect position Emphysema Asthma
73
causes of decreased FRC (5)
Pulmonary fibrosis Laparoscopic surgery Obesity Abdominal swelling Muscle relaxants

MRCS A (36 decks)

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