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MRCS A > Burns/Grafts/Organ Transplants > Flashcards

Burns/Grafts/Organ Transplants Flashcards

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
Q

full thickness burn - prognosis

A

heals by contracture >8 w
scars

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26
Q

ideal fluid for Burns resus

A

Hartmann’s

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27
Q

Parkland formula adults

A

Initial 24hrs (Adults): 4mL (Hartmann’s) x Weight (kg) x %TBSA burned
50% first 8h
50% next 16hr

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28
Q

Parkland formula paeds

A

Initial 24hrs (Children): 3mL (Hartmann’s) x Weight (kg) x %TBSA burned
50% first 8hr
50% next 16hr

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29
Q

transfer to burns unit if:

A

> 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

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30
Q

electrolyte imbalances 2’ to burns

A

hypernatraemia; subsequent hypokalaemia, hypomagnesaemia, hypocalcaemia, and hypophosphataemia

31
Q

GI complications burns

A

paralytic ileus, Curling’s ulcer, and bacterial translocation

32
Q

Why do you get a Curling’s ulcer with burns?

A

significant reduction in plasma volume following the injury
–> gastric mucosa ischaemia –> ulcer formation

33
Q

Def contractures

A

abnormal contraction or stiffening of tissues,
—> decreased movement and range of motion

34
Q

intrinsic vs extrinsic contracture

A

intrinsic = scarring within the affected area
extrinsic = scarring outside the affected area

35
Q

why excise the burn early?

A

to prevent post-burn hypertrophic scarring and contracture

36
Q

Mx formed scars and contractures

A

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
Q

medical Tx scars

A

intralesional corticosteroid injection,
cryotherapy,
laser treatment,
radiotherapy
5-fluorouracil

38
Q

2 main risks with electrical burns

A

arrhythmia and myoglobinuria

39
Q

what are the 4 steps of graft take

A

haemostasis
plasmatic inhibition (day 1-2)
inosculation (day 2-3)
re-innervation (2-4w)

40
Q

graft take - haemostasis

A

normal physiological response
to prevent XS bleeding

41
Q

graft take - plasmatic inhibition

A

fl migrates to graft bed
–> oedamatous but still avascular

42
Q

graft take - inosculation

A

vascular network = slowly re-established

43
Q

graft take - re-innervation

A

begins at w2-4
but sensation may take a few months to recover

44
Q

which microbe is the common infection in grafts

A

Strep spp

45
Q

how is harvest site closed in full thickness skin graft

A

as no epidermis left behind
closed with sutures

46
Q

full thickness graft to face - common donor sites (2)

A

post auricular + supraclavicular skin

47
Q

full thickness graft to upper eyelid - common donor site

A

contralateral eyelid

48
Q

full thickness graft to hand/flexural contractures - common donor site

A

flexural skin e.g. antecubital fossa

49
Q

full thickness graft to palms/soles - common donor sites

A

thigh + abdominal skin

50
Q

process of full thickness graft harvesting

A

harvested with scalpel
epidermis + dermis taken
all SCT fat = removed = ‘de-fatting’ with scissors
to be sutured into place at donor site

51
Q

what is a split-thickness graft

A

full epidermis with a variable thickness of dermis, leaving dermal remnants at the donor site to allow for re-epithelization

52
Q

skin graft vs flap - which has the higher chance of failure

A

highest failure = full thickness graft
then split thickness
then flap

53
Q

What is a pedicled flap

A

completely raised on a named vessel from the donor site and then transferred to the recipient site;

54
Q

Free flap - deep inferior epigastric perforator - donor site + aa

A

lower abdomen
(sparing rectus abdominis)

deep inferior epigastric aa

55
Q

Free flap - Transverse Rectus Abdominis Myocutaneous - donor site + aa

A

Skin, subcutaneous tissue, and part of the rectus abdominus
deep inferior epigastric aa

56
Q

Free flap - Latissimus Dorsi Myocutaneous Flap - donor siite + aa

A

Skin, subcutaneous tissue, and part of the latissimus dorsi
subscapular aa

57
Q

Free flap - Thoracodorsal artery perforator - donor site + aa

A

Skin and subcutaneous tissue of lateral back, sparing the latissimus dorsi

thoracodorsal aa

58
Q

Free flap - anterolateral thigh - donor site + aa

A

Skin and subcutaneous tissue of anterolateral thigh (can include vastus lateralis muscle)

descending branch lateral circumflex aa

59
Q

Keloid scar

A

XS collagen in the scar
BEYOND the boundaries of the scar

60
Q

drugs –> delayed wound healing (4)

A

Non steroidal anti inflammatory drugs
Steroids
Immunosupressive agents
Anti neoplastic drugs

61
Q

in wound healing, when do the fibroblasts –> myofibroblasts

A

usually after 6 weeks

62
Q

wound management I+D abscess

A

packing with alginate

63
Q

vasculogenesis vs angiogenesis

A

vascu = new
angi = pre
vasculogenesis - new vessels developing in situ from existing mesenchyme
angiogenesis - vessels develop from sprouting off pre-existing arteries

64
Q

Factors that increase the risk of abdominal wound dishiniscence

A
  • 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
Q

noradrenaline main receptor

A

a1

66
Q

dobutamine main receptor

A

b1

67
Q

binding to alpha receptors –>

A

vasoconstriction

68
Q

binding to beta 1 receptors –>

A

incr cardiac contractility + HR

69
Q

binding to beta 2 receptors –>

A

vasodilation

70
Q

binding to D1 receptors –>

A

renal and spleen vasodilation

71
Q

binding to D2 receptors –>

A

inhibits release noradrenaline

72
Q

causes of increases FRC (3)

A

Erect position
Emphysema
Asthma

73
Q

causes of decreased FRC (5)

A

Pulmonary fibrosis
Laparoscopic surgery
Obesity
Abdominal swelling
Muscle relaxants

MRCS A (36 decks)

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