Ellipse, ellipse variations and dog-ear repairs

Question 1

Antibiotic prophylaxis is not required for skin excisions in patients with artificial heart valves

Answer 1

F

Recommended for contaminated skin wounds or those that have been open >2hrs

Question 2

Most newer pacemakers have filters that block extraneous electrical current, permitting the routine use of short bursts of electrocautery

Answer 2

T

Question 3

Implantable cardioverter-debrillators (ICDs) are not typically adversely affected by electrical impulses

Answer 3

F

Options for these pts: disabling ICD temporarily, heat cautery, bipolar forceps.

Question 4

A longer scar limited to one cosmetic unit will be less noticeable than a shorter one that crosses the border between two units

Answer 4

T

Question 5

Gentian violet may ‘tattoo’ if not cleaned off before closing a wound

Answer 5

T

Question 6

Using 8.4% sodium bicarbonate to buffer lignocaine with adrenaline reduces its acidity and therefore minimises the burning and stinging sensation caused by the injection

Answer 6

T
Mix 1 part 8.4% sodium bicarb to 10 parts lignocaine
Will bring solution pH up to above the neutral range

Question 7

There are generally no side effects associated with topical chlorhexidine use.

Answer 7

F

Can cause keratitis with prolonged contact and oxotoxicity.

Question 8

Ellipse excisions should be designed with a length:width ratio of 3:1 or 4:1, with the apical angles ranging from 30-75 degrees.

Answer 8

T
3:1 with angles of 30 degrees is classical
May need 5:1 or more on trunk or limbs for large defect

Question 9

Excisions should be made along the relaxed skin tension lines in most instances.

Answer 9

T

Question 10

A smooth incision angled at approximately 10 degrees to the outside of the wound is required for ellipse excisions.

Answer 10

T

Question 11

For ellipse excisions, the incision should be carried down to the dermis on the first pass.

Answer 11

F
To Subcutis
consider using a 10 blade on the back to achieve this

Question 12

Heat cautery is only effective in a dry field.

Answer 12

F
Will work in a wet field

NB In this part of the book electrocautery is used to mean electrocoagulation
heat cautery is used to mean electrocautery

Question 13

Electrocautery is only effective in a dry field

Answer 13

T
In this part of the book electrocautery is used to mean electrocoagulation
heat cautery is used to mean electrocautery

Question 14

Random cautery is ineffective and may be harmful because it causes unnecessary thermal tissue damage.

Answer 14

T

Question 15

When there is persistent wound-edge bleeding from the dermal plexus at the edges, this must be cauterized

Answer 15

F

No need – will stop once wound is sutured.

Question 16

Undermining the surrounding skin is required to close any wound.

Answer 16

F

Only to an extent necessary to reduce tension.

Question 17

Often, simply undermining at the apices will obviate the need for excising small dog ears.

Answer 17

T

Question 18

With the use of adrenaline in anesthetic, vessels can go into spasm, only to relax and bleed 2-3 hours after surgery.

Answer 18

T

Question 19

Dermabond is octylcyanoacrylate tissue adhesive.

Answer 19

T

Question 20

All scars can contract up to 50% in length over time.

Answer 20

F

Up to 30%

Question 21

For most dog ear repairs, a curved repair gives a superior cosmetic result.

Answer 21

T

Question 22

Vitamin E can enhance the appearance of a scar and ‘speed’ the rate of healing.

Answer 22

F

Question 23

Most excess tissue can be removed in a linear fashion by extending the excision

Answer 23

T

Question 24

An alternative method of dog-ear repairs is excision of another small ellipse at the point of redundancy

Answer 24

T

Question 25

The disadvantage of the curves or hockey stick method of repair of standing redundant cones is that it doesn’t allow the surgeon to take advantage of natural creases

Answer 25

F | It does

Question 26

To perform a L-shaped repair an incision is made at a 90 degree angle to the original suture line, forming an L shape

Answer 26

T

Question 27

S-plasty achieves a superior cosmetic result on convex surfaces, such as the jaw and extremities.

Answer 27

T | same as lazy-S

Question 28

To excise a redundant cone of skin or dog ear, a T-shaped correction can be performed by making a cut at right angles to the original defect then excising excess tissue

Answer 28

T

Question 29

If a haematoma has developed post-operatively, the surgical wound must be opened for proper drainage.

Answer 29

F | Can usually drain with a 18G needle.

Question 30

Spitting buried sutures usually occur at 3-6 weeks postoperatively.

Answer 30

T | Should remove suture fragment asap to prevent granulomatous rcn

Question 31

Injection of LA should be performed using a 2.5cm long 30 gauge needle

Answer 31

True

Question 32

Maximally efficient anaesthesia is achieved by injecting into the dermis targeting the dermal neural plexus

Answer 32

T

Question 33

It may be unneccesary to use epidermal sutures if the wound approximation is excellent after inserting the deep sutures

Answer 33

T | can use steristrips or tissue adhesive instead

Question 34

A locking running suture provides additional haemostasis and is useful on areas with a rich blood supple such as the ear or genitals

Answer 34

T

Question 35

A few vertical mattress sutures added into a repair can provide additional wound eversion to areas prone to inversion such as forehead creases

Answer 35

T

Question 36

A running subcuticular suture is best performed using a suture with a high friction coefficient

Answer 36

F | low friction coefficient e.g. polypropylene (prolene), polydiaxanone (PDS)

Question 37

If oozing persists after closure firm pressure should be applied for 3 minutes

Answer 37

F 5 minutes by the clock if still bleeding after this need to open the wound and perform additional haemostasis

Question 38

Hydrogen peroxide is good for cleaning recent surgical wounds

Answer 38

False Is toxic to cells in vitro Tap water is fine

Question 39

Patients may shower 24 hrs after surgery

Answer 39

T | But keep stream of water away from wound until healed

Question 40

A shorter scar is always less noticable

Answer 40

F | a shorter scar is not necessarily a less noticeable scar

Question 41

Extensive intraoperative bleeding increases the possibility of postoperative bleeding

Answer 41

T | consider placing drain

Question 42

In areas more prone to infection (intertriginous areas, the extremities, and exposed cartilage), use acetic acid soaks and/or antibiotic prophylaxis

Answer 42

T

Question 43

Exposed cartilage, especially on the ear, is at an increased risk of infection, particularly Pseudomonas infection in diabetic patients

Answer 43

T

Question 44

Excessive wound tension increases risk of dehiscence

Answer 44

T | also increases keloid risk