Flashcards in Ellipse, ellipse variations and dog-ear repairs Deck (44):
Antibiotic prophylaxis is not required for skin excisions in patients with artificial heart valves
Recommended for contaminated skin wounds or those that have been open >2hrs
Most newer pacemakers have filters that block extraneous electrical current, permitting the routine use of short bursts of electrocautery
Implantable cardioverter-debrillators (ICDs) are not typically adversely affected by electrical impulses
Options for these pts: disabling ICD temporarily, heat cautery, bipolar forceps.
A longer scar limited to one cosmetic unit will be less noticeable than a shorter one that crosses the border between two units
Gentian violet may ‘tattoo’ if not cleaned off before closing a wound
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
Mix 1 part 8.4% sodium bicarb to 10 parts lignocaine
Will bring solution pH up to above the neutral range
There are generally no side effects associated with topical chlorhexidine use.
Can cause keratitis with prolonged contact and oxotoxicity.
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.
3:1 with angles of 30 degrees is classical
May need 5:1 or more on trunk or limbs for large defect
Excisions should be made along the relaxed skin tension lines in most instances.
A smooth incision angled at approximately 10 degrees to the outside of the wound is required for ellipse excisions.
For ellipse excisions, the incision should be carried down to the dermis on the first pass.
consider using a 10 blade on the back to achieve this
Heat cautery is only effective in a dry field.
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
Electrocautery is only effective in a dry field
In this part of the book electrocautery is used to mean electrocoagulation
heat cautery is used to mean electrocautery
Random cautery is ineffective and may be harmful because it causes unnecessary thermal tissue damage.
When there is persistent wound-edge bleeding from the dermal plexus at the edges, this must be cauterized
No need – will stop once wound is sutured.
Undermining the surrounding skin is required to close any wound.
Only to an extent necessary to reduce tension.
Often, simply undermining at the apices will obviate the need for excising small dog ears.
With the use of adrenaline in anesthetic, vessels can go into spasm, only to relax and bleed 2-3 hours after surgery.
Dermabond is octylcyanoacrylate tissue adhesive.
All scars can contract up to 50% in length over time.
Up to 30%
For most dog ear repairs, a curved repair gives a superior cosmetic result.
Vitamin E can enhance the appearance of a scar and ‘speed’ the rate of healing.
Most excess tissue can be removed in a linear fashion by extending the excision
An alternative method of dog-ear repairs is excision of another small ellipse at the point of redundancy
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
To perform a L-shaped repair an incision is made at a 90 degree angle to the original suture line, forming an L shape
S-plasty achieves a superior cosmetic result on convex surfaces, such as the jaw and extremities.
same as lazy-S
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
If a haematoma has developed post-operatively, the surgical wound must be opened for proper drainage.
Can usually drain with a 18G needle.
Spitting buried sutures usually occur at 3-6 weeks postoperatively.
Should remove suture fragment asap to prevent granulomatous rcn
Injection of LA should be performed using a 2.5cm long 30 gauge needle
Maximally efficient anaesthesia is achieved by injecting into the dermis targeting the dermal neural plexus
It may be unneccesary to use epidermal sutures if the wound approximation is excellent after inserting the deep sutures
can use steristrips or tissue adhesive instead
A locking running suture provides additional haemostasis and is useful on areas with a rich blood supple such as the ear or genitals
A few vertical mattress sutures added into a repair can provide additional wound eversion to areas prone to inversion such as forehead creases
A running subcuticular suture is best performed using a suture with a high friction coefficient
low friction coefficient e.g. polypropylene (prolene), polydiaxanone (PDS)
If oozing persists after closure firm pressure should be applied for 3 minutes
5 minutes by the clock
if still bleeding after this need to open the wound and perform additional haemostasis
Hydrogen peroxide is good for cleaning recent surgical wounds
Is toxic to cells in vitro
Tap water is fine
Patients may shower 24 hrs after surgery
But keep stream of water away from wound until healed
A shorter scar is always less noticable
a shorter scar is not necessarily a less noticeable scar
Extensive intraoperative bleeding increases the possibility of postoperative bleeding
consider placing drain
In areas more prone to infection (intertriginous areas, the extremities, and exposed cartilage), use acetic acid soaks and/or antibiotic prophylaxis
Exposed cartilage, especially on the ear, is at an increased risk of infection, particularly Pseudomonas infection in diabetic patients