Plastic Surgery, C68 P572-578

Question 1

Define the following terms:
Blepharoplasty
P572

Answer 1

Eyelid surgery—removing excess

skin/fat

Question 2

Define the following terms:
Face lift
P572

Answer 2

Removal of excess facial skin via hairline/

chin/ear incisions

Question 3

Define the following terms:
FTSG
P572

Answer 3

Full Thickness Skin Graft

Question 4

Define the following terms:
Langer’s lines
P573 (picture)

Answer 4

Natural skin lines of minimal tension
(e.g., lines across the forehead), incisions
perpendicular to Langer’s lines result in
larger scars than incision parallel to the
lines

Question 5

Define the following terms:
Mammoplasty
P573

Answer 5

Breast surgery (reduction/augmentation)

Question 6

Define the following terms:
Polydactyly
P573

Answer 6

Extra fingers

Question 7

Define the following terms:
Rhinoplasty
P573

Answer 7

Nose surgery, after trauma or cosmetic

Question 8

Define the following terms:
STSG
P573

Answer 8

Split Thickness Skin Graft

Question 9

Define the following terms:
Syndactyly
P573

Answer 9

Webbed fingers

Question 10

WOUND HEALING
What are the phases of
wound healing?
P573

Answer 10

Think: “In Every Fresh Cut” = IEFC:

1. Inflammation
2. Epithelialization
3. Fibroplasia
4. Contraction

Question 11

WOUND HEALING
What are the actions of the
following phases:
Inflammation?
P574

Answer 11

Vasoconstriction followed by vasodilation,

capillary leak

Question 12

WOUND HEALING
What are the actions of the
following phases:
Epithelialization?
P574

Answer 12

Epithelial coverage of wound

Question 13

WOUND HEALING
What are the actions of the
following phases:
Fibroplasia?
P574

Answer 13

Fibroblasts and accumulation of collagen,

elastin, and reticulin

Question 14

WOUND HEALING
What are the actions of the
following phases:
Wound contraction?
P574

Answer 14

Myofibroblasts contract wound

Question 15

WOUND HEALING
What is the maximal
contraction of a wound in
mm/day?
P574

Answer 15

0.75 mm/day

Question 16

EPITHELIALIZATION
What degree of bacterial
contamination prevents
epithelialization?
P574

Answer 16

> 100,000 organisms/gm tissue (10(5))

Question 17

EPITHELIALIZATION
In which structures does the
epithelium grow from
superficial burns/wounds?
P574

Answer 17

Epithelial lining of sweat glands and hair

follicles

Question 18

EPITHELIALIZATION
In full-thickness burns?
P574

Answer 18

From wound margins, grows in 1 cm
from wound edge because no sweat
glands or hair follicles remain; this
epithelium has no underlying dermis

Question 19

EPITHELIALIZATION
What malignant ulcer is
associated with a longstanding
scar/burn?
P574

Answer 19

Marjolin’s ulcer (a.k.a. burn scar

carcinoma)

Question 20

WOUND CONTRACTION
What are myofibroblasts?
P574

Answer 20

Specialized fibroblasts that behave like
smooth muscle cells to pull the wound
edges together following granulation

Question 21

WOUND CONTRACTION
Which contracts more: an
STSG or an FTSG?
P574

Answer 21

STSG contracts up to 41% in surface
area, whereas an FTSG contracts little,
if at all

Question 22

WOUND CONTRACTION
What is granulation tissue?
P575

Answer 22

Within 4 to 6 days after an open wound,
development of capillary beds and
fibroblasts provides a healthy base for
epithelial growth from wound edges; this
tissue also resists bacterial infection

Question 23

WOUND CONTRACTION
Name the local factors that
impair wound healing.
P575

Answer 23

Hematoma, seroma, infection, tight sutures,
tight wrap, movement/disturbance of the
wound (i.e., poking it with a finger)

Question 24

WOUND CONTRACTION
What generalized conditions
inhibit wound healing?
P575

Answer 24

Anemia
Malnutrition
Steroids
Cancer
Radiation
Hypoxia
Sepsis

Question 25

WOUND CONTRACTION What helps wound healing in patients taking steroids? P575

Answer 25

Vitamin A is thought to counteract the deleterious effect of steroids on wound healing

Question 26

``` WOUND CONTRACTION When does a wound gain more than 90% of its maximal tensile strength? P575 ```

Answer 26

After ≈6 weeks

Question 27

WOUND CONTRACTION Define the following terms: Laceration P575

Answer 27

Jagged wound

Question 28

WOUND CONTRACTION Define the following terms: Abrasion P575

Answer 28

Superficial skin removal

Question 29

WOUND CONTRACTION Define the following terms: Contusion P575

Answer 29

Bruise without a break in the skin

Question 30

WOUND CONTRACTION Define the following terms: Hypertrophic scar P575

Answer 30

Hypertrophic scar within original wound | margins

Question 31

WOUND CONTRACTION Define the following terms: Keloid P575

Answer 31

Proliferative scar tumor progressively enlarging scar beyond original wound margins

Question 32

WOUND CONTRACTION Why not clean lacerations with Betadine®? P575

Answer 32

Betadine® is harmful to and inhibits | normal healthy tissue

Question 33

WOUND CONTRACTION What is the best way to clean out a laceration? P575

Answer 33

Normal saline irrigation; remember, | “The solution to pollution is dilution”

Question 34

SKIN GRAFTS What is an STSG? P576

Answer 34

Split thickness: includes the epidermis | and a variable amount of the dermis

Question 35

SKIN GRAFTS How thick is it? P576

Answer 35

10/1000 to 18/1000 of an inch

Question 36

SKIN GRAFTS What is an FTSG? P576

Answer 36

Full thickness: includes the entire | epidermis and dermis

Question 37

SKIN GRAFTS What are the prerequisites for a skin graft to take? P576

Answer 37

``` Bed must be vascularized; a graft to a bone or tendon will not take Bacteria must be <100,000 Shearing motion and fluid beneath the graft must be minimized ```

Question 38

SKIN GRAFTS What is a better bed for a skin graft: fascia or fat? P576

Answer 38

Fascia (much better blood supply)

Question 39

SKIN GRAFTS How do you increase surface area of an STSG? P576

Answer 39

``` Mesh it (also allows for blood/serum to be removed from underneath the graft) ```

Question 40

``` SKIN GRAFTS How does an STSG get nutrition for the first 24 hours? P576 ```

Answer 40

Imbibition

Question 41

FLAPS Where does a random skin flap get its blood supply? P576

Answer 41

From the dermal-subdermal plexus

Question 42

FLAPS Where does an axial skin flap get its blood supply? P576

Answer 42

It is vascularized by direct cutaneous | arteries

Question 43

FLAPS Name some axial flaps and their arterial supply P576

Answer 43

``` Forehead flap—superficial temporal artery; often used for intraoral lesions Deltopectoral flap—second, third, and fourth anterior perforators of the internal mammary artery; often used for head and neck wounds Groin flap—superficial circumflex iliac artery; allows coverage of hand and forearm wounds ```

Question 44

FLAPS What is the most common cause of flap loss? P577

Answer 44

Venous thrombosis

Question 45

FLAPS What is a simple advancement flap? P577 (picture

Answer 45

(see picture)

Question 46

FLAPS What is a rotational flap? P577 (picture

Answer 46

(see picture)

Question 47

FLAPS What is a “free flap”? P577

Answer 47

Flap separated from all vascular supply that requires microvascular anastomosis (microscope)

Question 48

FLAPS What is a TRAM flap? P577

Answer 48

``` Transverse Rectus Abdominis Myocutaneous flap (see page 410) ```

Question 49

FLAPS What is a “Z-plasty”? P577 (picture)

Answer 49

(see picture)

Question 50

FLAPS What is a “V-Y advancement flap”? P578 (picture)

Answer 50

(see picture)