Plastics Flashcards
(94 cards)
1
Q
Topical burn antimicrobials side effects
A
Silver nitrate - electrolyte disturbances
Silvadene - leukopenia
Sulfamylon - metabolic acidosis
2
Q
6th branchial arch
A
Vagus n. (recurrent laryngeal)
Pulmonary artery
Cricoid / arytenoids
Intrinsic muscles of the larynx
3
Q
5th branchial arch
A
Degenerates!
4
Q
4th branchial arch
A
Superior laryngeal n.
Aortic arch / subclavian
Thyroid cartilage
Pharyngeal constrictors
5
Q
3rd branchial arch
A
Glossopharyngeal n.
ICA
Cartilage: hyoid
Muscle: stylopharyngeous
6
Q
2nd branchial arch
A
Facial n.
Stapedial artery
Cartilage: stapes, styloid process, stylohyoid (Reichart’s cartilage)
Muscle: mimetics + PSS (post belly digastric, stylohyoid, stapedius)
7
Q
1st branchial arch
A
Trigeminal n.
Cartilage: Meckel’s - malleolus, incus, mandible
Soft tissue: MATT - muscles of mastication, masseter, temporalis, med/lat pterygoids, mylohyoid, ant belly digastric, tensor tympani, TVP
8
Q
Muenke Syndrome
A
pro250ARg mutation in FGFR3 AD, variable expression Developmental delay Coronal synostosis Thimble-like middle phalanges Sensorineural hearing loss
9
Q
Saethre-Chotzen Syndrome
A
AD TWIST-1 gene Normal mental status Asymmetric brachycephaly Low frontal hairline Eyelid ptosis Prominent crus helicis Partial syndactyly Short stature
10
Q
Pfeiffer Syndrome
A
AD FGFR2 (95%, more severe), FGFR1 (less severe) Hydrocephalus High risk chiari malformation Normal mental status Turribrachycephaly Exorbitism, hypertelorism Low nasal bridge Broad thumbs and halluces
11
Q
Apert Syndrome
A
AD, most cases sporadic Increased ICP, may need VP shunt Bicoronal synostosis Exorbitism Severe midface hypoplasia Complex syndactyly hands and feet Acne
12
Q
Crouzon Syndrome
A
AD FGFR2 Hydrocephalus, increased ICP Bicoronal synostosis Midface hypoplasia NO limb abnormalities Exorbitism
13
Q
Type V Flap
A
One dominant + secondary segmental
Fibula
Lat dorsi
Pec major
14
Q
Type IV Flap
A
Segmental
Sartorius
Tibialis anterior
15
Q
Type III Flap
A
Two dominant pedicles
Gluteus
Pec Minor
Serratus
Rectus abdominus
16
Q
Type II Flap
A
Dominant + minor
Brachioradialis
Gracilis
Soleus
SCM
17
Q
Type I Flap
A
Single vascular pedicle
Gastroc
TFL
Jejunum
Vastus lateralis
18
Q
Pierre Robin Sequence
A
Triad: micrognathia, glossoptosis, respiratory distress
60-90% have cleft palate
Cardiac / renal abnormalities
19
Q
Treacher Collins
A
Cleft #6-8 AD Chromosome 5 Redundant upper lip, false ptosis Inferiorly displaced lateral canthus Absent zygomatic arch Hypoplastic temporalis Absent lateral inferior orbital rim Hypoplastic malar bones and mandible
20
Q
Goldenhaar’s Syndrome
A
Sporadic Frontal bossing Mandibular hypoplasia Low set ears Epibulbar dermoids Bilateral accessory auricles Vertebral abnormalities
21
Q
22q deletion
A
Velocardiofacial syndrome Bird-like face Soft palate dysfunction Developmental delay Various cardiac conditions Detected by FISH
22
Q
Van der Woude Syndrome
A
AD
IRF6 mutation (also causes popliteal pterygium syndrome)
Lower lip sinus tracts
23
Q
Deep posterior compartment
A
FHL - musc br of peroneal
FDL - br of PT
Tibialis posterior - musc br peroneal
Tibial n.
24
Q
Superficial posterior compartment
A
Gastrocnemius - sural br popliteal
Soleus - PT/peroneal/sural br popliteal
Plantaris - sural br popliteal
Popliteus - genicular br popliteal
Tibial n.
25
Lateral compartment
Peroneus longus - muscular br AT and peroneal
Peroneus brevis - musc branches of peroneal
Superficial peroneal n.
26
Anterior compartment
Tibialis anterior
EHL
EDL
Peroneus tertius
Deep peroneal n.
Anterior tibial a.
27
Sunderland classification of nerve injury
```
I. Neuropraxia (conduction block)
II. Axonotmesis (axonal injury)
III. II + endonurium injury
IV. III + perineurium injury
V. IV + epineurium injury (neurotmesis)
```
28
Types of BCC
```
Nodular
Superficial
Morpheaform
Micronodular
Infiltrative
Basosquamous
Multicentric
```
29
Melanoma subtypes
```
Lentigo maligna
Superficial spreading
Nodular
Acral lentiginous
Desmoplastic
```
30
ALT Flap
Descending br lateral circumflex femoral (from profunda)
Lateral femoral cutaneous n.
Fasciocutaneous flap (8x25cm)
Use: pedicled abdomen, perineum, knee if reversed
31
TFL Flap
Type I flap
Ascending br lateral circumflex femoral a.
Lateral cutaneous nerve of thigh
Muscle from ASIS + iliac crest --> lateral condyle of tibia via IT band / fascia lata
Fascia/skin
Use: abdominal recon, pressure sores
32
Gracilis Flap
Type II
Ascending branch of medial femoral circumflex
Ant branch obturator, ant fem cutaneous n.
Muscle from pubic symphysis, inf pubic ramus, ischium --> medial condyle tibia
Muscle/skin
Use: functional muscle
33
TUG Flap
Ascending br medial femoral circumflex
Ant branch obturator, ant fem cutaneous n.
Muscle/skin
11x25cm
34
Sartorius Flap
Type V
8-11 pedicles from SFA
No nerve
35
Rectus Femoris Flap
II
Descending branch of lateral femoral circumflex
Motor branch of femoral n.
Muscle / skin
36
Vastus Lateralis Flap
II
Descending branch LCFA
Greater trochanter, lateral femur --> quad tendon
Use: salvage repairs trochanteric pressure sores, salvage hip wounds, cover lower abdomen, groin, perineum, ischium, trochanter, acetabular fossa
37
Posterior Thigh Flap
Ascending branch of popliteal
| Pedicle reaches deep fascia 8-10cm above knee
38
Gluteus Flap
| SGAP / IGAP
Superior gluteal artery
| Interior gluteal artery
39
Hamstring Flap
Can be raised on all 4 hamstrings (biceps femoris, semitendinosus, semimembranosus)
Ischial pressure sores
Biceps femoris - long head tibial n. short head peroneal n.; type II muscle, major branch from 1st profunda perforator; minor supply from MCFA, IGA, genicular
40
Saphenous Flap
Saphenous artery - terminal branch of descending genicular branch of femoral a.
Fascia/skin 6x20cm
41
Free Fibula Flap
Peroneal artery
Bone/skin 20-26cm
5cm above lateral malleolus to preserve ankle fxn
5cm below fibular head to avoid common peroneal nerve injury
Can close up to 5cm defects
42
Soleus Flap
II
Sural artery
Muscle
Can cover middle 1/3 leg, 13x22cm
Medial and lateral parts
Vascularized by posterior tibial and peroneal arteries
Upper pedicle branch from popliteal
Upper middle pedicle from tibioperoneal artery or peroneal artery
43
Gastrocnemius Flap
I
Medial sural artery, lateral sural artery
Sural nerve
Use: knee, proximal 1/3 leg, reverse for posterior thigh
44
Tibialis Anterior Flap
IV
8-12 pedicles from tibial vessels
Deep peroneal n.
Muscle
Use: middle 1/3 tibial defects
45
Flexor Digitorum Brevis Flap
Lateral tarsal artery
Branches from DP
Deep peroneal n.
Muscle/skin, 4x5-6cm
46
Reverse Sural Flap
Sural branches from peroneal a.
Sural cutaneous n.
Used for heel/ankle
Pivot point 5cm above lateral malleolus
47
Lateral calcaneal Flap
Lateral calcaneal artery off peroneal a.
Sural n.
Island or reverse flow
Heal or posterior defects
48
Lateral Plantar Flap
Lateral plantar a. from posterior tibial a.
Lateral plantar n. in lateral 1/3
Medial plantar n. in medial 2/3
49
Medial Plantar Flap
Medial plantar a.
Medial plantar n.
10x7cm by STSG
50
Dorsalis Pedis Flap
Dorsalis pedis a.
Commonly delayed bc distal tip necrosis common
Must leave paratenon for STSG
Can use reverse flow to cover toe amp
51
Toe Transfer
Great and 2nd toe transfer based on circulation from dorsal metatarsal artery and DP system
Innervated by proper digital nerves and deep peroneal n.
52
Temporo-parietal Fascia Flap
Superficial temporal a.
Auriculotemporal n.
Fascia, skin, bone 12x14cm
Pedicle reaches to ear, nose, mouth
53
Trapezius Flap
II
Transverse cervical a. (upper ascending branch)
Dorsal scapular a. (lower)
Muscle / skin, 20x8cm
Use: neck, spine, skull, axilla, post. trunk, oral cavity
Trapezius based on SCA (superficial cervical a.) - for recon of pharynx, hypopharynx, oropharynx, floor of mouth
Trapezius based on DSA - lower face, ant neck, occipital, thoracic spine
54
Pectoralis Flap
III
Thoracoacromial a. (pectoral branch)
Internal mammary a.
Muscle/bone/skin (4th/5th rib)
Upper border of reach: zygomatic arch, can reach contralateral ant axillary line
55
Deltopectoral Flap
II
2nd-4th intercostal a. from IMA
Fasciocutaneous, 8x25cm, island flap
Use: some head, mainly neck
56
Scapular Flap
Horizontal branch circumflex scapular a.
Skin 10x25cm uniform thickness (2cm)
Bone: 3-4cm wide, males 14cm, females 10cm
57
Parascapular Flap
Descending branch of circumflex scapular a.
Skin and subQ, can include bone
Free flap
58
Flaps based on sunscapular arterial system
1) Scapular / parascapular fasciocutaneous
2) Scapular / parascapular osteocutaneous
3) Latissimus dorsi muscle flap
4) Latissimus dorsi musculocutaneous flap
5) Dorsal thoracic fascia flap (TDAP)
6) Serratus anterior muscle flap
7) Serratus anterior musculocutaneous flap
8) Serratus anterior osteocutaneous flap
59
Thoracodorsal Artery Perforator Flap (TDAP)
Perforator of thoracodorsal a. descending branch
25x15cm
Can reach shoulder, chest wall, neck, proximal arm
60
Latissimus Dorsi Flap
V
```
Thoracodorsal a.
Thoracodorsal n.
Muscle, skin, 10th rib
Use: scalp, leg
Donor site 50% seroma rate
```
61
Serratus Flap
III
Serratus a. from subscapular
Lateral thoracic (upper 4 slips)
Long thoracic n.
62
Lateral Arm Flap / Reverse Lateral Arm Flap
Posterior radial collateral / radial recurrent
Lateral brachial cutaneous n.
Fascia, skin, bone, strip of triceps
Use: Head, neck, hand, foot; retrograde pedicle covers elbow
63
Ulnar Forearm Flap
Dorsal branch ulnar a.
Skin, fascia, muscle, and/or bone
Do Allens test
Can be based proximally or distally
64
Posterior Interosseous Flap
PIA
Skin and fascia
Use: dorsal hand
65
Radial Forearm Flap
```
Radial a. and perforators
Lateral antebrachial cutaneous n.
Medial antebrachial cutaneous n.
Fascia/skin/bone
Use: oral lining
```
66
Rectus Abdominus (RAM, TRAM, VRAM) Flap
III
Deep inferior epigastric a.
Deep superior epigastric a.
Intercostal n.
Muscle/skin (vertical, horizontal, or oblique paddle)
30x10cm
Contraindication: subcostal (Kocher) incision or previous abdominoplasty
67
DIEP Flap
DIEP, DIEA
T7-T12 n.
Fat / skin 12-18cm wide
68
SIEA Flap
Superficial inferior epigastric a.
T11/12 n.
Fat/skin
69
Deep Circumflex Iliac Artery Flap
Deep circumflex iliac a.
| Bone - cancellous 15x6cm inner table or full thickness
70
Groin Flap
Superficial circumflex iliac a. (from SFA)
| Fascia, skin
71
Shaw Flap
SIEA
| Good for coverage of hand and forearm, lies higher on the abdomen than the groin flap
72
Jejunum Flap
2nd or 3rd branch of SMA
| Mucosa
73
Omentum Flap
Right gastro-epiploic a. to R omental
Fat
Use precluded by any abdominal surgery
Free up attachments to T-colon, dissect off greater curvature of stomach
Ligate left and middle omental artery, isolate on right omental
74
Submental Flap
Submental a. (branch of facial)
| Musculocutaneous
75
FAMM Flap
Facial a.
| Myomucosal flap
76
Keratoacanthoma
Benign
Behaves like SCC
Central crater / keratin plug
Tx: Excision
77
Actinic Keratosis
Can progress to SCC (13-20% over 10y)
Sun-exposed areas
Rough erythematous papule w/ white scale
Tx: Cryosurgery, 5FU
78
Seborrheic Keratosis
Senile wart
Benign, originates from basal and squamous cells
Waxy lesions, stuck-on appearance
Tx: Laser, cryo, excision
79
Nevus Sebaceous
Benign hamartoma head/neck
Can degenerate to BCC
Waxy, smooth, hairless
Tx: Excision
80
Juvenile Melanoma
Benign
"Spitz nevus"
Red, pink, brown papule or nodule with rapid growth
Tx: Complete excision with negative margins
81
Nevus of Ota
Benign blue nevus
Dermatome of 1st or 2nd branches trigeminal
Dermal proliferation melanocytes
Tx: Laser (Q-switched ruby, alexandrite)
82
Nevus of Ito
Subtype of Ota
Acromiodeltoid region
Tx: Same as Ota
83
Mongolian Spot
```
Benign
Entrapment of melanocytes in dermis during development
Multiple bluish gray spots
Disappear by 10y
Tx: Observation
```
84
Blue nevus
Benign
Well-circumscribed, firm, blue-pigmented nodule / papule
Common, cellular, or combined
Tx: Simple excision
85
Rosacea
Vascular (flushing/blushing) and inflammatory (papules/pustules) aspects
Exacerbated by hot food, alcohol, heat, sunlight
Can lead to rhinophyma (tx tangential excision, CO2 laser)
86
Chondrodermatitis Nodularis Helicis
Lateral surface of helix or antihelix in men >40
Nodule with central scale and underlying erosion
Tx: simple excision w/ removal of cartilage
87
Pilomatricoma
Benign
Firm, cystic nodule on head/neck children
Calcification on films
Tx: complete excision
88
Dermatofibroma
Benign
Proliferation of fibroblasts, histiocytes, vascular endothelial cells
Reaction to trauma, virus, insect bites
Small firm pink/brown nodule
Retracts beneath skin with compression "Fitzpatrick sign"
Tx: simple excision / observation
89
Neurofibroma
Benign
Tumor of Schwann cells
Multiple small, pink / skin-colored raised nodules
Can undergo malignant degeneration
Tx: Excision, CO2 laser, adjuvant chemo / rads when malignant
90
Schwannoma
```
Benign tumor from Schwann cells
Main nerve trunks extremities, esp flexor arm/wrist/knee
Solitary nodule
MRI well encapsulated egg-shaped tumor
Tx: Excision
```
91
Desmoid tumor
Benign
Arise from muscular aponeurosis
Can be locally aggressive
Tx: WLE, radiation, hormonal tx (Tamoxifen)
92
Cleft lip development
From failure of medial nasal process to contact maxillary process
93
Tensor veli palatini innervation
CN V (rest of muscles of velum innervated by pharyngeal plexus - IX, X, XI)
94
LOAF muscles (median innervation)
Lateral (radial) lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
