stop aspirin 2 weeks prior to
anticoagulant causes hematoma
stop smoking 2 weeks prior to
vasoconstrictor
ischemia
necrosis
stops wound healing
chlorhexidine gluconate
not for eyes or ears toxic
4 dyes for skin marking
methylene blue
indigo carmine
gentian violet
Bonny’s blue
epi to local
prolong effect
hemostasis/vasoconstrictor
goals of postop dressing
immobilize
even pressure
drainage
comfort
protect
pressure dressing
eliminate dead space
prevent seroma/hematoma
prevent 3rd spacing
stent/tie-over dressing
pressure dressing when bandage doesn’t fit
2 closed-wound suction devices
hemovac
jackson pratt
why use closed-wound suction drains
prevent seroma/hematoma
2 local anesthetics
xylocaine/lidocaine/marcaine/bupivicaine
2 topical anesthetics
tetracaine eyes
cocaine nose
4 drugs for sedation with local
diazepam
fentanyl
meperidine (demerol)
midazolam
allograft
tissue from same species
autograft
tissue from self
xenograft
tissue from different species
isograft
tissue from genetically identical person
homograft
tissue from same species
heterograft
tissue from different species
dermatome
STSG graft procurement
4 knife dermatomes
ferris smith
watson
weck
Desilva
drum dermatome
Reese
Padgett
why use dermatape/dermacement
reese
adhere drum to skin
motor driven dermatome
brown
what is a skin mesher
uniform slits in graft to make it larger
loupes
magnifying lenses to improve cosmetics
wood’s lamp
UV to determine vascularity of skin graft
sodium florescin with woods lamp
makes blood vessels purple
IV
why use a colorless prepping agent for grafting procedures?
see true skin color
access vascularity of donor graft
why are donor sites prepped separately but concurrently for grafting?
CHECK
prevent cross contamination
how are free grafts preserved
cool saline
what is used to access the vascular perfusion of grafts
wood’s lamp
what is a composite skin graft
epidermis
dermis
fat
other structures
how does a composite skin graft become vascularized?
ingrowth of vessels from recipient site
what is a STSG, Thiersch
from free knife
superficial defects
what is a FTSG, Wolfe
exact size/shape for face neck hands
joints
pros of STSG
cover large area
donor site reusable in 2-3 weeks
cons of STSG
contraction
fragile
poor look
pros of FTSG
minimal contracture
looks better
stronger
over areas of flexion
cons of FTSG
donor site can’t be used again
how does the donor site of STSG heal
regenerate epithelium from dermal elements
how does the donor site of FTSG heal
primary closure with a STSG over
why use topical thrombin, epi, or phenylephrine on donor site of skin graft
hemostasis
what is a composite graft
skin separated from blood supply
fat
hair follicles
example of a composite graft
hair transplant
omental graft
from omentum in abdominal cavity
why use an omental graft
soft tissue defects in face, neck, scalp
control infection/inflammation
vascular support for burns
pedicle flaps
attachment of elevated tissue w/vascular bundle
when is a pedicle flap used
reconstruct deformities of soft tissue loss
arterialized tissue flap
FTSG
skin graft with vascular bundle and subQ
myocutaneous flap
muscle with fascia, subQ, sin
vascular pedicle and nerves accompany
applications of myocutaneous flaps
soft tissue defects in lower extremities
pressure sores
after head/neck surgery or mastectomy
tissue expander
streches tissue
filled during an office visit
free flap
tissue moved from one area of the body to another with its own blood supply
why is a free flap autogenous
comes from the patient
why is microsurgery required when working with free flaps
vascular work
what is rhinoplasty
reshaping the nose
why is rhinoplasty performed
improve appearance of external nose
what is septoplasty, SMR,
straighten nasal septurm
goal of septoplasty
separate nasal cavities for a clear airway
blepharoplasty
excision of redundant skin/orbital fat
correct deformity of upper/lower eyelids
rhytidectomy
facelift
removal/redraping excess skin in the face
why perform rhytidectomy
tighten sagging skin
anesthesia for rhytidectomy
hypotensive for hemostasis
incision for rhytidectomy
CHECK
above and in front of the ear and behind pinna
what is mentoplasty
altering size or shape of the chin
why perform mentoplasty
functional bite disorder
aesthetics
micrognathia-underdeveloped jaw
what is otoplasty
repairing external ear
why perform otoplasty
burns
traumatic avulsion
what is dermabrasion
mechanical or chemical peeling of the skin
why perform dermabrasion
smooth skin damaged by acne scars
remove tattoos/wrinkles
3 methods of dermabrasion
mechanical
chemical
CO2 laser
scar revision with Z-plasty
z-shaped incision in same direction as skin line
less noticeable
what is a keloid
growth of extra scar tissue
what is liposuction
vacuuming fat
where is liposuction performed
abdomen
back
face
hips thighs knees
breasts
what is tumescent solution
local anesthetic with Wydase, epi, and saline
no GA, hemostasis, liquefy fat
max tissue removed by liposuction
1500-2000ml
2500-3000ml with tumescence
what is abdominoplasty
tummy tuck
goal of abdominoplasty
thinning fat, tightening muscles, remove fat and excess skin
indications for abdominoplasty
discomfort
unable to wash
how is the umbilicus preserved in abdominoplasty
vascularized stalk
repositioned after dissection
augmentation mammoplasty
inserting implants under breast tissue or psoas muscle
indications for breast augmentation
aesthetics
3 incisions for breast augmentation
periareolar
inframammary
transaxillary
what are breast implants filled with
saline or silicone
complications with breast implants
capsular contraction
skin necrosis
hematoma
what is reduction mammoplasty
remove excess breast tissue
indications for breast reduction in females/males
macromastia with back pain, intertrigo (skin infection), grooving in shoulders from bra
gynecomastia-large male breast
indication for breast reconstruction
post mastectomy
3 ways breast reconstruction can be done
available tissue + implant
tissue expanders
autogenous flaps
how are tissue expanders used with breast reconstruction
create skin by stretching
what solution is placed in expander
saline
complication due to seroma with tissue expander
rotation or malposition of expander
why use myocutaneous flap for breast reconstruction
significant tissue deficiency
when abdominal flap can’t be used
2 myocutaneous flaps for breast reconstruction
latissimus dorsi: lateral, donor side up
transverse rectus abdominis: supine
2 modifications for TRAM in breast reconstruction
pedicle-vascular bundle
free-from another part
2 ways a nipple can be reconstructed
autogenous tissue
tattooing
3 common causes of burns
thermal
chemical
electrical
4 classifications of burns according to depth
1st degree
2nd degree
3rd degree
4th degree
1st degree
outer epidermis
redness
heals rapidly
2nd degree
epidermis and dermis
blisters, redness
how does a 2nd degree burn heal
reepithelialization, thickened scars
3rd degree
skin, dermis, subQ
dry, pearly white, charred, no sensation
eschar
how does a 3rd degree burn heal
skin grafts
4th degree
bones, tendon, muscle, nerves
what is eschar
dry dark scab of dead skin
2 methods of burn %
lund-browler: kids
rule of 9s: adults
IV fluid for burn patients
fluid and electrolyte balance to maintain plasma
warm environment for burn patients
skin loses ability to thermoregulate
keep core temp stable
why is cleaning of burns important
reduces growth media of pathogens/prevent infection
excisional debridement
tangenital excision
escharectomy
tangenital excision
remove burned tissue until dermal tissue is reached
for deep partial thickness
escharectomy
remove full thickness eschar to fascia
why are tangenital excision and escharectomy performed
remove devitalized tissue so healing may occur with reduced chance of infection
prevents extensive tissue loss
escharotomy
incision into eschar to improve circulation to lower extremities
fasciotomy
incision into fascia to relieve compression
biologic dressing use
skin over burned area to prevent infection and regulate fluids
biologic dressing vs. autografting
extensive burns where there isn’t enough tissue for autograft
prevent infection and fluid loss
cultured epithelial autografts
biologically engineered tissue through injection of isolated cells, polymer scaffolds, encapsulated systems, polymer matrices with cells
why change dressings frequently for burn patients
control infection
silver on burn dressings
silver sulfadiazine: less painful removal, antimicrobial
mafenide acetate: reduce bacteria
silver nitrate
principles of maxillofacial surgery
restore anatomy
stabilize fracture
anatomic reduction
healing for function
3 classifications of LeFort fractures
transverse maxillary: nasal floor, septum, teeth
pyramidial: nasal cavity, hard palate, eye
craniofacial: zygomas, nose
symptoms of maxillary fracture
malocclusion
middle face deformity
inermaxillary fixation (arch bars) in maxillary fractures
immobilization for healing
purpose of treatment for mandibular fractures
restore dental occlusion
immobilization of the mandible
arch bars, plates, screws
blow-out fracture
depressed orbital floor fracture
intact infraorbital rim
symptoms of blow-out fracture
orbital contents herniate
inferior rectus/oblique become incarcerated
treat blow-out fracture
caldwell luc anterostomy
orthognathic surgery
rearrangement of the maxilla/mandible
why is elective orthognathic surgery performed
fix defects of maxilla/mandible
LeFort procedure differences
LeFort 1&2: closed reduction with intermaxillary fixation
LeFort 2&3: open reduction and intermaxillary fixation
cleft lip
deficiency in tissue on one or both sides of the upper lip
chelioplasty
reconstruct lip by moving tissue to approximate lip
why perform chelioplasty
feeding
infant/parent bonding
rule of 10s in cleft lip
10 weeks old
10lbs
hemoglobin 10g/dl
logan’s bow postop chelioplasty
relieve tension
cleft palate
separation of the palate in midline
functions of the palate
soft: speech
hard: prevent escape of air through nose during speech, liquid food out through nose
palatoplasty
adjacent tissue to close defect
when is palatoplasty performed
6 months
why use a pharyngeal flap in palatoplasty
when abnormal speech remains
mouth gag in palatoplasty
Dingman
if both cleft lip and palate what is repaired first
palatoplasty to preserve speech
syndactyly
webbing of hands or feet
how to treat syndactyly
separate and skin graft (full thickness)
after 1yr. old
polydactyly
extra fingers or toes
how to treat polydactyly
excision
microtia
underdeveloped pinna/absent ears
how to treat microtia
otoplasty
bony anatomy of the hand
14 phalanges (bones of the digits), 5 digits, 5 metacarpals (hand), 8 carpals (wrist)
how are the phalanges numbered
distal, middle, proximal
CHECK
8 carpals
scaphoid, lunate, triquetrum, pisiform
trapezium, trapezoid, capitate, hamate
dorsal/volar hand
dorsal: back
volar: palm
why is a tourniquet used in hand surgery
bloodless field
where is a tourniquet placed
as proximal as possible with cotton underneath
exsanguinate arm prior to tourniquet
3 in. esmarch wrapped distal to proximal
avulsion
body part forcibly detached
loss of joint movement
laceration
a jagged cut
loss of joint movement
repair avulsion/laceration tendon injury
primary flexor or extensor repair
suture tendon ends together
suture for tendon repair
3-0, 4-0 double-armed nonabsorbable
when is a free tendon graft used
large gap
failed primary repair
repair severed nerve
direct approximation of ends or graft
suture for nerve repair
nylon nonabsorbable 7-0, 10-0
implant arthroplasty
excise diseased joint cartilage
insert implant spacer
why perform implant arthroplasty
traumatic/rheumatoid arthritis
Dupuytren’s contracture
progressive disease of palmar fascia
cord pulls finger down
treat Dupuytren’s contracture
palmar fasciotomy/ectomy
carpal tunnel
volar/palm side with median nerve, tendons through
transverse carpal ligament and 3 bones
carpal tunnel syndrome
compression of median nerve
swelling, numbness, pain,
treat carpal tunnel
release transverse carpal ligament
