Soft tissue Flashcards
(79 cards)
What Z-plasty angle provides approximately 50% scar lengthening?
45 degrees. A 45° angle achieves roughly 50% lengthening, with each additional 15° increment adding about 25% more length (e.g., 60° achieves ~75%).
If you need 100% lengthening in a scar contracture via Z-plasty, what limb angle should you choose?
75 degrees.
According to Z-plasty principles, a 75° angle results in approximately 100% increase in scar length.
How much lengthening would a 60-degree angle achieve in a Z-plasty?
**About 75%.
**
Each incremental 15° increase from 30° adds roughly 25% additional lengthening
30° = 25%,
45° = 50%,
60° = 75%
75° = 100%.
Presence of fibrinous “rice bodies” in the wrist tenosynovium strongly suggests which diagnosis?
**Tuberculosis.
**Rice bodies are characteristic fibrinous formations commonly seen in chronic tenosynovial tuberculosis.
In a patient with chronic wrist swelling and carpal tunnel syndrome, finding fibrinous loose bodies intraoperatively should prompt suspicion of what atypical cause?
Tuberculous tenosynovitis.
This form of extrapulmonary tuberculosis often presents with fibrinous “rice bodies” and atypical carpal tunnel symptoms.
How might tuberculous tenosynovitis clinically present in the hand?
It commonly presents as a chronic compound palmar ganglion or wrist swelling, carpal tunnel symptoms, and characteristic intraoperative fibrinous rice bodies.
Why does a full-thickness skin graft generally have lower initial take rates than a split-thickness graft?
It includes the full dermis, making revascularization slower due to less superficial vascularity, necessitating ideal graft bed conditions.
True or False: A split-thickness graft donor site heals faster when thinner grafts are harvested.
True. Thinner grafts, harvested superficially with a high density of tiny bleeding points, heal faster than deeper, thicker graft harvests.
Can a skin graft survive on bare cortical bone, tendon, or cartilage?
Yes, but only via bridging. Small grafts may survive initially through bridging, where nutrients diffuse through a fibrin clot until neovascularization occurs.
What is the most reliable reconstructive option for a large dorsal hand defect with exposed tendons, joints, and bone following trauma?
A pedicled reversed radial forearm flap provides robust and reliable vascularized tissue coverage for extensive dorsal hand defects.
One possible option
Why is a negative pressure dressing alone inappropriate directly on exposed tendons without paratenon coverage?
Direct negative pressure dressings on denuded tendons cause desiccation, impairing future graft take and tendon viability.
Why might a bilayer dermal regeneration template (Integra®) be suboptimal for large contaminated dorsal hand defects with exposed structures?
Dermal templates require granulation tissue formation, are slow, infection-prone, and often fail in large contaminated wounds with exposed joints or bone.
According to Mathes and Nahai, into which category does the trapezius muscle flap fall?
Type II—characterized by one dominant vascular pedicle and minor pedicles.
What is the primary vascular supply for a Type II trapezius muscle flap?
The dominant pedicle is typically from the transverse cervical artery or dorsal scapular artery, supplemented by minor pedicles from posterior intercostal arteries.
Damage to which nerve can significantly impair trapezius flap function and shoulder stability?
Spinal accessory nerve (CN XI). Injury results in shoulder droop and instability due to impaired trapezius muscle function.
What anatomical landmark is crucial in deciding replantation for single index finger amputations?
Flexor digitorum superficialis (FDS) insertion. Amputations distal to the FDS insertion preserve PIPJ function and thus are favorable indications for replantation.
True or False: Anticoagulation post-digit replantation significantly improves outcomes.
False. There is currently no strong evidence (Level I-III) supporting improved outcomes with anticoagulation after digital replantation.
What is the most common late secondary procedure following a successful finger replantation?
Tenolysis. Tenolysis is the most frequent secondary procedure post-replantation, addressing adhesions and stiffness.
What is the axial vessel supplying the Moberg flap?
The Moberg flap is axial-pattern, based specifically on digital arteries supplying the thumb.
What type of flap is the reversed homo-digital island flap considered (axial or random)?
Axial-pattern flap. It relies on retrograde flow through digital arterial communications at the DIP joint level.
Optimal initial management for extravasation injury with chemotherapy agents classified as DNA-binding vesicants includes which approach?
Immediate localization, neutralization, and targeted treatment. For severe extravasation injuries, Dexrazoxane is indicated, along with cold compresses to limit tissue damage.
What is the first-line pharmacological therapy indicated for severe extravasation injury from anthracycline chemotherapy agents?
Dexrazoxane administration, initiated promptly, significantly mitigates tissue damage and is recommended for severe anthracycline extravasations.
Why are warm compresses contraindicated in the acute phase of DNA-binding chemotherapy extravasation?
Warm compresses exacerbate spread, potentially worsening tissue necrosis;
cold compresses localize and limit injury.
According to Cormack and Lamberty classification, what flap type is a radial forearm free flap?
Type C fasciocutaneous flap (fascial flap with axial blood supply), having reliable perfusion from radial artery perforators.
