To memorize Flashcards
(212 cards)
1
Q
Argon
A
488-514nm, oxyhb, melanin
2
Q
KTP
A
532 nm, oxyhb, melanin, tattoo
3
Q
PDL
A
585-600nm
4
Q
ruby
A
694mn, melanin, tattoo
5
Q
alexandrite
A
755nm, oxyHb, melanin, tatoo
6
Q
diode
A
800nm, oxyhb, melanin
7
Q
Nd:YAG
A
1064nm, oxyhb, melanin, tattoo
8
Q
Erbium:YAG
A
2940nm, H20
9
Q
CO2
A
10600nm, H20
10
Q
Vascular lesion lasers (4)
A
Oxyhemoglobin
IPL (560-1400nm)
PDL (585-595nm)
KTP (532nm)
Nd:YAG (1064nm)
11
Q
Lasers pigmented skin lesions (6)
A
Melanin
KTP (532)
Ruby (694)
Alexandrite (755)
Diode (800)
Nd:YAG 1064
IPL 400-1400
12
Q
Hair removal lasers (4)
A
Melanin
Diode 800
Alexandrite 755
Nd:TAG 10164
IPL 400-1400
13
Q
Scars lasers (3)
A
Water
Nd:YAG 532
Er:YAG 2940
CO2 10600
14
Q
Skin resurfacing lasers
A
CO2
Er:YAG
15
Q
Heparin MOA
A
Activates ATIII and inactivates thrombin + Xa (fibrinogen to fibrin)
16
Q
LMWH MOA
A
Activates ATIII and inactivates thrombin + Xa (fibrinogen to fibrin)
17
Q
Leeches MOA (3) and antibiotics
A
- Hirudin (thrombin inhibitor, inhibits fibrinogen to fibrin)
- Hyaluronidase (spread)
- Histamine-like compound (vasodialation)
, TMPSMX (septra), Fluroquinolones, 3rd gen cephalo
Aeromonas hydrophilia
18
Q
Dextran MOA
A
Unknown, lowers platelet adhesion
Pulmonary edema
19
Q
2 systemic and 2 local vasodilators
A
- Chlorpromazine (largactil) bb
- Nifedipine (CCB)
- Lidocaine - relieves vasospasm
- Papaverine (inhibites phosphodiesterase) local vasodilator
20
Q
ASA MOA
A
Irreversible inhibition of COX, limiting platelet adhesion
21
Q
tPA, streptokinase MOA
A
Converts plasminogen to plasmin
22
Q
3 mechanisms of venous return in reverse flaps
A
Venae commitantes, bypass vessels and valvular incompetence
23
Q
3 surgical and 2 non surgical method to address lateral hooding
A
Excise ROOF
Lacrimal gland pexy by suturing levator aponeurosis to arcus marginalis
Brow lift
Botox brow lift
Tissue filler brow lift
24
Q
Nerve transfer for shoulder abduction in brachial plexus
A
Medial head of triceps to axillary nerve
25
Nerve transfer for shoulder external rotation
Spinal accessory to suprascapular nerve
26
Nerve transfer for elbow flexion
Double transfer
FCU (ulnar) to biceps and FCR/FDS (median) to brachioradialis
27
Options for elbow flexion if nerve transfer not an option (4)
Steindler flexoplasty (pronator and flexor wad advancement)
Triceps to biceps TT
FFMT with gracilis
Pedicled lat dorsi
28
d. 3 indications chirurgical pour une fracture isolée du plancher de l’orbite
i. Enophtalmia >2mm
ii. Diplipia persistant after 2 weeks
iii. Inferior rectus entraptment
iv. Persistant oculocardiac reflex (bradycardia)
v. Radiologically, 1.5cmsquared deficit (new articles show percentage augmentation of orbit)
29
2 topical agents that can be used to remove tar for burns that won't harm the skin
Mineral oil
Polysporin/vaseline
30
Use rule of 10's to estimate LR rate in a burn of 75%
800cc/hour
20% TBSA or greater for adults 40-80kg (for every 10kg above 80, add 100cc/hour)
1. Estimate burn size to nearest 10
2. TBSA x 10 = initial rate in mL/h
31
4 substituts cutanés (temporaires ou permanents) qui peuvent être utilisés chez un grand brûlé qui manque de site donneur
i. Biobrane (porcine)
ii. Apligraf (bovine collagen + fetal keratinocytes and fibroblasts)
iii. Cadaveric allgraft
iv. Xenograft (tilapia, bovine, porcine)
v. Cultured epithelial autografts
vi. Bilaminar cultured skin autografts
32
Type of burn for sodium hydroxide, pathophysiology of the burn, and treatment intially
Chemical Alkaline burn, liquefactive necrosis
Alkaline substance is absorbed, fat saponification, hydroxyl ions penetrate and cause liquefactive necrosis
33
3 eléments pathophysiologique des dommages tissulaires causées par les brûlures électriques
Joule heating
Electroporation
Electroconformation
34
Camptodactylie bilatérale
a. 2 structures anatomiques atteintes pour expliquer la déformation
b. 2 trouvailles radiologiques
c. 2 diagnostics différentiels pour cette même déformation unilatérale chez un enfant
d. Traitement préconisé
a
Abnormal lumbrical insertion
Extra slip of FDS
Volar plate contracture
Joint abnormalities
b
i. Flattened head of P1
ii. Groove under the head of P1
iii. Volar lip of base of P2
iv. Smaller intra-articular space PIP
c
i. Central slip rupture (boutonniere)
ii. Trigger finger
d
i. Occupational therapy with serial splinting and excercises
35
what is decolonization therapy for MRSA
Decolonization therapy is the administration of
antimicrobial or antiseptic agents to eradicate or
suppress MRSA carriage
– Intranasalantibioticorantiseptic(e.g.,mupirocin,povidone-iodine)
– Topicalantiseptic(e.g.,chlorhexidine) – +/-Systemicantibiotics
36
Antibiotics for MRSA (3)
Vancomycin IV
Clindamycin
Linazolid
TMP-SMX
Doxycycline
Daptomycin
37
Elements of treatment of fight bite (4)
3 antibiotics
i. Xray
ii. Tetanos
iii. Culture
iv. Copious irrigation, Serial debridement in OR, Keep wound open and do daily dressing changes, Do not acutely repair extensor tendon
Tazo, clavulin, clinda
38
a. 2 bactéries en cause pour une fasciite nécrosant type 2
Monomicrobial
i. Strep group A (b hemolytic)
ii. MRSA
39
3 principles of surgery for the edentoulous mandible
3 advantages to using a locking reconstruction plate
A
i. Wide exposure (transfacial)
ii. Debridement, reduction with minimal periosteal stripping
iii. Reduction and plating with a large reconstruction plate with 3 locking screws on each side
iv. Bone grafting PRN
B
i. Does not rely on atrophic bone strength
ii. No MMF necessary
iii. Does not require perfect plate bending to conform to bone
iv. Less periosteal stripping required
40
Percent of people who no longer have neuropathic pain after surgery for CRPS II ?
70-80%
41
2 tests pour évaluer l’insertion du tendon canthal médial
i. Lateral traction test (bowstringing test)
ii. Intercanthal distance is higher than the normal
iii. Loss of dorsal support of the nose
42
2 options de traitement pour un épiphora persistant à 6 semaines post-op
i. Dacryocystorhinostomy
ii. Dilation of the lacrimal duct with stenting
43
Approche de Gillies
i. Couche de tissu profonde et superficiel à notre instrument lorsqu’on fait un réduction d’arc zygomatique par approche de Gillies
Temporalis muscle deep
Deep portion of the deep temporal fascia superficial
44
4 causes of lumbrical plus deformity
2 conservative treatments
2 operative treatments
i. Excessive length of graft after FDP tendon reconstruction
ii. Non repaired laceration of an FDP distal to origin of lumbrical
iii. Avulsion of FDP
iv. Amputation through middle phalanx
Buddy tape + lumbrical botox
FDP tenodesis + lumbrical section
45
11. Sein et réduction mammaire
a. 1 désavantage du pédicule inférieur
i. More bottoming out
ii. Boxiness
46
Superio medial pedicle vascularization
IMA IC 2-4
47
c. 3 avantages de la RMB avec pédicule supéromédian
i. More medial/superior fullness
ii. Less bottoming out/boxiness
iii. Easier to rotate/position NAC than superior pedicle
iv. Able to resect/empty lower pole
48
d. 2 avantages du pattern RMB vertical
i. Decreased scar burden
ii. Decreased risk of dehiscence (no T junction)
iii. Significan upper pole fullness
49
e. 2 avantages du pattern de Wise dans la RMB
i. Addresses horizontal and vertical skin laxity
ii. Can address lateral roll
iii. Versatile with regards to pedicle choice
iv. More control over nipple to IMF distance
50
3 objectives to reconstruct with tendon transfers for high ulnar nerve palsy
1. Thumb adduction
2. Correct clawing MCP hyperextension
3. FDP D4-5
51
3 regions that are improved with belt lipectomy
Abdomen
Lateral thigh
Waist
Buttock/lower back
52
d. 4 complications spécifiques d’un medial thigh lift
i. Injury to lymphatics
ii. Recurrence of medial thigh ptosis/dermatochalasis
iii. Saphenous vein injury
iv. Spreading of the vulvar commissure
53
Ratio male : female poland
3:1
54
Nerve at risk next to McGregor's patch ?
Zygomatico-cutaneous ligament, zygomatic nerve
55
f. Une fistule salivaire est suspectée, quel sont 2 éléments de la prise en charge
i. Compressive dressings
ii. Scolpolamine
iii. Bland diet
iv. Botox of salivary gland
56
Tranexamic acid MOA
Blocks binding sites on plasminogen, which blocks conversion of plasminogen to plasmin, which is the molecule that breaks down clots.
Inhibits the breakdown of clots
57
What is the effect of tranexamic acid on a formed clot
inhibits breakdown
58
Complications of TXA
Allergy
n/v
seizures
dvt
59
2 major and 5 minor sx in MIFE
Petechia
Hypoxemia
Altered mentality
Tachycardia
Fever
Thrombocytopenia
Anemia
Anuria
Retinal ambolism
Fat in urine
60
Timing of MIFE
24-72
61
Treatment of MIFE
Fluid resuscitation
Intubation
Albumin
Methylprednisone
62
Mortality MIFE/MAFE
10-30/99
63
3 local flaps for 5cm vertex wound
Pinwheel
Trapezius
Orticochea
O to S
Occipital transposition flap
64
4 features that differentiate goldenhar from hemifacial microsomia
i. Epibulbar dermoids
ii. Vertebral nomalies
iii. Pre-auricular skin tags
iv. Bilateral
65
a. Expliquer une raison pathophysiologique pour l’ORN
i. ORN is caused by chronic hypoxemia from post radiotherapy consequences (endarditis obliterans)
66
a. 2 différences cliniques entre une plaie d’insuffisance veineuse et une plaie d’insuffisance artérielle
* Plaie d’insuffisance artérielle : apparence punched-out (bien délimitée) et nécrose souvent sèche, located over bony prominences (lat/med malleolus)
* Plaie d’insuffisance veineuse : plaie mal délimitée avec nécrose humide et signes d’insuffisance veineuse (dermite de stase), located pre-tibial
67
5 cases consent it not necessary
i. Emergency when life is threatened with no availability of substitute decision maker
ii. Emergency when limb is threatened
iii. Psychiatric disorder with danger to self or others
iv. Reported of mandated information (transmissible disease, vital statistics, etc)
v. Suspicion of child abuse
68
2 most important ligaments for CMC stability
i. Volar beak ligament (anterior oblique)
ii. Dorsoradial ligament
69
2 surgeries for stage 1 eaton CMC
ii. Shortenning/oblique osteotomy 1st metacarpal
iii. Volar beak ligamenet reconstruction
70
2 muscles qui reçoivent des perforantes de l’artère radial et vascularisent l’os du radius distal
FPL PQ
71
3 indications to operate gynecomastia
Failed medical management
Symptomatic patient
High risk of breast cancer (Kleinfelter)
Non physiologic <12 months
72
b. 2 trouvailles cliniques associées avec seymour fracture
c. 4 principes de la prise en charge de cette fracture
i. Nail bed interposition in fracture site
ii. Avulsion of nail plate from proximal fold
l
ii. Remove nail bed from in the fracture + debridement + irrigation
iii. Reduction, Fixation + immobilization
v. Nail bed repair
vi. Antibiotics
73
% lengthening for z plasties, jumping man, and 4 flaps
Degrees / % lengthening
30 / 25
45 / 50
60 / 75
75 / 100
90 / 120
jumping man 125
4 flap 90/ 100
4 flap 120 / 150
74
a. Expliquer le principe de ligamentotaxie
i. Ligamentotaxis is a technique of using continuous longtitudinal force (distraction) in order to bring fracture fragments more closely together and to optimize healing of the articular surface. Can be done when the collateral ligaments are intact.
75
PIP fracture
c. 2 contre-indication à fixateur externe de type avec traction (Suzuki)
d. 2 avantages d’une réduction ouverte
e. 2 désavantages d’une réduction ouverte
Subactue or chronic presentation
i. Unreliable patient
ii. Inability to achieve closed reduction
i. Easier technique with visualization of the pieces
ii. Placement of rigid osteosynthesis material permitting early movement
iii. Can convert to hemi-hamate arthroplasty if necessary
i. Technical difficulty with comminuted pieces
ii. More ankylosis/scarring
iii. Infection
iv. Devascularized fracture fragements
v. Increased post op edema
76
% of eyelid that can be closed primarily
25% (elderly with lots of laxity up to 40%)
77
13. Reconstruction paupière inférieure (lambeau de Tenzel)
a. Pourcentage maximale de la paupière inférieure qui peut être fermée primairement
b. 2 techniques chirurgicales pour augmenter l’avancement du lambeau cervico-facial (Mustarde)
c. 3 principes pour le design d’un lambeau de Tenzel
d. 1 complication long-terme du lambeau de Tenzel
e. 3 sources de greffes pour le support de la paupière
i. 25% (elderly, up to 40%)
i. Larger dissection down to the neck/ thorax
ii. Back cut
iii. Burrow’s triangle
i. Semi-circular flap
ii. Extend 2/3 distance from canthus to hairline
iii. Width > vertical height
i. Loss of upper eyelashes
i. Concha
ii. ADM
iii. Free tarsoconjunctival graft
iv. septum
78
fillers qu’il ne faut pas utiliser pour des rides superficielles
i. Radiesse (calcium hydroxyapatite)
ii. High g-prime cross linked high viscosity HA
iii. Sculptra (PLLA)
iv. Artefill (PMMA)
79
2 authologous tissue fillers
fat grafting
dermal grafts
free flaps
80
21. Abuttement ulnocarpien
a. 3 trouvailles à l’examen Clinique
b. 3 choses à la radiographie
c. Quelle trouvaille aura le plus d’impact sur le choix de la procédure dans un stade précoce de la maladie
d. 2 procédures chirurgicales pour une atteinte mineure
e. Revient 10 ans plus tard et a très mal, quel est le diagnostic le plus probable
i. + fovea
ii. Pain ulnar deviation
iii. + grind
iv. + ballottement
i. Positive ulnar variance
ii. Ulno-carpal arthritis
iii. Lunate sclerosis
i. positive Ulnar variance
i. Wafer ulnar resection
ii. Ulnar shortening osteotomy
iii. Debridement of TFCC
i. TFCC degeneration
81
What is in triple antibiotics ?
Genta + ancef + baci/vanco
82
3 clinical signs of biofilm
wounds that recur or take long to heal
Infections that recur
Capsular contracture
BIA-ALCL
Failed skin graft with no apparent cause
83
d. Patient avec dysréflexie autonome, quelles sont les 2 manifestations les plus fréquentes?
i.
Bradycardia
ii. Hypertension
84
What 2 medications inhibits capsular contracture and what is its mechanism of action
montelukast
leukotriene inhibitor
antibiotics
85
Risk factors for compression neuropathies
i. Obesity
ii. Diabetes
iii. Hypothyroidism
iv. Charcot marie-tooth
v. RA
vi. Pregnancy
86
29. Fente du palais primaire
a. Quels éléments contribuent à la formation du palai primaire
b. 4 facteurs de risques de fente labiopalatine
c. 2 traitements pré-opératoire pour une fente large du palai primaire
d. 2 critères d’une fente labiale forme frustre ou microforme
i. Fronto-nasal process (medial nasal prominences) and maxillary process
Parent with FLP
Sibling with FLP
Advanced paternal age
Accutane/phenytoin
Smoking, ROH, folate deficiency
NAM
Lantham
Lip taping
i. Notching of vermillion
ii. Fibrous band from lip to nasal sill
iii. Asymmetry ala
iv. Shortened vertical lip height
87
30. Contracture de Volkman.
a. Position des articulations
b. 2 muscles les plus souvent atteints (compartiment fléchisseurs-pronateurs)
c. 2 conditions cliniques pouvant causer un Volkmann
d. 3 options chirurgicales (musculaires ou myotendineuses) possibles pour une contracture de volkmann
i. MCP Hyperextension
ii. IPP Flexion
iii. CMC pouce Adduction, extension
WRist flexion
Arm pronation
Elbow flexion
i. FDP
ii. FPL
i. Untreated compartment syndrome
ii. Devascularization of the upper extremity
iii. Electrican burn
iv. displaced supracondylar humerus fracture in children
tendon lengthening
tendon transfers
free functional muscle transfer
Muscle sliding procedure
88
3 objectives of otoplasty
i. Avoid deformities (ear glued to head)
ii. Better defined anti-helix
iii. Decrease lobular prominence
iv. Decrease depth of conchal bowl
89
TENS vs SJS % tbsa
TENS >30
SJS <10
90
b. 2 incisions que vous devez faire pour une séparation des composantes antérieure
Lengths gained
i. Incision lateral to the linea semilunaris into the anterior fascia of the external oblique muscle + medially between the posterior fasia and the rectus muscle
5-10/3
91
6 characteristics of asian eyelid
ideally where do we form the crease in asians, caucasian men and women ?
1. Absent palpebral crease
2. short tarsus
3. medial epicanthal fold
4. descent of preaponeurotic fat
5. minimal connections between levator and upper lid dermis
6. upward tilt of lateral canthus
6mm, 8mm, 10 mm
92
Tear trough triad: Association of several anatomic characteristics giving rise to a
prominent tear trough.
* Herniation of orbital fat
* Tight attachment of the orbicularis retaining ligament along the arcus marginalis
* Malar retrusion
93
Clinical signs of hemicoronal synostosis
4 functional issues
Contralaterally
1. Frontal bossing
2. Chin deviation
Ipsilateral
1. Frontal flattening
2. Root of nose towards
3. Eyebrow raised, more open looking eye (harlequin sign radiologically)
4. Ear is superior and anterior
Neurodevelopemental delay
ICP
Exorbitism
Aiway obstruction
CHiaria malformation
94
Age for first tetanus shot
2 monthts
95
Difference in measuring TBSA pediatrics and adults
Legs less
Trunk less
Head more
96
What is the antidote to phenol burns?
What 2 should not be irrigated ?
Polyethylene glycole, wipe skin with PEG or irrigate with PEG solution
1. Elemental metals (Na, Li, Mg) exothermic reaction
2. Dry lime (dry cement) should be brushed off, can form calcium hydroxide, which is a powerful alkali
97
3 options for paralytic ectropion
lateral tarsal strip canthoplasty
PL fascial sling
Tarsorrhaphy
98
Medial plantar
MN classification
Between which muscles
Which other nerve innervates
How to elongate
What other local flaps can be used ?
B septocutaneous
Abductor hallucis & Flexor digitorum brevis
Saphenous nerve
Proximal dissection and ligation of the lateral plantar artery
Reverse sural
Lateral calcaneous artery
Propellor off posterior tibial or fibula
Distal peroneus brevis
Distal hemi-soleus
99
Autonomic dysreflexia
what is it and what is the pathophysiology
Bradycardia and HTN
Pain
Sympathetic reflex of hypertension/vasoconstriction below spinal chord injury
Baroreceptors carotid activation, leading to parasympathetic bradycardia and vasodilation ABOVE level of injury
100
3 intranasal incisions for primary rhino
infra
trans
inter
101
how to close open roof deformity
nasal bone osteotomies
if too narrow, can do autospreader flaps, spreader flaps
102
Which arc is disrupted in perilunate
3 components of surgical treatment
Lesser (no fracture)
Greater (fracture)
1. CTR + LTq repair
2. Reduction + Kwire SL, RL, LTq, SC
3. Bone anchor SL and LTq
4. Capsulodesis
103
12) Neuropathie ulnaire
a. Signes sensitifs qui differencient proximal vs. distal
b. Signes moteurs qui differencient proximal vs. distal
c. Trouvaille clinique qui differencie proximal vs. Distal
d. Gap de 5cm au coude, comment retablir le sensibilite au cote ulnaire de la main et de l’auriculaire
e. Transfert de AIN, quel muscle sera denerve
f. Comment identifier fascicule moteur VS sensitif nerf ulnaire distalement
a) proximal
* Anesthesia in dorsal cutaneous branch territory
* Anesthesia in palmar branch territory
b) FCU, FDP D4-5
c) clawing worse distal injury
d) nerve grafting, nerve transfer 3rd webspace to ulnar sensory in hand
e) PQ
f) topography, motor is between the dorsal sensory and the ulnar sensory
find in guyon and neurolyse proximally
nerve stimulation
histochemical staining - acetylcholinesterase
104
Merkel cell carcinoma
a) origin?
b) imaging ?
c) adjuvant therapy
a) cutaneous neuroendocrine cells in epidermis
b) full body PET, CT PAC, brain MRI
b) radiotherapy + immunotherapy vs chemotherapy
105
describe bilobed
Pivot point of the flap should be one radius away from the deficit
Draw line connecting midpoint of deficit and pivot point
Draw line perpendicular (90 degrees) to this starting from pivot point
Draw line bisecting these 2 lines (45 degrees)
First lobe drawn at 45 degrees, length and width of the first flap equivalent to deficit
Second lobe drawn at 90 degrees, length at least 4 x radius, width ½ to 2/3 size of first lobe
106
indications of slnb melanoma other than breslow
systemic therapy
<0.8 with ulcerations, mitotic index >2, perilymphovascular invasion
recurrence or in transit metastasis
immune checkpoint inhibitor (anti PD1) ipilimumab, cemiplimab
BRAF kinase inhibitor
107
19) Long face syndrome
a. 4 characteristiques
b. Quel est lobjectif de incisal show apres le traitement (en mm)
c. Quel intervention chirurgie peut etre faite
a) long lower third of the face
teeth-gingival show at rest
anterior open bite
class 2 malocclusion
labial incompetence with mentalis strain
obtuse naso-labial angle
retrognathia
b) 2-3 mm man, 5-6 mm women
c) lefort 1 impaction with BSSO + genioplasty
108
2 medications to treat BDD
clomipramine (TCA)
fluoxetine (SSRI)
109
3 ddx for HS
TB
Carbuncles
Acne conglobata
110
What is the test for intrinsic tightness of MP and PIP, and explain how it works
Bunnel intrinsic tightness test
PIP passive flexion is done with MCP in extension and flexion. Tightness is demonstrated by difficulty flexing when MCP is in extension and improvement when MCP is in flexion.
Extension at MCP = all intrinsic tightness is transferred to PIP, therefore making it harder to flex.
If the opposite is true, then there is extrinsic tightness.
111
d. Contracture moderate to severe, quest ce que ca a comme impact for la mammographie
Calcifications make mammography harder to interpret which can lead to further imaging (US, MRI) and biopsies to rule out malignancy
Difficult to mobilise implant for
Ecklund views to thoroughly evaluate breast parenchyma
1-2 decreases tissue visualization by 30%
3-4 decreases tissues visualization by 50%
112
30) Petit deficit base du crane
a. 4 principes de reconstruction
b. 2 lambeaux pour un petit deficit de la base du crane anterieure
e. Si tu dois passer profond a la mandibule, quel muscle tu dois traverser
1. Watertight dural seal
obliterate dead space and sinuses
reestablish oral and orbitopharyngeal vacities
provide well vascularized soft tissue
reconstruct bony and soft tissue defects
suspend and support neural structures
cover exposed essels
optimal. cosmesis
b) temporalis, pericranial, galeo-occipitalis, glabellar
free : RFF, gracilis, rectus, LD
e) mylohyoid
113
RFF
max bone?
muscles taken with ?
how to avoid fractures ?
10 cm
FPL + PQ
Keel shaped, not more than 30%
Bone graft with locking plate
114
Complications of HBOT
d. Pour une plaie chronique, quel est le meilleur predicteur de succès
1. reversible myopia, optic barotrauma, pneumothorax, seizures]
TcPo2 (transcutaneous partial pressure of O2 measurement) >200 mmHg obtained while the patient is undergoing an HBOT treatment
115
3 ways to protect workers from injury during OR
what to do if you hurt yourself
Double gloving
Protective goggles or face shields
Retractable needles
Predetermined, dedicated space to pass sharps during surgery
wash out
be treated by occupational health
116
maternal and fetal risk factors hemangiomas
c. Quelle est la crainte si lesion trouvee au niveau…
i. >5 hemangiomes
iii. Au niveau lombaire
older age, placenta previa, oligohydramnios, personal hx, preeclampsia
female, white, preterm, multiple gestation
>5 hemangiomas is considered hemangiomatosis, these children are more likely to have infantile hemangioma of the internal organs. The liver is the most commonly affected and large tumors can cause heart failure.
Risk of LUMBAR association
LUMBAR association (Lower body infantile hemangioma, Urogenital anomalies, Myelopathy, Bony deformities, Anorectal malformations, Renal anomalies) is the posterior trunk equivalent of PHACE.19 The hemangioma is extensive and superficial. The tumor has minimal postnatal growth and a high risk of ulceration. The hemangioma typically affects the sacral area or lumbar region. Patients can have ventral–caudal malformations (omphalocele, recto-vaginal fistula, vaginal/ uterine duplication, solitary/duplex kidney, imperforate anus, tethered cord lipomyelomeningocele).19 Ultrasonography is obtained to rule-out associated anomalies in infants <4 months of age. MRI is indicated in older infants or when ultrasonography (US) is equivocal.
117
obstetrical brachial plexus
mechanism of horner
breech, which is most common
Interruption of the preganglionic sympathetic fibers that come off the T1 spinal nerve root
Upper C5-6
118
4 moments when you bridge coumadin
when do you stop coumadin, plavix, xa inhibitors, asa before surgery
antidote of pradaxa and eliquis/xarelto
how long does it take for coumadin to become therapeutic
* Mechanical mitral valve; mechanical aortic valve with additional stroke risk factors
* Embolic stroke within the previous three months or very high stroke risk (eg, CHADS2 score of 5 or 6)
* VTE within the previous three months
* Possibly in selected individuals with recent coronary stenting
* Previous thromboembolism during interruption of chronic anticoagulation (based on presumed increased risk; not addressed in clinical trials)
5 days, 5 days, 2 days, 7 days
praxbind, andexxa
5-10 days to become therapeutic
119
Ptosis correction
Good levator function (2)
Fair levator function (1)
Poor levator function (1)
Good : Muller's muscle conjunctival resection
Levator aponeurotic repair
Fair: Levator resection/advancement
Poor: Frontalis suspension (acquires)
Fascial grafts (congenital)
120
Max dose of botox in 3 months
400unite
121
Contraindications to TPA in frostbite
>48 hours
Bleeding diasthesis
Major trauma or surgery <3 weeks
Previous hem. stroke
Gi bleed <1 month
Cerebral infarct <6 months
Brain tumor, aneurism, av malformation
Aortic dissection suspected
Recent Deep biopsys that cannot be compressed
122
Trigger
a) Most common intra op finding
b) Risk factors for recurrence
c) What do you do if it recurrs and why do you not release A1 in PAR
d) diagnostic probable pour un patient qui a D5 qui clique mais sans signe de trigger à l’examen physique
a) A1 pulley hypertrophy
b) Younger age, diabetes (insulin dependent), multiple fingers
c) Removal of ulnar slip of FDS
indications
o persistent/recurrent triggering after A1 pulley release
o rheumatoid arthritis patients may benefit from FDS slip excision without A1 pulley release
sparing of A1 pulley may prevent exacerbation of ulnar drift at the MCP joint
d) Early swan neck deformity
Sagittal band rupture
Lateral bands luxating in early swan neck
123
d. 2 accusations qui peuvent être portés sur un médecin qui effectue une chirurgie sans le consentement
Negligence
Assault and battery
124
Fente labio-palatine
1. Range of surgery and what 2 things are considered in timing?
2. Describe intravelarveloplasty
3. 2 techniques for hard palate and explain
1. 9-12 months, speach vs. maxillary growth restriction
2. Under the microscope
Incise the cleft margins
Separate the velar muscle mass (levator veli palatini, palatoglossus, palatopharyngeus) and the tensor veli palatini from the oral and nasal mucosa, disinsert them from the posterior hard palate, reposition them posteriorly in their anatomic position
3-layer closure, nasal mucosa, velar musculature in anatomic position, oral mucosa
3. Von Langenbeck, bilateral, bipedicled, mucoperiosteal flaps are elevated and sutured in the midline
Bardach two flap, bilateral mucoperiosteal flaps based on greater palatine artery are elevated and sutured in the midline
125
Cleft hand
1. Which swanson category ? & what are the others
2. Typical vs atypical cleft hand
3. Surgical goals of cleft
1. Failure of formation of parts
Differentiation
Over growth
Undergrowth
Duplication
Constriction band
General skeletal abnormalities
2. Typical :
V shaped
AD
No nubbins
1st web syndact
Multiple limbs (feet)
Suppression of radial digits
A typical :
Sporadic
Nubbins
U shaped
No other limbs
May be associated with Poland
3. Release syndactyly
Recreate 1st webspace
Remove transverse bones that widen cleft
Close cleft
126
Littler flap innervation
Ulnar D3
127
Trigger thumb
1. 3 ddx
2. Stage 2 hypoplasia on exam
1. Arthrogryposis/clasped thumb
fracture
hypoplasia
2. small thumb
unstable UCL MP joint
small web space
intrinsics missing
128
Complication of unilateral and bilateral ischiectomy
1. Contralateral pressure sore, perineal pressure sore
129
Burns
1. What to give for CN intox
2. What are metabolic effects in the hypermetabolic state:
3. What are stragegies to minimize hypermetabolic state (non medical and medications)
4. What is the predictive formula Curreri formula for feeding and what percentages protein, carbs and fat?
how to calculate protein needs in grams
5. Role of Vitamin c and a in burns
1. Hydroxycolbalamine (cyanokit)
2. Increased catabolic hormones (cortisol, catecholamines)
Decreased anabolic hormones
Increase in bsal metabolic rate
INcreased basal body temp
Increased reistance to insulin
Glycogenolysis and glucongeogenesis
immune supression
3. thermoregulation
early excision and grafting
early and continuous enteral feeing
pain relief
prevention infection
propranolol
oxandrolone
4. adults 25kcal/kg + 40kcal/%tbsa
children 40kcal/kg + 40kcal/%tbsa
proteins 20%
carbs 50%
fats 30%
1.5-2g/kg
5. C :lower fluids required for resuscitation, reducte vent requirements
ACE: shorten wound healing time, infection rates and shorten hospital stay
130
1 histology characteristic for mechanical and biologic creep
Mechanic : displacement of water from ground substance and realignment of collagen fibers
Biologic:
epidermal proliferation
angiogenesis
increased collagen production
increased fibroblast mitosis
131
3 muscles for tear trough
Dose of hyaluronidase
orbicularis
levator labi superioris aleque nasi
levator labi superioris
200U repeated 3-4 times
132
define biocompatibility
Biocompatibility, capacity of a material to elicit a suitable host response in the specific application
133
bacteria + atb
cut while cleaning fish aquarium
rose thorn
Mycobacterium marinum, doxycycline
Sporothrix schenkii, fluconazole
134
Tetanos, dog bite
Name 2 indications for vaccine
Name 2 indications for IG
2 indications to give Rabies vaccine and IG
dirty wound
vaccine :
unknown
<3 doses
>5 years
IG
unknown
<3 doses
Vaccine = bite by infected dog, bite by skunk/fox/bat
IG = not previously vaccinated + bite by infected dog, or skunk/fox/bat
135
a) 2 ways to make sure that Nordhoff point is properly placed
b) name 2 advantages of adding a triangular flap above the white roll
c) by displacing nordhoff closer to commissure, what is the impact on vertical and horizontal lip dimensions
Point where the vermillion-cutaneous and the vermillion-mucosal junctions start to converge
Most medial point at which the quality of the white roll is maintained
b) Increases the vertical lip length on the cleft side
Breaks up the linear scar, therefore decreases the risk of scar contracture and lip shortening
c) Increases the vertical lip length on the cleft side
Decreases the horizontal lip length on the cleft side
136
c) what are 2 embryonic theories for atypical facial clefts
g) what is embryonic layer origin of dermoid cyst?
Failure of fusion of facial processes
Failure of mesenchymal penetration
Neuroectoderm
137
deep posterior leg compartment
flexor hallucis longus, flexor digitorum longus, tibialis posterior and popliteus muscles.
138
c) name 2 important aspects of Seymour fracture
Unstable fracture due to the deforming forces (FDP and terminal tendon of extensor mechanism)
Nail bed laceration and interposition in the fracture line when not recognized and repaired can lead to osteomyelitis and tenosynovitis
139
d) most common location merkel cell ca
What is a merkel cell and what is its function
Head and neck (sun exposed areas)
Cutaneous neuroendocrine cell located in the epidermis. It is a mechanoreceptor that responds to constant touch and pressure and static two-point discrimination.
140
b) 3 associated condition with pyoderma gangrenosum
what is pathergy
Crohn’s disease
Ulcerative colitis
Rheumatoid arthritis
Diabetes
state of altered tissue reactivity in response to minor trauma
141
Accepted angulation for metacarpal
shaft
neck
shaft :
D2/D3 : 10-20 10-15 = 10
D4 : 30 : 30-40 = 30
D5 : 40 : 50-60 = 40,50
142
d) most important vascularity in first toe free flap
a) up to what length of thumb amputation no significant functional deficit
1st dorsal metatarsal artery
Distal 1/3 or distal to IPJ
143
d) 3 physiological changes in flap delay
Tissue conditioning to mild ischemia
Opening of choke vessels
Reorientation of the vasculature along the axis of the flap
144
approaches to condlye
a) 3 physical exam findings other than malocclusion
Intra-oral approach
Retromandibular, transparotid
Retromandibular, retroparotid
Pre-auricular
Facelift approach
endoscopic
Loss of ipsilateral posterior facial height with contralateral open bite
Deviation of the chin to the affected side
Trismus
145
f. Quelle est la complication oculaire la plus fréquente d’une brûlure électrique.
Cataracts
146
e. Quel est le pourcentage de risque de transformation maligne de neurofibromes
What 2 malignant cancers?
5-15%
MPNST
Rhabdomyosarcoma
Malignant optic glioma
147
A. 2 façons d’améliorer la mobilisation du paraspinale + vascularization
B. Limites chirurgicales du trapeze et limite pour éviter d’avoir un affaissement de l’épaule
A. Incise the thoraco-lumbar fascia
Dissection to release the medial and deep muscle attachments +/- ligation of medial row perforators
lumbar artery perforators + segmental intercostals
B. Superior, spine of the scapula
Medial, midline of the back
Inferior, T12
Lateral, medial border of the scapula
Do not harvest descending portion of the trapezius above the spine of the scapula in order to avoid drop shoulder
148
25. Caput ulna
a. 3 trouvailles cliniques
c. 3 stabilisateurs de la DRUJ
a) Dorsal dislocation of the ulnar head
Attrition rupture of extensor tendons from ulnar to radial
Volar and ulnar translation of the carpus
Supination of the carpus
Radial deviation of the metacarpal bones
Volar subluxation of the ECU
c. Dorsal radio-ulnar ligament
Volar radio-ulnar ligament
TFCC
Pronator quadratus
149
e. Pourquoi c’est possible d’utiliser une concentration plus élevée dans liposuction que dermique (2 raisons)
Use of high quantities of lidocaine made possible because of:
* Diluted solution
* Slow infiltration
* Vasoconstriction of epinephrine
* Relative avascularity of fatty layer
* High lipid solubility of lidocaine
* Compression of vessels by infiltrate
150
d. Différence entre télécanthus et hypertélorisme
GIVE MEASUREMENTS
Telecanthus is increased intercanthal distance > 35 mm
Hypertelorism is increased interorbital distance > 25 mm
151
39. Laryngectomie et reconstruction
a. 4 principes de reconstruction
b. Si le déficit est circonférentiel, sur quoi allez-vous fixer votre lambeau
c. 3 raisons pourquoi le lambeau antébrachial libre est un meilleur choix comparativement au lambeau pectoral pédiculé pour la reconstruction des déficits partiels du larynx
d. 2 autres options de lambeau libre pour la reconstruction du larynx
a) Separation of the airway from the digestive tract
Restore continuity of the alimentary tract to permit deglutition
Protection of the great vessels
Restoration of speech function
Provision of stable soft tissue coverage that will withstand adjuvant radiotherapy
b) Prevertebral fascia
c) Larger skin paddle
Less risk of partial flap necrosis
Easier insetting because flap is less bulky
No unsightly bulge in the neck
d) ALT flap
Free jejunum flap
152
Raynaud's disease vs phenomenon
Disease = primary
Phenomenon = secondary
PAR
Lupus
Schleroderma
Sjogrens
Dermatomyositis polymyositis
153
Ages of phases for hemangiomas
Proliferating phase (0–1 year of age)
Involuting phase (1–4 years of age)
Involuted phase (after 4 years of age)
After involution, one-half of children will have residual telangiectasias, scarring, fibrofatty residuum, redundant skin, or destroyed anatomic structures.
Total involution occurs in 50% of hemangiomas by 5 years, in 70% by 7 years and in >90% by 9 years.
154
c. 2 extraplexus transfer for elbow flexion
Intercostal nerves
Spinal accessory
Phrenic nerve
155
litchman classification for kienboch and their treatments
1. normal x ray, positive bone scan and MRI
2. sclerosis on x ray
3a. collapse of lunate but good carpal alignement
3b. collapse of lunate with proximal migration of capitate and scpaphoid flexed
4. carpo-radial and midcarpal arthritis
Offloading procedures
* Ulnar lengthening
* Radial shortening
* Core decompression of the radius
* Lunate decompression, forage and bone grafting
Revascularisation
* Vascularized bone flap
156
Pathophysiology of HF burn
Liquefactive and coagulative necrosis
157
Pivot point of the PIA flap and what two muscles does it run between
Three ways to increase a keystone flap
This flap, located over the dorsum of the forearm, is based on the perforators from the posterior interosseous artery, located between the extensor carpi ulnaris (ECU) and the extensor digiti minimi (EDM). This flap pivots where the posterior interosseous artery anastomoses with the anterior interosseous artery approximately 2.5 to 3 cm proximal to the distal radioulnar joint.
Division of the deep muscle fascia
Double opposing keystone flaps
Undermine up to 50% of the flap subfascially
158
c. What is the afferent and efferent nerve for occulocardiac reflex
Afferent, nasociliary branch of CN V1
Efferent, vagus nerve
159
Vascularization of hard and soft palate
Hard :
Greater palatine (max descending palatine artery)
Nasopalatine (max via sphenopalatine)
Anterior and posterior superior alveolar arteries (max)
Soft:
Lesser palatine
Ascending pharygeal and palatine
160
b. 2 medication class that can increase the potency of Botox
Aminoglycosides
Penicillamine
Quinine
Calcium channel blockers
161
a. 3 advantages pre pec vs under the pect recon
Less risk of animation deformity
Less post-operative pain
Better symmetry for unilateral reconstruction with grade 1 to 3 ptosis
Decreased risk of lateral malposition of the implants
Better projection in very large breasts
162
e. What bacteria is associated with ALCL
Ralstonia picketii
163
When to operate
a. Cleft lip
b. Cleft palate:
c. Alveolar cleft (graft)
d. VPI:
e. 4 nose deformities associated with cleft
3 months
12 months
6-9 years
4-6 years
Cleft lip nasal deformity
○ The unilateral cleft nose :
§ Structure: deviated toward non-cleft side because of asymmetrical pull of the muscle
§ Lower lateral cartilage : attenuated, weakened
§ Tip: depressed and rotated towards noncleft side
§ Turbinate : hypotrophy (cleft side)
§ Alar base : posterior, lateral, inferior
§ Ala- depressed
§ Columella : shorter (cleft side)
§ Caudal septum : deviated to non cleft side
Maxilla: displaced inferiorposteriorly
164
Lefort 1
a) vascularization
b) soft tissue 4 effects
c) complications
d) complication in clefts
a) ascending pharyngeal (ECA) and ascending palatine (FA)
b) nasal flaring (advancement), septum deviation/buckling, sleep apnea, nose less projected,
c) lacrimal duct injruy, paresthesia, bleeding, blindness, maxillary necrosis
d) VPI
165
Vascularization of reverse soleus
Vasc of gastroc
Perforators from posterior tibial artery
Medial sural artery, sural nerve
166
c. Patient post arm replant is dyspneic, has myoglobinurea
2 causes for this clinical picture
EP
Rhabdomyolysis
167
a. Define mechanical creep
b. Define biological creep
i. Réponse aigu tissulaire mécanique lorsqu’une force constante est appliquée sur un région donnée. Il se produit une Élongation des fibres de collagène, microfragmentation de l’élastine et réallignement du collagène parallèle à la surface de l’expanseur.
i. Réponse chronique biologique lorsqu’une force constante est appliquée sur des tissus. L’activité des Fibroblastes est accrue et l’angiogénèse est stimulée.
168
pollicisation angles
radial abduction 20
palmar abduction 40
pronation 120
169
Why can't you freeze melanomas
a) canot tell with certainty where are melanocytes and canot tell if they re atypical or juste weird because of freezing because melanocytes die at -5 degrees
170
Where does the medial plantar pedicle come out ?
FDB
Abductur hallucis
(not abductor digiti minimi, which is third muscle in foot)
171
2 most important ligaments for CMC
degrees tolerate hyperextension cmc
how to manage MP hyperextension (3)
Volar beak (volar anterior oblique)
Dorsoradial
30
EPB tenotomy
volar MCPJ capsulodesis
fusion
sesamoid arthrodesis
palmaris longgus volar plate reconstruction
172
ABA sepsis criteria
Temp >39 or <36
Tach >110
Tachypnea >25
Thrombocytopenia
Hyperglycemia
Feed intolerance
173
d. Name what structure protects the facial nerve below the SMAS
e. What 2 structures do you need to release under the smas in the cheek
i. Fascia parotido masséterique
i. Ligaments zygomatiques
ii. Ligaments massétériques
174
b. What are 3 complications (acute) of prominauris surgery
d. What are 3 long term complications of prominauris correction
i. Infection
ii. Déhiscence de plaie
iii. Nécrose cutanée
iv. Hematoma
i. Asymétrie
ii. Récidive prominauris
iii. Extrusion fils non résorbables
iv. Keloids
v. Overcorrection
vi. Telephone deformity
175
Meds that give higher risk of scc
dose of vita A for wound healing
What is your recommendation for oncological follow-up breast cancer
voriconazole (ROR, 78.48) azathioprine (ROR, 34.13),
tacrolimus (ROR, 19.27), mycophenolate (ROR, 18.01), cyclosporine (ROR, 14.54)
Methotrexate
Infliximab
Prednisone
25k/day pO
Suivi avec oncologue q3-6 mois pour 5 ans puis annuel à vie
176
Distance to the optic canal
4cm laterally
4.5-5 cm medially
42 mm (24/12/6)
177
How can a perilunate dislocation progress to VISI?
LT disruption with palmar flexion of the lunate, causing SL angle to be <30 degrees
178
Compression sites AIN
Pronator syndrome
FLAP
FPL accessory muscle "gantzer"
Lacertus
Arch FDS
Pronator teres head
SLAP
Struthers ligament
179
Indications for surgical mallet
>33% articulation
volar subluxation
failure of conservative management
180
myoglobinurea with difficulty breathing 2 ddx
Hyperthermia malignant
rhabdomyolysis
PE
acute transfusion reactionPo
181
Position of immobilization for reduced MCP dislocation
30 flexion for 2 weeks then mobilization with extension bvlock
182
Most common saggital band rupture
a. 4 other structures that contribute to the deformity boutonniere
D3 radial
i. Migration palmaire des bandelettes latérales
ii. Contracture du ligament transverse retinacular (TRL)
iii. Étirement du ligament triangulaire
iv. Contracture des bandelettes latérales
v. Flexion par le FDS
vi. Contracture de la plaque palmaire
vii. Contracture des collatéraux
183
Pain in CRPS
allodynia - normal stim painful
hyperalgesia painful stim with extagerated perception
hyperpathia pain after stim removal
dysesthesia pain with no stim
184
3 mechanisms for soft tissue injury nicotine
i. Vasoconstriction avec diminution de la perfusion secondairement
ii. Shift de la courbe de dissociation de l’hémoglobine à gauche avec diminution du relargage d’oxygène périphérique
iii. Toxicité pour l’endothélium vasculaire
iv. Adhésion plaquettaire augmentée
185
3 meds that negatively impact wound healing
sirolimus (chemotherapy)
humira (anti tnf)
prenisone
186
What class and name do you give for ptosis
Apraclonidine
alpha adrenergic sympathetic activator of muller's muscle
187
Contra-indications to NSM
Inflammatory breast cancer
Cancer involving the nipple
188
Lifetime risk cancer BRCA 1&2
when to test for BRCA
72 % 69
Hx family
male
1st degree breast + ovarian
1st degree bilateral
189
Burns
a) 1st thing to do
b) Acids example
c) Phenol antidote
d) HF mechanism of action
e) White phosphorous
f) lime
g) cement
h) tar
a) remove offending agent
copious irrigation + antidote
atls
b) Chromic acid
acetic acid
hydrofluoric acid
formic acid
hydrochloric acid
c) PEG
d) coagulation necrosis and metabolic poison
e) irrigate with copper sulfate solution and remove pieces
f) aklali, brush away and irrigate
g) alkali and dessicant, brush away and irrigatte
h) remove from skin immediately, use mineral oil, vaseline, polysporin, butter
190
Rejection cells implicated in allograft skin
Langerhans dendritic cells are the antigen presenting cells, show to CD4 and CD8 lymphocyte T cells
191
Grafts for internal valve collapse
Allar batten grafts
Auto-spreader flaps
Spreader flaps
192
Hemitransfixion and killian approaches
a. Hemitransfixion, incision unitlaterale du septum a/n de sa jonction membraneuse et cartilagineux
b. Killian : Insicion unilatérale a/n du septum cartilagineux, pour accès au septum postérieur
193
Risk factors merkel
Staging 3
polyomavirus
immunosuppression
sun
age
TEP
Scan
MRI
194
Black person laser
Nd:yag
195
Epilation laser
Diode (ND:YAG if black)
196
What makes up the lateral canthal tendon and where does it insert?
Signs of lateral canthal tendon disruption
1. Superior tarsal plate
2. Inferior tarsal plate
3. Pretarsal and preseptal portions of the orbicularis oculi muscle
4. Lateral horn of the levator aponeurosis
5. Lockwood’s
suspensory ligament
6. check ligament of the lateral rectus muscle
Whitnall's tubercle
Blunting of canthal angle
Reduction of horizontal fissure
197
Serratus MN type and artery(ies)
III
Lateral thoracic
Serratus branch of thoracodorsal
198
b. Par rapport à la branche marginale mandibulaire, ou se situe t’elle par rapport à :
i. Platysma
ii. Angle mandibulaire
iii. Artère faciale
periauricular deformations post facelift
i. under
ii. posterior to facial artery, 80% above, anterior to it always above
iii. above (water under the bridge)
a. Pixi ear
b. Déformité du tragus
c. Alopécie
d. Distorsion de la ligne des cheveux
e. Cicatrice visible
f. Poil sur tragus
199
leaches what they release and moa of the anticoagulant
hirudin
histamine like substance
hyaluronidase
direct thrombin inhibitor
thrombin is active in the fibrinogen to fibrin transformation
200
ddx SJS
tx sjs
erythema multiforme
staphylococcus scalded skin syndrome
pemphigoid bullous
pemphigus vulgaris
TNF-inhibitor
cyclosporine
IVIG
Pred
lubrication eyes
stop offending drug
201
Indications for tenolysis
6 weeks failed hand therapy
3-6 months post surgery
adhesions (passive >> active)
repair intact
202
28) 3 récents articles dans des revues fiables ont parlé du risque augmenté de suicides chez les patients ayant eu une augmentation mammaire.
a. Quels éléments peuvent contribuer à l’obtention d’une erreur de type 1
b. Un autre article récent rapporte que sur 100 patientes, suivies sur une période de 3 ans, aucune ne s’est suicidée. Ils en concluent que les deux éléments ne sont pas associés. Quel élément peuvent contribuer à l’obtention d’une erreur de type 2 dans ce cas-ci
c. La consommation d’alcool semble reliée à une augmentation du risque de suicide. Nommer 2 façons de contrôler pour ce facteur
1) bias, confounding variables
2) inadequate sample size/power
c) randomization, matching, multivariate analysis, stratification
203
Recidive post fasciect dupuytren
20
204
McCune albright
Maffucci
Polyostotic fibrous dysplasia
-precocious puberty
-cafe au lait
-sporadic
Maffucci
-hemangiomas
-lymphangiomas
-polyostotic endochondromatosis
30% malignant transformation into chondrosarcoma
-sporadic
205
SCIA flap
What artery does it come from
three disadvantages
a. Pédicule court
b. Risque de lymphoedème
c. Dimension limitée en largeur
d. Lambeau mince
e. Pas fiable en libre
Femoral artery
206
artery of the converse flap and what it can be used for
superficial temporal
nasal reconstruction
207
Jersey finger classification, treatment
3 months post type III, what's your treatment
I - both vinculae ruptured, tendon retracts into palm, repair 7-10 days
2. Long vinvulum intact, tendon to PIP, late repair <3 months possible
3. Tendon held at A4 pulley by bone fragment, ORIF
4. fracture avulsion- ORIF + tendon reinsertion
5. # avulsion with comminution
a. Arthrodèse (si tendon rétracté)
b. Excision de l’os et pull out suture (si tendon en continuité)
208
Where is the inferior labial artery
Submucous and submuscular
209
Hyperthermia malignant MOST IMPORTANT TREATMENT
STOP OFFENDING AGENT
210
4 techniques to fix a double bubble
4 techniques ce qu’on avait dit si pli a la bonne place on lyse ou enleve le pli si mauvaise place avec implant bas, capsulorraphie, adm, neo pochette
211
Moebius nerves
7 facial
6 abducens
12 hypoglossal
9-10-11
212
