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ABSITE > 18 Plastics, Skin, Soft tissue flaps > Flashcards

18 Plastics, Skin, Soft tissue flaps Flashcards

1
Q

Keratinocytes

A

Main cell type in epidermis
Originate from basal layer
Provides mechanical barrier

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2
Q

Melanocytes

A

Neuroectodermal origin (neural crest cells)
In basal layer of epidermis
Transfer melanin to neighboring keratinocytes via melanosomes through dendritic processes
Density of melanocytes is the SAME amongst races - different rate of melanin production

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3
Q

Dermis

A

Structural proteins (collagen)

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4
Q

Langerhans cells

A

Antigen-presenting cells - MHC Class II
Originate from bone marrow
Contact hypersensitivity reactions (Type IV)

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5
Q

Pacinian corpuscles

A

Pressure

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6
Q

Ruffini’s endings

A

Warmth

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7
Q

Krause’s end-bulbs

A

Cold

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8
Q

Meissner’s corpuscles

A

Tactile sense

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9
Q

Eccrine sweat glands

A

Aqueous sweat - hypotonic

Thermal regulation

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10
Q

Apocrine sweat glands

A

Milky sweat
Most in palms and soles
Acetylcholine (BUT still sympathetic nervous system)

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11
Q

What type of drugs have best skin absorption?

A

Lipid-soluble drugs

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12
Q

Predominant type of collagen in skin?

A

Type I collagen
70% of dermis
Gives tensile strength

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13
Q

Definition - tension

A

Resistance to stretching

Collagen

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14
Q

Definition - elasticity

A

Ability to regain shape

Branched proteins that can stretch 2x normal length

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15
Q

Cushing’s striae

A

Caused by loss of tensile strength and elasticity

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16
Q

MCC of pedicled or anastomosed free flap necrosis?

A

venous thrombosis

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17
Q

How does tissue expansion occur?

A

Local recruitment
Thinning of the dermis and epidermis
MItosis

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18
Q

TRAM flaps

A

Transverse rectus abdominis myocutaneous
Complications: flap necrosis, ventral hernia, bleeding, infection, abdominal wall weakness
Blood supply - superior epigastric vessels

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19
Q

Most important determinant of TRAM flap viability?

A

Periumbilical perforators

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20
Q

Stage I pressure sore

A

Erythema and pain

No skin loss

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21
Q

Stage II pressure sore

A

Partial skin loss with yellow debris

Tx: Local, keep pressure off

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22
Q

Stage III pressure sore

A

Full-thickness skin loss, subcutaneous fat exposure

Tx: Sharp debridement; likely need myocutaneous flap

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23
Q

Stage IV pressure sore

A

Involves bony cortex, muscle

Tx: myocutaneous flap

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24
Q

UV radiation

A

Damages DNA and repair mechanisms
Both a promoter and initiator
Melanin is the single best factor for protecting skin from UV radiation

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25
What radiation is responsible for chronic sun damage?
UV-B
26
Risk factors for melanoma?
``` Dysplastic, atypical, large congenital nevi (10%) Familial BK mole syndrome (100%) Xeroderma pigmentosum Fair complexion, easy sunburn, intermittent sunburns Previous skin CA Previous XRT Immunosuppression 10% familial ```
27
Most common melanoma site on skin?
Men - back | Women - legs
28
Negative prognostic factors for melanoma?
Men Ulcerated lesions Ocular and mucosal lesions
29
Signs of melanoma?
``` Asymmetry (angulations, indentation, notching, ulcerations, bleeding) Borders irregular Color change Diameter increasing Evolving over time ```
30
Most omnious sign for melanoma?
Blue clor
31
Most common site for distant melanoma metastases?
Lung
32
Most common metastasis to small bowel?
Melanoma
33
Diagnosis of melanoma?
<2cm lesion - excisional biopsy | >2cm lesion (or cosmetically sensitive) - incisional biopsy (punch biopsy)
34
Thin lentigo maligna
Melanoma in situ, Hutchinson's freckle Just in superficial papillary dermis 0.5cm margins OK
35
Lentigo maligna melanoma
Least aggressive Minimal invasion Radial growth first Elevated nodules
36
Superficial spreading melanoma
Most common Intermediate malignancy Originates from nevus/sun-exposed areas
37
Acral lentiginous
Very aggressive | Palms/soles of AA
38
Nodular melanoma
Most aggressive Generally has metastasized at time of diagnosis Vertical growth first Bluish-black with smooth borders
39
Staging workup for melanoma?
For all melanoma >1mm deep: - Chest/abd/pelvic CT - LFTS - LDH - Examine all possible draining lymph nodes
40
Treatment for all stages of melanoma?
1) Resection of primary tumor with appropriate margins | 2) Management of lymph nodes
41
Surgical margins for melanoma?
In situ (0.5-1.0cc) <1.0mm (1.0cm) 1.1-2.0mm (1-2.0cm) >2.0mm (2.0cm)
42
Involved nodes in melanoma - signs?
Non-tender Round Hard 1-2cm
43
When do you reset nodes in melanoma?
Clinical positive nodes
44
When do you do a SLNB in melanoma?
Clinically negative nodes Tumor >1mm deep Tumors >0.72mm deep with worrisome factors
45
What do you need to add with anterior head/neck mealnomas >1mm?
Superficial parotidectomy (20% met rate to parotid)
46
Approach to axillary node melanoma with no other primary?
Complete axillary node dissection | Remove levels I, II and II - unlike breast CA
47
Medical treatment for systemic melanoma disease?
IL-2 | Tumor vaccines
48
Most common malignancy in united states?
Basal cell carcinoma of the skin
49
Origin of basal cell carcinoma?
EPidermis - basal epithelial cells and hair follicles
50
Pearly appearance, rolled borders, slow and indolent growth
Basal cell carcinoma
51
Path - peripheral palisading of nuclei, stromal retraction
Basal cell carcinoma
52
Basal cell carcinoma - morpheaform type
More aggressive | Has collagenase production
53
Treatment of basal cell carcinoma?
Margins - 0.3-0.5cm | XRT/chemo - inoperable disease, metastasis, neuro/lymph/vessel invasion
54
Overlying erythema, papulonodular with crust/ulcers; red-brown
Squamous cell carcinoma
55
Marjolin ulcer
Squamous cell carcinoma in post-XRT areas or old burn scars
56
Risk factors for squamous cell carcinoma
``` Actinic keratosis Xeroderma pigmentosum Bowen's disease Atrophic epidermis Arsenics Hydrocarbons (coal tar) Chlorophenols HPV Immunosuppresion Sun exposure Fair skin previous XRT Previous skin CA ```
57
Risk factors for metastasis of squamous cell carcinoma
Poorly differentiated Greater depth Recurrent lesions Immunosuppression
58
Treatment of squamous cell carcinoma?
Margins 0.5-1cm Mohs surgery (high risk) Regional adenectomy for clinically positive nodes XRT/Chemo - inoperable disease, mets, neuro/lymph/vessel invasion
59
Most common soft tissue sarcomas?
1# Malignant fibrous histiosarcoma | 2# Liposarcoma
60
Symptoms of soft tissue sarcoma?
Symptomatic mass GI bleed Bowel obstruction Neurologica deficits
61
Work up of soft issue sarcoma?
``` CXR - r/o lung mets MRI - r/o vascular, neuro, bone invasion Biopsy: - < 4cm - excisional - >4cm - longitudinal incisional ```
62
Mets of soft tissue sarcomas?
Hematogenous spread Rarely to LN Most common site - lung
63
Most common site of soft tissue sarcoma mets?
Lung
64
Treatment of soft tissue sarcoma?
3cm margins and at least 1 uninvolved fascial plane | Place clips - if recurrence, XRT
65
Indications for postop XRT for soft tissue sarcoma?
High-grade tumors Close margins Tumors >5cm
66
Chemotherapy for soft tissue sarcoma?
Doxorubicin
67
Indication for preop chemo-XRT with soft tissue sarcoma?
>10cm | Possibility of limb-sparing resection
68
Poor prognostic factors in soft tissue sarcoma?
Delay in diagnosis Difficulty getting total resection Difficulty getting XRT to pelvic tumors
69
Head and neck sarcomas?
Pediatric - usually rhabdomyosarcoma | Post-op XRT for positive or close margins
70
Visceral and retroperitoneal sarcomas?
Most common leiomyosarcoma and liposarcoma
71
Risk factor for mesothelioma
Asbestos
72
Risk factor for angiosarcoma
PVC and arsenic
73
Risk factor for chronic lymhedema
Lymphangiosarcoma
74
Kaposi's sarcoma
Vascular sarcoma Oral/pharyngeal mucosa most common - bleeding, dysphagia Immunocompromised - AIDS Tx: Palliation, HAART< XRT, Vinblastin, INF-a
75
Childhood rhabdomyosrcoma
``` #1 soft tissue sarcoma in kids Head/neck, GU, extremities, trunk Embryonal subtype - most common Alveolar subtype - worst prognosis Tx: Surgery, doxorubicin ```
76
Osteosarcoma
Increased incidence around the knees Originates - metaphyseal cells CHildren
77
Neurofibromatosis
CNS tumors, peripheral sheath tumors, pheochromocytoma
78
Li-fraumeni syndrome
Childhood rhabdomyosarcoma and others
79
Hereditary retinoblastoma
Includes other sarcomas
80
Tuberous sclerosis
Angiomyolipoma
81
Gardner's syndrome
Familial adenomatous polyposis adn itnra-abdominal desmoid tumors
82
Xanthoma
Yellow, contains histiocytes | Tx: Excision
83
Warts
Verruca vulgaris Viral, contagious, autoinoculable, painful Tx: Liquid nitrogen
84
Actinic keratosis
Premalignant sun-damaged areas | Tx: excisional biopsy if suspicious
85
Seborrheic keratosis
NOT premalignant Trunk on elderly Can be dark
86
Arsenical keratosis
Associated with squamous cell CA
87
Merkel cell carcinoma
Neuroendocrine Very aggressive - early regional and systemic spread Red to purple papulonodule or indurated plaque Neuron-specific enolase (NSE), cyutokeratin, neurofilament protein
88
Glomus cell tumor
Painful tumor composed of blood vessels or nerves Benign Most common in terminal aspect of the digit Tx: Tumor excision
89
Desmoid tumors
Benign, but locally invasive Occur in fascial planes High risk of recurrence, no distance spread Tx: Surgery, chemo (sulindac, tamoxifen)
90
Most common location of desmoid tumors
Anterior abdominal wall
91
Intraabdominal desmoid tumors
Gardner's syndrome and retroperitoneal fibrosis | Encases bwoel
92
Bowen's disease
SCCA in-situ 10% progress to invasive SCCA Associated with HPV Tx: Imiquimod, cautery ablation, topical 5-FU
93
Keratoacanthoma
Rapid growth, rolled edges, crater filled with keratin NOT malignant, but difficult to differentiate from SCCA Involutes spontanously over months Tx: - Small; excise - Large; biopsy and observe
94
Hyperhidrosis
Increased sweating - palms | Tx: thoracic sympathectomy if refractory to antiperspirants
95
Hidradenitis
Infection of apocrine sweat glands - axilla and groin Staph/strep Tx: - ABx, improved hygiene - Surgeyr to remove skin and sweat glands
96
Epidermal inclusion cyst
Most common | Mature epidermis with creamy keratin material
97
Trichilemmal cyst
In scalp | No epidermis
98
Ganglion cyst
Over tendons, commonly wrist | Filled with collagen material
99
Dermoid cyst
Midline intra-abdominal and sacral lesions | Need resection due to malignancy risk
100
Pilonidal cyst
Congenital coccygeal sinus with ingrown hair | If infected - needs excision

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