Advanced Derm Procedures - King

Question 1

reading

Answer 1

lab manual 183-189

Question 2

steps to derm procedure

Answer 2

evaluate area
cleanse area
anesthetize area
complete procedure
follow up care and suture removal

Question 3

wound evaluation

Answer 3

damage to structures, nerves, tendons, vessels, joints, bones

not recognizing - significant errors

Question 4

nerve injury

Answer 4

laceration of hand

test light touch and motor function

2-pt discrimination - hand and finger injuries

best control - compare B/L

Question 5

tendon injuries

Answer 5

resting deformity

forces opposed muscles unopposed

exam - check entire ROM

Question 6

vacsular injuries

Answer 6

emergency

delayed cap refill distal laceration

look for hematoma in area

expanding pulsatile mass

Question 7

bone injury

Answer 7

get an X-ray

Question 8

foreign bodies

Answer 8

complaint of feeling foreign body - specific and should not be ignored

localized pain or tenderness in high risk wound

pain worse with active/passive motion

Question 9

imaging studies

Answer 9

for all wounds involving glass - or other wound if foreign body suspected

Question 10

glass or inorganic

Answer 10

• plain X-ray

glass as small as 1mm - on xray

Question 11

organic material

Answer 11

wood, plastic - no Xray

ultrasound, CT, or MRI

Question 12

CI to wound closure

Answer 12

acute wound >6 hours old (face is exception)

foreign debris - not completely removed

active ooze of blood

dead space under skin

too much tension on wound

Question 13

not to do primary closure

Answer 13

risk of infection

Question 14

facial laceration

Answer 14

should close it

heal up well - lots of blood supply

Question 15

delayed primary closure

Answer 15

pack with gauze

hope of being able to sutures within 3-4 days

Question 16

don’t close

Answer 16

if need surgical consultation

Question 17

surgical consult needed if

Answer 17

deep wound hand or foot

full thickness - eyelid, lip, ear

lac - nerve, artery, bone, joint

penetrating of unknown depth

severe crush injury

severely contaminated wound

wound with worry for cosmetic outcome

Question 18

cleanse wound

Answer 18

saline is best
or tap water

can hurt - pain control

Question 19

betadine

Answer 19

causes tissue necrosis - don’t dump in wound

Question 20

epinephrine

Answer 20

decrease bleeding with anesthetic

Question 21

bupivicaine

Answer 21

long acting - 2-4 hours

Question 22

lidocaine

Answer 22

1 hour lasting

Question 23

avoid epinephrine

Answer 23

finger, nose, penis, earlobe

Question 24

admin of anesthetic

Answer 24

use smallest needle
-25 gauge ok

inject slowly - acidic - hurts

wait 5-10 minutes after inject

Question 25

langers lines

Answer 25

close parallel to these lines not perpendicular

Question 26

non-absorbable suture

Answer 26

need to be removed ``` silk nylon (ethilon) polypropylene (prolene) cotton stainless steel ```

Question 27

nylon

Answer 27

good for skin closure synthetic - no tissue rxn

Question 28

silk/cotton

Answer 28

organic material | -body defense attack - inflammation

Question 29

polypropylene

Answer 29

synthetic - stronger than nylon - easier to work with - costs more

Question 30

lowest tensile strength

Answer 30

silk

Question 31

high tensile strength, low cost, no tissue reactivity, requires lots of knots

Answer 31

nylon

Question 32

plasticity

Answer 32

polypropylene stretch - accommodate wound welling

Question 33

stainless steel

Answer 33

thoracic surgeon - if split sternum

Question 34

absorbable suture

Answer 34

in subQ layers - or deep layers catgut chromic gut

Question 35

catgut

Answer 35

from sheep - intestine separate collagen layer significant tensile strength - 5-7 days

Question 36

lasts 5-7 days

Answer 36

catgut

Question 37

lasts 10-14 days

Answer 37

chromic gut - treated with chromium salts to protect from proteolytic enzymes

Question 38

rapidly absorbed oral cavity

Answer 38

chromic gut

Question 39

polyglactin 910

Answer 39

vicryl lubricated - chain of sugars 60-90 days

Question 40

60-90 days

Answer 40

vicryl less tissue reactivity

Question 41

ideal for subQ sutures

Answer 41

vicryl tensile and knot strength less tissue reactivity lasts 60-90 days

Question 42

monocryl

Answer 42

monofilament poliglercaprone 25 less contamination - monofilament loses tension - 21 days

Question 43

polyglycolic acid

Answer 43

dexon braided polymer 25 days - 50% tensile strength binding and snagging when wet

Question 44

interrupted technique

Answer 44

doesn't give good cosmetic result bad distribution of tension

Question 45

continuous suture

Answer 45

baseball stitch closes wound quickly -cosmetically better than interrupted if breaks - all suture out

Question 46

subcuticular technique

Answer 46

no needle marks around wound better cosmetic

Question 47

vertical mattress

Answer 47

everts wound edges

Question 48

horizontal mattress

Answer 48

most strength** high tension areas - over joints

Question 49

layered closure

Answer 49

to give more strength close - muscle, fascia, dermis dermis - gives strength

Question 50

tissue adhesives

Answer 50

dermabond - 2-octylcyanoacrylate do in low tension areas -less strength than suture also avoid moist areas

Question 51

avoid tissue adhesives

Answer 51

moist areas | high tension areas

Question 52

CI for tissue adhesive

Answer 52

immunosuppressed diabetes contaminated jagged or complex lac avoid mucosal surfaces, groin, axilla

Question 53

biopsy

Answer 53

incisional and excisional

Question 54

incisional biopsy

Answer 54

take portion of area out shave and punch

Question 55

excisional biopsy

Answer 55

entire area of abnormal tissue removed

Question 56

excisional biopsy dimension

Answer 56

length 3-4x width 30 degrees or less at periphery

Question 57

wound healing

Answer 57

inflammation proliferation maturation initially - hemostasis and cross-linked fibrin formation

Question 58

wounds don't completely heal

Answer 58

until 1 year continue to remodels

Question 59

aftercare

Answer 59

antibiotic ointment 24 hours - remove dressing wash area - gentle soap and water - don't soak leave open to air after couple days elevated - decreased swelling - improve healing white petrolatum - as effective as antibiotic - not necessary - may delay

Question 60

time to heal face

Answer 60

3-5 days

Question 61

time to heal scalp

Answer 61

7-10 days

Question 62

time to heal arm

Answer 62

7-10 days

Question 63

time to heal trunk

Answer 63

10-14 days

Question 64

time to heal legs

Answer 64

10-14 days

Question 65

time to heal hands or feet

Answer 65

10-14 days

Question 66

time to heal palms/soles

Answer 66

14-21 days

Question 67

suture removal

Answer 67

decrease scarring -remove while scar weak steri strip across scar after suture removed