Basic Plastic Surgery Flashcards
What are the aims of wound management?
- Early healing
- Avoid infection
- Infected v contaminated wound
- minimise long term scarring
What are the causes of impaired wound healing?
- Vascular: arterial / venous insufficiency
- Pressure
- Infection
- Diabetes
- Nutritional
- Radiation
- Drugs inc steroids
- Smoking
What are the principles of wound management?
- Assessment of wound and patient
- Tetanus prophylaxis
- Debridement (remove dead tissue and foreign matter; lavage to reduce bacterial count)
- Wound closure
Critical bacteria count (for impaired wound healing)?
> 10^5 bacteria/mL critical
What is the most effective way to reduce wound bacterial count?
Debridement
How is wound infection diagnosed?
Based on clinical signs (wound swab to identify bacteria and sensitivity -not to diagnose)
Treatment of bite wounds?
- Debridement
- Antibiotics
- Wound closure vs delayed closure or secondary intention healing
What is important to note in Mx of human bite wounds?
Never suture closed a human bite wound.
Mechanism of pressure sores?
Impairment of blood supply due to weight of pressure of patient body on wound occluding vessels.
Treatment of pressure sores?
- Assess pt overall health
- Pressure care
- Debride to healthy tissue
- Skin graft/flap only when underlying causes have been corrected and good pressure care in place
What is the process of negative pressure wound therapy?
- Open cell sponge applied directly onto wound
- Clear, occlusive plastic dress
- Tubing connected to negative pressure pump
What is the rationale behind negative pressure wound therapy?
- Removes fluid from wound
- Evidence that NPWT promotes angiogenesis
What is a hypertrophic scar?
- Exaggerated normal remodelling response
- Stays within margins or original wound
- Affects all racial groups
- Responds to steroid injection and pressure e.g. silicone
Keloid scar cf hypertrophic scar?
Keloid:
- extends beyond original wound
- More common African and Asians
- Any part of body (earlobe common)
- progressive
- less responsive to steroids and silicone
What is a graft?
Transferred tissue dependent on recipient site for nutrition - develops vascular network from recipient bed
What is a flap?
Transferred tissue independent of recipient site for nutrition - carries own vascular network.
What is a split skin graft?
- Harvest epidermis and dermis like shave of skin
- Easier take (cf full) but contracts significantly and may have poor cosmetic appearance.
What is a full thickness skin graft cf split skin graft?
Full thickness skin graft has less contraction and better appearance and function HOWEVER donor site must be closed directly so size is limited by need to close.
- has adnexal structures
- less contraction
- improved cosmesis
What type of skin graft carries adnexal structures?
Full thickness
Indications for flap (cf graft)?
- Bed not sufficiently vascularised to support graft (e.g. exposed tendon / bone)
- Need to cover prosthetic material
- Better appearance
- Flaps can contain muscle, bone, nerve etc
What are the types of single stage local skin flaps?
- Transposition
- Rotation
- Advancement
