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MRCS A: Pathology II > Basic Plastic Surgery and Skin Lesions > Flashcards

Basic Plastic Surgery and Skin Lesions Flashcards

1
Q

Debridement techniques

A 
Surgical
Mechanical
Chemical 
Autolytic
Biological
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2
Q

Debridement techniques: Surgical

A

Surgical debridement-quick, dependent on surgeon’s judgement of non-viable tissue. Risk of damaging underlying or surrounding viable tissue

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3
Q

Debridement techniques: Mechanical

A

Cleaning of tissue or dressing removal

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4
Q

Debridement techniques: Chemical

A

Enzymes to lyse necrotic tissue

More selective

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5
Q

Debridement techniques: Autolytic

A

Allow body to remove tissue

Most selective but takes longest to work

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6
Q

Debridement techniques: Biological

A

Maggots and other agesnts to clear wound leaving a healthy base e.g. ischamic ulcers in PVD

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7
Q

Reconstructive Ladder

A 
Secondary intention
Primary Intention
Delayed prmary intention
Skin grafting (Split skin and full thickness)
Tissue expansion
Local Flap
Free flap
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8
Q

Split skin graft advantages

A

Epidermis and small layer of dermis

Cell islands at donor site regenerate-so multiple uses and multiple sites
Donor graft is thin so large surface area of graft site can be covered
Thin layer contours to underlying surface
May ‘take’ in graft sites with marginal blood supply

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9
Q

Split skin graft disadvantages

A 
Often poor cosmetic result:
Colour mismatch
graft contracts as it heals-also contractures may form
Meshing visible in final scar 
Donor site scarring
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10
Q

Full thickness graft (Epidermis and dermal components)

A

Usually reserved for the face

Less contracture
Grow alongside the local tissue
Better colour matching
epidermal appendages transplanted

Caveats:
Limited and once only harvestation
Require good graft site blood supply to take

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11
Q

Take

A

Adherence

Inosculation

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12
Q

Skin lesion classification

A

Benign, premalignant and malignant

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13
Q

Skin lesions: Benign (6)

A 
Cysts
Fibroma
Papilloma
Haemangioma
Moles and naevi
Hidradenitis suppurativa
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14
Q

Skin lesions: Premalignant

A

Keratocanthoma

Intraepidermal neoplasia

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15
Q

Skin lesions: Malignant

A

BCC
SCC
Malignant melanoma

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16
Q

Cysts

A

Epidermal cyst
Trichilemmal cyst
Pilar cyst
Dermoid cyst

17
Q

Epidermal cyst

A

Keratinous infected material often foul smelling and cheesy in appearance lying in a keratinised squamous cell lined cavity with a granular layer. Occurs from the infundibular portion of hair follicle.
Occur where sebacious glands are present in hair lying areas-not on soles of feet or palms

18
Q

Trichilemmal cyst

A

As for epidermal cyst but genetic element-autosomal dominant
No granular layer
Hair follicle epithelium derivation
May calcify

19
Q

Pilar Cyst

A

Proliferation of epithelium lining cyst

Ulcerates and proliferates and may resemble a SCC (Pott’s peculiar tumour)

20
Q

Dermoid cyst

A

Cysts deep to the skin lined by stratified squamous epithelium with epidermal appendages e.g. hair follicles, sweat glands etc (unlike in epidermal cysts)

21
Q

Dermoid cysts sites

A 
Sites of fusion:
Lateral and medial ends of eyebrow (external and internal angular dermoid)
Mid line of nose (nasal dermoid)
Sublingual
Mid line of neck
Mid line of trunk
22
Q

Fibromata: Dermatofibroma

A

Benign lesions of fibroblasts
May be pigmented red or brown
Require excision

23
Q

Fibromata: Neurofibroma

A

Overgrowth of neural (ectodermal) and fibrous (mesodermal) elements

Affected nerve e..g. VIII may be affected but most are symptomless

Regrowth common and can be difficult to excise

24
Q

Von Recklinghausen’s disease

A

AD multiple neurofibromatosis associated with:

  • Cafe au lait spots (>6 1.5cm) but may be absent
  • Acoustic neuromas
  • malignant change 5-13%
  • Phaeo’
  • Scoliosis
    Mental retardation
25
Q

Plexiform neurofibroma

A

Very rare
Excessive overgrowth of neural tissue (ectoderm)
May be confused with lymphatic oedema

26
Q

Papilloma: Benign papilloma

A

Overgrowth of all skin layers-not a neoplasm just skin tag

27
Q

Papilloma: Seborrhoeic keratosis

A

Overgrowth of basal epidermis

28
Q

Papilloma: Warts

A

Papilloma virus causes hyperkeratotic skin overgrowth

29
Q

Haemangiomas

A 
Strawberry naevus
Pyogenic granuloma
Port wine stain
Vin rose patch
Spider naevus
Telangiectasis
Osler Weber Rendu Syndrome
Campbell de Morgan spot
30
Q

Keratocanthoma

A

Overgrowth of hair follicles, central lump often collapses leaving a scar and mistaken for SCC

31
Q

Bowen’s disease

A

Thickened brown or pink plaques and may progress to SCC

32
Q

Solar keratosis

A

skin damage causing hyperkeratosis

MRCS A: Pathology II (15 decks)

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