Chapter 19 Flashcards
Plastic and Reconstructive Surgery
What are some diagnostic procedures relating to plastics?
-H&P
-Visual Exam
-Before and after pictures for reconstruction or cosmesis (done by computer imaging)
-X-rays
-CT
-MRI
What is Tumescent Solution?
Saline (dispersant and hydro-dissection) mixed with epinephrine, lidocaine, and Wydase (fat liquefier)
What is Cocaine?
A 4% controlled substance. Is a anesthetic and powerful vasoconstrictor used on rhinoplasties.
What are some unique instrument sets used in plastics?
-Liposuction set
-Breast augmentation set
-Lighted retractors for breast and abdominoplasty
-Minor ortho set (hand set, lead hand, doppler, vessel loops)
-Nasal (rhinoplasty sets)
-Dermatome
-Mesh Graft Device (Mesher)
What is a Dermatome?
Cuts thin slices for split thickness skin grafts.
Process includes:
-application of mineral oil/CHG to reduce friction
-pull tension to insure consistent thickness
-dermatome cuts to desired thickness
Types include:
-Handheld (for a small graft)
-Drum (large, flat graft)
-Oscillating (electric or nitrogen powered with adjustable graft thickness. a sterile disposable blade is loaded prior to passing cord and is tested prior to use)
What is a Mesh Graft Device (Mesher)?
Expands the size of skin graft to increase coverage to create evenly spaces slits and allows blood/fluid drainage. They are manually operated. Has a roller with sharp raised surfaces. Skin is placed on a derma-carrier ridge side up.
What is a split thickness skin graft-STSG? (Autograft)
Removes the epidermis and half of the dermis. Used for large surface areas
What is a full thickness skin graft (FTSG)?
Removes the epidermis, dermis, and may include some underlying structures. Used for small grafts or large flaps for deep surface areas.
What is a Homograft (Allograft)?
Comes from the same species and is used for a dressing/face transplant
What is a Heterograft (Xenograft)?
Comes from a different species and is used as a dressing.
What are some determining factors for skin grafts?
-Location of defect (recipient site)
-Condition of possible donor sites (Full/split thickness)
-Amount of surface areas to be covered
-Depth of defect
-Involvement of underlying tissues
-Cause of defect (trauma, disease, heredity)
What are the best donor sites for a split thickness skin graft?
Thighs, back, abdomen, and chest
What are flap grafts?
Free flap: comes from another location. micro vessels must be anastomosed. no sensation (ex: nipple reconstruction from labia)
Pedicle flap: remain attached to blood supply. will tunnel into existing skin or rotate (ex: latissimus dorsi musculocutaneous flap and the TRAM flap)
What are types of burns?
-Heat
-Cold
-Radiation
-Chemical/gases
-Electrical
All need immediate intensive are to restore homeostasis/sustain life. Long term physical and phycological therapy may be needed
What are some surgical procedures done for burns?
-Debridement of necrotic tissue or eschar
-Skin grafts
-Restoring function
-Cosmesis
What is a first degree burn?
-Superficial
-Erythema (no blister)
-Heals within a week
-No scarring
What is a second degree burn?
-Partial thickness
-Dermis to varying degrees
-Very painful blisters
-Superficial heal within two weeks with no scarring
-Deep heal slowly, may leave hypertrophic scars, and debridement/grafting may be necessary
What are third degree burns?
-Full Thickness of skin including subq
-permanent tissue damage
-very painful or painless
-white or charred-eschars
-skin grafting is necessary
-prone to infection
-if large area respiratory support, fluid replacement, and narcotic analgesics may be necessary
What are fourth degree burns? (char burns)
-Burns vessels, nerves, muscle, tendons, and bone
-Surgery is required (skin grafting/amputation)
-Prone to infection
-Will require respiratory support, fluid replacement, and narcotic analgesics
-Needs extensive reconstruction
What are the 5 criteria for the Abbreviated Burn Severity Index (ABSI)?
-Age of pt
-Sex
-Presence of inhalation injury
-Depth of burn (degree)
-TBSA burned
What are the body surface area (BSA) estimates methods?
Lund Method: Charted with variables according to age
Rule of Nines
What is the Rule of Nines?
Head and Neck- 9%
Anterior Trunk- 18%
Posterior Trunk- 18%
Upper Extremity- 9%
Lower Extremity- 18%
Perineum- 1%
What are systemic responses to burn?
For more than 30% TBSA burned there will be CV changes, respiratory changes, and immunological changes. There will be risks of hypotension, bronchoconstriction, respiratory distress, susceptibility to infection.
What are some components of a FTSG- Full Thickness Skin Graft?
Covers relatively small but deep defects. Blood and nerve supply will try to be maintained.
Types: Free Flap and Pedicle Flap
-You need a clean (donor site) and a dirty (recipient site) setup.
