Fundamentals of Plastic Surgery

Question 1

what is an ulcer?

Answer 1

An ulcer is a discontinuity of an epithelial surface (not unique to skin), which fails to heal spontaneously

Question 2

what is a sinus?

Answer 2

A sinus is a blind track, lined by granulation tissue, leading from an epithelial surface into the surrounding tissues.

Question 3

what is a fistula ?

Answer 3

A fistula is an abnormal connection between two epithelially-lined surfaces e.g. gut and skin

Question 4

where can’t a skin graft be used ?

Answer 4

Bone stripped of periosteum
Tendon stripped of paratenon
Cartilage stripped of perichondrium
Exposed metalwork
Open joints

Question 5

what is a flap?

Answer 5

A flap is a transferable block of tissue that may or may not include skin, which has its own blood supply.

Question 6

what are the three main requirements of wound healing ?

Answer 6

vascular response

inflammatory response

cellular response

Question 7

state 4 characteristics of hypertrophic scars?

Answer 7

Scar tissue raised above the normal level of the scar
Scar tissue stays within the original scar boundaries
Scar often red in appearance
Often resolve with time

Question 8

state 3 characteristics of keloid scars?

Answer 8

Scar tissue extends out with the boundaries of the original scar
Surrounding normal tissue involved
Excision usually leads to recurrence

Question 9

what is the treatment for bowens disease?

Answer 9

cryotherapy, topical chemotherapeutic agents, curettage, excision, lasers, photodynamic therapy and radiotherapy

Question 10

what is bowens disease?

Answer 10

squamous cell carcinoma in situ

usually from sun exposure

Question 11

what are the four classical appearance of BCC (basal cell carcinoma)

Answer 11

Raised, rolled edge
‘Pearly’ appearance
Telangectasiae
Ulcerated centre

Question 12

what is the treatment for BCC?

Answer 12

surgical excision

Question 13

if surgery isn’t appropriate what is the treatment for BCC?

Answer 13

cryotherapy or topical chemotherapeutic agents such as 5-Fluorouracil are generally reserved for patients who are unfit for anaesthesia or where surgery is not in their best interests.

Question 14

are SCC or BCC more aggressive?

Answer 14

SCC

Question 15

what is the presentation of SCC?

Answer 15

crusted lesion, with or without ulceration.

Question 16

for malignant melanoma, what are the major or minor features ?

Answer 16

Major Features

A change in size of a pre-existent pigmented lesion
A change in shape of a pre-existent pigmented lesion, particularly if irregular
A change in colour/colour pattern, or the presence of three or more colours/li

Minor Features

Symptomatic lesion - itch is commonest
Oozing or crusting. Bleeding and ulceration are late signs
Inflammation of lesion or surrounding tissue
Lesion with diameter greater than 5mm

Question 17

what criteria is used to measure a malignant melanoma ?

Answer 17

glasgow 7 point checklist

Question 18

what are the 5 clinical types of Malignant melanoma?

Answer 18

Superficial spreading (up to 80%
Nodular - raised, rapidly growing
Lentigo maligna - arise in pre-existent patches of pigmentation (lentigo)
Acral - on palms or soles of feet
Amelanotic - lack distinct pigmentation, therefore making diagnosis more difficult (up to 10% of MM’s)

Question 19

what is the thickness of the melanoma called?

Answer 19

breslow

Question 20

where does bowens disease commonly occur?

Answer 20

legs of elderly women

Question 21

what 5 characteristics should be noted about an ulcer?

Answer 21

site

ulcer edge

sensation

peripheral pulses

surrounding tissues

Question 22

what would cause a punched out ulcer?

Answer 22

ischaemic ulcer

Question 23

what appearance of ulcer does a BCC have?

Answer 23

pearly edge

Question 24

what investigations should be done for ulcers?

Answer 24

Peripheral pulses should be checked and ankle-brachial pressure indices measured by Doppler ultrasonography

autoantibodies to check for SLE

biopsy

Question 25

state some common places for pressure sores to be?

Answer 25

Sacrum
Ischial tuberosities
Greater trochanter of the femur
Heels