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Plastics > Fundamentals of Plastic Surgery > Flashcards

Fundamentals of Plastic Surgery Flashcards

1
Q

Two main layers of the skin

A

Epidermis

Dermis

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2
Q

What is responsible for 95% of skins thickness?

A

Dermis

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3
Q

What type of epithelium is the epidermis?

A

Stratified squamous epithelium

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4
Q

What do melanocytes produce?

A

Melanin

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5
Q

Function of melanin

A

Skin colour

Protection against UV radiation

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6
Q

Function of dermis

A

Strength and elasticity of skin

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7
Q

What type of tissue is the dermis?

A

Connective tissue

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8
Q

What is a key feature that the dermis contains?

A

Rich dermal vascular plexus

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9
Q

Assosiated appendages of the skin

A

Hair follicles
Glands
Nails

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10
Q

Function of layers beneath the skin

A

Nutrition of skin

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11
Q

Where do blood vessels run in the skin?

A

Through the muscular layers
Sending perforating vessels through the investing fascial layer
To contribute to the rich dermal plexus

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12
Q

Main function of the skin

A

Barrier

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13
Q

Skin provides protection to underlying structures from…..

A

Direct physical trauma
Chemicals
Biological agents e.g. bacteria, fungi
Radiation e.g. sunlight

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14
Q

Functions of the skin

A 
Barrier
Synthesis of vit D
Regulation of body temp 
Fluid balance
Sensory 
Social 
Aesthetic
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15
Q

People with facial disfigurement are likely to be stereotyped with what characteristic?

A 
Dishonest
Unintellegent
Untrustworth 
Ineffective
Unpopular
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16
Q

What is a wound?

A

The end result of damage to the skin or other secondary structures secondary to some form of trauma, whether accidental e.g. following an assault, or intentional e.g. during an operation

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17
Q

What is a bruise?

A

An area of injury (not unique to skin) assosiated with the escape of blood from ruptured underlying vessels, as a result of some form of trauma

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18
Q

Colour of bruises

A

Initial black/red

Gradually changes colour with time

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19
Q

Why do bruises gradually change colour over time?

A

Due to the breakdown of haemoglobin

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20
Q

What is an abrasion?

A

A graze or minor wound caused by rubbing or scraping of the skin

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21
Q

What is a laceration?

A

A tear of a tissue or organ, acquired secondary to trauma

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22
Q

Pathology of a laceration

A

The tissue is forcibly stretched and fails, resulting in a wound with irregular edges that have a compromised blood supply

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23
Q

What is an incised wound usually caused by?

A

Sharp object such as knife or scalpel

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24
Q

Pathology of an incision

A

Usually has clean, well defined edges with viable vascularity to the wound edges

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25
Q

What is degloving?

A

A type of laceration, in which the skin is sheared from the underlying fascia by rotational and/or crushing forces

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26
Q

What may degloving result in?

A

Skin ischaemia as the feeding blood vessels are torn

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27
Q

Most common cause of degloving injury

A

Limb is caught beneath a vehicle wheel

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28
Q

What is an avulsion?

A

Involves tearing or forcible separation of a structure from its origin e.g. the traumatic avulsion of a digit in machinery

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29
Q

What is a puncture wound?

A

Penetrating injuries usually caused by sharp objects

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30
Q

Pathology of puncture wounds

A

Extents into subcutaneous tissue or beyond

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31
Q

Significance of puncture wounds

A

Potential for damage to deep structures

Infection or foreign material may be carried deep into the wound

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32
Q

What is a haematoma?

A

An accumulation of blood within a tissue, organ or space, which clots and forms a solid swelling.

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33
Q

Why do haematomas increase the risk of a wound becoming infected?

A

They provide an ideal culture medium for various organisms

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34
Q

Natural history of a haematoma

A

Cycle of clotting and liquefaction

Gradual re-absorption

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35
Q

Potential issues caused by a haematoma

A

Discomfort
Compress underlying or overlaying structures
Infection risk

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36
Q

Example of a chronic wound

A

Ulcers

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37
Q

What is an ulcer?

A

A discontinuity of an epithelial surface (not unique to skin) which fails to heal spontaneously

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38
Q

What are ulcers usually associated with?

A

Infection

Inflammation

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39
Q

What is a sinus?

A

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

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40
Q

What is a fistula?

A

An abnormal connection between two epithelially lined surfaces e.g. gut and skin

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41
Q

Reasons for persistence of an acquired sinus/fistula

A

Presence of foreign body e.g. suture material
Infection
Malignancy

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42
Q

Two main groups of traumatic wounds

A

Clean

Contaminated

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43
Q

What are clean traumatic wounds?

A

Usually surgical or incised wounds, which contain no devitalised tissue

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44
Q

What are contaminated wounds usually as a result of?

A

Lacerating/crushing/avulsion/de-gloving injuries

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45
Q

Is it safe to close contaminated wounds primarily?

A

no

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46
Q

What may contaminated wounds contain?

A

Large amounts of devitalised tissue

Foreign material

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47
Q

What steps are necessary for the management of any wound?

A

Wound inspection + / - wound exploration
Wound lavage (washout with copious amounts of fluids)
Wound excision (excision of unhealthy or devitalised tissue
Wound closure

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48
Q

Which wounds should not be closed during first wound management procedure?

A

High degree of wound contamination

Large amounts of devitalised tissue

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49
Q

What is the basic used for planning a procedure for a removal of a lesion or management of a traumatic wound?

A

Reconstructive ladder

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50
Q

What are the steps of the reconstructive ladder?

A 
Primary suture or delayed primary suture
Split thickness skin grafts
Full thickness skin grafts 
Local flaps
Distant / free flaps
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51
Q

What does a primary suture involve?

A

Bringing skin edges together with sutures at the time of initial wound assessment

52
Q

What is delayed primary suture?

A

Suturing of the wound at a later date, following steps 1-3 of wound management

53
Q

What is healing by secondary intention?

A

Wound edges are not brought together by suturing, however the wound would still heal, would just be prolonged and an unsightly scar may result

54
Q

When would healing by secondary intention be used?

A

Grossly contaminated wound when closure would inevitably result in infection and wound breakdown
Areas of extensive abrasions
No definite wound edges to close

55
Q

What is a skin graft?

A

A piece of skin, either part, or the full thickness of skin, that is completely detached from its original site (the donor site) and moved to a distant site (the recipient site)

56
Q

What do split thickness skin grafts consist of?

A

Epidermis and variable amounts of dermis

57
Q

What will the donor site of a split thickness skin graft heal by?

A

Granulation

58
Q

Size of donor area available in a split thickness skin graft

A

Large

59
Q

What is used in split thickness skin grafts which means large areas can be covered?

A

Meshing

60
Q

Colour of split thickness skin grafts

A

Poorer colour match to surrounding skin

61
Q

What do full thickness skin grafts consist of?

A

Entire dermis and epidermis

62
Q

What does the donor site of a full thickness skin graft require?

A

Closure

63
Q

Size of graft of a full thickness skin graft

A

Limited

64
Q

Colour match of full thickness skin graft

A

Better colour match to surrounding skin

65
Q

Examples of donor sites for full thickness skin grafts

A

Posterior auricular skin

Skin of the supraclavicular fossa

66
Q

What is a ‘take’?

A

A skin graft gaining attachment to its recipient site and gaining a blood supply

67
Q

What is initial adherence of a graft due to?

A

Fibrin deposition

68
Q

What is fibrin deposition of a graft gradually replaced by?

A

Collagen

69
Q

What sites can skin grafts not be used?

A 
Bone stripped of periosteum 
Tendon stripped of paratenon 
Cartilage stripped of perichondrium 
Exposed metalwork 
Open joints 
Fat
70
Q

What can lead to graft failures and why?

A

Excessive mobility of the area - secondary to shear forces between graft and secondary site
Haematoma beneath graft can lift graft of its bed
Gross bacterial contamination

71
Q

What is a flap?

A

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

72
Q

What are flaps used to do?

A

Reconstruct defects when either the recipient area has an insufficient blood supply of its own to allow healing by a technique such as skin grafting, or when some characteristic of the tissue transferred is desireable e.g. skin colour for face

73
Q

Where does the skin receive its blood supply via?

A

Dermal plexus

74
Q

What are the large named vessels that supply muscles and fascia known as?

A

Vascular pedicle

75
Q

Names of different flaps

A 
Skin (cutaneous) flap 
Muscle flap 
Myocutaneous (muscle and skin)
Fascial flap 
Fasciocutaneous (fascia and skin)
76
Q

Where are local flaps transferred?

A

A site adjacent to the donor site

77
Q

When are local flaps commonly used?

A

Reconstruction of small facial defects

78
Q

Where are distant flaps transferred?

A

Transferred from a remote location or the area to be covered is taken to the flap donor site

79
Q

What is a free flap?

A

Completely detacted from its original site and blood supply transferred to a distant defect

80
Q

3 main requirements for wound healing

A

Vascular response
Inflammatory response
Cellular response

81
Q

What does the vascular response required for wound healing involve?

A 
Vasoconstriction
Activation of clotting cascades
Platelet activation 
Aims to stop bleeding by production of fibrin clot 
Platelet degranulation
82
Q

What does the inflammatory response involve in respect to wound healing?

A

Release of inflammatory mediators
Local capillaries become permeable
Cells can move from the bloodstream into the injured tissue
Scavenger cells migrate to the area to remove any foreign or devitalised material

83
Q

What does the cellular response required for wound healing involve?

A

Epithelialise and close defect with scar tissue
Fibroblasts produce collagen - which becomes organised into scar tissue
Width of wound is reduced over time by contraction of myofibroblasts

84
Q

What is a scar?

A

Normal end result of wound healing

85
Q

How long do normal scars take to mature?

A

6 months - 2 years

86
Q

3 major phases of wound healing

A

healing - 1-6 weeks = exudate scab fine line
Remodelling - 2 weeks - 2 years = red raised itchy tender contraction
Maturation - 6 months - 2+ years = pale flat, quiet contracture

87
Q

Reasons for poor final scar result

A

Poor wound preparation
Poor surgical planning and/or technique
Wound infection

88
Q

Characteristics of hypertrophic scars

A

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

89
Q

First line management of hypertrophic scars

A

Reassurance

90
Q

What else can help hypertrophic scars?

A

Massaging scar

Sustained pressure

91
Q

Characteristics of a keloid scar

A

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

92
Q

Notorious sites for keloid scar formation

A

Pre sternal region
Deltoid region
Earlobes

93
Q

Highest risk groups for developing keloid scars

A

African
Afro carribean
African American

94
Q

Management of keloid scars

A

Injection of steroid (triamicinolone) into the scar
Silicon massage of scar
Sustained pressure
Exision and radiotherapy - last resort

95
Q

What is the most common pigmented lesion in young people?

A

Naevi

96
Q

What are naevi?

A

A concentration of melanocytes in the epidermis

97
Q

Does the number of naevi increase or decrease from early life?

A

Increase

98
Q

How many naevi does the average adolescent have?

A

20-40

99
Q

Where are seborrheic ketatoses commonly found?

A

Trunk of older people

100
Q

Do seborrheic ketatoses have malignant potential?

A

No

101
Q

What do many patients with seborrheoic ketatoses report?

A

Lesion falling off

102
Q

Who does actinic keratoses affect?

A

Elderly

103
Q

What does actinic keratoses appear like?

A

Scaly skin areas seen on sun exposed areas e.g. scalp

104
Q

Does actinic keratoses have malignant potential?

A

Yes if not treated - turn into SCC

105
Q

Treatment of actinic keratoses

A

Cryotherapy
Topical chemotherapeutic agents
Excision

106
Q

Presentation of bowens disease

A

Often asymptomatic
Persistent reddish patch of skin
Crust or scaling
3/4 of lesions on leg

107
Q

Major aetiological factor for bowens disease

A

Sun exposure

108
Q

Who gets bowens disease?

A

> 60 y/o

F > M

109
Q

Pathology of bowens disease

A

SCC in situ (in epidermis)

110
Q

If bowens disease is left untreated, what may result?

A

invasive SCC

111
Q

Treatment of bowens disease

A 
Cryotherapy
Topical chemotherapeutic agents 
Curettage 
Excision 
Lasers 
Photodynamic therapy
Radiotherapy
112
Q

What old scars in particular can SCC arise in?

A

Burns scars

113
Q

What are SCC arising in old scars called?

A

Marjolins ulcers

114
Q

Why do marjolins ulcers grow slowly?

A

As the scars contain no blood vessels

115
Q

Treatment of marjolins ulcers

A

Excision of affected area

Followed by reconstruction using technique from the reconstruction ladder

116
Q

What is the commonest skin cancer?

A

Basal cell carcinoma (BCC)

117
Q

Relationship between incidence of BCC and age

A

Increases with age

118
Q

Major aetiological factor of BCC

A

UV exposure from sunlight

119
Q

Risk factors for BCC

A

UV exposure from sunlight
Sunburn in childhood
+ve FH of BCC/other skin malignancy

120
Q

Where are the majority of BCC found?

A

Head and neck

121
Q

Classical appearance of BCC

A

Raised, rolled edge
Pearly appearance
Telangectasiae
Ulcerated centre

122
Q

Treatment of BCC

A

Surgical excision
Reconstruction from reconstruction ladder
Cryotherapy
Topical chemotherapeutic agents

123
Q

What is a SCC?

A

A malignant skin tumour arising from the epidermis or its appendages

124
Q

Who is SCC common in?

A

Transplant patients taking long term immunosuppressants

125
Q

Presentation of SCC

A

Crusted lesion

With or without ulceration

126
Q

Treatment of SCC

A

Surgical excision
Reconstruction
Lymph node dissection may be required
Radiotherapy may be required post op

Plastics (4 decks)

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