general

Question 1

What is the most consistent finding seen in aging skin?

Answer 1

loss of dermal papillae and the flattening of the dermo-epidermal junction
; loss of intradigitation between layers; seen beginning in 60’s -> less resistence to shearing and increased vulnerability to injury; epidermis thins 6.4% every decade, melanocytes decrease in activity (causes uneven pigmentation), sebum production decreases 60%, decreased collagen turnover due to decreased fibroblasts and collagen/elastin synthesis

Question 2

What does near-infrared spectroscopy (NIRS) (postop flap monitoring) measure?

Answer 2

tissue oxygen saturation (StO2) - relative changes in the concentration of oxygenated and deoxygenated hemoglobin

improved flap salavge rate compared with doppler

SpO2 measures peripheral capillary arterial oxygen saturation which may not reflect perfusion

Question 3

which anatomic region has the highest associated complications with expansion?

Answer 3

lower extremity > neck/head > upper extremity > trunk

Question 4

Do you need abx ppx in a clean hand case lasting less than 2 hrs?

Answer 4

no

references
Ariyan S, Martin J, Lal A, et al. Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: an evidence-based consensus conference statement from the American Association of Plastic Surgeons. Plast Reconstr Surg. 2015 Jun;135(6):1723-1739.
2. Johnson SP, Zhong L, Chung KC, et al. Perioperative antibiotics for clean Hand Surgery: a national study. J Hand Surg Am. 2018 May;43(5):407-416.
3. Rizvi M, Bille B, Holtom P, et al. The role of prophylactic antibiotics in elective Hand Surgery. J Hand Surg Am. 2008 Mar;33(3):413-420.