Inservice 2014 Flashcards
Mathes flap classification
1 = single dominant pedicle 2 = dominant pedicle and minor pedicles 3 = 2 dominant pedicles 4 = segmental vascular pedicle 5= one dominant pedicle and secondary segmental pedicle
Examples of the types of flap classes
1 = TFL, gastroc, vastus lateralis 2 = gracilis, hamstring (biceps femoris), soleus 3 = gluteus maximus, rectus, intercostal, pectoralis minor 4 = sartorius, tibialis anterior 5 = latissimus dorsi, pec major
Complications of treatment with silver nitrate
Good for staph, gram negative aeroves, pseudomonas
Poor tissue penetration
Will cause leaching of sodium, potassium, and calcium
Complications of treatment with Sulfamylon (mafenide acetate)
Excellent tissue penetration, including eschar
Painful application
Inhibits carbonic anhydrase resulting in hyperchloremic meabolic acidosis
Complications of treatment of Silver sulfadiazine
Intermediate tissue penetration, painless
Transient leukopenia
Chemical peels and their depth of penetration
- Alpha-hydroxy acid (glycolic and lactic)- superficial peeling
- Beta-hydroxy acid (salicyclic)- superficial peeling
- Jessner solution - superficial
- 20 TCA - papillary dermis
- Phenol-croton oil - reticular dermis
Velar competence after treatment of VPI with Furlow double-opposing Z-plasty is strongly correlated with what?
Size of preoperative closure gap
Failure of fusion of what results in formation of a cleft lip?
Failure of fusion of medial nasal and maxillary prominences at weeks 6-8
Patient has VPI with no fistula, good coronal closure and poor lateral pharyngeal wall movement - intervention?
Sphincter pharyngoplasty - take pharyngopalatus
- do this when poor lateral wall movement to recreate a sphincter
What are the risks of a cleft lip :
- A child of male child with a cleft lip
- A child of female child with a cleft lip
- A child of a child of a child with a cleft (2nd gen)
- A child of a child with lip pits
- 4.7%
- 3.6%
- 17%
- 50% (van der woude, autosomal dominant)
What is the function of the meibomian gland secretions?
Outer oil lipid layer which prevents the evaporation of the tear film.
What is the function of the secretions of the lacrimal gland?
Middle aqueous layer to promote osmotic regulation and control of infectious agents
What is the function of the secretions of the mucin-secreting goblet cells?
Inner layer promotes dispersion of the the aqueous layer
Hering law
When ptosis is corrected in one eye, it reveals ptosis in the other eye
Between which eye fat pads is the inferior oblique muscle located?
Between the central and medial compartments of fat
what is the tetrad of findings for blepharophimosis?
Ptosis, telecanthus, epicanthus inversus, decreased horizontal lid fissue. (congenital ptosis)
SMAS is continuous with what structures?
Galea–> superficial temporal fascia (TPF) –> SMAS –> platysma –> superficial cervical fascia
The deep cervical fascia is continuous with what fascia?
parotidomasseteric
what are the ___ retaining ligaments ?
- osteocutaneous
- Fasciocutaneous
- zygomatic, mandibular
2. masseteric cutaneous, parotid cutaneous
At what age should molding therapy be initiated for prominent ears?
before 3 days old
Indications for surgery in Dupuytren’s:
MCP joint contrature <30 degrees, PIP joint contracture. If PIP joint is still contracted, release checkrein ligaments
Carpenter with distal ulcers on the ring and small finger, DBI<0.5, pain with exposure to cold?
Hypothenar hammer syndrome. Surgical tx with ulceration and DBI<0.7
The vascular pedicle fo the iliac osseocutaneous flap is?
Deep circumflex iliac vessels (DCIA)
Superficial circumflex iliac vessels supply which flap?
groin flap
What Mathes/Nahai classificaction is the gluteal V-Y myocutaneous flap?
III (superior and inferior gluteal artery)
Nerve supply to the medial plantar artery flap
medial plantar nerve
Nerve of the ALT
lateral femoral cutaneous nerve
Sensation to the lateral side of the foot
Sural nerve
Motor innervation to the lateral leg
superficial peroneal nerve
Sensory innervatino to the heel
Calcaneal nerve
Treatment for remote middle phalanx intraarticular fracture with inability to flex finger
hemi-hamate arthroplasty
Nerve injury: inability to extend thumb and MCP joints
radial nerve
Between which muscles does the radial nerve run?
Between the EDC and ECRB in the forearm. Between brachialis and triceps in the upper arm
Between which muscles does the median nerve run?
The course of the median nerve is relatively consistent. Just proximal to the elbow, at the medial epicondyle, there is a constant relationship of the median nerve, brachial artery, and the biceps tendon. From medial to lateral, the mnemonic, MAT, describes the relationship (Median nerve, brachial Artery, and biceps Tendon). In the cubital fossa, the nerve dives deep to the lacertus fibrosus, lying anterior to the brachialis muscle and medial to the brachial artery. The nerve enters the forearm between the superficial (humeral) and deep (ulnar) heads of the pronator teres muscle. As the nerve passes through the muscle bellies, it crosses the ulnar artery anteriorly, from medial to lateral, separated from the artery by the deep head of the pronator teres. After emerging from the pronator teres, the median nerve passes deep to an arch created by the two heads of the flexor digitorum superficialis. The nerve continues distally -forearm: between the flexor digitorum superficialis and flexor digitorum profundus.
-The nerve usually becomes superficial approximately 5 cm proximal to the wrist, emerging between the flexor digitorum superficialis and flexor carpi radialis, dorsal and slightly radial to the palmaris longus tendon.
Thumb functions to restore
Palmar abduction, flexion, and pronation
What nerve controls thumb function
median nerve
first line treatment of large venous malformation
sclerotherapy
First line treatment of arteriovenous malformation
embolization
Medical treatment for infantile hemangioma
propranolol, corticosteroids
First line therapy of lymphatic malformations
- macrocystic
- microcystic
- macrocystic = sclerotherapy
2. microcystic = sclerotherapy
Indications for surgical treatment of periorbital heangiomas
well-locatlied, greater than 2 diopters of astigmatism, visual obstruction, nonreponstive to medical tx (propranolol)
vessle options for head and neck free flaps
external carotids, facial artery, internal mammary, transverse cervical
2nd branchial arch nerves and muscles
Hyoid arch
95% of all branchial arch abnormalities
CN7 = facial expression: buccinators, stapedius, stylohyoid, posterior digastric, auricular, platysma
1st branchia arch nerves and muscles
Mandibular arch
trigeminal nerve
Muscles of mastication (temporalis, masseter, pterygoids, anterior digastric, tensor veli palatini,
3rd branchial arch
glossopharyngeal nerve (stylopharyngeus),
4th branchial arch
vagus nerve (superior & inferior laryngeal) , intrinsic muscle of the palate (+ levator)
Innervation of the anterior hard palate
sphenopalatine
trauma that results in boutenerre deformity
central slip disruption
swelling 4cm proximal to Lister tubercle, tenderness and crepitation over muscle bellies of APL and EPB
intersection syndrome: synovitis of the 2nd dorsal compartment
options for tendon transfers for wrist and hand extension
palmaris longus to EPL, pronator teres to ECRB, FCU to EDC
what articular surface is needed for proximal row carpectomy for SLAC wrist?
Capitolunate (scaphoid, lunate, triquetrum are removed)
What thickens when a tissue expander is placed and inflated?
Epidermis
What is the most appropriate first step in reconstruction of a severe rheumatoid wrist/hand with panarthritis?
Total wrist arthrodesis with ulnar head excision
Isolated rheumatoid DRUJ disease treatment
Sauve-Kapandji
What tendon will rupture in the rheumatoid hand?
Extensor carpi ulnaris leading to dorsal dislocation of the ulnar head and caput ulna syndrome
Marcus-Gunn pupil indicates injury to…
retina or optic nerve
Treatment of nevus of Ota
Q-switched ruby laser, alexandrite, or Nd:YAG
Describe the Gustilo classification
I Clean wound bed, simple/minimally comminuted bone injury, wound 1 cm
IIIA Wound highly contaminated, severe comminution, wound 1 to 10 cm
IIIB Wound highly contaminated, severe comminution, wound >10 cm
IIIC Major vascular injury requiring repair for limb salvage
Treatment for women with arm lymphedema s/p ax dissection and mastectomy for breast cancer who has failed medical managment
liposuction of the arm has improved lymphedema in post-BD therapy
Parotid malignancy with distant mets
Adenoid cystic carcinoma
Bilateral parotid tumors with large eosinophilic granular cells. Teatment?
Warthins tumor. Superficial parotidectomy
Craniofacial syndrome associated with hematoma of stapedial artery. What chromosome? What facial cleft is associated?
Hemifacial microsomia
Hemifacial microsomia, colobomas, epibulbar dermoids, vertebral and rib anomalies
Goldenhar
Chromosome 5q
Treacher collins
Retrognathia, glossoptosis, respiratory distress, +- u-shaped cleft palate
Pierre robin sequence
Long arm of chromosome 22q
Velocardiofacial syndrome. MC cleft palate; DiGeorge, Opitz
Symptoms of fat embolism syndrome
altered mental status, respiratory dysfunction, petechial rash
what is the fat grafting 6 month retention rate?
64%
What are the upper lateral and lower lateral cartilage differences between asian and caucasian noses?
Length is the same, overlap is the same, height of asian cartilage is shorter
What flaps for posterior decubitus ulcers are appropriate for ambulatory and sensate patients?
Go to thigh and fasciocutaneous flaps first; Gluteal thigh flaps; fasciocutaneous flaps. Posterior thigh flap with biceps femoris only
What are the stages of decubitus ulcers?
Stage I pressure sores are non-blanchable erythema of intact skin and usually resolve after 1 hour.
Stage II is partial-thickness skin loss presenting clinically as a blister, abrasion, or shallow crater.
Stage III pressure sores are full-thickness tissue loss down to, but not through, fascia.
Stage IV pressure sores are full-thickness loss with involvement of underlying muscle, bone, tendon, ligament, or joint capsule.
What are flap options for trochanteric ulcers?
TFL flaps, vastus lateralis flap
What are the flap options for sacral ulcers
V-Y fasciocutaneous flap; superior gluteal artery flap; reverse latissimus; lumbosacral flap; reverse lat;
What are flap options for ischial ulcers?
Use thigh flaps first; posterior thigh flap with biceps femoris (+semimem/tend if non-ambulatory); posteromedial thigh gracilis or adductor magnus perforator flaps.
Woman FOOSH’d. What are the bones most likely fractured if the distal radius and scaphoid are ok?
Distal radius -> scaphoid ->triquetral, trapezium, lunate, hamate
Most common bone tumor in children?
Osteochondroma
Most common bone tumor?
Endochondroma
