Miscellaneous

Question 1

What is Poland syndrome?

Answer 1

Poland syndrome is a birth defect characterized by an underdeveloped chest muscle and short webbed fingers on one side of the body.

There may also be short ribs, less fat, and breast and nipple abnormalities on the same side of the body. Typically, the right side is involved. Those affected generally have normal movement and health.

Question 2

How do you classify infected sternotomy wounds?

Answer 2

Classification Postoperative phase on which the infection occurs

Type I In the first week after sternotomy – serosanguinous discharge without evidence of cellulitis, costochondritis or osteomyelitis

Type II Between 2 to 6 weeks after sternotomy – osteomyelitis and or costochondritis on background of purulent mediastinitis

Type III After 6 weeks to years – fistulas or sinuses and chronic osteomyelitis, chondritis and foreign body

Question 3

What are the treatment options for sternal wound dehiscence?

Answer 3

Negative wound therapy – this will reduce bacterial load, increase blood flow, promote granulation tissue formation and improve respiration function

Surgery
Once there is satisfactory debridement of infected/necrotic tissue, removal of foreign bodies (including wires)
Aim is to fill dead space
Pectoralis major flap either a turnover or rotation advancement
Rectus abdominis flap – can be muscle only or with skin as myocutaneous flap (VRAM)
Omental flap

Question 4

Describe the Pannus grading

Answer 4

I - apron covers pubic hairline
II - apron covers gentials
III - apron covers upper thigh
IV - apron covers mid thigh
V - apron covers knees

Question 5

Describe the types of abdominoplasty

Answer 5

1. Standard abdominoplasty
2. Fleur-de-lys abdominoplasty

This is different to a standard abdominoplasty because it involves a vertical incision from the costal margin down to the pubis, which allows excess skin and tissue to be removed from the sides of the abdomen, not just below

3. Lipoabdominoplasty

A combination of liposuction followed by abdominoplasty

4. Panniculectomy

Functional excision of large apron to improve patient’s ADLs without undermining or plication of the rectus sheath

Question 6

What are the different levels of evidence?

Answer 6

1a: Systematic reviews of randomized controlled trials

1b: Individual randomized controlled trials

2a: Systematic reviews of cohort studies

2b: Individual cohort study or low quality randomized controlled trials

3a: Systematic review of case-control studies

3b: Individual case-control study

4: Case series (and poor quality cohort and case-control studies)

5: Expert opinion

Source: Oxford centre for Evidence Based Medicine

Question 7

What is NCEPOD?

Answer 7

National confidential enquiry into patient outcomes and death

Question 8

How is NCEPOD categorised?

Answer 8

1. Immediate – minutes
2. Urgent – hours
3. Expedited – days
4. Elective – planned

Question 9

Explain some key NCEPOD findings

Answer 9

NCEPOD 1997 – made suggestions to improve surgical safety, particularly during emergency surgery.
Suggested that operations should not take place out of hours if they can be avoided – this changed practice in the UK and introduced an assessment system of how urgent a case was.

Question 10

What are the components of the LRINEC score?

Answer 10

CRP (mg/L) ≥150: 4 points
WBC count (×103/mm3) <15: 0 points; 15–25: 1 point; >25: 2 points
Haemoglobin (g/dL) >13.5: 0 points; 11–13.5: 1 point; <11: 2 points
Sodium (mmol/L) <135: 2 points
Creatinine (umol/L) >141: 2 points
Glucose (mmol/L)>10: 1 point

A score >6 has a positive predictive value of 92% of having necrotizing fasciitis