Perineal Reconstruction Flashcards
Support of pelvic contents and obliteration of any dead
space is essential in perinea! reconstruction
T
The
anterior triangle contains the urogenital structures,
T
The deep fascia is contiguous to the Colles fascia in peroneal area
T
The challenges of reconstructing the perineum
dependent pressure during postoperative
recovery, bacterial contamination from urogenital and perianal areas,
and the propensity for radiation therapy to be used when oncologic
resection is necessary
Adult burned etiology is typically due to flame,
whereas pediatric etiology is usually due to scald burns
T
Perineal burn is moe common in male more than female
T
The presence ofa
perinea! burn is an independent risk factor for an increase in morbidity and mortality
T although this is not from injuries to the urogenital
structures, but is thought to be related to increased bacteremia and/
or relationship to more extensive injuries
Long-term
catheterization risks infection and urethral stenosis.
T
Unlike burns on other areas ofthe body, genitalia burns are typically not treated with early excision
T The exception
to this is the presence ofextensive, deep necrotic tissue.
Perinea!
wounds heal well with secondary intention after eschar excision
T
If the perinea! burn is part of more extensive burns, the other areas of
burns have priority for skin grafts from available donor sites
T
All wound of the perineum can heal by secondary intension well without grafting
F Larger
wounds may require excision and grafting to prevent deformities
Mortality rates range between 10% and 40% in Fournier gangrene
T
Ideally, blood cultures should be drawn prior to
antibiotic initiation
T
we can use HPO in Fournier gangrene
There are conflicting reports on the benefits and cost-effectiveness of hyperbaric oxygen therapy
Orchiectomy should be performed only ifthe testicle itselfis
not viable
T
Hidradenitis suppurativa a disease arising from inflammation of apocrine glands with subsequent bacterial superinfection
F Previously was thought that the disease occures in the apocrine glands now understood to be
a disease process of the terminal hair follicle, or the infundibulum
Pathophysiology
The resulting occlusion causes dilation of the follicle bulb and cyst formation. Eventually, the cyst ruptures, releasing keratin debris and other follicular contents, such as bacteria,
into the dermis, resulting in an acute neutrophilic inflammatory
response that progresses to a granulomatous stage with the presence of foreign body giant cells
If the inflammatory response is
extensive, abscess formation occurs, creating further destruction of
other follicles as well as apocrine and eccrine glands.
T
Advances in understanding the
pathophysiology ofhidradenitis suppurativa has given rise to the
term acne inversa.
T
The incidence ofhidradenitis is around 1%
T
There is a 3: I male
to female predominance and tends to manifest in the second or third
F There is a 3: I female
to male predominance and tends to manifest in the second or third
There is no role of hormonal component in HS
There may be a hormonal component associated with it, noting a decrease in severity after menopause
It is also associated with
obesity, diabetes mellitus, metabolic syndrome, and nicotine use as
well as other inflammatory disease processes, such as inflammatory
bowel disease, pyoderma gangrenosum, arthritis, and polycystic
ovarian disease
T
There are two commonly accepted scales describing the level of severity of hidradenitis, the Hurley Scale and the
modified Sartorius Scale
T
These grade according to severity, location,
and degree ofscaring
T
Treatment of HS ?
Life style modafication ,smoking secession, weight loss, and avoidance of compression and friction
Intralesional triamcinolone has been described
to decrease erythema, induration, pain, and lesion size in flare-ups,
topical treatments such as clindamycin gel and oral therapies
such as tetracycline, ampicillin, …..
treatments ranging from 2 to 6 weeks
T
staphyloccocus species are
predominant in many ofthe chronic abscess
T
chronic lesions often are
polymicrobial, in which anaerobic bacteria predominate
T
Antibiotic therapies do not treat the underlying problem, which
is an abnormal inflammatory response.
T
Patient with HS can improve on laser therapy
T Though improvement was
noted, recurrence can still occur
Surgical excision is the only method at present to definitively
treat the scars and sinus tracts ofchronic hidradenitis.
T
new areas ofhidradenitis may still occur adjacent to the treated areas
T
any nodule can be incise in HS ?
F Incision and drainage can relieve pain from fluctuant
abscesses but should be avoided in firm, solid nodules that are not
purulent
Local excision procedure such as unroofing
sinus tract or tangential excision may spare skin but are subject to
higher recurrence rates compared to wide excision.
T
Local excision of the for sinus tract should be closed by suturing
F These wounds
are left to heal by secondary intention
The smaller wounds can be closed primarily.
Larger wounds can be covered with split-thickness skin grafting.
T
Rotational flaps have been described to cover larger wounds.
T
If hidradenitis is left to fester as chronic
wound, over time, squamous cell carcinoma can arise in it, also
known as a Marjolin ulcer
T
