pimp questions Flashcards
Why leave the fascia on the muscle during the dissection?
So you will have a strong layer of tissue to suture too.
What suture style do you use for weaker tissue?
Figure of 8 because it has greater surface area and won’t “cheese wire” the tissue.
What is Red Breast Syndrome?
Type IV hypersensitivity (delayed) reaction to acellular dermal matrix.
What is the incidence of Tissue Expander infections?
7-10%
What is the blood supply to the pectoralis major muscle?
Type V Mathes and Nahai flap. Dominant supply pectoral branch of thoracoacromial trunk. Segmental supply of IMA perforators.
Mathes and Nahai type 1
Single Vascular Pedicle
ex: gastrocnemius, tensor fascia lata
Mathes and Nahai type 2
Dominant Vascular Pedicle(s) and Minor Vascular Pedicle(s)
ex: gracilis, hamstring (biceps femoris), rectus femoris, soleus, sternocleidomastoid, trapezius, triceps, and vastus medialis
Mathes and Nahai type 3
Two Dominant Pedicles
ex: gluteus maximus, rectus abdominis, serratus, and temporalis
Mathes and Nahai type 4
Segmental Vascular Pedicles
ex: sartorius, tibialis anterior
Mathes and Nahai type 5
Dominant Vascular Pedicle and Secondary Segmental Vascular Pedicles
ex: internal oblique, latissimus dorsi, pectoralis major
What is Pitanguy’s line?
topographic marking for the frontal branch of the facial nerve
0.5 cm inferior to the tragus to a point 1.5cm superior and lateral to the eyebrow
What is Pitanguy’s point?
transposition of inframammary fold [IMF] to anterior breast
Why smooth expanders?
ALCL linked to previous textured tissue expanders
What are the aesthetic units of the breast?
Primary venous drainage system of abdomen?
superficial system
Why wait after infiltrating to start liposuction?
For the onset of epinephrine. Onset time 8 minutes. Peak effect 26 minutes.
What does 1% solution mean?
This is 1000 milligrams in 100 milliliters of water. Which converts down to 10 mg per cc of solution.
How much epinephrine can you use?
This is an important question for cleft palate. It is a highly vascular region and absorbs quickly. It is rec that 10 μg/kg at 30 minute intervals be used.
How much lidocaine can you infiltrate?
5mg/kg without epi
7mg/kg with epi
Strongest suture technique?
Vertical mattress
Best suture tech for everting?
Horizontal mattress
Most ischemic stitch?
Horizontal mattress
Clip the artery or vein first on a flap?
The artery first so the flap isn’t engorged with blood.
How can you prevent new capsular contracture after breast implant exchange?
Switch planes from sub-glandular to sub-muscular. Alloderm can also decrease the chance of capsular contracture.
What are the grades of capsular contracture?
Grade I — the breast is normally soft and appears natural in size and shape
Grade II — the breast is a little firm, but appears normal
Grade III — the breast is firm and appears abnormal
Grade IV — the breast is hard, painful to the touch, and appears abnormal.
When you are making the keyhole for the new nipple in a breast reduction, why de-epilthelize?
In case the nipple becomes ischemic, you can thin it and graft it onto that surface.
What are the rates of capsular contracture?
Rates are lower sub-pectoral (3-4%) compared to pre-pectoral (12%). Smooth implants are higher than textured implants (1% sub-pectoral). The mechanism is perhaps thought to be from micro-motion.
Advantage of pre-pectoral?
Able to place TE more medially, less pain, no animation deformity, may be faster if you wrap.
Disadvantage of pre-pectoral?
Only being held by skin, subq so that breast implant may drop. You can also see the contour of the implant more easily.
Why use ADM (acellular dermal matrix)?
decreased capsular contracture, ?may decrease bottoming out of implant
Disadvantage of ADM (acellular dermal matrix)?
seroma formation
What must you do if the patient wants a larger breast size?
Be sure to have the incision low at the IMF. If the incision is too high, the NAC will be distorted during filling of the TE. (ie the nipple will point downward because the expander will be too high).
Unilateral DIEP Flap: where is the ideal perforator?
From the medial row (more centrally) so it can perfuse more of the flap. A lateral row might not perfuse the contralateral side of the flap as well.
DIEP Flap: what perforator is more morbid, medial, middle or lateral row?
The lateral row perforators much more morbid because you’re going to transect nerves more laterally and this is going to deinnervate more muscle.
You have a tourniquet up, but a half an hour into the case you start seeing dark blood seeping out from the wound. What’s happening?
You have a venous tourniquet and the buildup of pressure is forcing the blood out through the path of least resistance which is the capillaries in your wound bed. This tends to happen with calcified vessels.
How to identify EIP?
Deep and ulnar (compared to EDC to index finger in both hand and at 4th dorsal compartment). Most distal muscle belly in forearm. No juncturae tendinae.
How to identify motor recurrent branch of median nerve?
It is approximately where the index finger naturally flexes to the thenar eminence.
What is Kaplan’s cardinal line?
It is a line from the the apex of the first web space to the hook of hamate and represents the vascular palmar arch. The hook of hamate can be difficult to palpate and transposing a line parallel to the mid-palmar crease to the apex of the first webspace.
What is an intrinsic plus finger?
Force along FDP tendon is instead directed through lumbricals to lateral bands. This causes paradoxical extension of IPs during flexion. This sometimes occurs during OT sessions after FDP repair or after revision amps that remove the FDP insertion.
What is quadrigia?
Adjacent finger cannot flex completely because of a shortened tendon and a common FDP muscle belly. Term comes from chariots in ancient Rome with reins going to 4 horses.
What is the nutrition supply to tendons?
Vincula, direct diffusion through tendon sheath and from digital arteries.
Where does FPL lay in hand?
Between adductor and abductor policis brevis.
For thigh lifts or mass excisions, how do you prevent labial spreading?
Suture advanced dermis to Colle’s fascia.
For mandibular contouring, what structure on buccal mucosa near the first molar must avoid
Stenson/parotid duct
Approaching the end of cleft lip surgery, the patient begins to bleed while final sutures are placed. Why?
The cleft palate is a highly vascular region, and blood pressure rises as anesthesia becomes less deep.
At what age does the sphenoid sinus complete pneumatization?
7-8 years; MRI after this age will show complete pneumatization.
What are the layers of the scalp?
S Skin
C Connective Tissue
A Aponeurosis of Galea
L Loose Areolar Tissue
P Periosteum/Pericranium
When reflecting the scalp for calvarial procedures, what layer is separated?
Separate at layer of loose areolar tissue, reflect the scalp, then elevate the pericranium.
