Plastic, Oral, Maxillofacial on 9/16 Flashcards
Adip/o
fat
caus/o
burn
cauter/o
heat
burn
derm/o
skin
Dermat/o
skin
diaphor/o
sweat
eryther/o
red
erythemat/o
red
hydr/o
water
kerat/o
hard or horny tissue
cornea
leuk/o
white
lip/o
fat
lipid
melan/o
black
myc/o
fungus
onych/o
nail
phyt/o
plant
pil/o
hair
py/o
pus
seb/o
sebum
sebace/o
sebum
squam/o
squamous
steat/o
fat
trich/o
hair
ungu/o
nail
xer/o
dry
What makes up the integumentary system?
skin, hair, nail, and exocrine glands
What is he most visible and largest organ?
skin
What are 6 functions of the skin?
protection: barrier to outside
senses: pain, temp
Regulates: own body temp
Prevents loss of body fluids
Excretes through sweat glands
Absorption
What are the 3 main layers of skin?
Epidermis
dermis
hypodermis
What does the dermis layer of skin do for us?
provides strength and elasticity
callagen fibers
vascular layer
AKA true skin
What does the epidermis layer of skin do for us?
AKA false skin
continually replaces itself
non vascular
What does the hypodermis layer of skin do for us?
attaches skin to tissue
thick and fatty
AKA subcutaneous tissue
What are the purpose and goals of reconstructive skin procedures?
restore normal function/ appearance
correct congenital deformities/ disfigurements
scars or trauma
slef body immage
What is done to prep the skin for a face procedure? And what solution is used?
eyebrow/ lashes left alone
colorless prep solution used
hibiclense & betadine used
Hibiclense NOT near eyes and ears
What kind of draping used for plastic surgeries?
creative to expose several areas
universal drape
What kind of sutures are used in most plastic procedures?
fine sutures swagged to needles
2-0 to 8-0 depending on tissue
8-0 to 11-0 during microsurgeries (nerve & vessel)
What kind of anesthesia is used?
frequently local on WIWO
general on children or confused
What are the common anesthesia meds used?
xylocaine/lidocaine (1% or 2%)
bupivacaine/sensorcaine/
Marcaine (0.25%, 0.5%, 0.75%)
epinephrine as a local
What kind of visual equipment is used?
fiberoptic headlamp
lighted retractors
loupes- magnifying glasses
microscopes
What is an ESU?
electrosurgical unit used for coagulating and cutting tissue
What is a smoke evacuator?
used in conjunction with the ESU helps remove the smoke made
What is a pneumatic tourniquet? what are the steps to putting one on?
stops blood flow to extremity
What is a doppler used for?
identify sufficient blood flow through grafts
What is a nerve stimulator?
identifies nerves
used in craniofacial and hand reconstruction
facelift- facial and trigeminal nerve (cranial 5)
What powered instruments are used in plastic, oral, maxillofacial surgeries?
drills
z-serter for inserting small pins, plates, and screws
What is the liposuction vacuum machine and curettes used for?
removing excess subcutaneous fat
When handling plastics instruments what should be looked for on the forceps? scissors?
malocclusion- miss aligned teeth
burrs- uneven cuts
What are two reasons for doing implants and prostheses?
replace diseased, injured, or missing body parts
augment body parts
(mammoplasty-breast or mentoplasty- chin)
What does alloplastic mean?
material made from environmental materials
What kind of alloplastic materials are used?
dacron
silicone
silastic
mesh
teflon
stainless steel
Pressure dressing are frequently used when?
(FTSG) full thickness skin graft
aka stent dressing
What is the vacuum assisted closure device?
VAC
assists drainage with negative pressure
post-op dressing
used for pressure ulcers, flaps, and skin grafts to eliminate dead space
What is another name for neoplasm?
skin lesion
What is a skin lesion?
abnormal growth
benign or cancerous
anywhere on body
excised for cosmetic/ health
What is Basal cell carcinoma?
BCC
malignant tumor (most common)
head and neck
sun exposure
locally aggressive but rarely metastasizes
How is a lesion assessed?
Asymmetry
Border
Color
Diameter
Evolution
What is squamous cell carcinoma?
SCC
older people exposed to sun
rapid growing that can metastasize through lymph and blood
What is a malignant melanoma?
tumor of pigment cells
common on fair skin
can remain small or grow fast
tx- wide local excision
Prognosis determined by depth of tissue invasion
genetic predisposition
What is a pressure ulcer?
prolonged compression of soft tissue over bony prominences
Where are common sites of pressure ulcers?
sacrum
ischium
trochanter (hip)
malleolus (ankle)
heel
How many pressure ulcer stages are there?
4
Describe a stage 1 pressure ulcer
a reddend painful area that does not turn white when pressed on
Describe a stage 2 pressure ulcer
the skin is blistering or causing an open sore
Describe a stage 3 pressure ulcer
the skin develops an open or sunken hole called a crater or ulcer
need debridement
Describe a stage 4 pressure ulcer
sore deepens and may involve, muscle, bone, or tissue
need debridement and grafts
What are the classifications of burns?
first degree
second degree
third degree
fourth degree
Explain a second-degree burn
deep partial thickness burn damage into dermis
heals by regeneration if some dermis viable
blisters, severe pain, moist red pink appearance
EX bad sunburn
Explain a third degree burn
Full thickness burn epidermis and dermis destroyed
Eschar develops
lack of sensation
skin infection possible
Explain a fourth degree burn
char burns
damage to blood vessels, nerves, muscles, and tendons
extensive reconstruction
What is the rule of nines?
tool to estimate percentage of skin burned
What are the sections and the percentages for the rule of nines?
9% head and neck, and each arm
(27)
18% posterior trunk, anterior trunk, each lower leg (72)
1% for perineum
What is debridement ?
removal of foreign material, necrotic, or damaged tissue from a wound
What is being removed in a burn? (Specific term?
Eschar- dark tissue covering or shedding from wound
When is debridement of a burn performed? on what kind of thickness burns?
partial or full thickness
before healing or skin graft
What tool is used to excise the nonviable tissue
weck knife or
dermatome
How is homeostasis achieved in a burn?
electrocautery and topical thrombin
What are ways neoplasms are removed?
sharp dissection
electrosurgery
cryosurgery
laser surgery
radiation surgery
Mohs micrographic surgery
What is Mohs micrographic surgery?
procedure to treat skin cancer
cut away layers of skin, examine each layer until margins are clear
What is scar revision?
rearranging or reshaping a hypertrophic or keloid scar to improve appearance
What are 4 methods of scar revision?
excision
Z-plasty
W-plasty
Y-V-plasty
What is the simplest method of scar revision
excision and resuture it
What is the most common scar revision method?
Z-plasty
What is Z-plasty?
placing a Z shaped incision into scar and suturing it. The jagged edges help make healing better
What process can be used to improve the appearance of a large scar?
temporary sterile tissue expander
injection of NSS into port stretches the skin
scar is then excised & normal skin is reapproximated
What are the 3 types of skin grafts?
autograft
homograft
heterograft
What is an autograft skin graft?
=self
transfer one part of body to another
What are some example of autografts used?
cortical bone
cancellous bone
ribs
cartilage
tendons
fat
dermis
collagen
What is a homograft skin graft?
=another person
cadaver skin donation or skin bank
acellular dermal graft (alloderm)
placenta
What is another name for autograft skin graft?
autogenous graft
What is another name for a homograft skin graft?
allograft
What are some types of allografts used?
bone
cartilage
(ortho & nuero)
Where does a heterograft skin graft come from? What are 3 examples of donors?
= another species
porcine (pig) skin for burns
reduces fluid loss
protects wound from infection
Biobrane- synthetic
bovine cow
What is another name for heterograft skin graft?
Xenograft
What are 3 types of autografting techniques?
split-thickness graft (stsg)
full-thickness graft (ftsg)
composite graft
What layer or layers of skin are removed in a STSG? How much is removed (thickness)?
epidermis and portion of dermis
.010–.035 in (.3-1 mm)
What is the most frequently used graft?
Split-thickness skin graft (STSG)
What are some advantages for the donor site of a STSG?
heals rapidly by regeneration
can be reused 2 weeks later
What layer or layers of skin are removed in a FTSG? How much is removed (thickness)?
all of epidermis and dermis
more than 1mm
What parts of the body are FTSG preferred to be done on?
face
neck
hands
elbows
axilla
knees
feet
For what reason would a FTSG be done instead of a STSG?
causes less contraction
used on areas of flexion like knee and elbow
What kind of graft will the donor receive if the recipient is getting a FTSG?
a FTSG will be taken from one site and a STSK will be taken from another site
What are some disadvantages for the donor in FTSG?
primarily closed- will not heal on its own
site cannot be reused
What layer or layers are removed in a composite graft?
skin and underlaying tissue
including subcutaneous fat or cartilage
What are examples of composite grafts?
hair transport- plugs of skin, fat, and hair follicles
conchal composite grafts- postauricular (ear) skin & cartilage for nose & eyelid reconstruction
What is a tissue flap?
tissue detached from one area of body and transferred to recipient site with blood supply
What are two types of tissue flaps?
pedicle
free
What is a pedicle flap? What are 2 examples of?
tissue remains attached during transfer
when blood supply reestablishes some the flap can be detached
preserves skin sensation
loose tip of finger and mole cover up on lip
What is a free tissue flap?
tissue, including vascular bundle detached from donor site and transferred to recipient site
-anastomosis of arteries and veins done
When is a free tissue flap performed?
when a STSG & FTSG will not provide coverage
Where is a free tissue flap usually taken from
abdominis rectus
What are two examples of free tissue flaps?
toe to thumb- tissue transplant
jejunal tissue transfer to reconstruct pharynx & larynx for resection of tumor
What are tissue flaps used to cover?
areas with extensive tissue loss like exposed bone, tendons, and nerves
Some examples of tissue flaps are?
tissue expansion flap
musculocutaneous or myocutaneous
muscle
neurosensory
omental
What is a tissue expansion flap? What are 2 examples?
flap intended for later transplant/ implant
breast reconstruction
removal of a scar
What is a musculocutaneous or myocutaneous tissue flap?
flap that includes muscle, fascia, subcutaneous tissue, and skin
What are 2 examples of musculocutaneous/ myocutaneous tissue flaps?
TRAM flap- transverse rectus abdominis
Latissimus dorsi flap (back side)
both for post mastectomy
What is a muscle tissue flap?
muscle tissue and proximal blood supply
What is an example of muscle tissue flap?
gluteus maximus flap rotated to cover an ulcerated area of STSG needed to cover the muscle
What is a neurosensory tissue flap?
flap that involves sensory nerves to provide sensation to hands and feet
What is an example of a neurosensory tissue flap?
toe to hand surgery
anastomosis
figure of eight suturing to attach tendons
What is an omental tissue flap?
tissue mobilized to cover defects exposing vital organs
What is an example of an omental tissue flap?
cover chest wall following radiation necrosis
What is a dermatome?
a machine used to take STSG
What is the tech responsible for when dermatome is on the table?
inserting blade
attaching the guard
-surgeon will set depth-
What are three types of dermatomes?
oscillating-blade
knife
drum
What is an oscillating dermatome? What is used to power?
blade moves back and forth
electric or nitrogen powered
Where area is an oscillating dermatome used? rarely used?
firm underlying support areas
abdominal wall
What is used as a lubricant for a oscillating dermatome?
mineral oil
What are 3 examples (Brands)of oscillating dermatomes
Zimmer
Brown
Padgett
What is a knife dermatome
handheld knife
(reminds me of the barber knife used to shave a guy)
What are 3 types of knife dermatomes?
Weck
ferris-smith
humby- watson
What is the weck dermatome? What kind of graft is obtained?
knife dermatome
straight razor blade with sterile blades and interchangeable guards to determine depth of graft
obtain small STSG
What is a ferris-smith dermatome? What kind of graft is obtained?
knife dermatome
sterile straight razor
free hand grafts
What is a humby or watson dermatome?
knife dermatome
adjustable roller
controls thickness of graft
What is a drum dermatome?
bulk and hand held
round blade inside round metal drum
What are 2 examples of a drum dermatome?
Padgett-hood
Reese
What is a skin graft mesher?
cuts small slits in STSG
enlarges graft for larger coverage
What are advantages of a meshed skin graft?
facilitates drainage
prevents fluid accumulation
epithelial tissue able to grow
What are 4 considerations when doing skin grafts?
prepping
care of graft
graft healing
pressure or stent dressing
What kind of prep should be used on skin grafts?
colorless antiseptic agents
hibiclens or betadine
How are donor and recipient sites prepped for a skin graft?
prepped and draped separately
donor site prepped first
What is the most important thing to care for skin grafts?
do not allow to dry keep moist with NSS on 4x4
When caring for a STSG graft, what is done for dressing it?
thrombin spray/ pressure for homeostasis
donor site covered with fine medicated mesh
5x9 xeroform gauze
baciguent (bacitracin) and 4x4’s
When caring for a FTSG, what is done for dressing it?
recipient may get stent dressing
use 4-0 or 5-0 nylon to secure
When caring for a small graft on the face, what kind of dressing?
stent dressing over a rosebud (ball) of xeroform
What do stent and pressure dressings do on a skin graft?
exert even pressure
eliminate potential shearing forces
eliminate dead space
prevent edema or hemotoma
What is a craniomaxillofacial surgery?
reconstruction and repair of the facial bones and oral cavity
What two imaging studies are done to assess facial fractures?
panoramic radiographic
CT scan
What is visible/ seen in a panoramic radiographic image?
alveolar process
mandible
posterior maxillary sinuses
zygomas
When is a CT scan used for a facial fracture?
complex fractures
reconstruction procedure
What are the most common reasons for facial FX’s?
intentional violence
MVA
What is used to prep a facial surgery?
Betadine
entire face
NOT chloraprep
How is the head draped for a facial surgery?
Half drape
2 towels (wrapped like a turban)
3/4 drape for body
What is a maxillomandibular fixation?
surgery to preserve patients bite pattern
What is used to close and fixate the maxilla and mandible in a fixation?
Arch bars
What are arch bars used for? Special instructions?
thin metal wire strips (like braces)
wire cutters with patient in case of airway emergency
protocol to tighten clockwise
What is an ORIF midface fracture? What are they identified as? How many types?
open reduction and internal fixation
due to a trauma usually
LeForte
3
What is a LeFort 1 fracture? What separates? What else can be affected?
mustache area
most common
hard palate and alveolar process separate from maxilla
nasal septum, lateral maxilla sinus, & palatine bones
What is a LeFort 2 fracture?
mustache and nose
(pyramid shape)
What is a LeFort 3 fracture? Where are the fx’s at?
mustache, nose, and cheeks
fx’s of zygoma, maxilla, nasal
What are orbital-craniofacial deformities?
abnormalities to the cranial, facial, and orbital
congenital or severe disfigurements
What kind of discipline (doctors) are involved in orbital- craniofacial deformities?
dental
neurological
opthalmic
plastics
What is an orif frontal nasal sinus fx?
can be life threatening
can result in CSF leak or herniation of brain
bi-coronal incisions
FX’s exposed and repaired
What is an ORIF orbital floor FX?
result of increased orbital pressure by impact on the globe
AKA blowout
What are fx complications in a ORIF orbital floor Fx?
extrusion of globe into nasal sinus
entrapment of eye muscle
How is an ORIF orbital floor fx repaired?
sub ciliary or transconjunctival incision
orbit exposed- retractors moistened with saline
Fx reduced and repaired
incision closed
What happens immediately after a ORIF orbital floor fx?
double vision due to corneal shield and antibiotic ointment
What is a zygomatic fx? What instruments are used?
small temporal incision
dingman elevator
ORIF mandibular fx
What happens in a nasal fx reduction?
closed reduction of nasal bone and cartilage
topical or local anesthesia
What is a cheiloplasty procedure?
closure of a cleft lip
congenital defect
surgery at 3 months
use fine absorbable suture
What is a palatoplasty procedure?
closure of a cleft palate
soft, hard, or both
after 6 months of age
What is an otoplasty procedure?
procedure to change the shape, size, or position of the ear
What are some reasons for otoplasty surgery?
congenital deformity (big, small, not complete)
reconstruct microtia (small ear)
2nd set may be needed)
traumatic injury (burn)
What is a mentoplasty procedure?
procedure to reshape the chin
What is a mentoplasty procedure augmented with?
bone, cartilage grafts, or artificial chin implants
What is Micrognathia?
underdevelopment of the jaw
What is a blepharoplasty procedure What is another name?
procedure to repair droopy eyes
remove excess skin between eyes
dermachalasis
What kind of incision is most common in a blepharoplasty procedure? What kind of anesthesia?
an elliptical incision
MAC
What is a rhytidectomy procedure?
AKA facelift
removal of skin in lower third of the face
What kind of anesthesia is used in a rhytidectomy surgery?
local, MAC, or general
Where are the two incisions made in a rhytidectomy surgery?
hairline and behind the ear
indiscernible
What nerve needs to be protected in a rhytidectomy procedure?
Facial nerve (CNVII)
use nerve stimulator
Why are brow lifts preformed?
correction of ptosis of eyebrows, forehead, and wrinkles
What is a submalar augmentation?
fix deficiency in cheeks
trauma or atrophy
implants possible
What is a rhinoplasty procedure?
improve nose by altering shape or size
How is a rhinoplasty procedure performed?
rasping or cutting of bone
excising cartilage
shorten septum
What is a dermabrasion procedure?
sanding or planing of skin
removes epidermis and some dermis
Wear shields and mask
What is a hair transplant procedure?
hair follicles moved to balding areas
What is an abdominoplasty procedure?
AKA tummy tuck
excision of exceess fat
tighten rectus abdominis
What is a panniculectomy?
removal of the large apron of fat hanging from the abdomen
What is liposuction?
removal of fat for body contour
high vaccuum suction
What does the surg tech need to prepare, prior to a liposuction procedure?
tumescent solution- liquifies fat and makes it easier to suction
What is a mammoplasty procedure? What are the 2 types?
increase or decrease in the breast size
augmentation and reduction of
What are three incision sites used in an augmentation mammoplasty?
peri areolar
axillary crease
inframammary
What is an augmentation mammoplasty?
breast implant
placed under pectoralis major
What is a reduction mammoplasty?
reduce breast size
What are 3 types of breast lift techniques?
Crescent
Benelli -(uses cookie cutter)
Benelli-lollipop
What are the types of reconstructive mammoplasty flaps?
TRAM and free flap
What are 3 examples pedicle flaps?
Latissimus dorsi myocutaneous flap
TRAM flap
Free TRAM flap (lengthy)
What is a latissimus dorsi myocutaneous flap?
pedicle flap
uses muscles, fat, skin, and prosthesis
What is a TRAM flap? What does TRAM stand for?
(transverse rectus abdominus myocutaneous)
uses rectus muscles, fat, skin from lower abdomen
pedicle flap
What is nipple reconstruction in a mammoplasty procedure?
adding a nipple after a mammoplasty surgery
What kind of skin graft is taken for a nipple reconstruction? Where from?
Full-thickness
inner thigh or labial fold
What are the 4 main parts of the hand?
ulna
carpus
metacarpals
phalanges
How do you position and drape a patient for a hand surgery?
hand drape with cuff on arm board
stockinette to cover the arm
What are reasons to perform hand surgery?
congenital deformities
disease
trauma
-restore function of hand
What are some injuries treated in a hand surgery
nerve repair
fractures
tendon repair
blood vessel reanastamosis
amputated digits or limbs
What happens in a tendon repair?
sutured, grafted , or implanted
hunter rods may be used
palmaris longus commonly used (longest)
What kind of fractures are repaired? What is used?
ORIF or CR
(open reduction internal fixation or closed reduction)
use image intensifier, c-serter, or synthes mini drill and K wires
What happens in a severed nerve procedure?
digital nerves sutured or grafted
micro instruments used
What is the order of anastomosis in reattaching a limb or digit?
bones
tendons
vessels
nerves
What are three types of hand congenital deformities?
Radial Dysplasia
Syndactyly
Polydactyly
What is radial Dysplasia?
aka clubhand
radius fails to form properly
(%5 different procedures possible)
What is Syndactyly?
webbed or fused digits of hand or feet
Use FTSG
1yo and older
What is Polydactyly?
extra digits on hand or feet
5th finger duplication most common
excised during infancy
What causes joint deformities?
trauma
RA- rheumatoid arthritis
DJD- deformitive joint disorder
What is arthroplasty?
resurfacing of joint using silastic implant as a spacer
relieves pain
What 3 carpals are usually involved in an arthroplasty?
lunate, trapezium, and scaphoid
What is arthrodesis?
fusion of a joint
immobilization
What are fascial tissue contractures?
releasing or excising of constricted structures
What are 3 fascial tissue contractures?
Dupuytren’s contracture
DE Quervain disease
Carpal tunnel release
What is Dupuytren’s contracture?
progressive disease involving palmer fascia of hand
aka palmer fasciectomy
What is De Quervain disease?
pain on flexion & addduction of thumb
excise stenosing sheath at distal radius
What is carpal tunnel disease?
transverse carpal ligament compresses median nerve at volar surface of wrist
Burn patients are susceptible to what?
dehydration
septicemia
pneumonia
