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Trauma > Plastic Surgery > Flashcards

Plastic Surgery Flashcards

1
Q

What are the two main layers of the skin

A
  1. Epidermis

2. Dermis

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2
Q

What are the 5 layers of the epidermis

A
  1. Stratum germinativum
  2. Stratum spinosum
  3. Stratum granulosum
  4. Stratum lucidum
  5. Stratum corneum
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3
Q

What is the stratum germinativum

A
  • Basal layer
  • Only layer that is actively proliferating
  • Cells move towards the surface from here
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4
Q

Which skin layer is only found in the thick skin of the palm of the hand and sole of the foot

A

Stratum lucidum

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5
Q

Where are melanocytes derived from

A

Neural crest-derived

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6
Q

What proportion of skin thickness does the dermis constitute

A

95%

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7
Q

How is the dermis divided

A
  1. Papillary dermis

2. Reticular dermis

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8
Q

What type of collagen is most prolific in the skin

A

Type 1 (ration of 4:1 against type 3)

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9
Q

Which division of the dermis is most vascular

A

Papillary dermis

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10
Q

Define surgical debridement

A

Selective excision of dubious tissue to achieve a healthy wound

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11
Q

Define chemical debridement

A

Involves the use of enzymes or other compounds to remove necrotic tissue

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12
Q

Define biological debridement

A

Involves the use of maggot’s to clear a wound of necrotic tissue

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13
Q

Define skin grafting

A

The process of transferring a piece of skin without a blood supply from one site in the body to another, where the graft will obtain a blood supply and heal

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14
Q

Describe a split-thickness skin graft

A
  • Consists of epidermis and variable amounts of dermis

- As epidermal elements are left behind at the donor site the donor site can re-epithelialise

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15
Q

How can the coverage of split-thickness grafts be increased

A

Meshing

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16
Q

What is the most common site of split-thickness skin graft

A

Thigh

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17
Q

List the advantages of split-thickness skin grafting

A
  • Donor site will heal by re-epithelialisation
  • Large available donor area
  • Can cover large areas by meshing
  • Contour well to complex wounds
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18
Q

List the disadvantages of split-thickness skin grafting

A
  • Poor matching of colour and texture
  • Meshed pattern may be visible
  • Significant contraction with healing
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19
Q

Describe a full-thickness skin graft

A
  • Consist of the entire dermis and epidermis
  • Include dermal appendages
  • Donor sites require closure and are more limited
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20
Q

What is the most common use of full-thickness skin grafts

A

Facial reconstruction as provide superior cosmetic result

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21
Q

List the common donor sites for full-thickness skin grafts

A
  • Postauricular skin
  • Supraclavicular fossa
  • Medial arm
  • Groin
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22
Q

What are the 4 stages of skin-graft healing or ‘take’

A
  1. Adherence - fibrin bond between graft and site
  2. Plasmatic inhibition - nutrition of graft
  3. Revascularisation
  4. Maturation - contraction of wound and graft
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23
Q

Define a flap

A

Vascularised unit of tissue that is moved from a donor to a recipient site

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24
Q

What is a ‘random pattern’ flap

A

Flap with no named directional blood vessel providing its blood supply

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25
Q

What is an ‘axial’ flap

A

Flap with an identifiable source vessel running within the flap

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26
Q

What is a ‘local’ flap

A

Flap that is adjacent to the defect to be reconstructed

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27
Q

What are common examples of local flaps

A
  • Facial cutaneous flaps

- Z-plasty

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28
Q

What is a Z-plasty used for

A

Managing scar contractures and reorientation of scars

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29
Q

What is a ‘regional’ flap

A

A flap moved from a donor site nearby but not necessarily adjacent to the defect e.g. latissimus dorsi flap in breast reconstruction

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30
Q

What is a ‘free’ flap

A

A flap that is detached from its blood supply at the donor site and reconnected to vessels at the recipient site

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31
Q

What limits the size of flaps

A

The territory of its blood supply

32
Q

Describe the latissimus dorsi flap and its uses

A
  • Based on latissiumus dorsi and the thoracodorsal vessels

- Used for breast and chest wall reconstruction

33
Q

Describe scapular and parascapular flaps and their uses

A
  • Flaps based on the circumflex scapular arterial system

- Regional flap for axillary reconstruction

34
Q

Describe radial forearm flaps and their uses

A
  • Flaps based on the radial artery
  • Good source of fasciocutaneous flap
  • Pedicled use for hand and upper limb coverage
  • Free flap use for neck/intraoral reconstruction
  • Skin graft required for closure of the donor site
35
Q

Describe rectus abdominis/DIEP flaps and their uses

A
  • Flaps based on inferior epigastric arterial system

- Commonly used in breast, chest and pelvic reconstruction

36
Q

Describe gracilis flaps and their uses

A
  • Based on profunda femoris or medial circumflex femoral arterial systems
  • Regional flap used for perineal reconstruction
  • Can also be used for biceps reconstruction
37
Q

Describe fibular flaps and their uses

A
  • Based on the peroneal arterial system
  • Useful for long segment of vascularised bone
  • Used in mandibular reconstruction
38
Q

How do superficial/epidermal burns appear

A

Red, moist, blanching

39
Q

How do superficial partial thickness burns appear

A

Pale, dry, blanching

40
Q

How do deep partial thickness burns appear

A

Mottled red, non-blanching

41
Q

How do full thickness burns appear

A

Dry, leathery, hard wound, non-blanching

42
Q

When are IV fluids required in burn patients

A
  • Children - if TBA >10%

- Adults - if TBA >15%

43
Q

How is the volume and rate of IV fluid administrated in burns patients

A

Parkland Formula = TBA% x weight x2ml

Half of the fluid is given over the first 8 hours. The remaining half is given over the following 16 hours.

44
Q

Who should be transferred to a burns centre

A
  • Need burn shock resuscitation
  • Face/hands/genitals affected
  • Deep partial thickness or full thickness burns
  • Significant electrical/chemical burns
45
Q

When are Escharotomies indicated

A

Circumferential full-thickness burns to torso or limbs

46
Q

Should burns patients receive antimicrobial prophylaxis

A

No

47
Q

At what depth do burns become relatively painless

A

Deep partial thickness burns as nerve endings are damaged

48
Q

How may full thickness burns be repaired

A

Split-thickness skin graft

49
Q

What is the characteristic appearance of Seborrhoeic keratosis

A
  • Multiple lesions over face and trunk with greasy overlying scale
  • Can occur at any site other than palms/soles/lips
50
Q

How is seborrhoeic keratosis managed

A
  • Can be left

- Shave excision

51
Q

What is the characteristic appearance of Dermatofibroma and who do they typically affect

A
  • Pink, firm, papular lesions
  • Usually affect the extremities of young adults
  • Must be distinguished from amelanotic melanoma
  • Larger than they appear
52
Q

Where are epidermoid cysts typically found

A

Face, trunk, neck

53
Q

What is the characteristic appearance of an epidermoid cyst

A
  • Central punctum
  • Fixed to skin but mobile on subcutaneous tissue
  • Discharge cheesy material
54
Q

What are the two types of epidermoid cyst lining

A
  1. Normal epidermis (Epidermoid cyst)

2. Outer root sheath of hair follicle (Pilar cyst)

55
Q

How are epidermoid cysts managed and why

A
  • Total surgical excision of the cyst and overlying punctum

- Because the scarring that results from an infected cyst

56
Q

Describe Gardner syndrome

A

Autosomal dominant condition that presents with:

  • Multiple epidermal cysts
  • Osteomas of the jaw
  • GI polyps
57
Q

What precaution must be taken with dermoid cysts in the facial midline

A

Risk of intracranial extension - must assess with imaging prior to excision

58
Q

What is actinic keratosis

A
  • Solar keratosis
  • Crusty lesions at sun-exposed areas
  • Risk of SCC transformation
59
Q

What is Bowen’s disease

A
  • Squamous cell carcinoma in situ

- Reddish plaque lesion typically seen on the legs of elderly women

60
Q

What are the histological features of Bowen’s disease

A
  • Nuclear pleomorphism
  • Apoptosis
  • Abnormal mitoses
61
Q

What is the characteristic appearance of keratocanthoma

A

Rapidly growing mass of squamous cells with a keratin plug

62
Q

How are keratocanthomas treated

A
  • Curretage and cautery

- Formal excision biopsy if diagnostic doubt

63
Q

Describe a pyogenic granuloma

A

Friable overgrowth of granulation at sites of minor trauma. Bleeding on contact is common.

64
Q

What is the most common skin malignancy

A

BCC (Rodent ulcer)

65
Q

What syndrome predisposes to BCC

A

Gorlin syndrome

66
Q

What is the standard excision margin for BCC

A

3mm

67
Q

How are SCCs classified

A

Broder classification - degree of cell differentiation

68
Q

What are the standard SCC excision margins

A
  • Low-risk (<20mm) = 4mm

- High-risk (>20mm) = 6mm

69
Q

How do Merkel cell tumours present

A
  • Red dermal nodules 2-4mm in diameter
  • Lymph and distant metastases is very common
  • Rapidly progressive
70
Q

Melanoma is a tumour of…

A

Melanocytes

71
Q

GOLD standard investigation for melanoma

A

Excision biopsy

72
Q

What determines the excision margins for melanoma

A

Breslow thickness

73
Q

Outline the required melanoma excision margins

A
  • 0-1mm thick = 1cm
  • 1-2mm thick = 1-2cm
  • 2-4mm = 2-3cm
  • > 4mm = 3cm
74
Q

What type of naevus may resemble melanoma

A

Spitz naevus

75
Q

In which melanoma patients should lymph node FNA be performed

A

Those who are clinically node positive

76
Q

In which melanoma patients should sentinel node biopsy be considered

A

All those who are stage 1b or greater (<1mm thick, ulceration, mitotic rate >1)

Trauma (3 decks)

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