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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
What is an 'axial' flap
Flap with an identifiable source vessel running within the flap
26
What is a 'local' flap
Flap that is adjacent to the defect to be reconstructed
27
What are common examples of local flaps
- Facial cutaneous flaps | - Z-plasty
28
What is a Z-plasty used for
Managing scar contractures and reorientation of scars
29
What is a 'regional' flap
A flap moved from a donor site nearby but not necessarily adjacent to the defect e.g. latissimus dorsi flap in breast reconstruction
30
What is a 'free' flap
A flap that is detached from its blood supply at the donor site and reconnected to vessels at the recipient site
31
What limits the size of flaps
The territory of its blood supply
32
Describe the latissimus dorsi flap and its uses
- Based on latissiumus dorsi and the thoracodorsal vessels | - Used for breast and chest wall reconstruction
33
Describe scapular and parascapular flaps and their uses
- Flaps based on the circumflex scapular arterial system | - Regional flap for axillary reconstruction
34
Describe radial forearm flaps and their uses
- 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
Describe rectus abdominis/DIEP flaps and their uses
- Flaps based on inferior epigastric arterial system | - Commonly used in breast, chest and pelvic reconstruction
36
Describe gracilis flaps and their uses
- Based on profunda femoris or medial circumflex femoral arterial systems - Regional flap used for perineal reconstruction - Can also be used for biceps reconstruction
37
Describe fibular flaps and their uses
- Based on the peroneal arterial system - Useful for long segment of vascularised bone - Used in mandibular reconstruction
38
How do superficial/epidermal burns appear
Red, moist, blanching
39
How do superficial partial thickness burns appear
Pale, dry, blanching
40
How do deep partial thickness burns appear
Mottled red, non-blanching
41
How do full thickness burns appear
Dry, leathery, hard wound, non-blanching
42
When are IV fluids required in burn patients
- Children - if TBA >10% | - Adults - if TBA >15%
43
How is the volume and rate of IV fluid administrated in burns patients
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
Who should be transferred to a burns centre
- Need burn shock resuscitation - Face/hands/genitals affected - Deep partial thickness or full thickness burns - Significant electrical/chemical burns
45
When are Escharotomies indicated
Circumferential full-thickness burns to torso or limbs
46
Should burns patients receive antimicrobial prophylaxis
No
47
At what depth do burns become relatively painless
Deep partial thickness burns as nerve endings are damaged
48
How may full thickness burns be repaired
Split-thickness skin graft
49
What is the characteristic appearance of Seborrhoeic keratosis
- Multiple lesions over face and trunk with greasy overlying scale - Can occur at any site other than palms/soles/lips
50
How is seborrhoeic keratosis managed
- Can be left | - Shave excision
51
What is the characteristic appearance of Dermatofibroma and who do they typically affect
- Pink, firm, papular lesions - Usually affect the extremities of young adults - Must be distinguished from amelanotic melanoma - Larger than they appear
52
Where are epidermoid cysts typically found
Face, trunk, neck
53
What is the characteristic appearance of an epidermoid cyst
- Central punctum - Fixed to skin but mobile on subcutaneous tissue - Discharge cheesy material
54
What are the two types of epidermoid cyst lining
1. Normal epidermis (Epidermoid cyst) | 2. Outer root sheath of hair follicle (Pilar cyst)
55
How are epidermoid cysts managed and why
- Total surgical excision of the cyst and overlying punctum | - Because the scarring that results from an infected cyst
56
Describe Gardner syndrome
Autosomal dominant condition that presents with: - Multiple epidermal cysts - Osteomas of the jaw - GI polyps
57
What precaution must be taken with dermoid cysts in the facial midline
Risk of intracranial extension - must assess with imaging prior to excision
58
What is actinic keratosis
- Solar keratosis - Crusty lesions at sun-exposed areas - Risk of SCC transformation
59
What is Bowen's disease
- Squamous cell carcinoma in situ | - Reddish plaque lesion typically seen on the legs of elderly women
60
What are the histological features of Bowen's disease
- Nuclear pleomorphism - Apoptosis - Abnormal mitoses
61
What is the characteristic appearance of keratocanthoma
Rapidly growing mass of squamous cells with a keratin plug
62
How are keratocanthomas treated
- Curretage and cautery | - Formal excision biopsy if diagnostic doubt
63
Describe a pyogenic granuloma
Friable overgrowth of granulation at sites of minor trauma. Bleeding on contact is common.
64
What is the most common skin malignancy
BCC (Rodent ulcer)
65
What syndrome predisposes to BCC
Gorlin syndrome
66
What is the standard excision margin for BCC
3mm
67
How are SCCs classified
Broder classification - degree of cell differentiation
68
What are the standard SCC excision margins
- Low-risk (<20mm) = 4mm | - High-risk (>20mm) = 6mm
69
How do Merkel cell tumours present
- Red dermal nodules 2-4mm in diameter - Lymph and distant metastases is very common - Rapidly progressive
70
Melanoma is a tumour of...
Melanocytes
71
GOLD standard investigation for melanoma
Excision biopsy
72
What determines the excision margins for melanoma
Breslow thickness
73
Outline the required melanoma excision margins
- 0-1mm thick = 1cm - 1-2mm thick = 1-2cm - 2-4mm = 2-3cm - >4mm = 3cm
74
What type of naevus may resemble melanoma
Spitz naevus
75
In which melanoma patients should lymph node FNA be performed
Those who are clinically node positive
76
In which melanoma patients should sentinel node biopsy be considered
All those who are stage 1b or greater (<1mm thick, ulceration, mitotic rate >1)

Trauma (3 decks)

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