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Clinical Surgery > Plastic Surgery > Flashcards

Plastic Surgery Flashcards

1
Q

What are the stages of wound healing?

Timing?

A
  1. Haemostasis phase (Immediately within minutes, coagulation)
  2. Inflammatory phase (Days 1 – 4, cellular recruitment & increased vascular permeability, damage limiting)
  3. Proliferative stage (Days 4 – Week 3, reparative phase – granulation tissue & collagen)
  4. Remodelling Phase (Week 3 onward, maturation & strengthening)
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2
Q

Primary vs. Secondary Healing

A

● Primary intention: the two edges of skin are brought together and healing occurs rapidly between the two sides

● Secondary intention: if the two wound edges cannot be brought together or are deliberately left open (because of sepsis or swelling), the wound is kept clean and
granulation tissue forms in the gap (e.g. wound dehiscence); eventually this fills the space and the wound heals slowly by secondary intention.

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3
Q

What accelerates the process of healing?

A

● Good blood supply

● No foreign material or infection

● No excess tension of the wound/skin

● Accurate apposition (aligning of the skin)

● Platelet-rich plasma (PRP) + platelet-rich fibrin matrix (PRFM) provide growth factors

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4
Q

Factors Affecting Wound Healing?

A
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5
Q

Describe Hypertrophic Scarring vs. Keloid Scarring

  • Locations?
A

Hypertrophic Scarring- Red, raised enlarged scar remaining within the boundaries of original injury

  • Areas of tension: back, shoulder, sternum

Keloid Scarring – Red raised often pruritic scar extending beyond boundaries of original injury

  • Sternum, deltoid, earlobes, more common in darker skin groups
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6
Q

Scar Treatments?

A

Pressure garments

Silicone

Steroid injections

Surgical excision

Radiation therapy (Keloid)

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7
Q

Properties of an Ideal Dressing?

A

Maintain moist environment

Remove exudate

Act as a barrier to microorganisms

Leave no foreign particles

Provide mechanical protection

Be easy to remove w/o trauma to wound

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8
Q

Benefits of Negative Pressure Wound Therapy

A
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9
Q

Contraindications to Negative Pressure Wound Therapy

A

Exposed vital structures

Ongoing infection

Devitalized/malignant tissue

Adhesive allergy

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10
Q

Graft vs. Flap

A

Graft – A segment of tissue detached from its blood supply at the donor site, transferred to another site, and dependent upon revascularisation from the recipient site.

Flap – A segment of tissue transferred from one site to another with its vascular supply (a pedicle) intact.

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11
Q

What is the reconstructive ladder?

A

The principle of the reconstructive ladder is to outline a hierarchy of different reconstructive techniques of increasing complexity

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12
Q

Assessment of Depth of Burns

A

Severity of the burn will depend on it depth, size, location sensation and patient comorbidities.

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13
Q

___________________:

Color: Red

Blisters: No

Capillary Refill: Present

Sensation: Present

Healing: Yes

A

Epidermal

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14
Q

___________________:

Color: Pale Pink

Blisters: Yes (Small)

Capillary Refill: Present

Sensation: Painful

Healing: Yes

A

Superficial Dermal

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15
Q

___________________:

Color: Dark Pink

Blisters: Yes (Large)

Capillary Refill: Sluggish

Sensation: Painful; Sensation to light touch may be ost

Healing: Usual

A

Mid-Dermal

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16
Q

___________________:

Color: Blotchy Red

Blisters: Sometimes

Capillary Refill: Absent

Sensation: Absent

Healing: No

A

Deep Dermal

17
Q

___________________:

Color: White (leathery)

Blisters: No

Capillary Refill: Absent

Sensation: Absent

Healing: No

A

Full Thickness

18
Q

Characteristics of Superficial Burns

A

Blisters, wet, red and sensate

19
Q

Characteristics of Superficial Demrna/Deep Dermal Burns

A

Can be wet or dry (depending on depth)

Often fixed staining of dermis

Usually sensate, but sensation ↓ as depth ↑

19
Q

Characteristics of full thickness burns

A

Dry

Creamy white/leathery

Insensate

20
Q

Estimation of Total Body Surface Area of Burn

A
21
Q

Criteria for referral to burns unit

A

Inhalation injury

Burn >10% children, 15% adults

Any full thickness bruns >1%

Special Trauma Areas (Face/Perineum)

Polytrauma

Chemical/Electrical Burns

22
Q

First aid of burns?

A

Stop the burning process
Cool the burn wound

First aid is effective only within the first three hours from the time of the burn

23
Q

Management of thermal burns?

A
24
Q

Hypercatabolic Calorie Requirements for Burns

A

Curreri formula:

  • Adults: 25 kcal/kg + 40kcal x % burn
  • Children: 40-60 kcal/kg
25
Q

Primary Survey BURNS

A

A Airway Maintenance and C-Spine Control

B Breathing and Ventilation

C Circulation with Haemorrhage Control

D Disability – neurological status

E Exposure and environmental control

F Fluid Resuscitation

26
Q

Secondary Survey BURNS

A
27
Q

Further Management of Burns

A

Analgesia

Tetanus immunization

Enteral Feeding

DVT prophylaxis

Proton Pump Inhibitors (Reduce incidence of stress ulceration)

28
Q

Fluid Resuscitation for Burns

  • Formula to calculate?
  • How is it delivered
  • Monitoring?
A

Fluid resuscitation is indicated in adults with >15% TBSA burns and children with >10% TBSA burns

Burn injury results in fluid sequestration into the area of injury. This process becomes generalized when the size of the burn exceeds 20-30% TBSA. Oedema combined with continuing evaporative loss from the moist burn surface results in decreased plasma volume, which in turn leads to intravascular hypovolaemia.

Hartmann’s Solution is the internationally accepted choice for initiation of resuscitation

Parkland Formula: 3-4ml Hartmann’s Solution x Bodyweight (kg) x % Burn Surface Area

  • calculated volume given over first 24 hours from burn
  • half given in the first 8, half in the remaining 16 hours
  • Calculation of fluid requirements from TIME OF BURN not presentation

Adequacy of fluid resuscitation should be monitored by urine output (Insert a urinary catheter)

29
Q

Complications of Burns?

A
30
Q

What is Carpal Tunnel Syndrome?

Borders?

A

Carpal tunnel syndrome is the compression of the median nerve within the carpal tunnel. Presents as numbness/pain in distribution of median nerve

Borders

  • Carpal Bones (deep)
  • Transverse carpal ligament (roof)
  • Pisiform/Hammate (ulnar)
  • Saphoid/Lunate (radial)

Carpal tunnel syndrome is the most common nerve entrapment syndrome. Commoner in females 3:1

Clinical Surgery (20 decks)

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