Plastic Surgery Flashcards
What are the stages of wound healing?
Timing?
- Haemostasis phase (Immediately within minutes, coagulation)
- Inflammatory phase (Days 1 – 4, cellular recruitment & increased vascular permeability, damage limiting)
- Proliferative stage (Days 4 – Week 3, reparative phase – granulation tissue & collagen)
- Remodelling Phase (Week 3 onward, maturation & strengthening)
Primary vs. Secondary Healing
● 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.
What accelerates the process of healing?
● 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
Factors Affecting Wound Healing?
Describe Hypertrophic Scarring vs. Keloid Scarring
- Locations?
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
Scar Treatments?
Pressure garments
Silicone
Steroid injections
Surgical excision
Radiation therapy (Keloid)
Properties of an Ideal Dressing?
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
Benefits of Negative Pressure Wound Therapy
Contraindications to Negative Pressure Wound Therapy
Exposed vital structures
Ongoing infection
Devitalized/malignant tissue
Adhesive allergy
Graft vs. Flap
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.
What is the reconstructive ladder?
The principle of the reconstructive ladder is to outline a hierarchy of different reconstructive techniques of increasing complexity
Assessment of Depth of Burns
Severity of the burn will depend on it depth, size, location sensation and patient comorbidities.
___________________:
Color: Red
Blisters: No
Capillary Refill: Present
Sensation: Present
Healing: Yes
Epidermal
___________________:
Color: Pale Pink
Blisters: Yes (Small)
Capillary Refill: Present
Sensation: Painful
Healing: Yes
Superficial Dermal
___________________:
Color: Dark Pink
Blisters: Yes (Large)
Capillary Refill: Sluggish
Sensation: Painful; Sensation to light touch may be ost
Healing: Usual
Mid-Dermal
___________________:
Color: Blotchy Red
Blisters: Sometimes
Capillary Refill: Absent
Sensation: Absent
Healing: No
Deep Dermal
___________________:
Color: White (leathery)
Blisters: No
Capillary Refill: Absent
Sensation: Absent
Healing: No
Full Thickness
Characteristics of Superficial Burns
Blisters, wet, red and sensate
Characteristics of Superficial Demrna/Deep Dermal Burns
Can be wet or dry (depending on depth)
Often fixed staining of dermis
Usually sensate, but sensation ↓ as depth ↑
Characteristics of full thickness burns
Dry
Creamy white/leathery
Insensate
Estimation of Total Body Surface Area of Burn
Criteria for referral to burns unit
Inhalation injury
Burn >10% children, 15% adults
Any full thickness bruns >1%
Special Trauma Areas (Face/Perineum)
Polytrauma
Chemical/Electrical Burns
First aid of burns?
Stop the burning process
Cool the burn wound
First aid is effective only within the first three hours from the time of the burn
Management of thermal burns?
Hypercatabolic Calorie Requirements for Burns
Curreri formula:
- Adults: 25 kcal/kg + 40kcal x % burn
- Children: 40-60 kcal/kg
Primary Survey BURNS
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
Secondary Survey BURNS
Further Management of Burns
Analgesia
Tetanus immunization
Enteral Feeding
DVT prophylaxis
Proton Pump Inhibitors (Reduce incidence of stress ulceration)
Fluid Resuscitation for Burns
- Formula to calculate?
- How is it delivered
- Monitoring?
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)
Complications of Burns?
What is Carpal Tunnel Syndrome?
Borders?
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
