Plastic Surgery

Question 1

What are the four stages of wound healing?

Answer 1

1. Haemostasis (secs-mins): clot formation, vasospasm 2. Inflammation (mins-days): fight infection, remove debris 3. Proliferation (days-weeks): granulation tissue, angiogenesis, epithelialisation, scar formation 4. Maturation (weeks-years): collagen remodelling

Question 2

List the complications of wound healing.

Answer 2

Infection Keloid/hypertrophic scar Contractures Incisional hernia Dehiscence (wound rupture) Haematoma Marjolin’s Ulcer (SCC from chronic wound)

Question 3

How does a keloid scar differ from a hypertrophic scar?

Answer 3

Keloid: beyond borders of wound, does not resolve spontaenously, disorganised irregular collagen fibres Hypertrophic: limited to wound borders, resolves spontaenously, collagen loosely arranged

Question 4

What is the rule of nines for estimating %BSA in burns?

Answer 4

Each leg = 18% Each arm = 9% Torso front = 18% Torso back = 18% Head = 9% Perineum = 1% Palm of hand = 1%

Question 5

What is the Parkland formula?

Answer 5

4mL x weight x %BSA 50% given within first 8 hours, 50% given over remaining 16 hours

Question 6

What is the most painful depth of burn?

Answer 6

Superficial partial thickness burn

Question 7

What are the features of a deep partial thickness burn?

Answer 7

Thick-walled blisters, dull pain, bleeds/blanches slowly Injury extends to reticular dermis

Question 8

What are the indications for referral to a burns unit?

Answer 8

• Partial thickness >20% (>10% in young or old) - Full thickness >5% - Involvement of face, hands, feet, genetalia, major joints - Significant chemical or electrical burns - Inhalation injury or serious comorbidity

Question 9

Which organism is commonly implicated in impetigo?

Answer 9

Bullous: staph aureus Nonbullous: strep pyogenes

Question 10

Which organism is commonly implicated in folliculitis?

Answer 10

Staph aureus ‘Hot tub’ folliculitis = pseudomonas aeruginosa

Question 11

Which organism is commonly implicated in erysipelas?

Answer 11

Strep pyogenes

Question 12

Which organism is commonly implicated in cellulitis?

Answer 12

Staph aureus, strep pyogenes

Question 13

Which organism is commonly implicated in necrotising fascitis?

Answer 13

Type 1: multiple organisms Type 2: strep pyogenes

Question 14

What is clostridial myonecrosis also known as?

Answer 14

Gas gangrene

Question 15

What is Marjolin’s ulcer?

Answer 15

SCC arising from leg ulcers

Question 16

What are the excision margins for skin lesions based on Breslow’s thickness?

Answer 16

<1mm = 1cm excision

1-4mm = 2cm excision

>4mm = 3cm excision

Question 17

What is the most common site for BCC?

Answer 17

On the face, above the line from the edge of the mouth to the tragus

Question 18

What is the most common skin cancer?

Answer 18

BCC

Question 19

What are actinic or solar keratoses?

Answer 19

Patch of thick, scaly or crusted skin that may turn into an SCC if untreated.

Question 20

What is this lesion?

Answer 20

Squamous Cell Carcinoma

Question 21

What is this lesion?

Answer 21

Solar or actinic keratosis

Question 22

What is this lesion?

Answer 22

Malignant Melanoma

Question 23

What is this lesion?

Answer 23

Basal Cell Carcinoma

Question 24

What is this rash?

Answer 24

Multiple Seborrheic Kertaoses, called Leser-Trelat sign which is an ominous indicator of internal malignancy (paraneoplastic syndrome