Plastic Surgery Flashcards
What organisms are characteristic of cat bites?
Pasteurella
What organism is worrisome in ~15% dog bites?
Capnocytophagia canimoris
- can cause disseminated sepsis in elderly and aplenic patients.
- Gram negative.
What are the ideal timing of laceration closures for hand/leg, trunk and face?
Hand/leg 8 hours
What is the timing of suture removal for face, scalp/trunk, extremities/joints?
face: 5 days
scalp/trunk: 7 days
extremities/joints: 10-14 days
What are the contents of the carpel tunnel? (10 structures)
- Median n.
- Flexor digitorium profundus (4)
- Flexor digitorum superficialis (4)
- Flexor pollicis longus
What are the intrinsic m. of the hand? (5 categories)
- Thenar m (abductor pollicus brevis, opponens pollicis, flexor pollicis brevis)
- Hypothenar (opponens digiti minimi, flexor digiti minimi, abductor digiti minimi)
- Adductor pollicus
- Lumbricals
- Interossei
What is the thenar m. innervated by?
Median n. in some cases partially by the ulnar.
What are the flexors of the hand?
Flexor pollicus longus/brevis Flexor carpi radialis Flexor retinaculum Flexor digitorum Flexor digitorum profundus Flexor digitorum superficialis Palmaris longus Flexor carpi ulnaris Flexor digiti minimi
The extensor tendons of the hand are separated by how many fibro-osseous canals or compartments?
6
What are the 9 extensors of the hand?
Abductor pollicus longus
Extensor pollicus brevis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor pollicus longus
Extensor digitorum (communis) Extensor indicis (proprius)
Extensor digiti minimi
Extensor carpi ulnarus
What are the 4 classic signs (Kanavel) of flexor tenosynovitis?
- Position of flexion
- Pain on passive extension
- Fusiform swelling
- Tenderness on palpation of synovial sheath.
What is the motor and sensory function of the radial n.?
Motor: wrist extension
* in hand: purely sensory: Dorsum only
What layer does superficial partial thickness burns involve?
Deep partial thickness?
- Epidermis, Dermis (the papillary layer) sparing the hair follicles, sebaceous and sweat glands.
- Deep partial thickness involves the reticular layer of the dermis (involving hair follicles, sweat glands etc)
What physical exam findings are characteristic of superficial burns?
Erythema, very painful - sunburn like
NO blisters
Physical exam findings of superficial partial thickness burns?
- Erythema
- Blistering
- Very painful
- Cap refill present.
What time period should superficial partial thickness burns heal?
14-21 days (2-3 weeks)
Physical exam findings of deep partial thickness burns?
- May have blisters
- Yellow/white (not erythematous)
- NO cap refill
- No sensation
Hard to distinguish from full thickness burns
What time period should deep partial thickness burns heal?
3 weeks - 2 months
May need surgical intervention and skin grafting
Physical exam findings of full thickness burns (formerly 3rd degree)?
- Charred skin
- Pale
- Painless
- Leather like
- Goes into the subcutaneous fat tissue
ALL need skin grafting bc all dermal elements are destroyed.
Physical exam findings of 4th degree burns?
Extends to muscle and bone.
- Sometimes req amputation or extensive reconstruction
What is the parkland formula?
4cc x Kg x % BSA burn (not including superficial burns)
Ringers Lactate
- 1/2 given in first 8 hours, rest over 16 hours.
- U/O goal: 0.5-1 cc/kg/hr
What is tenosynovitis?
Inflammation of the synovium surrounding tendons
The synovium is a thin layer of tissue only a few cells thick which lines the joints and tendon sheaths. The synovium acts to control the environment within the joint and tendon sheath. It does this in two ways: first, it acts as a membrane to determine what can pass into the joint space and what stays outside; second, the cells within the synovium produce substances that lubricate the joint.
