Plastic Surgery Flashcards
Discuss the rule of 9s for estimating % total body surface area of burn
9% - torso - abdomen - leg 4.5% - arm - head 1% - groin
Severity
- mild <15%
- moderate 15-25
- severe >25%
Discuss the management of inhalation injuries
- lead to airway inflammation and obstruction
- can lead to pulmonary edema and insufficiency in 2-3 days
Presentation - hoarsenness, persistent cough
- stridor
- carbonaceous sputum
- soot in airway
Investigation - direct bronchoscopy
- arterial blood gas
- ECG
Management - supplemental oxygen
- prophylactic and early intubation
Discuss the fluid resuscitation principles for burn injuries
Parkland formula (RL or NS)
- 4mL/kg for each % TBSA burned over course of 24 hour where 1/2 delivered in first 8 hours and other 1/2 is delivered in subsequent 16 hours
- at >30hrs D5W to maintain normal sodium
Discuss the management of CO poisioning
Presentation - headache - confusion - coma - arrhythmia - high HbCO Management - hyperbaric chamber
Discuss the wound management for burns
Prevention of Infection
- topical silver sulfadiazine dressings applied
- gram positive bacteria from day 1-3 and then gram negative from day 3-5
Irrigation and Debridement
- remove sloughed or necrotic skin
- 1st dressing is non-adherent mesh gauze -> 2nd is fluffed dry gauze -> 3rd is layer of elastic gauze roll
Discuss the stages of wound healing
Inflammatory Reactive Stage (Day 1-6)
- inflammation prevents further damage
- debris is cleared by neutrophils day 1-2 and macrophages 2-4
- hemostasis through vasoconstriction and platelet plug
Proliferative Regenerative Phase (Day 4 to Week 3)
- macrophage secrete growth factors that recruit fibroblasts which initiate re-epithiliasation and matrix synthesis
Remodelling Maturation Phase (3 week to 1 year)
- increase collagen deposition to form crosslinks
Discuss the types of wound healing
Primary Closure
- wound edges brought together by sutures, staples in a clean, fresh wound
Secondary Closure
- wound wedges brought together spontaneously by the body
- best for dirty or large wounds
Tertiary closure
- wound is left open but brought together by external mechanism
- done so can be cleaned repeatedly
Discuss the presentation and management of paronychia
Pathogenesis - acute from staph aureus - chronic related to candida Presentation - swelling and inflammation of tissue surrounding fingernail Management - incision and drainage if abscess - warm compress - Keflex 500mg
Discuss the presentation and management of a felon
Pathophysiology
- paronychia with puncture leading to abscess in fingertip
Presentation
- inflammation of finger tip with intense swelling
Management
- incision and drainage
- cloxacillin 500mg Q^
Discuss the presentation and management of flexor tendor sheath infection
Pathophysiology
- penetrating injury leading to infection of tendon sheath
Presentation
- Kanavel’s 4 cardinal signs: point tenderness along flexor tendor sheath, severe pain on passive extension of DIP, fusiform swelling of entire digit, flexed posture
Treatment
- surgical emergency requiring incision and drainage in OR
Discuss the presentation and management of a deep palmar space infection
Pathophysiology
- infection in the thenar, midpalmar or hypothenar space
Presentation
- Thenar: abducted thumb and fullness within dorsal webspace with pain in adduction
- Midpalmar: loss of normal concavity, 3-4 partially flexed posture and pain on passive extension of 3-4
- Hypothenar: just swelling along dorsal and palmar aspect
Management
- surgical emergency requirement incision and drainage
Discuss the presentation and management of carpal tunnel syndrome
Pathophysiology
- compression of median nerve as it travels through the flexor retinaculum
Presentation
- decreased sensation in median nerve distribution
- atrophy of thenar eminence
- hand numbness at night relieved with shaking or dangling
- Tinel and Phalen positive
Investigation
- nerve conduction study
Management
- conservative with wrist splint and activity modification
- NSAID
- surgical decompression
