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Human Health and Disease > Plastic Surgery > Flashcards

Plastic Surgery Flashcards

1
Q

Types of Plastic Surgery

A
  • cosmetic
  • reconstructive
  • bariatric
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2
Q

types of reconstructive plastic surgery

A
  • cancer
  • burns
  • trauma
  • infection
  • congenital (present from birth)
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3
Q

Functions of the skin

A
  1. protection from UV radiation, mechanical and chemical stress
  2. reduce evaporation of bodily fluids
  3. thermoregulation
  4. immunological Function
  5. sensory function
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4
Q

how does the skin contribute to thermoregulation?

A

the skin is able to control sweating and blood flow

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5
Q

structure of the skin

A
  1. epidermis
  2. Dermis
  3. Subcutis (technically not part of the skin and is an underlying tissue)
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6
Q

Epidermis

A
  • is 95% keratinocytes
  • has melanocytes
  • has langerhans cells
  • NO blood vessels (gets nourishment through dermal capillaries)
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7
Q

keratinocytes

A
  • cells that form a barrier against heat, UV, water loss, bacteria, fungi, virus, parasites
  • they have fast turn over
  • they migrate from the basal layer (this allows for cell differentiation)
  • they secrete keratin and lipids which form the ECM
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8
Q

keratin

A

a protein that causes cells to be tough and pack together

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9
Q

melanocytes

A
  • cells that produce melanin (a pigment in the skin that leads to color)
  • these are found deep in the epidermis
  • they can pass melanin to other cells
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10
Q

Langerhans cells

A
  • antigen presenting cells

- they belong to the skin immune system

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11
Q

Dermis

A

A thick layer of living cells below the epidermis

  • connective tissue
  • tensile strength and elasticity
  • hair follicles
  • sweat glands
  • sebaceous glands
  • blood vessels
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12
Q

Subcutis

A
  • not part of the skin but is an underlying tissue (rich in adipose)
  • allows for the attachment of skin to muscle or bone
  • has blood vessels
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13
Q

how do wounds heal?

A
  1. hemostasis
  2. inflammatory phase
  3. proliferation phase
  4. remodeling phase
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14
Q

Hemostasis:

A

this is used to prevent and stop bleeding

-vessel constriction and blood clot formation

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15
Q

what happens during the inflammatory phase of healing of wounds?

A
  • vasodilation with immune cell migration
  • clearing of wound debris, bacteria, and dead cells
  • causes pain, swelling, redness and heat
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16
Q

what happens during the proliferation phase of healing of wounds?

A
  • granulation tissue (new connective tissue with microscopic blood vessels that are used to fill wounds)
  • fibroblasts (produce the structural framework of animal tissues)
  • myofibroblasts (differentiated fibroblasts that contain actin)
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17
Q

what happens during the remodeling phase of healing of wounds?

A
  • this begins roughly 3 weeks after and can last up to two years
  • reshaping collagen fibers into more orderly pattens
  • reducing the number of capillaries
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18
Q

What do you need to do for patients with minor wounds?

A
  1. PMS
  2. Tetanus Vaccination status
  3. Pain management
  4. suturing
  5. antibiotics
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19
Q

PMS

A
  1. pulsation
    - is there a pulse
  2. motor function
    - can they wiggle toes or fingers or is the wound affecting ability
  3. sensation
    - do they feel anything near or around the wound (pinch the area and ask where they feel it)
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20
Q

Suturing

A
  • used to hold body tissues together after a wound or surgery
  • surgeons try to do this in the natural lines of the skin to leave minimal scarring
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21
Q

primary closure

A

this is when the wound is cleaned and closed within 8 hours

22
Q

primary delayed closure

A
  • you wait 3-4 days before closure, treat with a bandage
  • almost equal results with primary closure
  • used for things contaminated for more than 8 hours or bite wounds
23
Q

secondary closure

A
  • the wound is left open
  • this is for people with thin skin or bad skin conditions
  • this can cause massive scarring
  • risk of infection
24
Q

tensions free closure

A

incisions in the relaxed skin tension lines

25
Q

ellipsoid Excision

A
  • cuts all the way around the wound to avoid skin tags (“dog ears”)
  • helps make the wound look nicer
26
Q

Atraumatic technique

A

this is when the skin is in bad condition or something is wrong
- you are gentle and only make holes where the needles need to go in

27
Q

what are the optimal conditions for patients?

A
  • don’t want smokers (more difficult healing)
  • it is important to know if someone has diabetes because they are not good healers
  • bad blood vessels is important to be aware of because you may need help building vascularization in the area
28
Q

1st Degree Burns

A
  • epidermis is affected
  • focus on:
    • pain management
    • moisturizing cream/ after sun
    • no further treatment
  • increases risk of skin cancer in the region
29
Q

2nd Degree burns

A
  • dermis is affected
  • blisters form (caused by damage to vessels and tissues)
  • very painful
  • can be superficial or deep
30
Q

Superficial 2nd degree Burn

A

-heals without scaring within 14 days
-no surgical treatment required
(sun burn causing blisters is almost always going to be superficial)

31
Q

Deep 2nd degree burn

A
  • healing time is greater than 3 weeks with scarring
  • surgical treatment is required
  • stem cells affected in the basal layer of the dermis, around the glads and hair sacs
32
Q

3rd degree burns

A
  • the subcutis is affected
  • skin is blackened with bloody blisters
  • painless within the area
  • no healing potential
  • required surgical intervention
  • can be down to the bone
33
Q

Primary intervention for burns

A
  • put lukewarm water on it
  • this helps stop the reaction from occurring
  • helps to reduce pain
  • rinse for 20-30 minutes
  • reduces damage to the area
34
Q

Rule of Nine

A
  • an evaluation tool to see how much of the body (in a percentage) is affected and helps guide what treatment will occur
  • this is not used for 1st degree burns
  • the surface of the hands is considered 1% of the body
  • each leg is 18%
  • each area is 9%
  • chest is 9%
  • abdomin is 9%
  • head is 9%
  • upper back is 9%
  • lower back is 9%
35
Q

When do adults need to be hospitalized vs children?

A
  • adults need to be hospitalized if more than 20% of their body is burned
  • children need to be hospitalized if more than 10% of their body is burned
36
Q

circumferential wound

A
  • if the wound goes all the way around the arm, they need o be hospitalized
  • the wound can tighten up and we don’t want that
37
Q

when do you need to transfer to a hospital with a special unit?

A
  • Hands or Face
  • Deep or large Burns
  • Large Joints or circumferential
  • abuse (both children and prostitutes)
  • comorbidity (having co-occuring conditions) or pregnancy
38
Q

What happens once a burn victim is admitted to the hospital?

A
  • they are put into a sterile, heated room
  • pain relief (morphine)
  • fluids,PVC and KAD
    - parkland formula
  • blood sample
  • prophylactic intubation
  • necrotomy and covering wound
39
Q

PVC

A

peripheral venous catheter

40
Q

KAD

A

bladder catheter

41
Q

Parkland formula

A
  • 4mL x TBSA x Bodyweight in Kg
  • half in the first 8 hours and half in the next 16 hours
  • there is risk of hypovolemic shock
  • will use a bone if you cannot find a good vein
42
Q

why is it important to take a blood sample?

A
  • check for creatine kinase (important because risk rhabdomyolysis and shock kidney) kidney shock = not good
  • CO intoxication (will treat with 100%O2 in a hyperbaric chamber)
43
Q

why is it important to heck prophylactic intubation?

A

If the patient inhaled any of the burn, it could mean that the throat is going to swell and this will block respiration

  • if the throat swells, this will also prevent an intubation tube from being placed
  • can check the nose hairs or soot in the mouth
44
Q

split-skin grafts

A

This is containing the epidermis and then part of the dermis

  • can be thin, medium and thick
  • removed with a dermatome
  • the skin will be peeled up and then will curl up slightly, but is able to be stretched
  • a machine is used to punch small holes into it and this allows for stretching to occur
45
Q

advantages of split-skin grafts

A
  • heals easier than full skin

- can cover large areas (meshing allows for an increase up to six times the original size

46
Q

disadvantages of split-skin grafts

A
  • thin and medium dries up easily (there are no sebaceous glands so cream is needed)
  • less optimal cosmetic and functional results
  • significant shrinking during healing
47
Q

Full- skin graft

A

this contains the epidermis and then the entire dermis

  • the donor spot must be directly closable with suture (need to think about where it is coming from and where it is going)
  • shrinks about 40% after the excision but can be stretched so that 20% is regained
  • there is minimal shrinking during healing
  • the flap has its own blood supply
48
Q

types of flaps

A

They are classified based on type of blood supply, tissue, or how they are transferred

  • random flap
  • axial flap
49
Q

random flap

A

no clearly defined blood supply

50
Q

axial flap

A
  • well defined blood supply with a stem and both arterial and venous vessels.
  • when this is completely removed from the donor cite it is known as a free flap
51
Q

types of skin grafts

A
  • Z or Y/V Plastic (used to cover joints or fingers)

- transposition plastic(moving a flap around an axis to some place in close proximity)

Human Health and Disease (11 decks)

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