Plastic Surgery, C68 P572-578 Flashcards
Define the following terms:
Blepharoplasty
P572
Eyelid surgery—removing excess
skin/fat
Define the following terms:
Face lift
P572
Removal of excess facial skin via hairline/
chin/ear incisions
Define the following terms:
FTSG
P572
Full Thickness Skin Graft
Define the following terms:
Langer’s lines
P573 (picture)
Natural skin lines of minimal tension
(e.g., lines across the forehead), incisions
perpendicular to Langer’s lines result in
larger scars than incision parallel to the
lines
Define the following terms:
Mammoplasty
P573
Breast surgery (reduction/augmentation)
Define the following terms:
Polydactyly
P573
Extra fingers
Define the following terms:
Rhinoplasty
P573
Nose surgery, after trauma or cosmetic
Define the following terms:
STSG
P573
Split Thickness Skin Graft
Define the following terms:
Syndactyly
P573
Webbed fingers
WOUND HEALING
What are the phases of
wound healing?
P573
Think: “In Every Fresh Cut” = IEFC:
1. Inflammation 2. Epithelialization 3. Fibroplasia 4. Contraction
WOUND HEALING What are the actions of the following phases: Inflammation? P574
Vasoconstriction followed by vasodilation,
capillary leak
WOUND HEALING What are the actions of the following phases: Epithelialization? P574
Epithelial coverage of wound
WOUND HEALING What are the actions of the following phases: Fibroplasia? P574
Fibroblasts and accumulation of collagen,
elastin, and reticulin
WOUND HEALING What are the actions of the following phases: Wound contraction? P574
Myofibroblasts contract wound
WOUND HEALING What is the maximal contraction of a wound in mm/day? P574
0.75 mm/day
EPITHELIALIZATION What degree of bacterial contamination prevents epithelialization? P574
> 100,000 organisms/gm tissue (10(5))
EPITHELIALIZATION In which structures does the epithelium grow from superficial burns/wounds? P574
Epithelial lining of sweat glands and hair
follicles
EPITHELIALIZATION
In full-thickness burns?
P574
From wound margins, grows in 1 cm
from wound edge because no sweat
glands or hair follicles remain; this
epithelium has no underlying dermis
EPITHELIALIZATION What malignant ulcer is associated with a longstanding scar/burn? P574
Marjolin’s ulcer (a.k.a. burn scar
carcinoma)
WOUND CONTRACTION
What are myofibroblasts?
P574
Specialized fibroblasts that behave like
smooth muscle cells to pull the wound
edges together following granulation
WOUND CONTRACTION
Which contracts more: an
STSG or an FTSG?
P574
STSG contracts up to 41% in surface
area, whereas an FTSG contracts little,
if at all
WOUND CONTRACTION
What is granulation tissue?
P575
Within 4 to 6 days after an open wound, development of capillary beds and fibroblasts provides a healthy base for epithelial growth from wound edges; this tissue also resists bacterial infection
WOUND CONTRACTION
Name the local factors that
impair wound healing.
P575
Hematoma, seroma, infection, tight sutures,
tight wrap, movement/disturbance of the
wound (i.e., poking it with a finger)
WOUND CONTRACTION
What generalized conditions
inhibit wound healing?
P575
Anemia Malnutrition Steroids Cancer Radiation Hypoxia Sepsis
WOUND CONTRACTION
What helps wound healing
in patients taking steroids?
P575
Vitamin A is thought to counteract the
deleterious effect of steroids on wound
healing
WOUND CONTRACTION When does a wound gain more than 90% of its maximal tensile strength? P575
After ≈6 weeks
WOUND CONTRACTION
Define the following terms:
Laceration
P575
Jagged wound
WOUND CONTRACTION
Define the following terms:
Abrasion
P575
Superficial skin removal
WOUND CONTRACTION
Define the following terms:
Contusion
P575
Bruise without a break in the skin
WOUND CONTRACTION
Define the following terms:
Hypertrophic scar
P575
Hypertrophic scar within original wound
margins
WOUND CONTRACTION
Define the following terms:
Keloid
P575
Proliferative scar tumor progressively
enlarging scar beyond original wound
margins
WOUND CONTRACTION
Why not clean lacerations
with Betadine®?
P575
Betadine® is harmful to and inhibits
normal healthy tissue
WOUND CONTRACTION
What is the best way to
clean out a laceration?
P575
Normal saline irrigation; remember,
“The solution to pollution is dilution”
SKIN GRAFTS
What is an STSG?
P576
Split thickness: includes the epidermis
and a variable amount of the dermis
SKIN GRAFTS
How thick is it?
P576
10/1000 to 18/1000 of an inch
SKIN GRAFTS
What is an FTSG?
P576
Full thickness: includes the entire
epidermis and dermis
SKIN GRAFTS
What are the prerequisites
for a skin graft to take?
P576
Bed must be vascularized; a graft to a
bone or tendon will not take
Bacteria must be <100,000
Shearing motion and fluid beneath the
graft must be minimizedSKIN GRAFTS
What is a better bed for a
skin graft: fascia or fat?
P576
Fascia (much better blood supply)
SKIN GRAFTS
How do you increase surface
area of an STSG?
P576
Mesh it (also allows for blood/serum to be removed from underneath the graft)
SKIN GRAFTS How does an STSG get nutrition for the first 24 hours? P576
Imbibition
FLAPS
Where does a random skin
flap get its blood supply?
P576
From the dermal-subdermal plexus
FLAPS
Where does an axial skin
flap get its blood supply?
P576
It is vascularized by direct cutaneous
arteries
FLAPS
Name some axial flaps and
their arterial supply
P576
Forehead flap—superficial temporal
artery; often used for intraoral lesions
Deltopectoral flap—second, third, and
fourth anterior perforators of the
internal mammary artery; often used
for head and neck wounds
Groin flap—superficial circumflex iliac
artery; allows coverage of hand and
forearm woundsFLAPS
What is the most common
cause of flap loss?
P577
Venous thrombosis
FLAPS
What is a simple
advancement flap?
P577 (picture
(see picture)
FLAPS
What is a rotational flap?
P577 (picture
(see picture)
FLAPS
What is a “free flap”?
P577
Flap separated from all vascular supply
that requires microvascular anastomosis
(microscope)
FLAPS
What is a TRAM flap?
P577
Transverse Rectus Abdominis Myocutaneous flap (see page 410)
FLAPS
What is a “Z-plasty”?
P577 (picture)
(see picture)
FLAPS
What is a “V-Y advancement
flap”?
P578 (picture)
(see picture)
