Plastic Surgery Classifications Flashcards
Classification of deep inferior epigastric artery branching pattern.
Classification of congenital nevi.
- Small: < 1.5cm^2
- Medium: 1.5 - 20cm^2
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Giant: > 20 cm^2
- Other cut-offs for ‘giant’ include > 1% TBSA or > size of the palm of the hand.
Classification of malocclusion.
Angle Classification of malocclusion.
Classification based on the maxillary first molar. In cases where the first molar is missing, canine teeth are used.
ANGLE Class I | NEUTROOCCLUSION: The mesiobuccal cusp of the maxillary first permanent molar occludes with the mesiobuccal groove of the mandibular first permanent molar.
ANGLE Class II | DISTOOCCLUSION (overjet): The molar relationship shows the mesiobuccal groove of the mandibular first molar is DISTALLY (posteriorly) positioned when in occlusion with the mesiobuccal cusp of the maxillary first molar.
ANGLE Class III | MESIOOCCLUSION (negative overjet): The mesiobuccal cusp of the maxillary first permanent molar occludes DISTALLY(posteriorly) to the mesiobuccal groove of the mandibular first molar.
Classification of nerve injury.
Seddon classification of nerve injury.
Sunderland classification of nerve injury.
MacKinnon classification of nerve injury.
Classification of midface fractures.
LeFort classification of midface fractures.
LeFort I:
- Seperates tooth-bear maxilla from midface.
- Extends from the piriform aperature posteriorly through the nasal septum, lateral nasal walls, anterior maxillary wall, through the maxillary tuberosity or pterygoid plates.
- Upper jaw clinically mobile.
LeFort II:
- Extends through the frontonasal junction along medial orbital wall, usually passing through inferior orbital rim at ZM, continues posteriorly through tuberosity or pterygoid paltes.
- Upper jaw and nasal bones clinically mobile as a single unit.
LeFort III:
- Craniofacial disjunction
- Extends through frontonasal junction along medial orbital wall and inferior orbital fissure and out lateral orbital wall.
- Complete separation of the midface at the level of the NOE and the ZF.
Classification of brachial plexus injury (level).
Level 1: Inside the (vertebral) bone (preganglionic root) injury, including spinal cord, rootlet, and root injury.
Level 2: Inside the (scalene) muscle (postganglionic spinal nerve) injury, located at the interscalene space proximal to the suprascapular nerve.
Level 3: Pre- and retroclavicular injury, including trunks and divisions.
Level 4: Infraclavicular injury, including cords and terminal branch injury proximal to the axillary fossa.
Classification of infected median sternotomy.
Pairolero classification of infected median sternotomy.
Classification of nasoorbital ethoid (NOE) fractures.
Manson-Markowitz classification.
- Type I: A single, non-comminuted, central fragment without medial canthal tendon disruption.
- Type II: Comminuted central fragment without medial canthal tendon disruption.
- Type III: Severely comminuted central fragment with disruption of the medial canthal tendon.
Classification of pressure ulcers.
Classification of pressure ulcers:
- National Pressure Ulcer Advisory Panel Classification.
- Shea Classification.
- Yarkony-Kirk Classification.
Classification of cleft palate (Veau).
Veau classification of cleft palate.
Angiosomes for a unipedicle TRAM.
Classification of polydactyly.
Wassel Classification of Polydactyly.
Classification of basilar thumb arthritis.
Eaton and Littler Classification of Basilar Thumb Arthritis
Stage I: Subtle carpometacarpal joint space widening.
Stage II: Slight carpometacarpal joint space narrowing, sclerosis, and cystic changes with osteophytes or loose bodies < 2 mm.
Stage III: Advanced carpometacarpal joint space narrowing, sclerosis, and cystic changes with osteophytes or loose bodies > 2 mm.
Stage IV: Arthritic changes in the carpometacarpal joint as in Stage III with scaphotrapezial arthritis.
Classification of craniofacial clefts.
Tessier classification of craniofacial clefts.
Within the Tessier clefts, there are 4 sub-groups.
Oral-Nasal Clefts (# 0-3): Oral-nasal clefts occur between the midline and cupid’s bow, disrupting both the lip and nose.
Oral-Ocular Clefts (# 4-6): Clefts connect the oral and orbital cavities without disrupting the integrity of the nose. They occur lateral to cupid’s bow, extend through the soft tissue of the cheek and maxillary process, and are called meloschisis.
Lateral Facial Clefts: Include Treacher Collins Syndrome, Goldenhar’s syndrome, hemifacial microsomia, and necrotic facial dysplasia.
Cranial Clefts: Clefts extend superiorly from the lateral orbit to the midline and proceed through the frontal bone and often into the base of the cranial vault.
COMPLETE TESSIER CLASSIFICATION
Tessier Cleft Number 0: Like cleft number 14, can yield absent or excessmidline skeletal and soft tissue involvement. Cleft begins between the upper incisors, extending through premaxilla, secondary palate (cleft), and nasal bones (potential absence OR potential bifid nose).
Tessier Cleft Number 1: Cleft begins between the lateral and central incisor moving superiorly through the margin of cupid bow and up between the nasal bones and the frontal process of the maxilla.
Tessier Cleft Number 2: Cleft originates at lateral incisor and margin of cupid bow and extends superiorly through the alar rim.
Tessier Cleft Number 3: Cleft begins between lateral incisor and canine and extends superiroly to create communication between oral, nasal, and orbital cavities with disruption of lacrimal system.
Tessier Cleft Number 4: Cleft begins between lateral incisor and canine teeth extending superiorly lateral to the piriform and medial to the infraorbital foramen into the lower eyelid.
Tessier Cleft Number 5: Cleft begins lateral to the canine and courses lateral to infraorbital foramen terminating in the lateral aspect of lower eyelid and orbital floor.
Tessier Cleft Number 6: Cleft extends from the oral commissure along the junction of the maxilla and zygoma into the lower eyelid and inferior orbital fissure.
Tessier Cleft Number 7: Cleft begins at the oral commissure and extends outward affect the ramus/condyle/coronoid of the mandible and include the ear.
Tessier Cleft Number 8: Largely isolated to the orbit with the cleft affecting the frontozygomatic suture with a hypoplastic or absent zygoma with coloboma of the lateral commisure.
Tessier Cleft Number 9: Cleft involves the lateral third of the upper eyelid and brow with a hypoplastic greater wing of the sphenoid; can have encephaloceles.
Tessier Cleft Number 10: Cleft lateral to the supraorbital foramen, yielding encephaloceles and hypertelorism from inferolateral orbital rotation.
Tessier Cleft Number 11: Cleft extending upward from the medial third of the eyelid accompanied by hypertelorism and encephaloceles.
Tessier Cleft Number 12: Cleft lies medial to the medial canthus extending upward and coming out lateral to the cribriform plate, yielding hypertelorism.
Tessier Cleft Number 13: Paramedian cleft with disruption of cribriform plate, hypertelorism, and frontal encephalocele.
Tessier Cleft Number 14: Midline cleft often with significant CNS abnormalities (including holoproencephaly), midline encephalocele and cyclopia - consequently, limited life expectancy often.
Tessier Cleft Number 30: Mandibular cleft originating between the central incisors and extending inferiorly, yielding notching of the lower lip and a bifid tongue.
Classification of dorsal PIP Fracture-Dislocations.
Kiefhaber modification of Hastings classification dorsal PIP Fracture-Dislocations.
Type I - Stable fracture-dislocation: Less than 30% articular base of middle phalanx Congruent through full range of motion
Type II - Tenuous: 30% to 50% articular base of middle phalanx, reduces with less than 30 degrees flexion
Type III - Unstable: Mote than 50% of A-P diameter or less than 50% but requires more than 30 degrees PIP flexion to maintain reduction.
Classification of cleft lip and palate (Kernahan and Stark).
Kernahan and Stark classification.
Classication of Scapholunate Advanced Collapse (SLAC).
Watson Classication of Scapholunate Advanced Collapse (SLAC).
Stage I: Arthritis between scaphoid and radial styloid
Stage II: Arthritis between scaphoid and entire scaphoid facet of the radius
Stage III: Arthritis between capitate and lunate
Clark staging of melanoma.
Classification of Complex Regional Pain Syndrome (CRPS)
CRPS type I: Causation by an initiating noxious event, such as a crush or soft tissue injury; or by immobilization, such as a tight cast or frozen shoulder. No nerve injury.
CRPS Type II: Presence of a defined nerve injury.
Classification of sun reactive skin types.
Fitzpatrick’s classification of sun-reactive skin types.
Staging of arteriovenous malformations (AVMs)
Schobinger staging of arteriovenous malformation.
Classification of pediatric fractures.
Salter-Harris classification.
Classification of wrinkling and photoaging.
Glogau classification: Ranks the degree of skin wrinkling and severity of photoaging. Four stages assessing degree of wrinking, skin damage, keratoses; has typical associated ages with them.
Classification of thumb hypoplasia.
Blauth classification of thumb hypoplasia.
Scale for predicting pressure sore risk.
Braden Scale for predicting pressure sore risk.
- SEVERE RISK: Total score 9
- HIGH RISK: Total score 10-12
- MODERATE RISK: Total score 13-14
- MILD RISK: Total score 15-18
Classification of nasal bone fractures.
Stranc and Robertson classification of nasal bone fractures.
Fractures are described as “Frontal” or “Lateral” depending on the direction of the force sustained, and based on the ‘plane’ based on the degree of the fracture.
Plane I: The caudal end of the nasal bones and the septum are injured.
Plane II: The entire caudal end of the nasal bones as well as the frontal process of the maxilla at the piriform aperture and the septum.
Plane III: The nasal bones are fractured and extend to the frontal bone as well as one or both frontal processes of the maxilla extending the orbital rim. These are NOE fractures.
Classification of osteoarthritis (all joints).
Kellgren and Lawrence classification of osteoarthritis.
Grade 0: no radiographic features of OA are present
Grade 1: doubtful joint space narrowing (JSN) and possible osteophytic lipping
Grade 2: definite osteophytes and possible JSN on anteroposterior weight-bearing radiograph
Grade 3: multiple osteophytes, definite JSN, sclerosis, possible bony deformity
Grade 4: large osteophytes, marked JSN, severe sclerosis and definite bony deformity
Classification of vaginal defects.
Classification of vaginal defects.
Type I: Partial defect.
> Type Ia: Anterior or lateral wall. Partial defect.
> Type Ib: Posterior wall. Partial defect.
Type II: Circumferential defect.
> Type IIa: Upper two-thirds. Circumferential defect.
> Type IIb: Total vaginal defect. Circumferential defect.
Classification of ZMC fractures (energy).
High-energy fractures: demonstrate comminution at each articulation; therefore they require surgial exposure of each articulation to ensure accurate reduction.
Low-energy fractures: non-comminuted and generally do not require surgical exposure as aggressively as for high-energy injuries.
Classification of abdominal defects.
Rohrich classification of abdominal defects (1-6).
Mathes classification of abdominal defects (I-III).
Classification of sensation and motor function on physical examination.
British Medical Research Council (MRC).
Classification of ateriovenous malformations (AVMs)
Schobinger classification of ateriovenous malformations.
Classification of the Scaphoid Non-Union Advanced Collapse (SNAC).
Watson classification of SLAC often used for classification of the Scaphoid Non-Union Advanced Collapse (SNAC).
Vender classification is specific to Scaphoid Non-Union Advanced Collapse (SNAC).
Stage I: Interface between the radius scaphoid fossa and the fractured scaphoid distal fragment interface is affected.
Stage II: Interface between the fractured scaphoid proximal fragment and capitate is also affected.
Stage III: Radius-scaphoid, scaphoid-capitate and lunate-capitate interfaces are affected.
Classification of dorsal PIP dislocations.
Eaton-Littler classification of dorsal PIP dislocation.
Type I: Hyperextension injury. There is an injury to the volar plate, in addition to an incomplete tear that occurs between the proper and accessory collateral ligaments. The joint surface remains congruent after the injury.
Type II: Dorsal dislocation. There is a complete disruption of the volar plate and a complete tear between the accessory and proper collateral ligament. The middle phalanx lies on the dorsum of the proximal phalanx in a bayonet fashion.
Type III: Fracture dislocation. There is a fracture and a dislocation. The volar plate, accessory collateral ligament, and proper collateral ligament are damaged. The volar margin of the middle phalanx fractures at the site of proper collateral ligament insertion and remains with the proximal phalanx while the middle phalanx moves dorsal and proximal.
Stable: < 40 % of volar articular surface (dorsal CL still attached, holds reduction)
Unstable: > 40% of volar articular surface avulsed with VP (no CL attachment)
Classification of lower extremity injuries.
Classification of lower extremity injuries: (a) Gustillo, (b) Byrd
Perfusion zones TRAM flap (traditional).
Zone I: Ipsilateral to pedicle, overlying rectus muscle.
Zone II: Contralateral to pedicle, overlying contralateral rectus.
Zone III: Ipsilateral to pedicle, lateral to rectus.
Zone IV: Contralateral to pedicle, lateral to rectus.
Classification of Mallet Finger injuries.
Doyle’s Classification of Mallet Finger injuries.
Type I: Closed injury with or without small dorsal avulusion fracture.
Type II: Open injury (laceration).
Type III: Open injury (deep soft tissue abrasion involving loss skin and tendon substance).
Type IV: Mallet fracture
- *A:** distal phalanx physeal injury (pediatrics)
- *B:** fracture fragment involving 20% to 50% of articular surface (adult)
- *C:** fracture fragment >50% of articular surface (adult)
Classification of Jersey Finger (FDP avulsion).
Leddy-Packer classification of Jersey Finger (FDP avulsion).
Type I: FDP tendon retracts into the palm with rupture of both vincula (no avulsion fragment).
Type II: FDP avulses with small bony fragment of the distal phalanx. Long vinculum remains intact and tendon retracts to PIP joing (A3 pulley).
Type III: FDP avulses with large bony fragment is avulsed with the tendon and is prevented from retraction beyond the middle phalanx (A4 pulley).
Type IV: Avulsion fracture of the distal phalanx combines with tendon avulsion from the fragment with tendon traction (as in Type I).
Classification of Hidradenitis Suppurativa.
Hurley Stages of Lesions in Hidradenitis Suppurativa.
Stage I: Localized and includes the formation of single or multiple abscesses, without sinus tracts and scarring.
Stage II: Characterized by recurrent abscesses, with sinus tract formation and scarring, occurring as either single lesions or multiple, widely separated lesions
Stage III: disease, which includes diffuse or nearly diffuse involvement of the affected region, with multiple interconnected tracts and abscesses across the entire area.
Perfusion zones DIEP.
Classification of Basilar Thumb Arthritis.
Eaton & Littler Classification of Basilar Thumb Arthritis.
Burton Classification of Basilar Thumb Arthritis.
Eaton & Littler
Stage I: Slight joint space widening (pre-arthritis).
Stage II: Slight narrowing of CMC joint with sclerosis, osteophytes <2mm.
Stage III: Marked narrowing of CMC joint with osteophytes, osteophytes >2mm.
Stage IV: Pantrapezial arthritis (STT involved).
Burton
Stage I: Pain; Positive grind test; Ligamentous laxity; Dorsoradial subluxation of the trapeziometacarpal joint
Stage II: Instability; chronic subluxation; radiographic degenerative changes.
Stage III: Involvement of the scaphotrapezial joint or less commonly; the trapeziotrapezoid or trapeziometacarpal joint to the; index finger.
Stage IV: Stage II or III with degenerative changes at the
metacarpophalangeal joint
Angiosomes for a free TRAM or DIEP.