Plastics

Question 1

what is a wound + what types of wounds are there

Answer 1

wound: disruption of normal anatomical r/s of tissues — due to injury

types of wounds
laceration
contusion (ie bruise) —- skin intact but injured
abrasion (ie graze) — superficial skin removed
crush
puncture — depth&raquo_space; opening
avulsion — tissue forcefully separated from surroundings

Question 2

stages of wound healing

Answer 2

1. haemostasis/coagulation — immediately (within mins)
2. inflammation/lag phase — day 1-4
3. proliferative phase — day 4 to wk 3
4. remodelling phase — wk 3 onwards

Question 3

factors affecting wound healing

Answer 3

wound vs patient vs surgical factors

wound factors
infection
ischaemia – sec to hypoxia, poor arterial/venous flow, smoking, oedema
tissue trauma
anatomical area – eg. over major joint, scarring

patient factors
age
smoking
poorly controlled DM
drugs
chemo or RT
low albumin, malnutrition

surgical factors
aseptic technique
wound edge eversion
tension free closure
minimisation of tissue trauma
prompt removal of sutures

Question 4

what are the 2 types of wound closure

Answer 4

primary intention: by direct approximation of wound edges
secondary intention: wound left open to heal spontaneously

Question 5

approach to managing a wound

Answer 5

clean skin
consider documentation (clinical photography)
debride clots, debris, necrotic tissue
assess wound for tissue loss, damage to underlying structures
antibiotics
immunisation — tetanus??

dress wound

+/- -ve wound pressure therapy — ie VACD vacuum-assisted closure device

Question 6

graft vs flap

Answer 6

graft: segment of tissue detached from its blood supply at donor site — transferred to another site — dependent upon revascularisation from recipient site

flap: segment of tissue transferred from 1 site to another w its blood supply (a pedicle) intact

Question 7

what is the reconstructive ladder

Answer 7

its a ladder for methods to reconstruct a wound going from the lowest to highest complexity. — usually aim to choose the most simple option possible

(lowest complexity)
secondary intention
primary intention
delayed primary closure
skin grafts
local flap
regional flap
free flap
(highest complexity)

Question 8

what is squamous cell carcinoma

Answer 8

it is a cancer of the cells of the epidermis — forming a superficial keratinous squamous layer

Question 9

what is the primary biggest modifiable risk factor for skin cancer

Answer 9

UV exposure