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Plastics Flashcards

1
Q

Topical burn antimicrobials side effects

A

Silver nitrate - electrolyte disturbances
Silvadene - leukopenia
Sulfamylon - metabolic acidosis

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2
Q

6th branchial arch

A

Vagus n. (recurrent laryngeal)
Pulmonary artery
Cricoid / arytenoids
Intrinsic muscles of the larynx

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3
Q

5th branchial arch

A

Degenerates!

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4
Q

4th branchial arch

A

Superior laryngeal n.
Aortic arch / subclavian
Thyroid cartilage
Pharyngeal constrictors

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5
Q

3rd branchial arch

A

Glossopharyngeal n.
ICA
Cartilage: hyoid
Muscle: stylopharyngeous

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6
Q

2nd branchial arch

A

Facial n.
Stapedial artery
Cartilage: stapes, styloid process, stylohyoid (Reichart’s cartilage)
Muscle: mimetics + PSS (post belly digastric, stylohyoid, stapedius)

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7
Q

1st branchial arch

A

Trigeminal n.
Cartilage: Meckel’s - malleolus, incus, mandible
Soft tissue: MATT - muscles of mastication, masseter, temporalis, med/lat pterygoids, mylohyoid, ant belly digastric, tensor tympani, TVP

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8
Q

Muenke Syndrome

A 
pro250ARg mutation in FGFR3
AD, variable expression
Developmental delay
Coronal synostosis
Thimble-like middle phalanges
Sensorineural hearing loss
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9
Q

Saethre-Chotzen Syndrome

A 
AD
TWIST-1 gene
Normal mental status
Asymmetric brachycephaly
Low frontal hairline
Eyelid ptosis
Prominent crus helicis
Partial syndactyly
Short stature
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10
Q

Pfeiffer Syndrome

A 
AD
FGFR2 (95%, more severe), FGFR1 (less severe)
Hydrocephalus
High risk chiari malformation
Normal mental status
Turribrachycephaly
Exorbitism, hypertelorism
Low nasal bridge
Broad thumbs and halluces
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11
Q

Apert Syndrome

A 
AD, most cases sporadic
Increased ICP, may need VP shunt
Bicoronal synostosis
Exorbitism
Severe midface hypoplasia
Complex syndactyly hands and feet
Acne
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12
Q

Crouzon Syndrome

A 
AD
FGFR2
Hydrocephalus, increased ICP
Bicoronal synostosis
Midface hypoplasia
NO limb abnormalities
Exorbitism
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13
Q

Type V Flap

A

One dominant + secondary segmental

Fibula
Lat dorsi
Pec major

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14
Q

Type IV Flap

A

Segmental

Sartorius
Tibialis anterior

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15
Q

Type III Flap

A

Two dominant pedicles

Gluteus
Pec Minor
Serratus
Rectus abdominus

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16
Q

Type II Flap

A

Dominant + minor

Brachioradialis
Gracilis
Soleus
SCM

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17
Q

Type I Flap

A

Single vascular pedicle

Gastroc
TFL
Jejunum
Vastus lateralis

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18
Q

Pierre Robin Sequence

A

Triad: micrognathia, glossoptosis, respiratory distress
60-90% have cleft palate
Cardiac / renal abnormalities

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19
Q

Treacher Collins

A 
Cleft #6-8
AD
Chromosome 5
Redundant upper lip, false ptosis
Inferiorly displaced lateral canthus
Absent zygomatic arch
Hypoplastic temporalis
Absent lateral inferior orbital rim
Hypoplastic malar bones and mandible
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20
Q

Goldenhaar’s Syndrome

A 
Sporadic
Frontal bossing
Mandibular hypoplasia
Low set ears
Epibulbar dermoids
Bilateral accessory auricles
Vertebral abnormalities
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21
Q

22q deletion

A 
Velocardiofacial syndrome
Bird-like face
Soft palate dysfunction
Developmental delay
Various cardiac conditions
Detected by FISH
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22
Q

Van der Woude Syndrome

A

AD
IRF6 mutation (also causes popliteal pterygium syndrome)
Lower lip sinus tracts

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23
Q

Deep posterior compartment

A

FHL - musc br of peroneal
FDL - br of PT
Tibialis posterior - musc br peroneal

Tibial n.

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24
Q

Superficial posterior compartment

A

Gastrocnemius - sural br popliteal
Soleus - PT/peroneal/sural br popliteal
Plantaris - sural br popliteal
Popliteus - genicular br popliteal

Tibial n.

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25
Q

Lateral compartment

A

Peroneus longus - muscular br AT and peroneal
Peroneus brevis - musc branches of peroneal

Superficial peroneal n.

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26
Q

Anterior compartment

A

Tibialis anterior
EHL
EDL
Peroneus tertius

Deep peroneal n.
Anterior tibial a.

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27
Q

Sunderland classification of nerve injury

A 
I. Neuropraxia (conduction block)
II. Axonotmesis (axonal injury)
III. II + endonurium injury
IV. III + perineurium injury
V. IV + epineurium injury (neurotmesis)
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28
Q

Types of BCC

A 
Nodular
Superficial
Morpheaform
Micronodular
Infiltrative
Basosquamous
Multicentric
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29
Q

Melanoma subtypes

A 
Lentigo maligna
Superficial spreading
Nodular
Acral lentiginous
Desmoplastic
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30
Q

ALT Flap

A

Descending br lateral circumflex femoral (from profunda)
Lateral femoral cutaneous n.
Fasciocutaneous flap (8x25cm)
Use: pedicled abdomen, perineum, knee if reversed

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31
Q

TFL Flap

A

Type I flap

Ascending br lateral circumflex femoral a.
Lateral cutaneous nerve of thigh
Muscle from ASIS + iliac crest –> lateral condyle of tibia via IT band / fascia lata
Fascia/skin
Use: abdominal recon, pressure sores

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32
Q

Gracilis Flap

A

Type II

Ascending branch of medial femoral circumflex
Ant branch obturator, ant fem cutaneous n.
Muscle from pubic symphysis, inf pubic ramus, ischium –> medial condyle tibia
Muscle/skin
Use: functional muscle

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33
Q

TUG Flap

A

Ascending br medial femoral circumflex
Ant branch obturator, ant fem cutaneous n.
Muscle/skin
11x25cm

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34
Q

Sartorius Flap

A

Type V

8-11 pedicles from SFA
No nerve

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35
Q

Rectus Femoris Flap

A

II

Descending branch of lateral femoral circumflex
Motor branch of femoral n.
Muscle / skin

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36
Q

Vastus Lateralis Flap

A

II

Descending branch LCFA
Greater trochanter, lateral femur –> quad tendon
Use: salvage repairs trochanteric pressure sores, salvage hip wounds, cover lower abdomen, groin, perineum, ischium, trochanter, acetabular fossa

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37
Q

Posterior Thigh Flap

A

Ascending branch of popliteal

Pedicle reaches deep fascia 8-10cm above knee

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38
Q

Gluteus Flap

SGAP / IGAP

A

Superior gluteal artery

Interior gluteal artery

39
Q

Hamstring Flap

A

Can be raised on all 4 hamstrings (biceps femoris, semitendinosus, semimembranosus)
Ischial pressure sores
Biceps femoris - long head tibial n. short head peroneal n.; type II muscle, major branch from 1st profunda perforator; minor supply from MCFA, IGA, genicular

40
Q

Saphenous Flap

A

Saphenous artery - terminal branch of descending genicular branch of femoral a.
Fascia/skin 6x20cm

41
Q

Free Fibula Flap

A

Peroneal artery
Bone/skin 20-26cm
5cm above lateral malleolus to preserve ankle fxn
5cm below fibular head to avoid common peroneal nerve injury
Can close up to 5cm defects

42
Q

Soleus Flap

A

II

Sural artery
Muscle
Can cover middle 1/3 leg, 13x22cm
Medial and lateral parts
Vascularized by posterior tibial and peroneal arteries
Upper pedicle branch from popliteal
Upper middle pedicle from tibioperoneal artery or peroneal artery

43
Q

Gastrocnemius Flap

A

I

Medial sural artery, lateral sural artery
Sural nerve
Use: knee, proximal 1/3 leg, reverse for posterior thigh

44
Q

Tibialis Anterior Flap

A

IV

8-12 pedicles from tibial vessels
Deep peroneal n.
Muscle
Use: middle 1/3 tibial defects

45
Q

Flexor Digitorum Brevis Flap

A

Lateral tarsal artery
Branches from DP
Deep peroneal n.
Muscle/skin, 4x5-6cm

46
Q

Reverse Sural Flap

A

Sural branches from peroneal a.
Sural cutaneous n.
Used for heel/ankle
Pivot point 5cm above lateral malleolus

47
Q

Lateral calcaneal Flap

A

Lateral calcaneal artery off peroneal a.
Sural n.
Island or reverse flow
Heal or posterior defects

48
Q

Lateral Plantar Flap

A

Lateral plantar a. from posterior tibial a.
Lateral plantar n. in lateral 1/3
Medial plantar n. in medial 2/3

49
Q

Medial Plantar Flap

A

Medial plantar a.
Medial plantar n.
10x7cm by STSG

50
Q

Dorsalis Pedis Flap

A

Dorsalis pedis a.
Commonly delayed bc distal tip necrosis common
Must leave paratenon for STSG
Can use reverse flow to cover toe amp

51
Q

Toe Transfer

A

Great and 2nd toe transfer based on circulation from dorsal metatarsal artery and DP system
Innervated by proper digital nerves and deep peroneal n.

52
Q

Temporo-parietal Fascia Flap

A

Superficial temporal a.
Auriculotemporal n.
Fascia, skin, bone 12x14cm
Pedicle reaches to ear, nose, mouth

53
Q

Trapezius Flap

A

II

Transverse cervical a. (upper ascending branch)
Dorsal scapular a. (lower)
Muscle / skin, 20x8cm
Use: neck, spine, skull, axilla, post. trunk, oral cavity

Trapezius based on SCA (superficial cervical a.) - for recon of pharynx, hypopharynx, oropharynx, floor of mouth

Trapezius based on DSA - lower face, ant neck, occipital, thoracic spine

54
Q

Pectoralis Flap

A

III

Thoracoacromial a. (pectoral branch)
Internal mammary a.
Muscle/bone/skin (4th/5th rib)
Upper border of reach: zygomatic arch, can reach contralateral ant axillary line

55
Q

Deltopectoral Flap

A

II

2nd-4th intercostal a. from IMA
Fasciocutaneous, 8x25cm, island flap
Use: some head, mainly neck

56
Q

Scapular Flap

A

Horizontal branch circumflex scapular a.
Skin 10x25cm uniform thickness (2cm)
Bone: 3-4cm wide, males 14cm, females 10cm

57
Q

Parascapular Flap

A

Descending branch of circumflex scapular a.
Skin and subQ, can include bone
Free flap

58
Q

Flaps based on sunscapular arterial system

A

1) Scapular / parascapular fasciocutaneous
2) Scapular / parascapular osteocutaneous
3) Latissimus dorsi muscle flap
4) Latissimus dorsi musculocutaneous flap
5) Dorsal thoracic fascia flap (TDAP)
6) Serratus anterior muscle flap
7) Serratus anterior musculocutaneous flap
8) Serratus anterior osteocutaneous flap

59
Q

Thoracodorsal Artery Perforator Flap (TDAP)

A

Perforator of thoracodorsal a. descending branch
25x15cm
Can reach shoulder, chest wall, neck, proximal arm

60
Q

Latissimus Dorsi Flap

A

V

Thoracodorsal a.
Thoracodorsal n.
Muscle, skin, 10th rib
Use: scalp, leg
Donor site 50% seroma rate
61
Q

Serratus Flap

A

III

Serratus a. from subscapular
Lateral thoracic (upper 4 slips)
Long thoracic n.

62
Q

Lateral Arm Flap / Reverse Lateral Arm Flap

A

Posterior radial collateral / radial recurrent
Lateral brachial cutaneous n.
Fascia, skin, bone, strip of triceps
Use: Head, neck, hand, foot; retrograde pedicle covers elbow

63
Q

Ulnar Forearm Flap

A

Dorsal branch ulnar a.
Skin, fascia, muscle, and/or bone
Do Allens test
Can be based proximally or distally

64
Q

Posterior Interosseous Flap

A

PIA
Skin and fascia
Use: dorsal hand

65
Q

Radial Forearm Flap

A 
Radial a. and perforators
Lateral antebrachial cutaneous n.
Medial antebrachial cutaneous n.
Fascia/skin/bone
Use: oral lining
66
Q

Rectus Abdominus (RAM, TRAM, VRAM) Flap

A

III

Deep inferior epigastric a.
Deep superior epigastric a.
Intercostal n.
Muscle/skin (vertical, horizontal, or oblique paddle)
30x10cm
Contraindication: subcostal (Kocher) incision or previous abdominoplasty

67
Q

DIEP Flap

A

DIEP, DIEA
T7-T12 n.
Fat / skin 12-18cm wide

68
Q

SIEA Flap

A

Superficial inferior epigastric a.
T11/12 n.
Fat/skin

69
Q

Deep Circumflex Iliac Artery Flap

A

Deep circumflex iliac a.

Bone - cancellous 15x6cm inner table or full thickness

70
Q

Groin Flap

A

Superficial circumflex iliac a. (from SFA)

Fascia, skin

71
Q

Shaw Flap

A

SIEA

Good for coverage of hand and forearm, lies higher on the abdomen than the groin flap

72
Q

Jejunum Flap

A

2nd or 3rd branch of SMA

Mucosa

73
Q

Omentum Flap

A

Right gastro-epiploic a. to R omental
Fat
Use precluded by any abdominal surgery
Free up attachments to T-colon, dissect off greater curvature of stomach
Ligate left and middle omental artery, isolate on right omental

74
Q

Submental Flap

A

Submental a. (branch of facial)

Musculocutaneous

75
Q

FAMM Flap

A

Facial a.

Myomucosal flap

76
Q

Keratoacanthoma

A

Benign
Behaves like SCC
Central crater / keratin plug
Tx: Excision

77
Q

Actinic Keratosis

A

Can progress to SCC (13-20% over 10y)
Sun-exposed areas
Rough erythematous papule w/ white scale
Tx: Cryosurgery, 5FU

78
Q

Seborrheic Keratosis

A

Senile wart
Benign, originates from basal and squamous cells
Waxy lesions, stuck-on appearance
Tx: Laser, cryo, excision

79
Q

Nevus Sebaceous

A

Benign hamartoma head/neck
Can degenerate to BCC
Waxy, smooth, hairless
Tx: Excision

80
Q

Juvenile Melanoma

A

Benign
“Spitz nevus”
Red, pink, brown papule or nodule with rapid growth
Tx: Complete excision with negative margins

81
Q

Nevus of Ota

A

Benign blue nevus
Dermatome of 1st or 2nd branches trigeminal
Dermal proliferation melanocytes
Tx: Laser (Q-switched ruby, alexandrite)

82
Q

Nevus of Ito

A

Subtype of Ota
Acromiodeltoid region
Tx: Same as Ota

83
Q

Mongolian Spot

A 
Benign
Entrapment of melanocytes in dermis during development
Multiple bluish gray spots
Disappear by 10y
Tx: Observation
84
Q

Blue nevus

A

Benign
Well-circumscribed, firm, blue-pigmented nodule / papule
Common, cellular, or combined
Tx: Simple excision

85
Q

Rosacea

A

Vascular (flushing/blushing) and inflammatory (papules/pustules) aspects
Exacerbated by hot food, alcohol, heat, sunlight
Can lead to rhinophyma (tx tangential excision, CO2 laser)

86
Q

Chondrodermatitis Nodularis Helicis

A

Lateral surface of helix or antihelix in men >40
Nodule with central scale and underlying erosion
Tx: simple excision w/ removal of cartilage

87
Q

Pilomatricoma

A

Benign
Firm, cystic nodule on head/neck children
Calcification on films
Tx: complete excision

88
Q

Dermatofibroma

A

Benign
Proliferation of fibroblasts, histiocytes, vascular endothelial cells
Reaction to trauma, virus, insect bites
Small firm pink/brown nodule
Retracts beneath skin with compression “Fitzpatrick sign”
Tx: simple excision / observation

89
Q

Neurofibroma

A

Benign
Tumor of Schwann cells
Multiple small, pink / skin-colored raised nodules
Can undergo malignant degeneration
Tx: Excision, CO2 laser, adjuvant chemo / rads when malignant

90
Q

Schwannoma

A 
Benign tumor from Schwann cells
Main nerve trunks extremities, esp flexor arm/wrist/knee
Solitary nodule
MRI well encapsulated egg-shaped tumor
Tx: Excision
91
Q

Desmoid tumor

A

Benign
Arise from muscular aponeurosis
Can be locally aggressive
Tx: WLE, radiation, hormonal tx (Tamoxifen)

92
Q

Cleft lip development

A

From failure of medial nasal process to contact maxillary process

93
Q

Tensor veli palatini innervation

A

CN V (rest of muscles of velum innervated by pharyngeal plexus - IX, X, XI)

94
Q

LOAF muscles (median innervation)

A

Lateral (radial) lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

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