Plastics Flashcards
What are the three common types of skin cancers?
Melanoma
Basal
Squamous
Which skin cancer has the highest occurrence rate?
Basal at 70%
Which skin cancer is most aggressive?
Squamous
What is Mohs surgery?
Specialized excision used to tat basal and squamous. Layer by layer under microscope examination until abnormal tissue removed
What type of burns are there?
Thermal
Chemical
Electric
What are the degrees of burns?
First degree - outer layer of epidermis e.g sunburn
Second degree - all epidermis and upper part of dermis. Blisters present. No graft needed.
Third degree burn - skin, nerves, hair follicles, sweat glands, and subcutaneous tissue.
Fourth degree burn - all in third degree plus bone, muscle, tendons, blood vessels.
What do we do different for patients with burns regarding linen and room temp?
Sterile linen and increase room temp.
What is excharotomy?
Debridement in 3rd degree burns - removal of eschar Remove necrotic tissue Expos fatty tissue underneath Tissue rehydration Skin graft
What is a Split thickness skin graft (STSG)?
Graft of epidermis and uppermost portion of dermis
Heals in approx 14 days
Site reused.
What is a full thickness skin graft?
Epidermis and dermis
Retains characteristics
Tissue does not regenerate.
Which skin graft instrument is used for a split thickness skin graft?
Brown dermatome
What is the humbler knife?
Manual adjustable roller skin graft instrument where the thickness of the graft can be controlled
What is the rule of nines?
Divide body into 11 areas of 9% each to estimate amount of skin surface burned in adult
What are flaps?
Tissue transferred from one area of body to another. Blood supply remains intact or is restored.
What types of flaps are there?
Skin
Subcutaneous tissue
Fascia, muscle
Bone
Reasons for flaps?
Replace tissue from trauma etc
Provide padding over bony prominences
Bring better blood supply to poorly vascularized areas
What are axial pattern flaps?
Specific artery and vein along axial portion of flap.
Can be longer and are used as island, pedicle, or free flaps
What are random pattern flaps?
Blood supplied by dermal and sub dermal vessels.
Limited length/width ratio
Used to rotate to fill defects
What are musculocutaneous flaps?
Skin, subcutaneous tissue, and muscle
Blood supply provided by muscles vessels, enabling survival from vascularity of muscle.
What are free flaps?
Used in extensive reconstructive procedures of head and neck following radical excisions for cancer.
May contain bone, vascular pedicle and nerves that may restore motor function and sensation
What are pedicle flaps?
Consists of skin and muscle
Very mobile although attached at one end
Can be rotated into distant defects
What kind of flaps may be used in reconstructive breast surgery?
Pedicle
Free flaps using microsurgical techniques
What is placed and why after breast reconstruction?
Drains to prevent hematoma
What is a latissimus dorsi myocutaneous flap?
Flap of skin and muscle taken from latissimus dorsi muscle of back and used for breast
What is a TRAM.
Transverse rectus abdominis myocutaneous flap.
Most common
Flap from abdomen which adds benefit of abdominoplasty
When is nipple reconstruction usually done?
6-8 weeks postoperatively
Where is skin obtained to make a nipple?
Raising flap Groin tissue Buttock crease Auricle Conga lateral nipple
Sometimes may be tattooed on.
When is the ideal time within an injury to perform surgery for an amputated body part?
4-6 hours after injury
Up to 24 hours if cooled
How are amputated digits cooled?
In saline soaked gauze immersed in iced saline
What type of maxillary fractures are there?
La forte 1 - below nose but involves nasal floor septum. 30-45% of mid face fractures.
La forte 2 - from nasal bone to maxilla
La forte 3 - complete separation of mid face through skull base
Unilateral or bilateral orbital fractures
Worst facial fractures
How are mandibular fractures fixed?
Closed reduction - arch bars with suspension wire, stabilizes fracture
ORIF maxilla - small plate and screws
What is important to remember in the contents of care for the pt who has sx for a mandibular fracture?
Have wire cutters available at all times in case of aspiration.
How and when is cleft lip repaired?
Three layer closure of the skin, muscle, and mucosa.
Done at 3 months of age following the rule of 10.
What are the rules of ten for a cleft lip?
10 weeks of age
10 pounds
Hemoglobin of 10g/dl
When is a cleft plate repaired?
Approx 6 months of age preferable before speech
What is congenital webbing of toes and fingers called?
Syndactyly
What method is used to correct syndactyly?
Separate digits and use z-plasty. Breaks up linear scar.
What type of anesthesia is usually used for repair of syndactyly?
General or local.
What is the surgical term used to remove and redrape excess skin of face and neck with repositioning of underlying muscles and platysma (neck/chest muscle in front)?
Rhytidectomy
What is blepharoplasty?
Removal of excess eyelid skin by removal or repositioning of periorbital fat, and tightening and smoothing of muscles under eye.
Can be outpt with local anesthesia
What is the surgical term for pinning ears and why does this deformity occur?
Otoplasty
Results from absent or insufficiently pronounced antithelical fold of the external ear.
What are the three types of microdermabrasion?
Chemical - chemical peel
Manual - nylon brush/sandpaper
Mechanical - dermabrader with rotating tip, co2 laser
What is an abdominoplasty?
Tightening abdominal area and removing excess skin or fullness
What are the three types of abdominoplasty?
Mini-abdominoplasty - skin is mostly full and there is no looseness. Small incision and no relocation of umbilicus required.
Full abdominoplasty - looseness present, incision hip to hip, relocate umbilicus
Endoscopic abdominoplasty - if only muscle repair needed
What should the pt have after abdominoplasty?
Abdominal binder or compression garment
When might capsulotomy be required?
Exaggerated scar response to implants
May need to release or remove constrictive tissue
What are the three types of prosthesis placements?
Sub glandular
Sub pectoral
Biplanar/submuscular
What method is used to correct congenital asymmetry of breasts?
Reduction mammoplasty
What is mastopexy?
Correction of breast ptosis by moving nipple to more normal position and removing excess skin
What is gynecomastia associated with?
Advanced age and marijuana use.
How might gynecomastia be treated and what should be remembered for postoperatively?
Liposuction
Use of compression garment postop
What does the radial nerve supply?
Back of hand
What does the media nerve supply?
First three fingers and half of ring finger
What does the ulnar nerve supply?
Other half of ring finger and pinky
What nerve is affected in carpal tunnel syndrome and who does it affect more.
Median nerve
Women
What is dupuytren’s contracture?
Ring finger pulled down by contracture of palmar fascia
