Plastics Crash Course Flashcards
3cm in length - rugby - laceration to left cheek
No LOC or other injuries
Full-thickness lac to muscle
Suture?
D
The larger the number ascribed to the suture, the … the diameter
Smaller the diameter
Minimal tension area - suture should be finer
Facial sutures should be removed at
One week - excellent blood supply
Too long = railroading of stitch, scarring possible
Keloid scar
Grows outside of the original wound borders
Abnormal scarring
Hypertrophic vs Keloid
Management of a keloid which wont go away
Intra-lesional steroid injection
What is widely used as an initial treatment for keloids and hypertrophic scars?
Injection of steroids
Infection likely
Skin grafts - split vs full thickness
Causes of skin graft failure - SHIN
Initial management
IV fluids, ABs and urgent debridement
Necrotising fasciitis
Initially there is microbial invasion within the superficial fascia
Release of enzymes/endo/exo-toxins resulting in rapid spread through fascial planes
Skin necrosis becomes more evident as it progresses
Urgent surgical debridement !!!!
Why is urgent surgical debridement necessary in necrotising fasciitis?
Antibiotics are unable to penetrate infected necrotic Gussie
Due to the thrombogenic nature of NF, early and aggressive surgical debridement remains the priority
Timing and adequacy of the initial debridement is a major determinant of mortality
Reconstructive breast surgery
Arterial problem as cold and pale tissue with a prolonged or absent capillary refill
Patient is warm, haemodynamically stable with good urine output
Infection is unlikely as very early post-op
Venous congestion is suggested by purplish discolouration and brisk capillary refill so more likely arterial
Depth of burn?
Superficial dermal
Burn overview
Total burn surface area
What is the most appropriate method of estimating the TBSA?
Lund + browder chart
Lund and browder chart
Squamous cell carcinoma
Renal transplant recipient - more likely to get SCC
SCC
Malignant tumours which arise from cells of the epidermis or its appendages
Tend to have crust on top
Infective tenosynovitis
Infective tenosynovitis
… an acute infection within the flexor sheath
Kanavel signs of infective flexor tenosynovitis
Compartment syndrome !
Crush injuries - may lead to …
Rhabdomyolysis
Acute compartment syndrome is a surgical emergency
Increased pressure - muscle ischaemia and necrosis
Leakage of intracellular contents including CK and myoglobin (dark urine)
