Pretest_3_WoundsInfectionsBurns Flashcards
The margins for excisions of melanomas are what for:
1) lesions less than 1 mm deep
2) lesions greater than 1 mm deep
<1 mm: 1 cm
1 mm deep: 2 cm margins
What are the stages of wound healing? What is the timeline? What are the main players?
(hemostasis)
1) inflammatory phase = rapid influx of neutrophils. 2 days later: mononuclear cells phagocytose debris and bacteria nad secrete growth factors (TNF, PDGF)
2) Proliferative phase: angiogenesis, collagen formation (mainly type 3). Fibroblasts enter about day 3.
3) Remodeling phase (at about 2-3 weeks, when collagen content is maximal). Elastic type 3 collagen is replaced by rigid type 1 collagen fibrils. Remodeling take up until a year.
Wounds exposed to hydrofluoric acid should be treated with
calcium gluconate
What is the treatment of pyoderma gangrenosum?
Systemic steroids and immunosuppressants, like cyclosporine
How is frostbite treated?
elevation to minimize edema, administration of antibiotics, tetanus toxoid, debridement of necrotic skin, rapid rewarming in water slightly above normal body temperature
The tendons of the superficial and deep flexors of the hand are nourished by which vessels?
Vincula tendinum (short mesenteries)
What is a “clean wound”?
Wounds in which no part of the respiratory, gastrointestinal, or genitourinary tract is entered. Ex: breast surgery, herniorrhaphy
What are “clean contaminated” wounds?
Respiratory, GI, and GU tracts are entered but without evidence of active infection or gross spillage. Ex: elective cholecystectomy or elective colon resection with adequate bowel prep
What are “contaminated wounds”?
open accidental wounds encountered early after injury, those with extensive introduction of bacteria into a normally sterile area of the body, or gross spillage of viscus contents such as from the intestine.
Examples include penetrating abdominal trauma, large tissue injury, and enterotomy during bowel obstruction.
What are “dirty wounds”?
Include traumatic wounds in which a significant delay in treatment has occurred and there is necrotic tissue present, those created in the presence of purulent material, and those involving a perforated viscus with a high degree of contamination.
Ex: perforated diverticulitis, necrotizing soft tissue infections
What is “Marjolin’s ulcer”?
How is it treated?
an aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatized, chronically inflamed, or scarred skin
Treated wit hsurgical excision or amputation
_________ occurs in people who have had chronic sun exposure, chronic ulcers or sinus tracts (including draining osteomyelitis), or a history of radiation or thermal injury (Marjolin’s ulcer).
Is it more or less invasive/metastatic than BCC?
Squamous cell carcinoma. More metastatic and invasive than basal cell carcinoma.
Early wound management of burn wounds is characterized by early excision of areas of devitalized tissue, with the exception of deep wounds of ___________, along with topical antimicrobials such as _________ in order to delay colonization.
palms, soles, genitals, and face
silver sulfadiazine
In the management of burn wounds, when is escharotomy performed?
the first sign of vascular comprise
What are the 6 Ps of compartment syndrome?
- pain out of proportion to expected based on exam
- paresthesias
- pallor
- paralysis
- pulselessness
- poikilothermia (loss of normal temperature regulation)
What are the main complications associated with the three main topical agents to treat burns:
1) silver nitrate
2) silver sulfadiazine
3) mafenide acetate
1) silver nitrate = electrolyte abnormalities (hyponatremia, -kalemia, -calcemia, -chloremia)
2) silver sulfadiazine = neutropenia
3) mafenide acetate = metabolic acidosis (inhibits carbonic anhydrase)
Most squamous cell carcinoma of the lips occurs on the (upper/lower) lip
lower (greater sun exposure)
Where do lip tumors (SCC for example) metastasize first?
To the ipsilateral submental node
While __________ is responsible for the healing of a closed incision, __________ is the primary method of closure in open wounds.
closed incision: epithelialization
open wounds: wound contracture
What is the treatment for leukoplakia of the mouth? When is biopsy indicated?
Avoidance therapy! Avoidance of alcohol, tobacco, and proper oral hygine
Biopsy is reserved for thick lesions or for those in whom the lesion does not resolve after avoidance therapy
What is the protocl for repair of cleft lip and palate?
Repair of cleft lip in the first 3 months (usually weeks 10-12).
Repair of palate at 12-18 months; after 2 years, often requires speech therapy
In melanoma, the depth of invasion is known as _________ level and the thickness of the lesion is known as _______ level.
depth: Clark
thickness: Breslow
What is the treatment of Karposi sarcoma?
radiation
T/F: The presence of pedal pulses would preclude the diagnosis of compartment syndrome.
False! If the diagnosis is in question, measure compartment pressures: greater than 30-40mm Hg is diagnostic!
Wounds that are dirty or contaminated (animal bites), that are traumatically induced (by puncture, gunshot, or crush injury) or that are older than __ hours should be left open.
6
Which antibiotics can be started an hr before incision to adequately cover gram negative and anaerobic bacteria (as in bowel resections?
1) clinda/flagyl with 3rd gen cephalosporin
2) penicillin/B-lactamase inhibitor
3) cefoxitin or cefotetan (2nd gen ceph)
Staph epidermis is coagulase (positive/negative)
negative
What is the Parkland formula for volume resuscitation in TBSA victims?
4 ml LR/kg for each percent TBSA burned over the first 24 hours (if 80 kg person and 50% TBSA, then 4 x 80 x 50); 1/2 over the first 8 hours and the remaining half over the following 16 hours
Skin lesion with rolled, pearly borders:
BCC
What is the most common type of skin cancer?
BCC
________ are typically located over the medial malleolus, are painless, and may be associated with brawny induration.
Venous stasis ulcers
________ are associated with other symptoms of severe peripheral vascular disease such as rest pain and are commonly located on the dorsum of the foot or the lateral first or fifth toes.
Ischemic ulcers
Where are venous stasis ulcers typically located?
Ischemic ulcers?
Diabetic ulcers?
venous stasis: medial malleolus
ischemic: dorsum of foot, lateral first or fifth toes
diabetic: plantar surface of foot
What is the treatment of venous stasis ulcers?
leg elevation, compression stockings, local wound care, possible surgical debridement
What is the treatment of ischemic ulcers?
revascularization
What is the treatment of diabetic ulcers?
optimization of blood sugars, protective shoe wear, debridement of necrotic tissue
What is healing by secondary intention?
Wounds that were contaminated at the tinital surgery and left open by the surgeon or wounds tha tbecame infected and required opening in teh immediate postoperative period. Secondary intention is characteriszed by the formation of granulation tissue which fills in the cavity that occurs when the skin edges are not opposed
What is an intervention to retard the wound contraction process?
Split thickness skin grafts
For a skin graft to attach successfully, the bacterial count on the granulatio nbed must be less than ___ bacteria per gram of tissue
10^5
What is the initial treatment of alkali burns?
Lavage of the burn wound with large volumes of water
The (superficial/deep) flexors of the fingers arise from a common muscle belly.
deep
Radiation therapy should not be used in patients who have SCC due to
radiation or one arising in a burn scar
one from the sun is ok, as long as the patient does not have ongoing sun exposure
In cleft palate, when should lip repair occur?
as soon as the infant can tolerate anesthesia (10-12 weeks)
In melanoma, sentinel lymph node biopsy is performed for which lesions?
> 1 mm in depth
Which generation cephalosporins have anaerobic coverage?
2nd: cefoxitin or cefotetan
What are the most common BCCs?
nodulocystic or noduloulcerative
