Reconstruction Flashcards
What are type one sternal infections?
Occur within several days and present with serosanguinous drainage
Treated with irrigation, minimal debridement enclosure
What are type two sternal infections?
Present a few weeks postoperatively with cellulitis, mediastinitis, osteomyelitis, and drainage of pus
Treated with irrigation and debridement and may require reconstruction
What are type three sternal infections?
These occur months later with osteomyelitis chondritis and a chronically draining sinus tract
Can be treated with debridement irrigation, and possible reconstruction
What is the most common organism identified in sternal infections?
Staph
What structures are most commonly affected by primary lymphedema?
Lower extremity followed by genitalIa followed by upper extremities
What is the genetic cause of primary lymphedema?
VEGFR3, FOXC2, SOX18, CCBE1
Milroy disease
Lymphedema which presents at birth With a mutation in VEGFR3
Meige disease
Lymphedema presenting an adolescence with a family history of the disease, but no genetic mutation has been identified
What is the most common complication of lymphedema?
Cellulitis
Lateral compartment, muscles, and innervation
Perineus longus and brevis
Superficial perineal nerve
Ankle eversion
Superficial posterior compartment
Gastrocnemius, solus and plantaris
Posterior tibial nerve
Deep posterior compartment
Flexor Hallucis, flexor digitorum longus, tibialis posterior
Posterior tibial nerve
Anterior compartment
Tibialis anterior extensor digitorum longest extensor Hallucis longus, peroneus tertius
Deep perineal nerve
What nerve may accompany the lesser saphenous vein
Sural Nerve
Travels between the Achilles tendon and the lateral malleolus
Give sensation to the posterior lateral lower leg and lateral foot
Muscles of the superficial layer of the plantar surface of the foot
Flexor digitorum Brevis
Abductor hallucis
Abductor digiti quinti
What nerve is at risk during the harvest of the plantaris tendon?
The posterior tibial nerve
Dissection begins posterior to the medial malleolus
How many compartments exist in the thigh?
Three the anterior medial and posterior
Anterior thigh compartment
Femoral nerve and artery
Quadriceps sartorious illiopsoas pectineus
Medial thigh compartment
Obturator nerve
Profunda femoral artery
Adductor brevis longus and magnus
Gracilis, obturator externus
Posterior thigh comp
Sciatic nerve
Branches of the profunda femoris
Adductor Magnus, semi tendonosus and membranous, biceps femoris
What is the most common location of bone sarcoma of the lower extremity?
Proximal tibia
What to do if the common perineal nerve is disrupted?
You can do a tibialis posterior transfer because in an equinvarus deformity develops
What does the mangled extremity severity score consider
Shock, ischemia, age and skeletal or soft tissue damage
What is the ideal length that should be preserved for a below knee amputation
12 to 15 cm from the joint line
What is aLisfranc amputation
Amputation at the level of transmetatarsal joint
What is a symes amputation
Amputation just above the ankle joint
What lab test is useful in osteomyelitis
ESR above 120
What is the angle of protrusion of the ear?
25 to 30°
What is the lymphatic drainage of the ear?
Superior lateral ear and anterior external auditory meatus drain to the parotid
Superior medial ear and posterior external auditory, drained to the mastoid
Inferior ear and lower external auditory Meatus drain to superficial cervical
Concha and meatus drain to the pre-auricular nodes
What is a banner flap?
Post ear flap from the superior sulcus, which is used in conjunction with a cartilage graft for upper 1/3 defects
Dieffenbach flap
Post ear flap with contralateral cartilage support used for reconstruction of defects of the middle 1/3
Cartilage graft is sutured into the defect with the skin advanced over for skin coverage and the flap is then divided 2 to 3 weeks later
Do patients with microtia have hearing difficulties
Most patients have a atresia of the external auditory canal, tympanic membrane and middle ear ossicles resulting in conductive hearing loss
What happens to the dermis during tissue expansion?
Thins
Increased fibroblast and myofibro blasts
Increase collagen
Fragmentation of elastin fibers
What happens to muscle during tissue expansion?
Increased number of mitochondria
Th thinning
What is the significance of the temporal line of the calvarium?
It is the line along which the deep temporal fascia fuses with the pericranium
What is aplasia cutis congenita?
Localized, absence of skin, dermal, appendages, and subcutaneous tissues
Can occur anywhere on the body, but majority occur on the scalp
And 15 to 30% of cases, it can’t be associated with defects of the underlying skull or Dura, exposing the brain and sagittal sinus
When do lips begin to develop?
At 4 to 5 weeks
What muscle planes does the facial artery travel within?
Deep to the platysma , Risorius and zygomaticus major and superficial to the buccinator and levator Anguli Oris
How do you find the mental nerve?
It is located below the second mandibular bicuspid
Where are the majority of malignancies of the lip?
Lower
What is the blood supply of the tongue?
Lingual artery arising from the external carotid artery drainage into the internal jugular vein
What is the lymphatic drainage of the tongue?
Level two nodes are most commonly affected
Level one and three are also at risk
What antidotes are available for extravasation injuries?
Phentolamine should be given within 12 hours of alpha adrenergic agents
Derazoxane should be given within six hours of anthracycline like Doxorubicin
In what extravasation injuries do you want to use a warm compress?
When you want to have a dilute and disperse effect
With TPN calcium potassium, mannitol, phenytoin, and contrast media
In what extravasation injuries do you use a cold compress?
DNA binding vesicants
Chemotherapeutic agents except non-DNA binding vesicants
When should you not use cold compresses?
Vika alkaloids, which are a non-DNA binding vesicant like vincristine and vinblastine
What is purple gloves syndrome?
Phenytoin related soft injury
Three phases
Pain and purple discoloration, distal access site
Glove like circumferential erythema with edema
Bullae formation, skin, necrosis, and possible compartment syndrome
What are non-DNA binding vesicants
Vinca alkaloids and taxanes
What are DNA binding agents?
Anthracycline Alkylating agents
Mitomycin
What are the risk factors associated with pharyngo cutaneous fistula formation?
Hemoglobin less than 12.5
Neck dissect
Prior radiation and chemo radiation
What head and neck tumors are treated with radiation
Sarcoma like rhabdosarcoma Ewing sarcoma neurofibro sarcoma
Retinoblastoma
Leukemia
At what radiation dosages is cranial facial growth altered
Soft tissue effects are seen at four
Bony effects are seen at 30
What are the different fields targeted in breast radiation?
The chest wall and the three noodle basins, including the axillary supraclavicular and internal mammary artery
What is pathologic gynecomastia?
Related to underlying disease
Adrenal tumor
Hypogonadism
Tumor
Liver disease
What is the pathogenesis of senescent gynecomastia?
Primary testicular failure, resulting in hypogonadism and increased adipose tissue leading to increase production of estrogen by aromatase
Elevated levels of which gonadotropin’s lead to gynecomastia
LH and HCG
How does primary testicular failure cause increased estrogen to androgen ratio and gynecomastia?
Reduced androgen production and increased aromatase activity in Leydig cells results and increased estrogen levels
How do testicular tumors increase estrogen?
Steroid producing tumor cells and paraneoplastic production of hCG
How is gynecomastia associated with hyperthyroidism?
Increase peripheral conversion of androgens to estrogen and increased sex hormone binding globulins
What two mechanisms result in gynecomastia and liver patients
Increased hCG secretion and increased aromatization of circulating adrenal androgens
What chronic disease diseases are associated with gynecomastia
Ulcerative colitis
Cystic fibrosis
HIV
Renal failure
Liver disease
Malnutrition
Where does the medial canthal ligament attach
Frontal process of the maxilla, the thicker posterior portion inserts on the posterior lacrimal crest
Describe location of para spinous muscles
Deep to LD except @ T 10 -l1 where the serratus poster is sandwiched
Describe the development of reproductive organs
Female / male differentiation begins @ 6 weeks
Female is default which comes from paramesonephric
Male comes from mesonephric which develops because of mullerian inhibiting substance from Sertoli cells
The male organs develop due to testosterone from Leydig cells
Types of osseous callus
Periosteal = appears day 3 very important for comminuted fracture non union healing
Medullary = appears day 4 important for stable non displaced, time to union is shortest
Most common pathogens in open joints
Pseudomonas and klebsiella
EDL flap
Anterior tibial artery
For <5cm wounds
Incision 2cm lateral to tibia
Located lateral to tibial artery
Preserve superficial peroneal nerve
Cross leg flap
Local flap necrosis 40%
Infection 28%
Axial blood supply of the post. Descending subfascial cutaneous branchof popliteal artery
What tissue does not have lymphatics
Muscle
Meige’s disease
MOST COMMON primary LE
Associated with vertebral, cvs malformation, hearing loss.double row of eyelashes
Ad
FOXC2 mutation
