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Proc Derm 2020 > Scar revision > Flashcards

Scar revision Flashcards

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Dermatology Board Prep flashcards
1
Q

Fusiform elliptical excision is the simplest surgical technique for scar revision but the resultant scar is always longer than the original scar

A

T

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2
Q

W-plasty, geometric broken-line closure and Z-plasty each use irregular lines, to give a less visible scar.

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3
Q

Z-plasty, V-Y repair and Y-V repair are techniques to shorten scars.

A

F

Lengthen.

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4
Q

Dermabrasion and ablative laser both can improve uneven scar edges and raised grafts and flaps.

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5
Q

Scars with poor cosmetic results include those that are wide, raised, depressed, red or pigmented, or those that transect natural relaxed skin tension lines.

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6
Q

Scars that run parallel to the relaxed skin tension lines reduce the tension across a wound, resulting in a thinner scar.

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7
Q

Pin-cushioning occurs due to contraction of the flap wound bed during healing, causing the flap to buckle.

A

T

is less noticable if a whole cosmetic unit has been replaced eg nasal tip

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8
Q

Square-edged flaps are more likely to pin-cushion.

A

F

Rounded or U-shaped flaps.

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9
Q

Pin-cushioning can be minimised by widely undermining the defect so that the flap and the surrounding skin contract together during the wound healing process.

A

T

and adequatley sizing and defatting the flap

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10
Q

Scars can take over 1 year to mature as collagen continues to remodel

A

T

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11
Q

Scar massage should begin as soon as possible after any flap surgery.

A

F

Should start approx. 1 month post surgery.

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12
Q

Intralesional steroid is ideal for hypertrophic linear scars, as well as bulky grafts and flaps.

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T

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13
Q

Intralesional steroid should be delayed until at least 2 months after surgery.

A

F
at least 1 month. Often done at 6 wks
Can repeat monthly until scar flattened.

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14
Q

PDL reduces overall scar redness, as well as promoting collagen remodelling and scar softening

A

T

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15
Q

PDL treatment of scars works best at higher fluences.

A

F

Subpurpuric fluences.

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16
Q

PDL can be used for atrophic scars.

A

F

1550nm fractional Erbium (fraxel)

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17
Q

Treatment of hypopigmented scars with fractional lasers is highly efficacious.

A

F

Limited efficacy.

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18
Q

Fusiform elliptical surgery is best suited for spread, or depressed scars that usually result from excess tension and/or poor wound eversion at the time of the initial surgery.

A

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19
Q

W-plasty and geometric broken-line closures rely on the principle that an irregular line is less visible than a straight one.

A

T

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20
Q

For a W-plasty, the tips of the ‘W’ should run perpendicular to the relaxed skin tension lines.

A

F

Parallel or within the RSTLs (assuming the original scar is perpendicualr to the RSTLs)

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21
Q

For a W-plasty, the width of each triangular cut out should be approximately 5mm to achieve a visibly regular line.

A

F

to achieve the desired visibly irregular line.

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22
Q

The advantage of the W-plasty is reduced with longer scars because the regularity of hte zigzags makes it more noticeable

A

T

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23
Q

A geometric broken-line closure is preferable for longer scars.

A

T

pattern determined by surgeon but must be mirrored on opposite side of wound

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24
Q

The Z-plasty alters the direction of a prominent scar placed perpendicular to the RSTLs to be parallel to the RSTLs.

A

T

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25
Q

The Z-plasty lengthens a contracted scar.

A

T

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26
Q

The geometry of the Z-plasty consists of two zigzagging triangular flaps transposed into the shape of a Z.

A

T

27
Q

A rhombic transposition flap is an asymmetric Z-plasty.

A

T

28
Q

In scar revision using a z-plasty the central diagonal is the scar

A

T

29
Q

In a Z-plasty, the angle of the designed triangle does not affect the degree of tissue lengthening.

A

F

Greater angles results in greater gains.

30
Q

The length of the central diagonal in a Z-plasty is usually predetermined by the length of the scar.

A

T

31
Q

The classic 60 degree Z-plasty angle results in a 90 degree change in scar direction and a 75% gain in tissue length

A

T

32
Q

Multiple Z-plasty has the advantage of better hiding the ‘Z’ shapes along the scar line, as well as distributing the tension across multiple smaller transverse diagonals.

A

T

33
Q

The resultant scar from a z-plasty is usually well hidden

A

F

It is quite noticeable due to the large “Z” configuration

34
Q

V-Y repairs do not alter the scar length.

A

F
Lengthen scar
similar to V-Y flap but incision is a true V shape below the point to be raised rather than the triangular complete incision of a V-Y island pedicle flap

35
Q

Y-V repairs can be used to lower an anatomical point. The initial incision is made in a Y-shape and converted to form a V.

A

T

opposite to the V-Y repair used to raise an anatomical point

36
Q

Mild trapdoor deformities are usually be managed with intralesional steroids

A

T

start 4-6 wls after surgery

37
Q

A technical trick of a surgical trapdoor deformity repair is to use a no.69 Beaver blade which is rounded at the tip

A

T

use to remove a disc of fibrofatty tissue from under flap after elevating one edge

38
Q

In repairing an ectropion, scars should be oriented perpendicular to the lower lid margin.

A

T

39
Q

Even mild ectropion does not resolve spontaneously

A

F

It can resolve over several weeks postoperatively

40
Q

Grafts near the eyelid margin should be oversized up to double the defect size to compensate for the massive contraction that occurs with thinner grafts in this region.

A

T

41
Q

Periosteal tacking sutures should not be used near lid margins.

A

F

Can prevent pull on the lower lid.

42
Q

Canthoplasty can be performed by making a horizontal incision several millimetres lateral to the lateral canthus

A

T
Exposing the lateral canthal ligament, then tracking down this ligament to the superior orbital rim, thereby resulting in a tightening of the lower lid skin

43
Q

V-Y repairs are helpful for prominent ectropion

A

F

Mild ectropia. Use FTSG if prominent.

44
Q

The ideal donor site for a FTSG repair of an ectropion is the upper lid skin.

A

T

Should be oversized up to double the defect size.

45
Q

In severe ectropion, the lower lid can be tacked to the eyebrow in order to suspend the lower lid to an elevated position for approximately 3 weeks.

A

T

46
Q

The ideal timing for dermabrasion scar revision is 4 weeks post-operatively.

A

F

6-12 weeks.

47
Q

Dermabrasion abrades down to the level of the papillary dermis

A

T

48
Q

Margins along the scar undergoing dermabrasion should be extended and feathered into the normal surrounding skin, including an entire cosmetic unit or subunit.

A

T

49
Q

Small scars can be lightly dermabraded to the point of pinpoint bleeding using sterile 500-600grit sandpaper wrapped on dental roll

A

F

300-400grit

50
Q

CO2 laser is more precise than Er:YAG in ablating raised scar edges.

A

F

Er;YAG is more precise

51
Q

Er:YAG has a high affinity for water and so is more precise in ablating raised scar edges

A

T

52
Q

The Er:YAG laser causes more thermal necrosis and thus promotes more wound contraction and collagen remodelling than CO2 laser

A

F

CO2 laser does

53
Q

Er:YAG laser promotes more wound contraction and collagen remodelling.

A

F

CO2 laser does

54
Q

Using dermabrasion, you should treat down to the reticular dermis in order to achieve the best scar revision.

A

F

Must not treat deeper than papillary dermis.

55
Q

PDL can be used early post op (just after suture removal) to prevent keloids and hypertrophic scars

A

T

56
Q

The 532nm freq doubled Nd:YAG has been used for scar revision of keloids and hypertrophic scars

A

F

1064nm Nd:YAG

57
Q

Fractional ablative Er:YAG resurfacing lasers result in redness and swelling that lasts a mean of 3 days, whereas the fractional CO2 laser causes hemorrhagic crusting, swelling, and redness that lasts a mean of 1 week

A

T

58
Q

Atrophic scars can be treated with chemical peels, dermabrasion, tissue augmentation (fillers) or non-ablative fractional laser resurfacing

A

T

59
Q

In sebaceous skin, scarring can be minimized by beveling one edge and counterbeveling the other, creating a “tongue-in-groove” effect when sutured

A

T

60
Q

when doing staged revision a wide scar the first stage revision removes the entire original scar

A

F

ellipse is oriented within the width of a broad scar, resulting in an increasingly narrowed scar width with each stage

61
Q

All ablative procedures, including both dermabrasion or laser ablation, carry a slight risk of worsening a scar from overly aggressive treatment or from pigmentary alteration

A

T

lower risk w/ fractional resurfacing

62
Q

radiofrequency energy can be used in place of mechanical energy for subcision treatment of rolling acne scars

A

T

63
Q

radiofrequency energy subcision of rolling scars causes more haematoma formation to result in better elevation of depressed scars

A

F

radiofrequency delivered by electrosurgery probe applied to sheathed cannula, in cutting mode –> less bleeding

Proc Derm 2020 (50 decks)

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