Skin and Soft Tissue Flashcards
What seven initiatives have been shown to reduce surgical site infections?
- avoid hyperglycemia
- normothermia
- ppx within 60 minutes of incision
- selection of appropriate abx ppx
- abx ppx discontinued within 24hrs of OR end
- use a clipper (not razor) for hair removal
- remove urinary catheters within 2 days
How are necrotizing soft tissue infections classified microbiologically?
- type I: polymicrobial
- type II: monomicrobial (MC group A strep)
- type III: gram negative marine organisms (V. vulnificus)
What is the LRINEC score?
- scoring system for likelihood of NSTI
- 6 or higher is suggestive
- includes WBC (> 15), CRP (>150), Hgb (< 13.5), Na (<135), and Glucose (> 180)
What are the initial antibiotics for treating NSTI?
- Vancomycin (gram + coverage)
- zosyn (gram - coverage)
- clindamycin (toxin coverage)
What is the preferred treatment for a finger felon?
vertical incision preferred to limit risk of neuromuscular injury
What is hidradenitis suppurativa?
recurring infection of the apocrine sweat glands
What are the risk factors for hidradenitis suppurativa?
female, obese, smoking
What are the stages and treatment of hidradenitis suppurativa?
- stage I: localized abscess without tracts/scarring, treat with lifestyle modifications and antibiotics
- stage II: recurrent abscess with tract/scarring but healthy skin separating areas of involvement, treat with TNF-a inhibitors and excision
- stage III: diffuse disease or multiple interconnected tracts/scarring, treat with wide excision and STSG or healing by secondary intention
What are the risk factors for pilonidal disease?
- male
- obesity
- dense hear
- prolonged sitting
How are pilonidal abscesses and cysts treated?
- acute abscess: I&D
- chronic disease: classically excision and marsupialization, primary repair, or secondary intention
What is the most common skin cancer?
basal cell
How are basal cell carcinomas managed?
with WLE to a 4-10mm margin
What is the precursor lesion to a squamous cell carcinoma?
actinic keratosis
How are squamous cell carcinomas treated?
with wLE to a 4-10mm margin
What is a Merkel cell carcinoma? How does it present? How is it treated?
- a rare, neuroendocrine malignancy
- presents as a rapidly growing, firm, red/purple nodule without ulceration
- requires staging PET scan and then WLE with 1-2cm margins and SLNB
- adjuvant radiation for lesions > 2cm (stage II) or any lymph node involvement (stage III)
For patients with dermatofibrosarcoma protuberans, what is indicative of metastatic disease?
fibrosarcomatous changes, most commonly going to lung
What are the resection margins for melanoma?
- in situ: 5-10mm
- <1mm: 10mm
- 1-2mm: 10-20mm
- > 2mm: 20mm
Which melanoma patients need SLNB?
those with stage IB or higher disease (i.e. with depth 0.8mm or with ulceration)
What did the MSLT-II trial show?
that there is no difference in melanoma-specific survival for patients with positive sentinel lymph nodes who undergo observation versus completion lymphadenectomy, thus suggesting that these patients can be monitored with serial ultrasound
What is the preferred agent for treating metastatic melanoma?
pembrolizumab, a monoclonal antibody against PD-1
How is a subungual melanoma excised?
with amputation of the finger at the mid proximal phalanx or of the toe including the metatarsal head
What are the boundaries of the femoral triangle?
- superior: inguinal ligament
- lateral: sartorius
- medial: adductor longus
How is herpetic whitlow treated?
with observation and avoidance of contact
What is the most common organism causing lymphangitis?
Streptococcus pyogenes
What are the three most common bacteria associated with Fournier’s gangrene?
E. coli, Klebsiella, and Enterococci
