Skin and soft tissue review Flashcards
most common nerve injury with anterior shoulder dislocation
axillary nerve
most common way to see an ulnar nerve injury from trauma?
elbow fracture
- decreased sensation in 4th and 5th digit of hand
- reduced grip
- inability to flex 4th and 5th digit
what was injured?
ulnar nerve injury
most common way to see median nerve injury in trauma?
supracondylar humerus fracture
inability to abduct thumb
inability to flex 2nd and 3rd digits of the hand
- what was injured?
median nerve injury
inability to extend the wrist, what was injured?
radial nerve injury
initial treatment for brown recluse spider bite?
rest
compression
elevation
patient on chronic steroids with a chronic wound, what can you supplement to help with wound healing
vitamin A
patient with immune thrombocytopenic purpura is post op from splenectomy, still complaining of nose bleeds…next step?
- peripheral smear to look for howell-jolly bodies
- if absent then look for accessory spleen
you see a splenic cyst incidentally on CT scan, what is your next step?
- test for echinococcal species -> if positive patient has hyatid disease
how do you treat hydatid disease?
- can sterilize cyst in spleen with injection of hypertonic saline, alcohol, or silver nitrate
- then splenectomy trying to make sure no contents are spilled
what is Bowen’s disease
squamous carcinoma in situ of the skin
what does actinic keratosis morph into given enough time?
Bowen’s disease AKA squamous carcinoma in situ of the skin
What is a Marjolin Ulcer?
Squamous cell carcinoma arising from a burn
stage 1 pressure ulcer
intact skin, non-blanching erythema
stage 2 pressure ulcer
partial thickness skin loss with exposed dermis
stage 3 pressure ulcer
full thickness skin loss with exposed fat and granulation tissue
stage 4 pressure ulcer
full thickness skin loss with exposed fascia, muscle, bone, cartilage, or bone
first stage of wound healing
hemostasis
- less than 1 day
First stage of wound healing
inflammation
1-3 days
third stage of wound healing
proliferation
4 days-3 weeks
fourth stage of wound healing
remodeling
starts at any time after 5 days and lasts years
mediators of inflammatory phase of wound healing
neutrophils (1st to get to wound)
Macrophages
predominant cell during the proliferation phase of wound healing?
fibroblast
lay down collagen matrix
cells active during proliferation stage of wound healing?
fibroblasts and myofibroblasts
when do you get 80% of tensile strength from a healing wound?
6 weeks
predominant method by which negative pressure wound therapy heals wounds?
promotes formation of granulation tissue
cells needed in a wound to promote proliferation and angiogenesis?
Macrophages
what is a composite skin graft?
small graft with skin and underlying cartilage or other tissue
major molecules involved in first phase of wound healing
inflammatory phase
TNFa, IL-1, PDGF
major molecules involved in second phase of wound healing
proliferation stage
PDGF, fibroblast growth factor (FGF), epidermal growth factor (EGF)
flesh colored atrophic plaque, biopsy shows spindle cells and stains positive for CD34 and vimentin
Dermatofibrosarcoma
Treatment for dermatofibrosarcoma?
can down stage with imatinib
wide local excision with 2-4 cm margin
Fothergill’s sign
palpable abdominal mass that remains fixed with abdominal muscle contraction
- rectus sheet hematoma
raised purple subcutaneous lesion, biopsy shows monomorphic large pale cells with whirled appearance
Merkel Cell Carcinoma
what does Merkel Cell carcinoma stain for traditionally?
Cytokeratin-20 (CK-20)
what does small cell carcinoma stain for?
CK-20 and TTF-1 (thyroid transcription factor 1)
first cell to arrive to wound after hemostasis?
neutrophil
Imbibition
diffusion of nutrients into a skin graft without a direct blood supply
Insoculation
donor and recipient capillaries align
When does revascularization happen with a skin graft?
typically after POD 5
salmon colored fluid coming from midline incision, sign of what?
fascial dehiscence
margin for basal cell carcinoma
0.5 cm
patient had resection of a pleomorphic adenoma from their parotid gland, now recurred. how do manage this?
-radiation therapy, too difficult to resect in an already operated field
thigh mass with biopsy showing atypical spindle cells
sarcoma
mainstay of treatment for a soft tissue sarcoma
- 1-2 cm margin
- at least one uninvolved fascial plane
role of radiotherapy in soft tissue sarcomas
- adjuvant radiation treatment mainly
- used to reduce recurrence: tumor > 5cm, <1cm margin, unable to re-resect positive margin, high grade
abdominal wall mass with biopsy showing long, sweeping fascicles containing bland cells and atypia
- Desmoid tumor
treatment for Desmoid tumor
- typically self resolve, follow with 3-6 month follow up CT
- if sx then resect
most concerning feature of dermatofirbosarcoma protuberans
fibrosarcomatous changes
most common form of melanoma in black patients
Acral lentiginous melanoma
contraindication for transverse rectus myocutaneous flap
previous abdominal surgery/compromised superior epigastric artery
margin needed for skin squamous cell carcinoma
4-6 mm
margin needed for 1 cm basal carcinoma
2 mm
margin needed for 1-2 cm basal cell carcinoma
3-5 mm
margin needed for > 2 cm basal cell carcinoma
1 cm
empiric treatment for soft tissue infection
penicillin or carbapenem AND clindamycin
first line treatment for moderate to severe hydradenitis
tetracyclines (eg Doxycycline)
