SR 68 - Plastic Surgery Flashcards
Blepharoplasty
Eyelid surgery
Removing excess skin/fat
Face lift
Removal of excess facial skin
Hairline/chin/ear incisions
FTSG
Full Thickness Skin Graft
Includes entire epidermis and dermis
Langer’s lines
Natrual skin lines of minimal tensions
Incisions perpendicular to them result in larger scars than those parallel to the lines
Mammoplasty
Breast surgery (reduction or augmentation)
STSG
Split thickness skin graft
Includes the epidermis and a variable amount of hte dermis
10/1000 to 18/1000 of an inch thick
What are the phases of wound healing?
Inflammation
Epithelialization
Fibroplasia
Contraction
‘In Every Fresh Cut’
What are the actions of the following phases of wound healing? Inflammation
Vasoconstriction followed by vasodilation, capillary leak
What are the actions of the following phases of wound healing? Epithelialization
Epithelial coverage of wound
What are the actions of the following phases of wound healing? Fibroplasia
Fibroblasts and accumulation of collagen, elastin, and reticulin
What are the actions of the following phases of wound healing? Wound contraction
Myofibroblasts contract wound
What is the maximal contraction of the wound in mm/day?
0.75mm/day
What degree of bacterial contamination prevents epithelialization?
> 100,000 organisms/gm tissue
In what structures does the epithelium grow from superficial burns/wounds?
Epithelial lining of sweat glands and hair follicles
In what structures does the epithelium grow from full-thickness burns/wounds?
From wound margins
Grows in
What malignant ulcer is associated with a long-standing scar/burn?
Marjolin’s ulcer
aka Burn scar carcinoma
What are myofibroblasts?
Specialized fibroblasts that behave like smooth muscle
Pull the wound edges together following granulation
Which contracts more - an STSG or an FTSG?
STSG contracts up to 41% of the surface area
FTSG contracts little, if at all
What is granulation tissue?
Days 4-6 after open wound
Development of capillary beds and fibroblast provides a healthy base for epithelial growth from wound edges
This tissue is resitant to bacterial infections
Local factors that impair wound healing?
Hematoma Seroma Infection Tight sutures Tight wrap Movement/disturbance of the wound
What systemic conditions inhibit wound healing?
Anemia Malnutrition Steroids Cancer Radiation Hypoxia Sepsis
What helps wound healing in patients taking steroids?
Vitamin A
Counteracts the effect of steroids on wound healing
When does a wound gain more than 90% of its maximal tensile strength?
~6 weeks
Laceration
Jagged wound
Contusion
Bruise without a break in the skin
Hypertrophic scar
Overgrowth of collagen stays within the original wound margins
Keloid
Overgrowth of collagen that progerssively enlarges beyond the original wound margins
Why do you not clean lacerations with Betadine?
It is hearmful to and inhibits normal healthy tissue
What is the best way to clean out a laceration?
Normal saline irrigation
What are the prerequisites for a skin graft to take?
Bed must be vascularized - not bone or tendon
Bacteria
What is better bed for a skin graft - fascia or fat?
Fascia (better blood supply)
How do you increase the surface area for a STSG?
Mesh it (allows for blood/serum to be removed from beneath the graft)
What does a STSG get nutrition for the first 24 hours?
Imbibition
Where does a random skin flap get its blood supply?
From the dermal-subdermal plexus
Random flaps are simpler and have no named blood supply. Rather, they are supplied by generic vascular networks.
Where does an axial skin flap get its blood supply?
It is vascularied by direct cutaneous arteries
Axial flaps are supplied by a named artery and vein. This allows for a larger area to be freed from surrounding and underlying tissue, leaving only a small pedicle containing the vessels.
Name some axial flaps and their arterial supplies?
Forehead flap - superficial temporal artery (used for intraoral lesions)
Deltopectoral flap - anterior perforators of the internal mammary artery (head and neck wounds)
Groin flap - superficial circumflex iliac artery (hand and forearm wounds)
What is the most common cause of flap loss?
Venous thrombosis
What is a simple advancement flap?
Incisions are extended out parallel from the wound, creating a rectangle with one edge remaining intact.
This rectangle is freed from the deeper tissues and then stretched (or advanced) forward to cover the wound.
What is a rotational flap?
A rotation flap is similar except instead of being stretched in a straight line, the flap is stretched in an arc. The more complex transposition flap involves rotating an adjacent piece of tissue, resulting in the creation of a new defect which must then be closed.
What is a ‘free flap’?
Flap separated from all avascular supply that requires microvascular anastomosis
What is a TRAM flap?
Transverse Rectus Abdominis Mycutaneous flap
What is a ‘Z-plasty’?
Functional (elongate and relax scars) or cosmetic (realign scars to make them less noticeable).
The transposition of two triangular flaps.
What is a V-Y advancement flap?
A surgical method for lengthening tissues in one direction by cutting in the lines of a V, sliding the two segments apart, and closing in the lines of a Y.
