SR 68 - Plastic Surgery Flashcards by Ryan Bird

Blepharoplasty

Eyelid surgery

Removing excess skin/fat

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Face lift

Removal of excess facial skin

Hairline/chin/ear incisions

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FTSG

Full Thickness Skin Graft

Includes entire epidermis and dermis

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Langer’s lines

Natrual skin lines of minimal tensions

Incisions perpendicular to them result in larger scars than those parallel to the lines

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Mammoplasty

Breast surgery (reduction or augmentation)

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STSG

Split thickness skin graft
Includes the epidermis and a variable amount of hte dermis
10/1000 to 18/1000 of an inch thick

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What are the phases of wound healing?

Inflammation
Epithelialization
Fibroplasia
Contraction

‘In Every Fresh Cut’

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What are the actions of the following phases of wound healing? Inflammation

Vasoconstriction followed by vasodilation, capillary leak

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What are the actions of the following phases of wound healing? Epithelialization

Epithelial coverage of wound

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What are the actions of the following phases of wound healing? Fibroplasia

Fibroblasts and accumulation of collagen, elastin, and reticulin

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What are the actions of the following phases of wound healing? Wound contraction

Myofibroblasts contract wound

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What is the maximal contraction of the wound in mm/day?

0.75mm/day

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What degree of bacterial contamination prevents epithelialization?

> 100,000 organisms/gm tissue

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In what structures does the epithelium grow from superficial burns/wounds?

Epithelial lining of sweat glands and hair follicles

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In what structures does the epithelium grow from full-thickness burns/wounds?

From wound margins

Grows in

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What malignant ulcer is associated with a long-standing scar/burn?

Marjolin’s ulcer

aka Burn scar carcinoma

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What are myofibroblasts?

Specialized fibroblasts that behave like smooth muscle

Pull the wound edges together following granulation

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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.