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NYU Review > Trauma > Flashcards

Trauma Flashcards

Jas Dillon 2015

1
Q

Leading cause of death in first 4 decades of life?

A

Trauma

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2
Q

Describe the trimodal death distribution…

A

Immediate deaths within the first hour

Early deaths - ATLS used here within first 4 hours of trauma

Late deaths = deaths that occur from injuries 3-4 weeks after trauma

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3
Q

Acronym for Primary survey?

A 
ABCDE
Airway and c-spine protection
Breathing/ventilation
Circulation and hemorrhage control
Disability = neuro status
Environment/Exposure
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4
Q

Adjuncts to Primary survey?

A

Vital signs, ABG, Pulse Ox, Urine output, ECG

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5
Q

What are two types of cricothyroidotomy? How is each one completed? Downsides?

A

Needle Cricothyroidotomy

  • 14 gauge angiocatheter to cricothyroid membrane - can attach O2 canula to maintain oxygen saturation
  • only temporary - lasting about 30 minutes due to CO2 build up. Cannot ventilate patient well.

Surgical cricothyroidomy

  • 2 cm vertical incision between thyroid and cricoid cartilages.
  • Incision through membrane then use blunt end of scalpel or tracheal spread to open. Insure ET tube size 6 (small opening)
  • Make sure you are in the midline!
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6
Q

Diameters of cricothryoid membrane?

A

13 mm below vocal cords

1 cm in length

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7
Q

what is secondary survey?

A 
AMPLE acronym
Allergies
Meds
Past illnesses/prenancy
Last meal
Events/Environment
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8
Q

What is battle’s sign?

A

ecchymosis behind ear - suggestive of base of skull fractures

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9
Q

what are the zones of the neck and what delineates them?

A

Zone 1 = clavicle to cricoid
= danger zone - great vessels and lungs here.
= do not explore = 12 % mortality when explored

Zone 2 = cricoid to mandible inferior border

Zone 3 = mandible to base of skull

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10
Q

What is recommendation for blunt and penetrating neck trauma?

A

CTA +/-pan endoscopy

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11
Q

GCS? Min and max?

A

3-15
Intubated = T

Eyes =4
Verbal=5
Motor=6

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12
Q

Tertiary survey?

A

Third time to do entire exam once patient is on floor

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13
Q

Tracheostomy Describe procedure

A

MArk out laryngeal prominence (thyroid cartilage) and sternal notch.

Horizontal incision is between these two landmarks.

blunt dissection down - feel for rings

constantly check midline

cricoid hook to pull superiorly

tracheotomy = incision
or
tracheostomy= cut out piece to create window

Place tube and secure

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14
Q

Missing tooth s/p trauma and patient doesn’t know where it is what do you do?

A

Chest x-ray to exclude aspiration

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15
Q

Do overjet, overbite, and lip incompetence affect dentoalveolar traumas?

A

3-4 x more likely for tooth fracture with these

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16
Q

Ellis classifications

A 
I= enamel fx
II= through dentin
III= through pulp
IV= roots
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17
Q

What vaccination is important if tooth is avulsed and reimplanted?

A

Tetanus vaccination

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18
Q

Ellis I and II tx

A

Temproary restoration to prevent sensitivity and check occlusion

f/u for pulpal necrosis over 3-6 months

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19
Q

Ellis III

A

Partial pulpotomy at General dentist with CaOH paste to seal tooth.

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20
Q

Ellis IV

A
  • Reposition and splint (semirigid) teeth for 4 weeks
  • Refer to GD to eval vitality
  • poor prognosis
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21
Q

Worse type of root fracture / poorest prognosis

A

Vertical root fracture is worst, then cervical third fracture, then middle third, then apical third

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22
Q

Concussion of tooth?

A

nondisplaced but percussion sensitivitive.

tx = remove from occlusion and check vitality periodically

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23
Q

Subluxation of tooth?

A

tooth is loose but nondisplaced

tx - semi rigid split vs soft diet.

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24
Q

Luxation of tooth 3 types?

What is worst type?

A

Intrusion, extrusion, lateral

Intrusion is worst

tx = reposition and splint semi rigid

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25
Q

Avulsed deciduous tooth?

A

do NOT reimplant

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26
Q

Avulsion of tooth?

A
  • avoid disrupting PDL/do not touch root
    TX for parents- gently wash for 10 seconds in cold water and reimplant in mouth
  • if unable to reimplant and patient is old enough - place in cheek - saliva = great pH
  • Alternatives = milk or hanks solution
  • If replaced with 30 minutes = good prognosis
  • If dry >60 minutes = poor prognosis
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27
Q

Intruded teeth treatment?

A

let rerupt on its own… consider orthodontic extrusion if it doesn’t erupt

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28
Q

Avulsion of closed vs open apex tooth and <60 minutes has gone by?

A

Closed= semirigid splint for 7-10 days up to 14 days max, RCT while in splint, abx for a week

Open = semirigid splint for 3-4 weeks, check vitality to see if RCT is needed, abx 1 week

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29
Q

Avulsed tooth > 60 minutes

A

consider tx of root surface with 2% NaF for 20minutes (soak tooth in sodium fluoride)

-semirigid splint x 4 weeks with RCT prior to reinsertion or 1 week after reinsertion
abx 1 week

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30
Q

Alveolar fracture treatment

A

Reposition alveolus

Rigid splint x 4 weeks

Extract hopeless teeth after fracutre heals

Abx recommended 1 week

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31
Q

How does strain affect mandibular boney healing s/p fracture?

A

Mechanical forces produce strain that elongates boney healing - if too much strain bone will not heal = nonunion

prevent with fixation

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32
Q

Direct vs indirect bone healing

A

direct = bone to bone contact

indirect = small boney gap

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33
Q

Must be ware of muscle pull with fracture type?

what areas of mandible have the strongest and weakest muscle pulls?

A 
strongest = symphysis
weakest = condyles

Muscles of mastication will alter muscle pull forces and vectors

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34
Q

Name vectors and attachment of mandibualr muscles?

A

Temporalis = cornoid (medial pole) pulls superiorly

Lateral ptergoid= condyle anterior pole pulls anterior and medially

Medial pterygoid = angle (medial side)superiorly and anterily

Massetter = same as M. pterygoid but on lateral side of mandible angle

Mylohyoid= pulls inferiorly

Geniohyoid and genioglossus pull mandible posteriorly at symphysis

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35
Q

Mandibular Fracture Classifications (6 types)

A

Simple

Compound/open = communicates with PDL or laceration

Comminuted (multiple pieces)

Greenstick = no mobility, no distortion, one cortex has fx line

complex/complicated (involves adjacent structure - nerves and vessels

Telescoped = one segment into another

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36
Q

Closed reduction

A

Indirect fixation= stabilization at site distant from fracture.

Can be used on majority of fx’s though may not have best outcome.

6-8 weeks ( unless condylar of childrens fx)
jaw stretching exercises

beware of locking someone in a kicking out gonial angles

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37
Q

transoral approach pros and cons

A

Advantages

  • direct access
  • no scar

cons

  • difficult access
  • tough to see psoterior
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38
Q

extraoral pros and cons

A

pros = better access

cons = infection (cross contamination of skin, scarring, facial nerve involvement

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39
Q

Principles of mandibular fracture tx

A
  1. Reduce fragments
  2. reestablish occlusion
  3. apply stable fixation
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40
Q

Mandibular fx tx options

A
  1. CR- MMF
  2. ORIF - lag screws vs plates
  3. Ex fix
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41
Q

What are fracture patterns i.e favorable vs unfavorable

A

favorable = muscle pull segments together
vertically favorable = resists superior displacement (masseter and m.pterygoid)
horizontally favorable = resists medial displacement (lateral pterygoid)

unfavorable = segments are pulled apart

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42
Q

Condylar fx in younger patients

A

consider less CR

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43
Q

Indications for extraction of teeth in line of fracture (5)

A
  1. periapical pathology
  2. Partially erupted third molars with signs of pericoronitis or cyst
  3. fractured roots or severe bone resorption (2/3) root exposed
  4. delay in treatment
  5. prevents adequate reduction
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44
Q

Semirigid vs nonrigid vs rigid fixation

A

less incidence of infection in rigid fixation due to less micro movement

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45
Q

Indication to avoid closed reduction

A
  1. noncompliant patient
  2. seizures
  3. alcoholic (vomiting)
  4. mental disability
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46
Q

Where are your zones of tension and compression in the mandible?

A

Tension line are superior by teeth and this can open the fracure (spread fracture)

Compression lines are along inferior border and these compress boney segments

Coronoid = lines of tension in superior direction

Condyle = Anteriorly = tension zone, posteriorly = compression zone

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47
Q

Load sharings vs Laod bearing plates

A

load sharing = bone and implant share work

load bearing= plate takes all force

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48
Q

Load bearing IF indications?

A

infected, comminuted/complex fractures, grafting sites, noncompliant patients

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49
Q

Worry in comminuted fractures?

A

blood supply to fractured segments and subsequent necrosis if lacking

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50
Q

what is fracture simplification?

A

taking small pieces and combining them into larger pieces using miniplates to then place recon plate

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51
Q

Facial nerve appears injured post op, but reexploration shows intact facial nerve… what causes facial droop?

A

traction to neuropraxia injury

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52
Q

guardsman fracture?

A

symphysis fracture and both condylar heads

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53
Q

Considerations for pediatric patients with fractures (4)

A
  • deciduous eeth
  • bulbous teeth - difficult to put in MMF
  • teeth buds ( no screws)
  • growth
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54
Q

Considerations for elderly patients with fractures (5)

A
  • Medications (steroids, bisphosphonates, etc)
  • cannot tolerate MMF
  • edentulous
  • loss of IAN blood supply
  • Atrophic mandible
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55
Q

Examples of functionally stable, semirigid fixation

A
  • Closed reduction.
  • arch bar and minipalte
  • champy plate at lines of tension

micromovement occurs

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56
Q

Champy plate theory?

Pro’s?
Con’s?

A

Lines of tensions in superior aspect of mandible and on superior and inferior aspect of symphysis can be banded with monocortical screws and miniplate as functionally stable semi rigid fixation.

Pros = less risk to IAN
cons= semirigid = increased risk of infection
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57
Q

How many plates are needed to minimize infection with angle fxs?

A

no difference between one vs two plates

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58
Q

Load sharing rigid internal fixation theory?

A
  1. Use lag screws to bring segments together, Compressing them.
  2. can also be two smaller/nonrecon plates
  3. can also be arch bar and heavier plate

this puts forces on both screw and bone

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59
Q

Risk of symphysis fractures?

A

gonial flaring/ lingual gap

tx - must compress angles with assistants or orthopedic pelvic clamp

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60
Q

Best option for fixation

  1. arch bar and plate
  2. 2 plates
  3. lag screws
  4. 3d printed plates
  5. no difference was seen
A

ellis 2014

Lag screws and 1 plate with an arch bar are superior to two plates in termed of post op complications

two plates can cause wound dehiscence at second plate and increased risk of infection

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61
Q

Treatment of condylar fractures -

indications for Open
4 absolute
3 relative

A
  1. Closed reduction
    2.ORIF
    Absolute:
    a.malocclusion/cannot reduce with CR

b. condylar head displaced laterally extracapsular
c. foreign body intracapuslar
d. limited function

Relative
e. bilateral condylar fxs with midface fx (panface) or lacks posterior dentition - maintains vertical height

f. cannot tolerate CR
g. severe atrophy of mandible

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62
Q

Access and plating for condylar fx ORIF

A

Retromandibular vs Preauricular/endaural

try to place two plates

63
Q

treatment for atrophic mandible?

A

Load bearing/Recon plate required

  • inferior border placement of plate = reduced OR time and
  • consider BMP with abdominal micromesh to improve healing +/- bone graft
  • beware of superior IAN
  • loss of blodd supply
64
Q

Complication with BMP

A

Airway swelling

65
Q

Displaced fractures are at an increased risk of ?

A

IAN fractures

If not numb preop-tell patients they will be numb postop due to compression of nerve

66
Q

What is dysthesia?

A

pain from sensation that do not usually cause pain

67
Q

tx for dysesthesia?

A
  1. try meds? Lyrica, gabapentin
  2. remove plates
  3. diagnostic nerve block
  4. If positive then remove nerve
68
Q

House Brackmann Classification is used for?

A

Facial nerve injuries

I = normal
II= mild dysfunction - slight weakness
III= moderate dysfunction -obvious weakness but nondisfiguring, eye closure is complete
IV=moderately severe dysfunction - disfiguring asymmetry on motion, incomplete eye closure
V=severe dysfunction, asymmetry at rest
VI=total paralysis

69
Q

What drug can be used offlabel to aid in post traumatic peripheral facial nerve regeneration?

A

Nimodipine

60 mg TID x 10 days
minimal side effects
expensive

70
Q

facial nerve injuries usually resolve after?

A

6 months

71
Q

Differences between peds and adult fractures? Name a few

A

bones are mroe flexible

faster healing (~10 days)

Greenstick fx common

Nonunions are rare

tooth buds

72
Q

Pediatric mandible fx tx?

A

CR (not to exceed 2 weeks) vs soft diet vs resorbable fixation vs ORIF

73
Q

When do you take the plates off and whats difficult about removing plates?

A

Remove plates to avoid growth disturbance

Remove after ~3months

Hard to find plates since it is encased in bone

74
Q

16 month old with guardsmand fx what is the treatment?

  1. ORIF symphysis and condyles
  2. CR with risdon
  3. soft diet
A

soft diet!!

75
Q

Dehiscence of plates in mandible 1 month after placement what do you do??

A

Conservative with abx is ok

Likely will need to remove hardware and fixate with CR, mandibular wires, splint, or exfix

76
Q

What makes a LeFort fx a Lefort fx??

A

Pterygoid plates must be fractures

77
Q

What are the four horizontal buttresses of the face?

A

Frontal

Zygomatic,

Maxillary

Mandibular

78
Q

What are the four vertical buttresses of the face?

A

Nasomaxillary (piriform rim)

Zygomaticomaxillary

Pterygomaxillary

Ramus-condylar complex

79
Q

Treatment LeFort I and II?

A

Transoral access

Adequately mobilize to avoid forcing condyle out of fossa

Place in MMF

Put on ORIF

Verify occlusion

80
Q

Treatment of palatal fracture?

A

Palatal splint vs ORIF vs CR

Beware of opening both sides of segment due to blood loss

81
Q

LeFort III treatment options

A

Require multiple approaches

Important to verify facial width and height and OCCLUSION

Start with frontal zygomatic suture and work down

82
Q

Tripod is a misnomer. What are the four sutures/articulations of the zygoma?

A

Frontal, Maxillary, Temporal, Sphenoidal

83
Q

ZMC fracture treatments

A

Gillies approach and internal reduction - elevator is above muscle below deep layer of temporalis fascia

Use rowe elevator

Preauricular vs coronal for transoral with ORIF

84
Q

reasons to do surgery on midface fractures?

A

function deficit
cosmetic
paresthesia

85
Q

Best and worst ways to assess ZMC reduction intraoperatively? (which sutures do you want to see aligned)

A

Worst = frontozygomatic suture (infraorbital rim is next worse)

Best= sphenozygomatic suture

zygomaticomaxillary buttress and arch are also useful

86
Q

What test do you do before any orbital or ZMC fracture repair?

A

Forced duction

87
Q

How many bones are in the orbit? Which are they?

A

7 bones

ethmoid, lacrimal, zygoma, sphenoid, palatine, frontal, maxillary

88
Q

What is the volume of the orbit? The globe?

A

30 mL , 7 mL

89
Q

What lies on the floor of the orbit? What runs through this?

A

Inferior orbital fissure and Infraorbital groove

Contains CN V2 and infraorbital vessels and the zygomatic nerve

90
Q

What is the acronym for superior orbital fissure nerves?

A

Lazy French Tarts Sit Nakedly In Anticipation

Lacrimal nerve ( most superior) - CN1
Frontal Nerve- CN1
Trochelear Nerve - CNIV
Superior Oculomotor nerve (CNIII superior division)
Nasociliary nerve (CN V1)
Inferior Oculomotor nerve (CNIII)
Abducens Nerve (CN VI)

Also contains branches of ophthalmic veins and arteries

91
Q

What is the distance between the ethmoidal arteries on the medial wall of the orbit from the anterior lacrimal crest?

A

24 mm - anterior ethmoid foramen
36mm - posterior ethmoid foramen
42mm = optic canal

92
Q

What is the difference between afferent and effect nerve pathways?

A

afferent is towards CNS

Efferent is away from CNS
E=exit

93
Q

Efferent eye defect affects what nerve?

A

CN III

The pupil of affect eye is unresponsive to light, but opposite eye will have a normal consensual response to light show in affected eye.

94
Q

Afferent eye defect affects what nerve?

A

CN II

The affected eye has a normal consensual response to light, but the unaffected eye with not have a consensual response when light is shown in the affect eye.

95
Q

What is the Marcus Gunn Pupil?

A

Afferent pupillary defect

Disease of optic nerve (defect)

Affected eye will not have good constriction to direct light, but will dilate to consensual/opposite eye direct light

96
Q

(SO4LR6)3 - what does this mean?

OD vs OS?

A

superior oblique = CN IV -looks down and media
Lateral rectus = CN VI
Medial rectus, inferior oblique, inferior rectus, superior rectus = CN III

OD = right eye , OS = left eye

97
Q

What is hyphema?

A

blood in anterior chamber of eye- avoid surgery until resolved

Grade I = <1/3 full
Grade II = 1/3-1/2
Grade III= >1/2
Grade 4 = total

98
Q

what is tonometry?

A

measurement of intraocular pressure

normal is 10-20 (intraoc 12 oclock (12-24)

99
Q

When is a lateral canthotomy and inferior cantholysis indicated?

A

IOP >35-40

100
Q

What is fundoscopy?

A

Visualization of retina

101
Q

Superior Orbital Fissure Syndrome - what are clinical findings?

A

“Lazy French Tarts Sat Nakedly In Anticipation”

Lacrimal Nerve (CNV1) and Frontal Nerve CN V1 = numbness to head

Superior and Inferior divisions of Oculomotor = CN III and Trochlear Nerve = CN IV and abducens CN VI all cause opthalmaplegia and ptosis upper eyelid (CN III)

Nasociliary = CN V1 = loss of corneal reflex (touch eye and it blinks)

also expect proptosis and edema due to vasculature loss

tx= supportive with ophtho consult

102
Q

How is Orbital Apex syndrome different from SOF syndrome?

A

Same clinical with the addition of loss of visual acuity

Tx= supportive with Ophtho and ORBITAL DECOMPRESSION NEEDED

103
Q

What is Traumatic Optic Neuropathy?

A

Decreased vision with Afferent pupillary defect

Caused by deceleration injuries with head trauma

Best tx = high dose IV steroids, optic nerve decompression, observation = let Ophtho decide

104
Q

What are the indications for ocular surgery?

Contraindications?

A

Enopthalmos/hypoglobus and mechanical restriction= absolute

Relative indications = enophthalmus once swellign is gone and diplopia

Contraidications = “only seeing/non blind” eye, ocular injury (hyphema, retinal tears, globe injuries)

105
Q

What is the ratio for increase in intraorbital volume and enophthalmus?

A

1 cc increase in volume leads to 1 mm

106
Q

Caused of enophthalmus?

A
  1. increase in volume ( worse in posterior half)

2. soft tissue changes ( fat atrophy, scarring

107
Q

Trap door injury?

A

Often in peds do to entrapment of EOM

Nausea, vomiting , bradycardia from oculocardiac reflex.

Requires immediate intervention in 48 hours

108
Q

What are orbital fracture approaches?

A

Subciliary
subtarsal
infraorbital
transconjunctival (pre or post septal)

109
Q

Reconstruction of orbital floor - what materials?

A

autogenous (cranium) - resorbs unpredictably

allogenic bone = less resorption

Alloplasts = gold standard, but risk of foreign body rxn
- metallic, Medpor, silicon or teflon.

MEDPOR = porous polyethylene - hard to see on imaging - risk of infection.

Bioabsorbables are good for very small areas (gelfilm, PGA, PDS, PLA)

110
Q

Which wall of orbit is most likely to cause enophthalmus?

A

medial wall

111
Q

How can you approach/access medial wall?

A

Pre-caruncular
- uses horner’s muscle to guide surgery (posterior limb of medial canthal tendon attachment)

trans/postcaruncular approach
- tendency for granulomas and edema

112
Q

How can you find the posterior edge of an orbital floor fracture?

A

Elevate soft tissues superiorly

Place periosteal into maxillary sinus and find posterior wall.

Track wall superiorly to find posterior edge

113
Q

What is normal intercanthal distance?

What is enlarge intercanthal distance secondary to trauma called?

A

33-34mm = normal intercanthal distance

Telecanthis

114
Q

What lies between the two limbs of the medial canthal tendon?

A

lacrimal sac

115
Q

Where does the MCT attach?

A

Anterior and posterior lacrimal crest (frontal process of the maxilla)

Anterior limb runs horizontally (inserts into anterior lacrimal crest)

Posterior limb runs vertically and becomes horners muscles ( inserts into posterior lacrimal crest

116
Q

Where does the nasolacrimal system drain?

A

Inferior meatus/ turbinate

117
Q

NOE very commonly damage the nasolacrimal system. If not identified and repaired what complication occurs?

How do you test this?

what procedure repairs this?

A

Epiphora

Jones Test-
Cannulate duct
Inject die (methylene blue or green fluoroscein)
Verify it comes out nose

DCR-Dacryocystorhinostomy

118
Q

What clinical examination determiens MCT integrity?

A

bowstring test

119
Q

What is the NOE classification?

A

Markowitz

I = large segments and attached MCT
II=comminuted segments and attached MCT
III=comminuted and unattached MCT

120
Q

Approaches to NOE fx?

A

local incisions

coronal

eyelid incisions

intraoral incision

121
Q

IF MCT is unattached how do you treat?

What direction should the repair go?

A

Transnasal wiring/canthopexy

MCT is directed superiorly and posteriorly, must overcompensate

122
Q

What is a panfacial fracture?

A

complex fractures involving two or more facial thirds (mandibular, midface, frontal)

123
Q

How can you sequence Panfacial fractures? 3 ways

A
  1. Inside - out, bottom to top
  2. Out to in, top to bottom
  3. bottom to top to middle
124
Q

Do children have a frontal sinus?

A

No radiographic evidence until age 6 but development begins at 2 years of age

125
Q

What vasculature supplies the forntal sinus?

A

Supraorbital and anterior ethmoidal veins and arteries and the diploic veins (veins of breschet)

126
Q

What kinds of epithelium lines all sinus cavities?

A

Pseudostratified ciliated columnar respiratory epithelium with goblet cells that produce mucin

127
Q

where does the Nasofrontal duct lie in the frontal sinus?

where does it empty?

A

posterior medial floor of sinus

middle meatus

128
Q

What are tests for CSF leak?

A

Halo test (subjective bedside test)

Beta-2 tranferrin- only found in CSF - takes 1 day to receive results

Direct fluid analysis of glucose, protein and K+ can also be done ( should be decreased in CSF compared to serum but is unreliable)

129
Q

tx for CSF leak?

A

early reduction of fx vs conservative tx

conservative = bed rest, elevate HOB, sinus precautions

ENt and neuro are moving away from treatment

130
Q

frontal sinus classification?

A

Anterior table displacement

Posterior table involvement

Nasofrontal duct obstruction

131
Q

Goal of frontal sinus fx treatment?

What is treatment

A

Nasofrontal duct is key

Esthetics secondary

tx- 
Sinus obliteration (fat is gold standard), temporalis

Sinus cranialization (pericranial flap vs fibrin glue)

132
Q

Frontal Sinus tx

A

Bell algorithm

If the posterior table is displaced (more than width of bone) or comminuted then tx is cranialization and repair of anterior table (no matter status of nasofrontal duct or anterior table)

You only obliterate the sinus if the nasofrontal duct is not patent but the psoterior table is intact

133
Q

What is an infection associated with frontal sinus repair?

What is the most common chronic frontal sinus complication?

A

Frontal bone osteomyelitis = Puffy Potts tumor!

Mucocele/mucopyocele - must resurgerize to remove respiratory epithelium

134
Q

Phases of wound healing? how many, how long, what are they?

A

Phase I = injury

Phase II = Inflammatory phase (4 days)

Phass III = proliferation phase 4 weeks

Phase IV = Maturation = 4 months

135
Q

What occurs during phase II? 3 phase of ….

A

3 phase of hemostasis!!

  1. Vasocontriction early
  2. Platelet aggregation and plugging
  3. Coagulation ( then fibrin formation and vasodilation late to allow healing cells and blood flow for repair)
136
Q

What is the hallmark of phase III?

A

Granulation tissue!!

Phase is the neovascularization and reepithelialization of wound

Macrophases, fibroblasts are common

137
Q

Phase IV/Maturation phase allows for what kind of collagen placement?

A

Type I collagen replaces type III collagen.

Strength is 80-85% original strength

138
Q

what kind of bug is tetanus?

A

Anaerobic gram + rod

139
Q

What is fitzpatrick classification?

A

Skin type

Darker = increased risk for scarring and keloids

140
Q

Esthetic units of the face are classfied via?

how many are there?

A

Classified based on thickness
-Thick (cheek, mentalis, nose, upper lip) vs Medium Forehead, neck, nose) vs thin (eyelids and ear)
14 units

141
Q

Subunit theory of esthetic reconstruction is based on?

A

the idea that our eyes find unexpected/unnatural areas and focus on them

142
Q

Lower lip reconstruction based on defect size?

<1/3 lip avulsed tx?
1/2-2/3 lip avulsed tx?
>2/3 lip avulsed tx?

A

<1/3 = primary closure

> 1/3 = local flap, or free flap

  • karapandzic flap
  • johanson flap
143
Q

What are principles of scalp reconstruction?

How large a wound can be closed primarily?

What is needed for healing by secondary intention? what is a complication of this?

A

Can closed up to 3 cm defect with subgaleal undermining widely.

secondary intention is only possible if viable tissue base (pericranium) and are will be hairless

144
Q

Secondary repair of scalp defect include?

A

Local flaps

Tissue expansion

Hair transplant

Skin graft - will not contain hair)

Free tissue transfer - lacks hair

145
Q

What are flap complications? 5 types

A

hematoma

flap necrosis ( secondary to venous congestion or ischemia)

infection

dehiscence

fistula

146
Q

Key to nasal lacerations

A
  1. rule out septal hematoma

2. low tension closure

147
Q

What nerves innervate the ear? 4 nerves

A 
Superiorly = auriculotemporal
Anteriorly = vagus n. auricular branch
Posteriorly = lesser occipital
inferiorly = greater auricular
148
Q

What are most common bacteria in human bites?

Dog bites?

Cat bites?

A

Aneorobic bacteria - human mouth

Dog bites = Capnocytophagia canimorsus

Cat Bites/barnyard animals = Pasteurella multocida

149
Q

What is best antibiotic for any bite?

A

Augmentin

150
Q

What disease must be considered for any animal bite?

A

Rabies!!!

Is dog UTD with vaccines, wild vs domestic vs unknown

151
Q

What is treatment for venous congestion?

A

Leech treatment q8h x 72 hours

  • protext ear canal (leach will enter)
  • cover with ciprofloxacin abx
152
Q

What causes perichondral hematoma?

What is treatment for it?

A

Hematoma forms under periochondrium - cartilage dies - fibrosis forms

tx= drain with pressure dressing

153
Q

Tx for partial ear avulsion?

A
  1. impression of other ear
  2. Rib cartilage harvest
  3. remove soft tissue near avulsed region
  4. Posterior pocket
  5. Allow to heal
154
Q

Post op instructions for laceration care?

A

NO water x 48-72 hours

Bacitracin x 3-5 days 3x /day

Massage BID x 10 minutes once sutures are out (10 days after injury) Rotary hand movements with enough pressure to blanch us petroleum

Petroleum jelly x 1 months

Petroleum jelly is superior to vita E and maderma

Silicone sheeting/gel (gold standard) (Scarfade) is very useful after reepithelizes ~1 month
Sheets = q12h for 3-6 months ( hard in head and neck)
gel = BID x 3-4 months

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