Trauma soft tissue Flashcards
List the bacteria commonly present in dog bites.
Pasteurella multocida, Staphylococcus aureus, Streptococcus viridans, and oral anaerobes
As a general rule, how long after initial injury can
simple lacerations be closed?
Up to 3 days
What are the benefits of applying a negative
pressure wound VAC to a partial avulsion injury?
Application of subatmospheric pressure has been shown to
decrease bacterial counts, promote granulation tissue
formation, and improve the rate of contracture.
Cleaning soft tissue injuries with hydrogen peroxide, modified Dakin’s solution, or povidone-iodine has been shown (in vitro) to be toxic to what cell types?
Fibroblasts and keratinocytes
Pigmented debris left in a wound bed may lead to what complication?
Traumatic tattooing
What is the mechanism of a pincushion (trapdoor)
deformity after soft tissue trauma?
● When elevated or redundant tissue abuts a curvilinear-
shaped scar
● Most likely results from concentric wound contracture
and lymphedema
Why should eyebrows be trimmed conservatively
(not shaved) when treating patients with extensive
facial trauma?
Regrowth of eyebrow hair may take as long as 6 months,
and hair regrowth may be incomplete.
What suture technique is best for everting skin
edges when closing a soft tissue laceration?
Vertical mattress
As a general rule, what suture type should be used to close the epidermis of young pediatric patients?
Absorbable suture is used because permanent suture will be difficult to remove in the office setting.
Which wound adhesive is approved by the Food
and Drug Administration (FDA) for closure of skin?
Octyl-2-cyanoacrylate (Dermabond)
What is the mechanism of action of the tissue
adhesive octyl-2-cyanoacrylate?
On exposure to moisture, octyl-2-cyanoacrylate undergoes
an exothermic reaction as it polymerizes to form a strong
tissue bond.
How does the location of a facial laceration
influence whether or not wound exploration should be carried out for facial nerve neurorrhaphy?
Because of the extensive distal arborization of the facial nerve, injuries medial to the lateral canthus are unlikely to result in significant facial nerve deficits and generally do not warrant wound exploration.
What is the preferred management of a traumatically avulsed segment of the proximal extratemporal facial nerve?
Mobilization with primary (end-to-end) neurorrhaphy is
preferred. If a tension-free anastomosis cannot be obtained, then an interposition cable graft using greater auricular
nerve or sural nerve should be used.
What treatment options can be used to decrease
the risk of sialocele after traumatic parotid duct
transection?
Options include primary anastomosis over a stent, duct ligation, or fistulization of the duct into the oral cavity.
What length of the lower lip can be managed with
primary closure without significant distortion or
microstomia?
Loss of up to one-third, or even one-half, of the lower lip can be managed with primary closure without significant distortion or resultant microstomia.
How much of the eyelid can be closed primarily
after an avulsion injury?
25%
What must be done to the avulsed segment of the auricle before its burial in a postauricular pocket for delayed reconstruction?
De-epithelialization of the avulsed segment
What antibiotic class should be used for injuries involving cartilage?
Fluoroquinolones should be used in adult and adolescent patients to adequately cover Pseudomonas aeruginosa.
Fluoroquinolones represent the only oral antibiotic class with reliable activity against Pseudomonas spp. Parenteral anti-psuedomonal cephalosporins (ceftazidime and cefe-
pime) should be used in children if perichondritis or
chondritis is suspected.
What is the definition of a first-degree burn?
Damage no deeper than the epidermis, resulting in pain and erythema, but little or no permanent injury
What is the definition of a second-degree burn?
Injury involves the epidermis and a portion of the dermis
(partial thickness) and is accompanied by pain, erythema,
and blistering. The depth of dermal injury is used to further stratify second-degree burns as being either superficial or
deep.
What is the definition of a third-degree burn?
Injury involves the epidermis and the full thickness of the
dermis, destroying adnexal structures, blood vessels, and
nerve endings.
The head and neck make up what percentage of
the total body surface area (TBSA)?
9% The “rule of nines” for calculating TBSA: ● Each leg = 18% TBSA ● Each arm = 9% TBSA ● Anterior trunk = 18% TBSA ● Posterior trunk = 18% TBSA ● Head and neck = 9% TBSA
What is the Parkland formula for fluid resuscitation
of burn victims?
Total volume is administered in the first 24 hours of
resuscitation (with lactated Ringer’s solution) = 4 mL x
weight (kg) x %TBSA burned. Half of the calculated volume
is given over the first 8 hours, and the remaining volume is
delivered at an even rate over the next 16 hours.
In addition to IV antibiotics, why are topical antibiotics recommended to prevent superinfection in burn patients?
Burn eschar has a poor blood supply, decreasing the
likelihood that therapeutic levels of systemically delivered
antibiotic will penetrate the wound bed.
When should burns involving the oral commissure
be reconstructed?
Most surgeons recommend initial observation with conservative wound care and waiting to surgically intervene only after full scar maturation.
What treatment should be considered for patients
with oral commissure electrical burns to decrease the risk of microstomia?
Oral appliance use is designed to splint the oral commissure.
