Trauma soft tissue

Question 1

List the bacteria commonly present in dog bites.

Answer 1

Pasteurella multocida, Staphylococcus aureus, Streptococcus viridans, and oral anaerobes

Question 2

As a general rule, how long after initial injury can

simple lacerations be closed?

Answer 2

Up to 3 days

Question 3

What are the benefits of applying a negative

pressure wound VAC to a partial avulsion injury?

Answer 3

Application of subatmospheric pressure has been shown to
decrease bacterial counts, promote granulation tissue
formation, and improve the rate of contracture.

Question 4

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?

Answer 4

Fibroblasts and keratinocytes

Question 5

Pigmented debris left in a wound bed may lead to what complication?

Answer 5

Traumatic tattooing

Question 6

What is the mechanism of a pincushion (trapdoor)

deformity after soft tissue trauma?

Answer 6

● When elevated or redundant tissue abuts a curvilinear-
shaped scar
● Most likely results from concentric wound contracture
and lymphedema

Question 7

Why should eyebrows be trimmed conservatively
(not shaved) when treating patients with extensive
facial trauma?

Answer 7

Regrowth of eyebrow hair may take as long as 6 months,

and hair regrowth may be incomplete.

Question 8

What suture technique is best for everting skin

edges when closing a soft tissue laceration?

Answer 8

Vertical mattress

Question 9

As a general rule, what suture type should be used to close the epidermis of young pediatric patients?

Answer 9

Absorbable suture is used because permanent suture will be difficult to remove in the office setting.

Question 10

Which wound adhesive is approved by the Food

and Drug Administration (FDA) for closure of skin?

Answer 10

Octyl-2-cyanoacrylate (Dermabond)

Question 11

What is the mechanism of action of the tissue

adhesive octyl-2-cyanoacrylate?

Answer 11

On exposure to moisture, octyl-2-cyanoacrylate undergoes
an exothermic reaction as it polymerizes to form a strong
tissue bond.

Question 12

How does the location of a facial laceration

influence whether or not wound exploration should be carried out for facial nerve neurorrhaphy?

Answer 12

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.

Question 13

What is the preferred management of a traumatically avulsed segment of the proximal extratemporal facial nerve?

Answer 13

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.

Question 14

What treatment options can be used to decrease
the risk of sialocele after traumatic parotid duct
transection?

Answer 14

Options include primary anastomosis over a stent, duct ligation, or fistulization of the duct into the oral cavity.

Question 15

What length of the lower lip can be managed with
primary closure without significant distortion or
microstomia?

Answer 15

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.

Question 16

How much of the eyelid can be closed primarily

after an avulsion injury?

Answer 16

25%

Question 17

What must be done to the avulsed segment of the auricle before its burial in a postauricular pocket for delayed reconstruction?

Answer 17

De-epithelialization of the avulsed segment

Question 18

What antibiotic class should be used for injuries involving cartilage?

Answer 18

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.

Question 19

What is the definition of a first-degree burn?

Answer 19

Damage no deeper than the epidermis, resulting in pain and erythema, but little or no permanent injury

Question 20

What is the definition of a second-degree burn?

Answer 20

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.

Question 21

What is the definition of a third-degree burn?

Answer 21

Injury involves the epidermis and the full thickness of the
dermis, destroying adnexal structures, blood vessels, and
nerve endings.

Question 22

The head and neck make up what percentage of

the total body surface area (TBSA)?

Answer 22

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

Question 23

What is the Parkland formula for fluid resuscitation

of burn victims?

Answer 23

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.

Question 24

In addition to IV antibiotics, why are topical antibiotics recommended to prevent superinfection in burn patients?

Answer 24

Burn eschar has a poor blood supply, decreasing the
likelihood that therapeutic levels of systemically delivered
antibiotic will penetrate the wound bed.

Question 25

When should burns involving the oral commissure

be reconstructed?

Answer 25

Most surgeons recommend initial observation with conservative wound care and waiting to surgically intervene only after full scar maturation.

Question 26

What treatment should be considered for patients

with oral commissure electrical burns to decrease the risk of microstomia?

Answer 26

Oral appliance use is designed to splint the oral commissure.