TRUNK AND LOWER EXTREMITY Flashcards
Posterior and lateral chest wall defects involving three or
more adjacent ribs or that are 5 cm in width or greater
will benefit from skeletal reconstruction.
T.
Bioprosthetic mesh should be used for skeletal chest wall
reconstruction in patients at high risk for wound healing
complications
T
spinal instrumentation should be remove in case of acute wound infection
f spinal instrumentation should be maintained at
all costs in cases of acute wound infection
The paraspinal muscle advancement flap is an
adequate option at any spinal level.
T
Defects of the chest wall and intrathoracic space most commonly result from infection
F Defects of the chest wall and intrathoracic space can result from
tumor resection, infection, radiation injury, or trauma
whereas sternal wounds are most frequently associated with infectious complications after cardiothoracic procedures, such as mediastinitis or sternal
osteomyelitis
T
The posterior trunk is
often related to tumor resection or infectious complications following spinal instrumentation. T. F
T
The
intercostal neurovascular bundle runs along the internal surface of
each rib, at the inferior border
f The intercostal neurovascular bundle runs along the interior surface of
each rib, at the inferior border between the internal and innermost
muscle fibers
the majority of chest wall defect com from locally invading tumors from adjacent structures, including
breast cancer, lung cancer, mediastinal tumors, and mesothelioma
t
majority of chest wall lesions are caused by the hematogenous metastasis of solid tumors,
F minority ofchest wall lesions are caused by the hematogenous metastasis of solid tumors,
osteoradionecrosis of the skeletal
chest wall can emerge many years after the completion of radiation
therapy
T
reconstruction has been shown to decrease postoperative mechanical ventilation and length of stay.
T
defects in previously irradiated
chest walls often do not require skeletal reconstruction because the
radiation-related fibrosis will decrease chest wall compliance, which
in turn, decreases the likelihood of paradoxical motion
T
all synthetic materials carry a risk of infection of up to 5%
depending on the material and study
T
polytetrafluoroethylene FOR CHEST RECONSTRUCTION can be Encapsulates; no tissue ingrowth and Seroma formation
T
Methylmethacrylate features
Cures byan exothermic reaction, putting tissues at risk for thermal injury
* May fracture
* Rigidity is nonanatomic
* No tissue
ingrowth
* Seroma
formation
Bioprosthetic features
■ Expensive
■ Permeable
■ not maintain
chest contour in
large defects
■ Infection/
exposure does
not necessitate
removal
Titanium rib plating
Expensive
■ Long term
durability
unknown
■ Requires an
underlay
synthetic or
biologic mesh
for pleural
reconstruction
■ Requires
specialty
instrumentation
■ Radiopaque
all patients with infection of the chest wall had coexistent necrosis
of the overlying skin flaps
T
A bioprosthetic mesh can revascularize wound
T
A bioprosthetic mesh Initially xenograft t was most commonly used for chest wall reconstruction
F human dermal allograft was most commonly used for chest wall reconstruction
For large skeletal chest wall defects, synthetic and bioprosthetic
meshes are unable to maintain the natural thoracic curvature.
F For large skeletal chest wall defects, synthetic and bioprosthetic
meshes alone are unable to maintain the natural thoracic curvature.
Spanning
plate reconstructions have been associated with a low complication
rate, good cosmetic result, and superior pulmonary function
T
Rib spanning plates should always be combined with a synthetic or
biologic mesh underlay for reconstruction of the parietal pleura
T
If the underlying
rib, sternum, or hardware is exposed or if there is a history of radiation to the area, skin grafts or local random flaps are unlikely to be
successful
T
angiosarcoma, are treated primarily with radiation therapy.
F angiosarcoma, may occur as a side effect of previous radiation
therapy, necessitating wide resection in an irradiated field
The avoidance
of synthetic materials in the irradiated chest wall is recommended
T
Unfortunately, despite an
adequate debridement and reconstruction, wounds in an irradiated
field are incredibly complex and continue to be prone to infection,
wound dehiscence, and soft tissue fibrosis.
T
Patients presenting with signs and symptoms of mediastinitis should
have wound and blood cultures obtained.
T
in case of mediastinitis All hardware and
sternal wiresshouldberemoved
T
. Titanium sternal plating systems
may be best reserved for high-risk patients with multiple comorbidities contributing to poor healing
T
prophylactic sternal plating may reduce or even prevent
mediastinitis
T
In case of internal mammary art has been used for coronary graft we can’t use the rectus muscle for the reconstruction of sternal wounds.
no we can by relaying on the eighth
intercostal vessels when the internal mammary vessels have been
disrupted
the intrathoracic cavity is a bony, collapsible space
F the intrathoracic cavity is a bony, noncollapsible space
What is the Eloesser falp ?
an Eloesser is essentially a marsupialization of the pleural cavity to
form a controlled fistula for spontaneous drainage
(pec major , latis , omentum ,etc )Flaps can also be transferred prophylactically in patients thought to be at high risk for bronchial stump
T
the rectus abdominis
muscle and omentum are passed into the chest through window in the cest wall
F the rectus abdominis
muscle and omentum are passed into the chest through a surgically
created diaphragmatic window
The trapezius muscle is the most
deep muscle in the midline posterior trunk,
F The trapezius muscle is the most
superficial muscle in the midline posterior trunk,
the trapezius overlaps
with the latissimus dorsi muscle from T7 to Tl2
T
The paraspinous muscles are immediately deep to the latissimus dorsi, in the TlO-Ll location,
F The paraspinous muscles are immediately deep to the latissimus dorsi, except in the TlO-Ll location, where
the serratus posterior inferior muscle fibers may be found sandwiched
between the paraspinous and latissimus dorsi
Reconstruction of the lateral posterior trunk is most commonly
required after the spinal instrumentation
F Lateral trunk result from malgnancy medial trunk from spinal instrumentation fusion
in spinal osseous defects >10 cm, up to 50% of patients fail to progress
to fusion
F in
spinal osseous defects >4 cm, up to 50% of patients fail to progress
to fusion
Early infections in spinal surgery(<6 weeks from the index procedure) are usually adequately treated with antibiotics, aggressive surgical debridement, and muscle flap reconstruction with the maintenance of the spinal instrumentation.
t
Chronic hardware infections, defined as a deep
space infection at least 6 months In addition
to debridement, the patient may require hardware removal and
replacement for definitive treatment
t
In the lateral back defect, The thoracodorsal vessels may be an option for the free flap, but a vein graft or the arteriovenous loop is needed.
T
In case of middle trunk posterior defect, the dressing should change twice daily as out patients ?
F Because of the proximity of the central
nervous system, in this scenario it is advisable to return to the operating room and perform all dressing changes under general anesthesia
Th e hard ware of teh spinal surgery should be removed in case of infection ?
f Hardware that is well fixed promotes healing and prevents infection by eliminating micromotion and shearing of the fragile, traumatized soft
tissues.
Paraspinous Muscle Flaps Mathes and
Nahai type 3 flaps.
F type 4
teh paraspinous mucscle used to closed the wound in the back The muscles are then imbricated into the midline
defect using a Lembert suture, which nicely directs the medial
third of the flap into the dead space
T
In cervical spine reconstraction the anterior approach to the cervical spine is more likely to have a wound healing complication or infection
F the posterior approach to the cervical spine is more
likely to have a wound healing complication or infection
paraspinous muscle flaps Trapezius muscle
flaps used for cervical reconstration but hav high rate of seroma
T
The paraspinous muscles are the largest and most mobile in the
cervical spine
F The paraspinous muscles are the largest and most mobile in the
lumbar spine
Lumbar region reconstructions tend to have a
higher rate of minor wound healing complications (seroma, skin
edge separation, etc), owing to the more dependent location and
lordotic spinal curvature,
T
of the S1 nerve roots are resected,
then incontinence
of the S2 nerve roots are resected,
then incontinence
Total sacrectomies and partial sacrectomies, many surgeons believe that the longevity of the hardware construct may be improved with the addition ofa vascularized bone flap
T
Free fibula flapswill usuallydemonstrate radiographic signs of ossification at 6 weeks whereas fibula bone grafts may
require 12 months or more for bony union
T
Acute hardware exposure is defined as occurring within 6 week
of placement whereas a chronic exposure occurs more than
6 week after.
F Acute hardware exposure is defined as occurring within 6 months
of placement whereas a chronic exposure occurs more than
6 months after.
Chronic exposure occurs more than 6 months after should be removed
F except hardware
encased in bone can be left in place and not removed
who can diagnose the csf leak?
serous discharge with postural headach anf postive betatransferrin
Hernia mesh reduces hernia recurrence by about 50%.
t
Diastasis recti there is facial defect
F , no facial defect only widening in the linea alba
paper in the Lancet, support the use of
hernia mesh prophylactically in high risk undergoing laparotomy to
prevent hernia occurrence
T
The recti originate from the symphysis pubis and the pubic crest
and insert onto the fifth, sixth, and seventh costal cartilages and the
xiphoid process
T
What is the arcuate line?
The arcuate line is a horizontal line below the umbilicus
that demarcates the lower limit ofthe posterior rectus sheath, and it is
also where the inferior epigastric vessels perforate the rectus abdominis.
the extternal oblique aponeurosis splits into an anterior and
a posterior layer at the sernilunar line to envelope the recti)
F the internal oblique aponeurosis splits into an anterior and
a posterior layer at the sernilunar line to envelope the recti)
External oblique flaps can be raised between the internal
and external oblique muscles
T
The rectus muscle is innervated by the lower
intercostal and lumbar neurovascular bundles traveling between the
internal oblique and transversus abdominis muscles
T
Degradable meshes are significantly
more expensive than nondegradable meshes but purportedly safer for
use in clean-contaminated and contaminated cases
T
> 20% of ventral hernia
repairs recur and this is most often due to failure at the mesh, suture,
and tissue interface from suture cheese wiring through the tissue or
through the mesh
T
surgery is indicated for all ventral hernias
T
imaging surveillance, including CT scan, MRI, or ultrasound
may identify symptomatic ventral hernias or recurrences from previous abdominal surgery.
F. identify asymptomatic ventral hernias or recurrences from previous abdominal surgery.
incarcerated hernia nonreducible hernia in which the blood supply to the hernia contents
is obstructed and will result in necrosis if not repaired
F an incarcerated hernia is a nonreducible hernia that may contain bowel
but has no findings of vascular compromise.
Hernia grafts were popularized in
as a means to overcome mesh infection
T
Hernia grafts do not need to remove in the second operation
t
The main disadvantages to using a hernia graft
are that they are more expensive than synthetic
meshes and they lose their mechanical properties as they degrade
T
mesh with the smallest pores because large-pore meshes
have less material, which clinically related to less chance of infection and less pain because of reduced inflammation
F mesh with the largest pores because large-pore meshes
have less material, which clinically related to less chance of infection and less pain because of reduced inflammation
Care should be taken in using temporary mesh in patients who grow
show as children or women of child-bearing age.
F Care should be taken in using permanent mesh in patients who grow
show as children or women of child-bearing age.
Because the mesh or graft is adynamic, it is inferior
to an anatomic repair. Use of a degradable mesh in bridge repair has
a high incidence of hernia recurrence.
T
prosthetic mesh in all cases of incisional hernia repair except
in situations of gross contamination
T
prosthetic mesh was recommended in patients with medical comorbidities or any gross
contamination
F Bioprosthetic mesh was recommended in patients with medical comorbidities or any gross
contamination
Compinant seperation allowing
the recti to centralize, without damaging the recti nerves or destabilizing the abdominal wall
T
The posterior rectus sheath
is released from the rectus muscles to obtain medialization of the
recti 10 cm in epigastrium, 10 cm at the umbilicus, and 5 cm at the
suprapubic region.
F The posterior rectus sheath
is released from the rectus muscles to obtain medialization of the
recti 5 cm in epigastrium, 10 cm at the umbilicus, and 3 cm at the
suprapubic region.
Previous stoma or surgery through the rectus muscle is an absolute contraindication to component separation
F Previous stoma or surgery
through the rectus muscle is not an absolute contraindication to
component separation
What the benefit of componant seperation tech…?
reduce seroma formation and skin necrosis.
laparoscopic and open incisional
hernia repairs with mesh had comparable outcomes including recurrence rates less than 10%
T
In general, tissue expansion does not work well for abdominal wall reconstruction unless
expanders are placed above a stable bone platform like ribs or pelvis
T
Free flaps are indicated for any
large epigastric defects
F , free flaps are indicated for very
large epigastric defects that are difficult to cover with pedicled flaps
Onlay mesh placement was found to have the least hernia occurrence
T but have higher seroma rates due to the increased subcutaneous tissue elevation
In the lower third of abdominal wall reconstruction using the External oblique is preferable.
F . Internal oblique
The superficial femoral art. gives rise to the circumflex femoral system
F the profunda (deep fermoral artery ) gives rise to the circumflex femoral system
All the venous system in the leg mimic the Arterail one T F
F The venous anatomy, with the exception of the saphenous vein, mimics the arterial anatomy.
posterior compartments contain muscles that flex the foot
F. Foot and toes
compartment pressure >40 mm Hg or 20 mm Hg below the diastolic pressure or 30 mm Hg below the mean arterial blood pressure
T
Vascular
injuries typically require management before fracture stabilization
T
external
fixation has decreased healing times and lower rate of malunion and
nonunion,
F external
fixation has increased healing times and a higher rate of malunion and
nonunion,
The most common injury art in the lower leg is the posterior tibial artery
F anterior tibial artery
angiography less invasive than CT angio
F CT angio is less invasive and
uses less contrast and radiation than traditional angiography
When we need to use formal angiography rather than C t angio?
Formal angiograms are more expensive and invasive,
but they may be necessary if CTA has too much scatter from hardware. Formal angiograms are particularly helpful in vasculopaths and
patients requiring concomitant vascular reconstruction
Pedicled flaps also have a higher complication rate in
diabetics patients, although they also have a higher rate of success than
extremity-free flaps in these patients
T
Microsurgery can be very difficult as local vessels are needed for inflow and tend to be calcified
t
Absent plantar sensation at presentation was not an indicator for
amputation or functional outcome.
T
longer than 8 hours warm ischemia time is an indication for amputation
T
Replantation is important for the lower limbs
F Replantation is usually not performed because prostheses can
make a functional lower limb.However, replantation can be considered if there is minimal warm ischemia time and a durable, sensate,
and painless foot seems possible
Early reconstruction: of the lower limp within first 24 hours
F 72
The failer rate of limp reconstraction between 3 week and 3 month is 5 %
F 12%
lesions less than 6 cm can be treated with traditional, or nonvascularized, bone grafts,
T
The free fibula graft can underwent resorption
F
bone remains organized, does not resorb, and can hypertrophy to increase strength.
Sural flap has a high complication rate and lower aesthetic appeal.
T
Lateral and Medial Calcaneal Artery Flaps can’t be asensate flap ?
F The sural nerve can be included for sensation, and the abductor hallucis muscle can be included with the
medial flap_
Keystone Flap is ffasciocutaneous perforator flap
T
Keystone Flap two V-Y flaps on either end
T
Keystone Flap the width of the flap is similar to the widest
portion of the flap.
T
Instep Flap in sensate flap
T can maintain sensation through the medial plantar nerve
Instep Flap based on medial plantar artery only
F (although laterally basing is possible as well
t is always necessary to perform the anastomosis outside the zone of injury,
T
t was thought
that muscle was superior to fasciocutaneous flaps for fracture healing
and infection prevention, but this theory has been disproven.
T
Fasciocutaneous
flaps are easier to raise for secondary procedures
T
Extensor digitorum brevis is type 2 nahai
F type 1
gastrocnemius is usually used as a mayocutanous flap
F gastrocnemius is the typical choice
for reconstruction and is usually used as a muscle-only flap and
covered with a skin graft.
Tissue Expansion
used
for skin resurfacing, coverage of wounds, removal of benign defects,
and repair of contour abnormalities
Expander in lower leg a
relative contraindication to their use
T
t is best to expand tissue vertically from the defect, as the tissue moves better in that plane.
F is best
to expand tissue transversely from the defect, as the tissue moves better in that plane.
The wound VAC used as a definitive reconstruction
F temporary
VAC increase the survival of random pattern flaps.
T
What is Integra ?
bovine type
I collagen with glycosaminoglycans that is covered with a silicone
layer.
medial femoral condyle free bone graft can cause sagnificant instability
F the distal femur is well tolerated and does not cause any instability; the
patient can be weight-bearing on the donor site immediately
How long the length of the flap we should preserve form a lower limb prosthesis?
About 14 cm of
length is necessary to support a prosthesis for a below-knee amputation
what is the standard tendon transfer for foot drop?
A posterior tibialis tendon to anterior tibial tendon transfer
is the standard tendon transfer to treat foot drop
If the cosmetic result after the initial reconstruction is
poor, a revised reconstruction with a fasciocutaneous free flap may
provide a better resuit.
T
The perineum has a superficial and deep fascia!
layer. The superficial fascia is contiguous to the Colles fascia.
F has a superficial and deep fascia!
layer. The deep fascia is contiguous to Colles fascia
In perineal burns there is an increased male to female ratio.
T
The presence ofa
perinea! burn is an independent risk factor for an increase in morbidity and mortality
T
Long-term
catheterization IN PERNIEAL BURN IS ADVOCATED
F Long-term
catheterization risks infection and urethral stenosis.
Genetelia burn can be treated with excision
F Unlike burns on other areas of the body, genitalia burns are typically not treated with early excision.
If the perinea! burn is part of more extensive burns, the perinea! areas of
burns have priority for skin grafts from available donor sites
F If the perinea! burn is part of more extensive burns, the other areas of
burns have priority for skin grafts from available donor sites
Fournier gangrene. It can involve the skin, subcutaneous tissue, only
F Fournier gangrene. It can involve the skin, subcutaneous tissue, fascia, and muscle
Alcoholism on of the risk factors for fornier gangrane
T
There are no role of hyperbaric oxygen in fornier gangrene
F There are conflicting reports on the benefits and cost-effectiveness ofhyperbaric oxygen therapy
Hidradenitis Suppurativa it can present in any area of the body with eccrine glands
F Hidradenitis Suppurativa it can present in any area of the body with apocrine glands
Though staphyloccocus species are
predominant in many ofthe acute abscess, chronic lesions often are
polymicrobial, in which anaerobic bacteria predominate.
T
Using laser in Hidradenitis improvement was
noted, recurrence can still occur.
T
The definitive treatment of HS is biological therapy
F Surgical excision is the only method at present to definitively
treat the scars and sinus tracts of chronic hidradenitis
Incision of the solid nodules in HS that are not purulent is indicated
F Incision and drainage can relieve pain from fluctuant
abscesses but should be avoided in firm, solid nodules that are not
purulent
squamous cell carcinoma can arise in it, also
known as a Marjolin ulcer. can occur in Hidradintes Suppertiva
T
combination of closure with flaps decreases major
wound complications compared to primary closure
T
the omental flap can be added to obliterate pelvic dead space.
T
lotus petal flaps on wich pedicle depend?
Internal pudendal art
Middle-third defects can be reconstructed
with Singapore flaps or lotus petal flaps if the field been radiated
F Middle-third defects can be reconstructed
with Singapore flaps or lotus petal flaps if the field has not been radiated
In case of the patient has multiple osteotomies we cannot use the rectus muscle flap instead us muscle-sparing flap This can spare rectus function, especially if multiple ostomies are necessary.
T
The suatable option of calss IB defect of the vagina is singagor flap
F rectus abdominus myocutaneous flap.
For type IIB vaginal defect option for total vaginal
reconstruction is bilateral gracilis myocutaneous flaps This is also a good choice if multiple ostomies
are necessary
T
what the option of reconstraction of total vagina in In obese patients, in whom a myocutaneous flap would be
too thick, or those with multiple medical comorbidities, ?
a rectus
abdominis or gracilis muscle flap paired with a split thickness
skin graft may suffice.
for total vaginal reconstruction, an inner diameter of about 9 cm
f for total vaginal reconstruction, an inner diameter of about 4 cm
Those who were not sexually active prior to surgery did not become
sexually active after surgery. Therefore, in this population, vaginal
reconstruction may not be necessary
T
perinea! reconstruction can be necessary with concurrent
genital reconstruction
F perinea! reconstruction can be necessary without concurrent
genital reconstruction
The radial forearm free flap provides
thin, sensate tissue that allows for both urethral and penile reconstruction.
T
Blood Supply to the singapore flap ?
Pos. labial art.
singapore flap is an iland flap
T
The percentage of congenital lymphoedema in primary cases?
Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
The percentage of Lymphedema praecox in primary cases?
(77%-94%) of cases. Lymphedema praecox affects women four times as often as men.
The percentage of lymphedema tarda
11 %
weight loss interventions can ameliorate symptoms of secondary lymphedema
T
The natural history of lymphoedema depends more on underlying causal mutations and their penetrance rather than the time of onset.
T
Patients who develop BCRL typically present an average of 8 to
12 months after surgery
T
20% of patients who will develop
BCRL do so by the third year after surgery
F 77% of patients will develop BCRL does so by the third year after surgery and then 1% per year
up to 90% of gynecological and genitourinary
these patients who developed secondary lymphedema did so within
the first year of surgery
F 75% of
these patients who developed secondary lymphedema
most accurate objective measurement for lymphodema is indoscinen green
F Water displacement (volume of water a limb displaces when
immersed) is considered the most accurate measurement because
of its high reliability
Circumferential measurements are the most commonly used measure in clinical practice
T
No standard protocol for quantifying radiocolloid uptake and transit time, making in Lymphoscintigraphy, it difficult to standardize the quantification of disease severity across centers and studies
T
. Near-infrared fluorescence lymphography is better in describe the severity of the disease
TR
The MD Anderson classification of lymphoedema depend on what ?
defines stages of lymphedema based
on flow patterns observed on ICG lymphography
The MD Anderson classification defines stages of lymphedema based
on flow patterns observed on ICG lymphography
T
Lopsuction can be don for nonpitting edema ni lymoedema
T
liposuction alone has been shown
to be a safe and effective technique for significantly reducing limb
liposuction combined with controlled compression therapy has been shown to be a safe and effective technique for significantly reducing limb
Liposuction should be performed with tumescent technique and
no need for tourniquet control in lymphoedema
F Liposuction should be performed with a tumescent technique and
under tourniquet, control to minimize blood loss and the need for
transfusions.
. Contraindications
to liposuction?
include metastatic disease, open wounds, medical history of coagulopathy, patients unfit for surgery, or patients
deemed unreliable to adhere to postoperative compressive therapy
Rapid recurrence occurs if the patient is noncompliant with postoperative compressive therapy.
t
The Charles procedure resects skin only
F The Charles procedure resects skin and subcutaneous tissue to the
level of the deep fascia
LVA
is considered by most authors to be appropriate for patients with
early-stage lymphedema.
t
A tourniquet is necessary for LVA
F A tourniquet is not necessary
Increasing the number of LVA can significantly improve the outcome
F no evidence associating a threshold number of anastomoses with the likelihood of success.
LVA is a
minimally invasive procedure that involves a high risk of morbidity
to patients.
F LVA is a
minimally invasive procedure that involves a low risk of morbidity
to patients.
Vascularized lymph node flaps can be transferred to the
distal recipient sites in the affected limb only
F Vascularized lymph node flaps can be transferred to proximal or
distal recipient sites in the affected limb.
the number of vascularized lymph nodes in
the transferred flap is positively correlated with the degree of limb volume reduction
T
vascularized lymph nodes are better to transfer distally or proximally?
Distaly is better nterstitial fluid accumulating distally
in lymphedematous limbs would maximize the drainage efficiency of
flaps transferred to distal recipient sites.
distal recipient site include an unscarred and non-operated area with available recipient vessels
vascularized lymph nodes are better to transfer distally or proximally?
Distaly is better nterstitial fluid accumulating distally
in lymphedematous limbs would maximize the drainage efficiency of
flaps transferred to distal recipient sites.
distal recipient site include an unscarred and non-operated area with available recipient vessels
The groin vascularized lymph node flap are
that it has a substantial number of lymph nodes that have been
correlated with better outcomes with VLNT
F Submental flap has plenty of vascularised lymph node
there
is no risk of iatrogenic lymphedema. in submental flap
T
urinary or fecal incontinence are directly related to pressure-related injuries themselves
F there is no known direct evidence
linking urinary or fecal incontinence with the direct formation of
pressure-related injuries themselves
MRI is gold standard for diagnosis. of osteomiliates
F Bone biopsy is gold standard for diagnosis.
In pressure Sore hydrogel and low-adherence dressings for the epithelialization stage
F hydrocolloid
and low-adherence dressings for the epithelialization stage
hydrogels during the debridement stage,
T
There is evidence the
use of alginates with hydrocolloid results in significantly
greater reduction in the size of stage 3 and 4 pressure injuries compared to hydrocolloid alone
T
the ability to solubilize necrotic tissue by Negative-Pressure Wound Therapy
T
Contraindications to the use of NPWT
include
exposed vessels or organs, nonenteric and unexplored fistulas, malignancy, and untreated osteomyelitis
HBOT not indicacted inteh osteomalities ?
HBOT may be
used as adjunctive treatment for chronic refractory osteomyelitis
within a pressure injury or a failed graft or flap.
Bedside depridemen tin no advocated in PS ?
Risk of bleeding patients comfort autonomic dysreflexai
Sacral flap design should consider the depth of wound and potential need to fill dead space.
T
the TFL can be sensate via Ll-L3 by way of the lateral femoral cutaneous nerve
T
Patients with lesions above T6 are particularly susceptible. To autonomic dysreflexia
T
Marjolin ulcer) from decubetes ulcer need excision with lymphnode
F. lymph node dissection is not recommended unless clinical involvement
rectus muscle
advancement for sternal wound reconstruction has been described using the deep inferior epigastric system and
releasing the other fascial and tendinous attachments to provide a 12 cm advancement
t
Möbius syndrome and
therefore with the absence of cranial nerves V and VI
F Möbius syndrome and
therefore with the absence of cranial nerves VI and VII
pectus carinatum seen in conjunction with Poland’s syndrome
T
Below the arcuate line, the
posterior sheath consists of only transversalis fascia
T
Zone II does share blood supply from zone I with input from the deep inferior epigastric vessels
T
biologic materials in abdominal wall reconstruction can used for the infection site
T
how much advancement can be achieved at the waist after a
bilateral component separation
20 CM 5 cm at the epigastrium, 10 cm at the
middle third, and 3 cm in the suprapubic region fOR UNILATERAL
the serratus posterior inferior muscle fibers present at wich level in relation to LD
n the T10–L1 location, where the serratus posterior inferior muscle fibers may be found sandwiched
between them and latissimus dorsi
