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
