wk 7- podiatric surgery

Question 1

phases of wound healing

Answer 1

1. haemostasis
   - within minutes post injury. platelets aggregrate at the site of injury to form a fibrin clot
2. inflammatory
   - bacteria and debris are phagocytosed and removed, and factors released that cause the migration and division of cells involved in proliferative phase
3. proliferation-
   angiogenesis, collagen deposition, granulation tissue formation, epithelialisation and wound contraction.
4. remodelling-
   collagen is remodelled and realigned along tension lines and cells that are no longer needed are removed by apoptosis

Question 2

what patient factors affect healing capacity (10)

Answer 2

age
nutrition status
blood supply
dehydration
chronic disease
immune response
radiation therapy
tissue quality
revision/infection
compliance

Question 3

layers of the epidermis

Answer 3

stratum basale.
stratum spinosum.
stratum granulosum.
stratum lucidum.- not in thin skin
stratum corneum.

Question 4

primary intention wound healing

Answer 4

immediately sealing wound with suture, skin graft or flap closure

Question 5

secondary wound healing

Answer 5

no sealing of wound

wound closed by re-epithelisation and contraction, some scar tissue

healing is slower

Question 6

tertiary wound healing

Answer 6

delayed primary closure

surgical intervention after repeated debridement and antibiotic therapy

mixture of secondary and primary wound healing

Question 7

what are relaxed skin tension lines and what are they used for

Answer 7

creases in the skin that develop with normal flexion and exension of joints, incision parallel to these lines helps with healing and less scarring as those areas are under less stress

Question 8

how should incision be done

Answer 8

vertical to the skin using the tip of the blade and using the belly of the blade to cut

while this is being done, skin tension is applied either side

Question 9

where are neurovascular bundles located

Answer 9

superficial fascia

Question 10

why dont you want to cut into neurovascular bundles

Answer 10

nerve damage, blood loss and delayed healing

Question 11

ways to minimise blood loss

Answer 11

tourniquets
compression
packing

Question 12

types of sutures

Answer 12

1- absorbable or non absorbable (less scarring)
2- monofilament or milutifilament (harbour bacteria)
3-dyed (dont use on skin) or undyed

Question 13

what are steri strips

Answer 13

alternative to suturing

okay for low tension wounds

Question 14

soft tissue surgery can be used for

Answer 14

flexible and semi flexible deformity where soft tissue requires some rebalancing

Question 15

surgeries for tendons

Answer 15

tenotomy- tendon cut
tenectomy- removal of tendon
lengthening
transfer
reroute

Question 16

surgeries for ligaments/capusle

Answer 16

released
repaired
plicated- tightening

Question 17

semi rigid deformities often include

Answer 17

osteotomy - bone surgery to realign and also
soft tissue surgery to rebalance

Question 18

pathologies for excision and biopsy

Answer 18

neuroma
ganglion
bursa
fibroma
nodule
tophi
lipoma
cyst
granuloma

Question 19

what are ganglions

Answer 19

gelatinous fluid of mucopolysaccharides attached to joints or tendon sheaths

Question 20

treatment for ganglions

Answer 20

aspiration, steroid injection, bible- LA and squeezing out fluid, surgery

Question 21

complication with ganglions

Answer 21

can erode bode and be painful due to pressure on underlying structures

Question 22

incision types for mortons neuroma (4)

Answer 22

dorsal- 3rd met space, usually heals quicker, hard to move through anatomy

websplitting- 3rd met space to toe web spaces, increased risk of infection

plantar linear- healing longer, better view of anatomy especially with stump neuroma, scarring on forefoot

plantar transverse- scarring on forefoot

Question 23

conservative treatment for mortons neuroma

Answer 23

typically fail

neurectomy successful in 80-95%

Question 24

what is a stump neruoma

Answer 24

when a mortons neuroma surgery is unsuccessful because pathology is left behind causing recurring symptoms

Question 25

what is fibromatosis

Answer 25

hypertrophied disorganised collagen material
recurrent

Question 26

treatment for fibromatosis

Answer 26

because recurrent surgery isnt indicated as much

deep heat/rubefacient and massage in to skin to elicit blood flow and help break down and reorganise the collagen and symptoms

then next step is
LA and corticosteroid to break it down

then surgery- not long term treatment, recurrent

Question 27

mucous/mycoid cyst

Answer 27

mostly seen on the distal interphalangeal joint on the 2nd toe

often painless

herniation of the joint capsule- risk of a joint infection

Question 28

treatment of myxoid cyst

Answer 28

podiatrist
pop, betadine, dress, monitor but it will recur

aspirate/LA

surgery:
nephrectomy of the joint

Question 29

what surgeries are used for chronic compartment syndrome

Answer 29

fasciotomy, release of fascia to reduce pressure
fasciectomy, fascia removed to reduce pressure

Question 30

what is a myeectomy

Answer 30

removal of muscle

Question 31

acute compartment syndrome is

Answer 31

a medical emergency

Question 32

chronic compartment syndrome

Answer 32

happens over time and usually sympmtoms occur on exertion as the muscle increases in size

Question 33

types of biopsy

Answer 33

punch- skin
needle- deep structures, fluid
shave- blade to take sample of superficial lesion
excisional- total removal, cures and idenitifies at the same time
curettage- used for verrucae and neur vasuclar lesions and cautery used either chemically or electrically

Question 34

curettage be cautious with

Answer 34

bone and smoking

Question 35

when to perform an excisional nail surgery

Answer 35

1. nail plate pathology
2. exostectomy
3. nail lip hypertrphy
4. regrowth