Basic Plastic Surgery

Question 1

What are the aims of wound management?

Answer 1

• Early healing
• Avoid infection
• Infected v contaminated wound
• minimise long term scarring

Question 2

What are the causes of impaired wound healing?

Answer 2

• Vascular: arterial / venous insufficiency
• Pressure
• Infection
• Diabetes
• Nutritional
• Radiation
• Drugs inc steroids
• Smoking

Question 3

What are the principles of wound management?

Answer 3

• Assessment of wound and patient
• Tetanus prophylaxis
• Debridement (remove dead tissue and foreign matter; lavage to reduce bacterial count)
• Wound closure

Question 4

Critical bacteria count (for impaired wound healing)?

Answer 4

> 10^5 bacteria/mL critical

Question 5

What is the most effective way to reduce wound bacterial count?

Answer 5

Debridement

Question 6

How is wound infection diagnosed?

Answer 6

Based on clinical signs (wound swab to identify bacteria and sensitivity -not to diagnose)

Question 7

Treatment of bite wounds?

Answer 7

• Debridement
• Antibiotics
• Wound closure vs delayed closure or secondary intention healing

Question 8

What is important to note in Mx of human bite wounds?

Answer 8

Never suture closed a human bite wound.

Question 9

Mechanism of pressure sores?

Answer 9

Impairment of blood supply due to weight of pressure of patient body on wound occluding vessels.

Question 10

Treatment of pressure sores?

Answer 10

• Assess pt overall health
• Pressure care
• Debride to healthy tissue
• Skin graft/flap only when underlying causes have been corrected and good pressure care in place

Question 11

What is the process of negative pressure wound therapy?

Answer 11

• Open cell sponge applied directly onto wound
• Clear, occlusive plastic dress
• Tubing connected to negative pressure pump

Question 12

What is the rationale behind negative pressure wound therapy?

Answer 12

• Removes fluid from wound

- Evidence that NPWT promotes angiogenesis

Question 13

What is a hypertrophic scar?

Answer 13

• Exaggerated normal remodelling response
• Stays within margins or original wound
• Affects all racial groups
• Responds to steroid injection and pressure e.g. silicone

Question 14

Keloid scar cf hypertrophic scar?

Answer 14

Keloid:

• extends beyond original wound
• More common African and Asians
• Any part of body (earlobe common)
• progressive
• less responsive to steroids and silicone

Question 15

What is a graft?

Answer 15

Transferred tissue dependent on recipient site for nutrition - develops vascular network from recipient bed

Question 16

What is a flap?

Answer 16

Transferred tissue independent of recipient site for nutrition - carries own vascular network.

Question 17

What is a split skin graft?

Answer 17

• Harvest epidermis and dermis like shave of skin

- Easier take (cf full) but contracts significantly and may have poor cosmetic appearance.

Question 18

What is a full thickness skin graft cf split skin graft?

Answer 18

Full thickness skin graft has less contraction and better appearance and function HOWEVER donor site must be closed directly so size is limited by need to close.

• has adnexal structures
• less contraction
• improved cosmesis

Question 19

What type of skin graft carries adnexal structures?

Answer 19

Full thickness

Question 20

Indications for flap (cf graft)?

Answer 20

• Bed not sufficiently vascularised to support graft (e.g. exposed tendon / bone)
• Need to cover prosthetic material
• Better appearance
• Flaps can contain muscle, bone, nerve etc

Question 21

What are the types of single stage local skin flaps?

Answer 21

• Transposition
• Rotation
• Advancement