Final Exam Flashcards

Question

Purposes of skin

Answer 1

1. Protection from infection 2. produces Vitamin D from the sun 3. temperature control 4. excretory organ (sweat, oil) 5. prevents fluid loss

Answer 2

* Epidermis: has **five** layers but thinner than the dermis * Dermis: has **two** layers (blood vessles here)

Answer 3

state kind and % of solution in lound and clear voice

Answer 4

1. Penis 2. fingers 3. toes 4. nose

Answer 5

* Autograft (autollogus tissue) of the same individual's body * allograft- from same species (homo) * Xenograft- from a different species (hetero) * ex: pig

Answer 6

* Sometimes referred to as the graft site, the area where the skin graft is being transplanted to

Answer 7

the area the graft is being taken from

Answer 8

* approximating fat to fat * doesn't work that well * Plain Gut 2-0 CT-1

Answer 9

* approximating dermis to dermis * 4-0 monocryl PS-2

Answer 10

* approximating epidermis to epidermis * nylon * dermabond * monocryl 4-0 PS-2

Answer 11

1. Where is the graft being taken from? 2. Where are we putting the graft?

Answer 12

* condyle * disc/meniscus * fossa * ligaments, blood supply, nerves TMJ can weather or become displaced be mindful of nearby structures

Answer 13

* dislocation or damage to disc * Osteophytes (bone spurs) of condyle or temporal bone * TMJ ankylosis (joint doesn't close)

Answer 14

* TMJ arthroscopy- looking into joint with scope * TMJ arthroplasty

Answer 15

* Usually the **first surgical treatment option** for TMJ disorders * may involve disc repair or resection * may use microdebrider to remove osteophytes * may be used to irrigate and remove debris (arthrocentesis)

Answer 16

* More invasive than arthroscopy * incision is preauricular * may repair ligaments, disc, or condyle * may replace total or partial joint * circular drape used * may use plates and screws and ball to replace

Answer 17

* lead hand * used in hand surgery * holds fingers * over time is can weaken or break * broken edge would not be sterile * sharp

Answer 18

* contracture of palmar fascia usually causing the ring and little fingers to bend into the palm so that they cannot be extended * cause is unknown * no correlation between occupation and development of this condition

Answer 19

* the condition of having more than the normal number of fingers and toes * can occur by itself, or more commonly, as one feature of a syndrome of congenital anomalies

Answer 20

* fusing of fingers or toes * tx: Z-plasty

Answer 21

* FTSG * all layers of the skin, including the dermis, which house hair follicles, oil and sweat glands, are resected form the donor site and moved to the graft site * the donor sire is primarile closed (edges brought together) Due to this fact, the graft itself must be relatively small (elliptical incision) * usually gives a better cosmetic result, provided skin tone and presence or lack of hair at donor and graft site match well * usual donor sites nclude neck, behind the ear, and groin/inguinal area * usually take graft from nearby area

Answer 22

stays open granulation wound vac possibly

Answer 23

let it granulate then later closure

Answer 24

* Mohs surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. * may need FTSG

Answer 25

* a pressure dressing that employs sutures placed through the skin * these sutures may also be used to approximate the skin. A single interruped suture is placed where the graft meets the preexisting skin. one end is left long. this continues all the way along the incision site, usuallly with at least 20 or so sutures placed. a nonadherent (telfa, adaptic, xeroform) ointment impregnated dressing is placed on top of graft. a bulky dressing usually cotton wadding or gauze is placed above that. the long sutures are tied together over the gauze creating a pressure dressing (want the graft to be immobile) * silk suture because we want knots to hold

Answer 26

1. Basal cell carcinoma 2. Sqamous cell carcinoma 3. Malignant melanoma

Answer 27

* arises from the basal, or lower layers of the skin * most often ocurs on fair-skinned individuals with long-term sun exposure * males are twice as likely to develop basal cell carcinoma than females (don't know why) * peak incidence is among those aged 55-75 * asymmetrical * no uniform shape or color * excise in elliptical shap with clean margins frozen section

Answer 28

* arises from the outer epidermis * metastasis of sqamous cell carcinoma is more common than that of basal cell carcinoma * tx includ surgical ecision, chemptherapy and radiation therapy

Answer 29

* arises form melanocytes (responsible for skin color) * aggressive, highly metastatic cancer * incidence is highest in white, fair-skinned people who burn easliy and tan poorly; mostly found on previously sun-exposed skin * in people of color, the highest incidence of malignant melanomas are on non-sun exposed areas * lesions may start as a benign nevus or mole-like growth * apperance usually raised, dark brown or black, irregular surface * prognosis varies depending on pt. age stage of disease and lesion thickness (people die from this)

Answer 30

* Common in diabetics (poor vascularity, nueropathy) * non-ambulatory pts are all at risk for developing decubitus ulcers from having too much pressure on a given area * occur most often on skin located over bony prominences * due to neglect * move every 2 hours

Answer 31

* Scars may shrink over time, especially when tension is on them, causing pain in surrounding skin. Infection or an other process which delays healing will produce a larger than normal scar * Keloid: scar hypertrophy at its most pronounced, producing a dense fibrous overgrowth of scar tissue, which at its extreme state may appear as a hard, pedunculated mass. more common in darker-skinned people * in those who tend to keloid with each new incision, surgical intervention is undertaken only when keloids are quite large. care is taken to avoid placing excess suture in any layer of the skin. steroids are often injected at the incision site of the resected keloid

Answer 32

* acid peel * dermabrasion * laser

Answer 33

* Thermal--caused by contact with fire, hot objects or fluids * Electrical-- caused by contact with strong electrical current, and is usually characterized by an exit and an entrance wound * Chemical-- caused by contact with corrosive or irritating chemicals * Radiation-- caused by overexposure to radiant energy OR rooms kept warm

Answer 34

* a superficial burn affecting only the epidermis * erythema and tenderness occur, but healing is rapid * Ex: sunburn, touching hot object

Answer 35

* involes entire epidermis and varying degrees of the dermis without affecting the deepest cells of the basal level * they are painful, moist, red, and weeping or blistered * re-epithelialization withough a scaar is still possible since a layer of the dermis is viable

Answer 36

* affects the entire epidermis and dermis * with medical care, may regenerate from the edges of the surrounding dermis * may need skin graft * appear as mottled pink, red, or waxy white areas with blisters * nerve endings may be damaged resulting to loss of sensation * the healed tissue is usually a scar

Answer 37

* extends into the subcutaneous layer or below * affects blood vessels, nerves, muscles, tendons, and bones; deep char * the most common type of burn resulting in this deep char is an electrical burn * all 3rd degree burns will require surgical intervention which may include grafting, some of which may be extensive

Answer 38

1. used for estimating total body surface burned 2. divides the body into 9% areas \*need adequate hydration to compensate for loss

Answer 39

* an important treatment protocol in treating second and third degree burn pts is adequate hydration, since fluid is constantly being lost from these areas * the rule of nines is used to help estimate amount of water loss through tissues

Answer 40

* only the skin layers above the dermis are taken (epidermis) * Since the basal layer of the dermis is always left in a split-thickness skin graft, the donor site heals by granulation, therfore, the donor site can be much larger * for additional coverage, a split-thickness skin graft may also be meshed * split thickness grafts have the advantage of offering more coverage. They are also ideal for diabetic pts or pts with any peripheral vascular difficulties, as the resulting graft is thinner and more easily perfused. However they have the disadvantage of producing a much more noticable, scarred effect when healed * usual donor sites: legs, could be abdomen, flank

Answer 41

Once the graft site has been prepared: 1. Mineral oil is applied to the dermatome, as well as the donor site 2. The correct depth is decided upon, and the dermatome is set for the desired thickness 3. traction is applied to the skin on either side of the donor site 4. the dermatome is applied to the skin to harvest the graft. Adson tissue forceps should be at hand at all times to assure the graft does not get caught in the dermatome 5. Most surgeons will ask that a lap sponge soaked in a saline-epo mix be applied to the donor site for hemostasis one the graft has been harvested 6. Once the graft is harvested it is usually placed on a skin graft carrier, and moistened with saline 7. if the graft is to be meshed, it is meshed at this time. the graft, still on the carrier is carefully brought to the graft site 8. staples or interupted sutures may be placed along the edges of the graft 9. a nonadherant dressing is paced over the skin. depending on graft site, pressure dressings vary 10. Once the graft site is dressed, the donor site is alo dressed the lap sponge is removed, which by this time has minimized bleeding. the area is usually covered with an Opsite or tegaderm. this impervious dressing stays in place for at least one week and limits chances of donor site infection while skin regenerates

Answer 42

* If the pt. has a decubitus ulcers or burns, graft site may need to be debrided prior to graft placement. what is the significance of this for the surgical technologist?--may need another set up for the "dirty" part * instrumentation and equipment notes: * dermatome is usually pneumatic and needs nitrogen extension hose. Mesher is always PRN until confirmed with surgeon. Dermatome has a large disposable blade, so always remember to remove it after the case! Test the dermatome before and should be set on safe when not in use

Answer 43

split thickness graft

Answer 44

* stent dressing

Answer 45

* Def: the term flap always applies to moving autologous tissue form one area to another. If the word "free" does not precede flap then the tissue in question has not been fully detached from its original site. This area is referred to as the flaps pedicle, meaning it carries the blood supply

Answer 46

* usually rectangular in shape, and advanced to a nerby position. they may be for a skin graft only, or may contain skin, subq, and muscle layers as well * pedicle

Answer 47

* another flap that mya include skin or skin, fat, and muscles. this flap is moved at an angle from its original site * pedicle

Answer 48

* a semicircular flap rotating along its axis * pedicle

Answer 49

* are always containing muscle and have an island of skin and subq tissue on them they are tunneled to another location * ex: L/D and TRAM * pedicle

Answer 50

* Used when there is not enough skin to cover a defect and a flap repair is preferred. * In the first surgical procedure, a tissue expander with injection port is placed under skin * patient returns to office for repeared injections * once enough volume has been reached, another procedure is done to remove the expander and create the flap

Answer 51

* functional indications for muscle-containing flaps: a good choice in locations where bone or tendon is exposed and muscle is needed along with skin to pad a bony prominence * flaps have the advantage of looking more natural than a skin graft and skrinking less, but the disadvantage of bringing more "bulk" to the transposed area than a skin graft would * small skin flaps usually rotational ones are commonly used on cheeks or noses where a skin cancer has been resected

Answer 52

* a specialized flap * a z shaped incision is cut, creating two triangular-shaped flaps, which are transposed. this results in * areas where there is scar tightening, can be used to lenthen incision line to decrease tension. It can also lengthen a flap if added to the flaps incision line * since the flaps are transposed the orientation of the original incision line rotates 90 degrees

Answer 53

* tumescent solution (recipe: Lactated ringers with lido with epi) * tumes means to swell. fat comes out easier helps break up fat * infusion pump * infusion tubing * tumescent handpiece with tips * liposuction tubing * liposuction machine * liposuction cannulae * \* clamp tubing before you hand it off so it doesn't go everywhere

Answer 54

* subglandular * submuscular * pnemothorax risk (collapsed lung)

Answer 55

* Mammary Gland * Three tissue types * breast of mammary gland tissue, aka ductal tissue * adipose tissue * cooper's ligaments * breast tissue extends laterally into the axilla as the tail of spence which contains lymph nodes in its lateral aspect

Answer 56

* 2 main arteries * internal mammary artery * axillary artery * Veins * venous drainage parallels arterial supply * Lymph * peristernal nodes * axillary/central nodes

Answer 57

* 2 main motor nerves * thoracodorsal nerve * long thoracic nerve (of bell) * Sensory nerves * intercostal nerves

Answer 58

* When reconstruction is scheduled at the same time as mastectomy, some details of the mastectomy that affect the reconstruction: * Template (make a template of defect--keep glove wrapper to trace) * weigh all breast tissue * temporary closure

Answer 59

* tissue expander with implant only * no flap come back later * latissimus dorsi flap with implants (pedicle) * trans rectus abdominus myocuaneous flap (TRAM) pedicle * DIEP flap (free flap) * Deep * Inferior * epigastic * perforator * named for the artery we harvest when taking tissue from the abdomen

Answer 60

* expander is usually placed posterior to the pectoralis major (submuscular) muscle * comes with either injection dome or port * may be removed and replaced with a permanent implant, or convert to implant * most common risks: infection, capsular contracture--body sees as forgeign and walls it off becomes scar tissue

Answer 61

* a skin flap and muscle are taken from donor site in back * tissue is tunneled to the mastectomy and used to create a breast mound * an implant can also be used to create the breast mound

Answer 62

* if procedure is unilateral, pt. will start positioned laterally * if procedure is bilateral, pt. will start prone, so you will need chest rolls for the bed * since the pt. will be reprepped and redraped, usually use four split sheets

Answer 63

* an elliptical incision is marked and incised above the pts latissimus dorsi muscle * only part of the whole muscle is taken as a flap so where possible it is split in the direction of its fibers * the pedicle is the latissumus dorsi's insertion on the humerous * the flap is rotated into the axilla, and the dorsal incision is closed deep and subcuticularly * once the pt. is reprepped and draped in the supine position, staples are removed from mastectomy incision * the flap is gently tunneled and rotated into position * due to the relatively small size of the island flap, an implant is usually needed to match the size of the resected breast * the implant is placed below the flap and the muscle flap is sewn to the serratus muscle creating a pocket for the implant to sit in * skin is usually trimmed to fit the incision site and it is closed subcuticularly the incision site is still elliptical in shape

Answer 64

* usually, there is enough muscle and fat to create a breast mound without the need for implants * in some cases, a general surgeon will perform the mastectomy while a plastic surgeon begins work on harvesting the flap below * if the procedure is bilateral: both rectus muscles (L and R) are harvested. This noticeably weakens the abdominal wall. usually mesh will be placed at the donor site if both rectus muscles are harvested * the umbilicus is in the middle of the elliptical harvest area and a border just outside is is incised circumferentially. the umbilicus is left on a stalk of subq tissue and an area of the reapproximated tissue is resected to make room for the umbilicus * the inferior epigastric vessels will be transected and ligated if this is not a delay procedure you will need med. hemaclips and appliers * once the flap has been tunneled and rotated to the graft site, the abdominal incision that results has tension on it, and the abdominal wall is weaker due to loss of muscle tissue * fascial plicating suture usually 0 or 1 prolene or PDS is placed. drains placed wound closed * the bed is flexed to help reapproximated subq and skin layers and post-op the pt. transport and recovery beds need to be flexed to keep tension off this area

Answer 65

* if the mesh placed for bilateral TRAM fails, the pt. will develop an insicional hernia * a contraindication to this procedure is being overweight. If the blood supply has become attenuated due to fat, the risk of flap necrosis is too great to undertake the surgery * risks: flap necrosis, infection, hematoma, seroma, ventral hernia

Answer 66

* pts with poor casculature or who are overweight may be candidates for a 2-stage TRAM or delayed TRAM * first stage: a farly minor procedure in which the inferior epigastric vessels are ligated and transected. this is usually done 1-2 weeks before a TRAM reconstruction

Answer 67

* nipple reconstruction is always done several weeks post-reconstruction * in austin, most surgeons use a specialized flap procedure to create a nipple from the skin of the breast mound * once the nipple reconstruction heals, about 2 weeks, the pt. has an areola tattoed on the nipple. some docs do this themselves some use a tattoo artist

Answer 68

* implants are placed to enlarge the breasts. may sit submuscularly or subglandularly. incision may be inframammary, periariolar, axillary, or umbilical

Answer 69

* repair ptosis (drooping) of aging breasts the procedure is much like a reduction, only less breast tissue and more skin is resected. may be done in tandem with augmentation

Answer 70

* Dx: bilateral mammary hypotrophy or mammary hypoplasia * nearly always bilateral * insert implants filled with silicone or saline * subglandular vs. submuscular placement

Answer 71

* check implants with surgeon before pt goes to sleep! * breast implant sizers available * a closed system for delivering IV saline to the implant * sterile IV tubing * 3-way stopcock * 2-3 60 ml syringes * SAS * risks: flap necrosis, infection, hematoma or seroma formation, capsular contracture * fyi: all implants have a silicone outer shell there are 2 types of implants. saling or silicone

Answer 72

* usually a transverse curvilinear inframammary incision * if implant is being replaced usually soak in SAS first * on the mayo--think deep * mosquitos * tonsils * allis * long metz * asdons with teeth * geralds * cat claws * army navy * deaver * bovie extension * need to ask if we are replacing them

Answer 73

* capsular contracture is the formation of a fibrous capsule around a breast implant after wither breast reconstruction or augmentation mammoplasty * once a capsule has formed, it will generally persist until it is addressed surgically * the only way to avoid risk of another capsule formation is a complete capsulectomy with removal of the implant * the capsule may also simply be divided by electrocautery. this may promote its resorption by the body the implant may be exchanged for a new implant replaced after casulectomy or capsulotomy or removed altogether

Answer 74

* Dx: bilateral mammary hypertrophy * nearly always bilateral * most common: inferior pedicle, keyhole to anchor incision

Answer 75

* pt should not be sedated until seen by the surgeon marks must be made with breasts in anatomic position, meaning either sitting up or standing * is is very important to preserve the surgeons marks during the prep * arms are usually out on armboards at 90 degrees and since pt may be brpught into a sitting position, kerlix or webril is used to secure arms to armboards * usual drapes of choice: split sheet X 2\ * PRN lamis syringes, needles, tubing and compression bags lip cannulaw tubing and lip unit * rarely a pedicle will be too long to leave the nipple aroalr complex on it. in these cases the areola is removed and trated just like a full thickness skin graft incuding suturing and stentimg this is called a free nipple graft * risks: hematoma seroma infection

Answer 76

* lots of #10 * asons with teeth * debakey * cookie cutter * marking pen * hemostats * allis * towel clip * cat claws * supercuts * mayo scissors

Answer 77

* breast tissue in males is usually removed by lipo * part one * several small stab incisions are made. tumescent solution consisting of IV saline mixed with epi and sometimes lidocaine is introduced through tubing which leads to a Lamis handpiece or syringe, onto which one of several lengths and thicknesses of blunt ended needles can be placed. optimally, this solution is allowed to stay in the tissues into which it was tumesced for 20 minutes, which will allow it time to * break up or emulsify the fat through mechanical pressure * promote hemostasis during lipo by allowing time for the epi to cause localized vasoconstriction * Part 2 * one of seceral lipocannulaw is inserted into the incision and the unit is activated. pressure should reach about 30psi vigorus motion combined with suction serve to resect the fat * incisions are closed usually at skin level only with prolene or nylon. a compressive garment is applied

Answer 78

* nasal fracture: commonly treated by closed reduction * a nasal fracture or a congentital condition may lead to a deviated septum, which may lead to one of two surgical procedures * septoplasty (function) * rhinoplasty (shape)--risk of necrosis of nasal tip

Answer 79

1. leaves no discernable scar (incision on inside) 2. is less invasive 3. carries less risk of nasal tip necrosis

Answer 80

* z-shaped or tansverse incision across the base of the columella * entire skin layer if reflected superiorly back from the nose, offering maximum exposure of the nasal septum * provides access to the entire anterior surface of the nose * rhinoplasty may be needed if a septoplasty will not be able to reach the affected part of the septum or if a septoplasty has been attempted but failed to bring unobstructed breathing to the pt.

Answer 81

* goal: restore pre-injury dental occlusion * most commonly, wires or pins are set within the maxilla, and arch bars are fastened to the teeth, which are then wired shut * Important: send wire cutters with pt. to prevent aspiration (not the ones in your set)

Answer 82

1. Le Fort I--transverse maxillary fracture 2. Le Fort II-- pyramidal maxillary fracture 3. Le Fort III--craniofacial dysjunction 4. usually require ORIF

Answer 83

* zygomatic fractures * orbital floor fractures

Answer 84

* orgonathic procedures (aka Le Forte or BSSO(bilateral sagital split osteotomy)) * for pts who have an extreme under or over bite which orthodontics alone cannot fix * cleft lip/palate repair

Answer 85

* blepharoplasty in general refers to the resection of skin and fat form above and below the eyes * functional blepharoplasties are always upper done to correct loss of vision from drooping skin above the eye

Answer 86

cheek implants

Answer 87

fixing ears from sticking out

Final Exam Flashcards

(121 cards)