Plastic Surgery

Question 1

What organisms are characteristic of cat bites?

Answer 1

Pasteurella

Question 2

What organism is worrisome in ~15% dog bites?

Answer 2

Capnocytophagia canimoris

• can cause disseminated sepsis in elderly and aplenic patients.
• Gram negative.

Question 3

What are the ideal timing of laceration closures for hand/leg, trunk and face?

Answer 3

Hand/leg 8 hours

Question 4

What is the timing of suture removal for face, scalp/trunk, extremities/joints?

Answer 4

face: 5 days
scalp/trunk: 7 days
extremities/joints: 10-14 days

Question 5

What are the contents of the carpel tunnel? (10 structures)

Answer 5

• Median n.
• Flexor digitorium profundus (4)
• Flexor digitorum superficialis (4)
• Flexor pollicis longus

Question 6

What are the intrinsic m. of the hand? (5 categories)

Answer 6

1. Thenar m (abductor pollicus brevis, opponens pollicis, flexor pollicis brevis)
2. Hypothenar (opponens digiti minimi, flexor digiti minimi, abductor digiti minimi)
3. Adductor pollicus
4. Lumbricals
5. Interossei

Question 7

What is the thenar m. innervated by?

Answer 7

Median n. in some cases partially by the ulnar.

Question 8

What are the flexors of the hand?

Answer 8

Flexor pollicus longus/brevis
Flexor carpi radialis
Flexor retinaculum
Flexor digitorum
Flexor digitorum profundus
Flexor digitorum superficialis
Palmaris longus
Flexor carpi ulnaris
Flexor digiti minimi

Question 9

The extensor tendons of the hand are separated by how many fibro-osseous canals or compartments?

Answer 9

6

Question 10

What are the 9 extensors of the hand?

Answer 10

Abductor pollicus longus
Extensor pollicus brevis

Extensor carpi radialis longus
Extensor carpi radialis brevis

Extensor pollicus longus

Extensor digitorum (communis)
Extensor indicis (proprius)

Extensor digiti minimi

Extensor carpi ulnarus

Question 11

What are the 4 classic signs (Kanavel) of flexor tenosynovitis?

Answer 11

1. Position of flexion
2. Pain on passive extension
3. Fusiform swelling
4. Tenderness on palpation of synovial sheath.

Question 12

What is the motor and sensory function of the radial n.?

Answer 12

Motor: wrist extension

* in hand: purely sensory: Dorsum only

Question 13

What layer does superficial partial thickness burns involve?

Deep partial thickness?

Answer 13

• Epidermis, Dermis (the papillary layer) sparing the hair follicles, sebaceous and sweat glands.
• Deep partial thickness involves the reticular layer of the dermis (involving hair follicles, sweat glands etc)

Question 14

What physical exam findings are characteristic of superficial burns?

Answer 14

Erythema, very painful - sunburn like

NO blisters

Question 15

Physical exam findings of superficial partial thickness burns?

Answer 15

• Erythema
• Blistering
• Very painful
• Cap refill present.

Question 16

What time period should superficial partial thickness burns heal?

Answer 16

14-21 days (2-3 weeks)

Question 17

Physical exam findings of deep partial thickness burns?

Answer 17

• May have blisters
• Yellow/white (not erythematous)
• NO cap refill
• No sensation
  Hard to distinguish from full thickness burns

Question 18

What time period should deep partial thickness burns heal?

Answer 18

3 weeks - 2 months

May need surgical intervention and skin grafting

Question 19

Physical exam findings of full thickness burns (formerly 3rd degree)?

Answer 19

• Charred skin
• Pale
• Painless
• Leather like
• Goes into the subcutaneous fat tissue
  ALL need skin grafting bc all dermal elements are destroyed.

Question 20

Physical exam findings of 4th degree burns?

Answer 20

Extends to muscle and bone.

- Sometimes req amputation or extensive reconstruction

Question 21

What is the parkland formula?

Answer 21

4cc x Kg x % BSA burn (not including superficial burns)
Ringers Lactate
- 1/2 given in first 8 hours, rest over 16 hours.
- U/O goal: 0.5-1 cc/kg/hr

Question 22

What is tenosynovitis?

Answer 22

Inflammation of the synovium surrounding tendons

The synovium is a thin layer of tissue only a few cells thick which lines the joints and tendon sheaths. The synovium acts to control the environment within the joint and tendon sheath. It does this in two ways: first, it acts as a membrane to determine what can pass into the joint space and what stays outside; second, the cells within the synovium produce substances that lubricate the joint.