SUR 105 - Test 2
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SUR 105 - Test 2
Plastic Reconstructive Surgery
primary goal of plastic and reconstructive treatment
restoration of form and function
performed to improve appearance but does not address function (cosmetic surgery)
basis of plastic surgery
fulfill fundamental need for social acceptability
vital functions of skin/integumentary system
protects underlying tissues and organs
excretes organic waste and stores nutrients
excretes water and dissipates heat for thermoregulation
its sensory organs transmit touch, pressure, pain, and temp
outer layer of skin
primary tissue cells of epidermis
5 epidermal layers
stratum germinativum (stratum basale)
most superficial epidermal layer - transparent and composed of dead keratinocytes filled with keratin
extremely thin epidermal layer - may not be found on thin skin regions
thick epidermal layer that produces keratin
epidermal layer that contains undifferentiated cells that become specialized as they migrate to skin surface
deepest epidermal layer - its cells undergo mitosis - contains melanocytes (produce melanin)
function of dermis layer
provides nourishment and enervation to the epidermis
what are blood vessels of dermis responsible for?
oxygenation of tissue and thermoregulation
skin layer that contains numerous sensory receptors for pain, touch, heat, cold, and pressure
examples of skin appendages
what does a hair follicle consist of?
sometimes apocrine gland
visible portion of hair
erector pili muscle - aids thermoregulation by producing goose bumps
2 types of sweat glands
apocrine - located in axilla and groin
eccrine - secrete sweat over body surface through small tubules
what is sebum?
combination of wax, lipids, cholesterol, triglycerides
soft tissues of the face
tissue plane that separates the subcu tissue into deep and superficial layers
superficial musculoaponeurotic system (SMAS)
fat is densest in which regions of the face?
cheek and neck regions
defect of palate
defect of lip
when is surgical treatment for cleft lip performed?
at 10 to 12 weeks for initial repair
most common type of skin cancer
basal cell carcinoma
second most common skin cancer
squamous cell carcinoma
rarest of skin cancers but accounts for most fatalities from skin cancer
burn involving epidermis only
first-degree (partial-thickness burn)
burn involving both epidermis and dermis
second-degree (partial-thickness burn)
burn causing permanent damage to skin and underlying tissues
third-degree (full-thickness burn)
solution commonly used for face preps
what are graft sites prepped with?
what instruments is sharp dissection performed with?
tenotomy or fine metz scissors and toothed tissue forceps
with what is a large split-thickness graft removed?
dermatome set includes:
most commonly used mechanical dermatome
used less often than other types of dermatomes
drum dermatome (Reese and Padgett)
used to remove full-thickness skin graft
split-thickness graft modified by what?
purpose of aeration of skin graft by the graft mesher
prevent blood and serum from accumulating under the graft during healing
allows graft to stretch, increasing surface area and providing precise fit
techniques for which pneumatic power drill is used
model bone tissue with rotating burr or cutter
create anchor holes for wire or screws
cut through bone with oscillating saw blade
Endobrow instruments include:
4- or 5-mm endoscope in 0- and 30-degree angles
blunt and sharp dissection instruments
what is CO2 laser used for?
facial resurfacing procedures
objective of stenting
to apply pressure over graft site to prevent accumulation of serum or blood between graft and recipient site
build up tissue
2 fundamental types of grafts
biosynthetic grafting material
absorbed by body or enhances healing, but not derived from biological tissue
graft transferred from one individual to another
commonly used allografts
skin, bone, cartilage
biological graft taken from one area of body and transplanted to another area in the same patient
commonly used autografts
skin, bone, cartilage, fat
biological graft consisting of more than one tissue type
graft that contains only dermis
split-thickness (partial-thickness) (STSG)
graft that contains dermis and epidermis
graft made of tissue taken from one species that is grafted into another species
synthetic, natural, or biosynthetic substance used to fill in or replace an anatomical structure
silicone implants used for what types of purposes?
breasts, cheek, chin
porous, cause little inflammatory reaction, remain stable, but difficult to sculpt and can damage tissue when removed
when/where are Gore-Tex implants used?
removing diseased, damaged, or infected tissue
enzymes are used to dissolve tissue - impregnated into wound dressings
tissue removed using sharp dissection with surgical instruments
debridement performed using fine jet spray of saline - used most commonly in burn and trauma patients
pressurized saline debridement
how is soft tissue remodeled?
sculpted by sharp and blunt dissection or with laser
how is dense connective tissue remodeled?
sculpted with a variety of drills and bone cutters
positioning for excision of superficial lesions
prone for lesions of back and buttocks
lateral for lesions of hip and shoulder
supine for facial or limb procedures
if surgical wound can be closed by primary intention, what anesthetic is used?
how is skin lesion removed and cut during Mohs surgery?
cut into quadrants before frozen section, which are used to map the tumor and determine exact location of malignant margins
purpose of scar revision
to remodel a previous scar or remove keloid
scar that develops excess tissue and may be red or raised
healing time of hypertrophic scar
generally heals after 6 months and may resolve over a period of years
scar that forms at wound site and may become bulbous and unsightly, and can invade nearby tissue
what does skin from first-degree burn look like?
red or pink, dry, and painful to touch
what does skin from partial-thickness second-degree burn look like?
blistered, red, and moist
very sensitive to environmental exposure and touch
what does skin from full-thickness second-degree burn look like?
white, smooth, shiny surface with dry blisters and edema
what does skin from third-degree burn look like?
white, brown, or black, and appears waxy
devitalized, nonelastic tissue that adheres to wound site
what are lap sponges soaked in for debridement of burns?
sterile saline and topical epinephrine
what is applied to graft site to reduce friction as the blade glides over the skin?
purpose of pedicle graft
provide coverage and vascularization to soft tissue defect
graft that is raised from the donor site but not immediately severed free
pedicle graft (flap graft)
types of pedicle grafts
raised from tissues in immediate area of the defect
semicircular and require some degree of turning to reach and cover recipient defect
resection of the eyelid
drooping of anatomical structure
brow lift approaches
at the hair line
at the level of the brow itself
redundant and sagging supportive tissue of the face reduced or modified
what does laser skin resurfacing do?
removes epidermis and portion of the dermis to reduce facial lines and wrinkles
after entire face has been resurfaced, what is applied?
malar augmentation incision
intraorally below the parotid duct
surgical creation of external ear
what is used to recreate the antihelix on the anterior surface of the ear?
increasing size and improving shape of breast
implants used for an elective procedure on intact breast
in postmastectomy reconstruction, where is pocket created for implant?
musculofascial tissue of the pectoralis major
in postmastectomy reconstruction, what is inserted into the pocket?
tissue expander with saline reservoir
amount of saline used to fill reservoir
150 to 300 mL
excess breast tissue removed and breast reconstructed
excessively large breasts
macromastia in males
tissue flap containing skin, subcutaneous tissue and muscle is raised from lower abdomen and transferred to mastectomy site
why is TRAM flap performed?
to reconstruct breast without use of implants
in nipple reconstruction, areola is constructed from?
full-thickness graft taken from medial thigh crease
in nipple reconstruction, nipple is created with?
full-thickness skin graft taken from labia
performed to remove excess deep fat
tubing required for liposuction
large-bore tubing with high-vacuum apparatus
performed to remove excess skin and adipose tissue from abdominal wall