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Phases of wound healing?
- 1. Inflammatory phase - till 72 hours
- - Hemostasis, coagulation and chemotaxis
- - Arteriolar vasoconstriction, thrombus formation and platelet aggregation due to endothelial damage - vasodilatation
- 2. Proliferative phase - 3 days to 3-6 weeks
- - Formation of granulation tissue and repair or wound
- - Epithelial migration
- - Proliferation of type III collagens
- - Re-epitheliation
- 3. Maturation (remodelling) - 6 weeks to 1 year
- - Contraction, scarring and remodelling
What are other types of dermoid cyst?
Sequestration dermoid - formed by sequestration of some ectodermal cells into deeper layer during embryonic development.
Implantation dermoid: Cyst develops due to implantation of epidermal cells into the deeper tissue usually due to a pin prick.
Tubulodermoid: Cysts developing from a nonobliterated portion of a congenital ectodermal duct. The cyst is formed by accumulation of secretions of the lining ectodermal cells, e.g. thyroglossal cyst.
Teratomatous dermoid: Cyst developing from totipotential cells and contains different structures arising from ectodermal, mesodermal and endodermal elements. The cyst may contain hairs, bones, teeth and other elements.
What is sebaceous cyst?
This is a retention cyst in relation to sebaceous gland due to blockage of sebaceous duct and accumulation of secretion within the gland.
Short note on Keloid. [TU 2073/4]
Difference between keloid and hypertrophied scar?
- A hypertrophic scar is defined as excessive scar tissue that does not extend beyond the boundary of the original incision or wound. It results from a prolonged inflammatory phase of wound healing and from unfavourable scar siting (i.e. across the lines of skin tension). In the face, these are known as the lines of facial expression. Hypertrophic scar does not have itching, no sign of increased vascularity and gradually regresses after 6 months. Usually does not get worse after 1 year.
- A keloid scar is defined as excessive scar tissue that extends beyond the boundaries of the original incision or wound. Its aetiology is unknown, but it is associated with elevated levels of growth factor, deeply pigmented skin, an inherited tendency and certain areas of the body (e.g. a triangle whose points are the xiphisternum and each shoulder tip).
- The histology of both hypertrophic and keloid scars shows excess collagen with hypervascularity, but this is more marked in keloids where there is more type III collagen.
Treatment of Keloid and HTS?
- Pressure – local moulds or elasticated garments
- Silicone gel sheeting (mechanism unknown)
- Intralesional steroid injection (triamcinolone)
- Excision and steroid injectionsa
- Excision and postoperative radiation (external beam or brachytherapy)
- Intralesional excision (keloids only)
- Laser – to reduce redness (which may resolve in any event)
Characteristic shapes of the edges of ulcers?
- (a) Non-specific ulcer: note the shelving edge.
- (b) Tuberculous ulcer: note the undermined edge.
- (c) Basal cell carcinoma (rodent ulcer): note the rolled edge, which may exhibit small blood vessels.
- (d) Epithelioma (SCC and BCC): note the heaped-up, everted edge and irregular thickened base.
- (e) Syphilis: note the punched-out edge and thin base, which may be covered with a ‘wash-leather’ slough.
Name sclerosing agents?
- 1% polidocanol
- Hypertonic saline
- Sodium tetradecyl sulfate
Different types of hemangioma?
- Depending on the nature of blood vessels involved, there are three types of hemangioma:
- Capillary hemangioma
- Cavernous hemangioma
- Arterial or plexiform hemangioma
Different types of capillary hemangiomas?
- Salmon patch
- Port wine stain
- Strawberry angioma
- Spider nevus
[@ Strawberry decays, patch can be removed, stain stays = strawberry angioma regresses with age, salmon patch also regresses by 1st year of life, port wine stain stays forever.]
In which abscesses the fluctuation is not demonstrable?
- ischiorectal abscess
- Parotid abscess
- infection in palmar space
- Breast abscess
- iliac abscess
- Thigh abscess.
Hilton’s method for drainage of abscess?
- When the abscess is situated in an important site containing major vessels and nerves then there is possibility of injury of underlying structures during drainage of abscess. to avoid this, the abscess drainage in important site is done by Hilton’s method.
- The skin and subcutaneous tissues are incised with a knife. The point of a hemostat or a sinus forceps is pushed through the most prominent part of the swelling and the blades are then opened. The opening is thus enlarged and pus drained. A finger may be introduced into the abscess cavity and all the loculi broken.
- Lister Sinus forcep -