Transcript Review 2004 : Plastic Surgery

Ottawa Review 2010
Plastic Surgery
 Hand surgery
 Burns
 Wound healing
 Skin Cancer
 Facial injuries
Murray W. Allen MD FRCSC
Hand Surgery : Applied Anatomy
 Nerve
 Tendon
 Vascular
 Bone and joint
 Ligament
Median Nerve
 Sensory
Median Nerve
 Motor
Median Nerve
 Carpal tunnel
syndrome
Median Nerve
 Location
 Block
Ulnar Nerve
 Sensory
Ulnar Nerve
 motor
Ulnar Nerve
 Motor to
 the intrinsics
Ulnar Nerve
 Froment’s sign
Ulnar Nerve
 Cubital tunnel
syndrome
Ulnar Nerve
 Location
 Block
Radial Nerve
 Sensory
 Location
Radial Nerve
 Block
Tendons
 Extensors
 Testing
Tendons
 Flexors
 Testing
Tendons
 Anatomy
Tendons
 Flexor tenosynovitis
 Kanaval
Tendons
 Repair
Tendons
 Rehab
Vascular
 Anatomy
 Allen’s test
Bone
 Fractures
Joints
 Septic arthritis
Ligaments
Anatomy
Ligaments
 Dislocation
Ligaments
 Gamekeepers Thumb
 Grade 1, 2 ,3
 Stener lesion
Amputation
 Cool the part
 Avoid clamping
vessels
 Transport ASAP
Amputation
 Many will contract on
their own if the bone
is still covered
 1 square cm rule?
Burns
 Depth
 Extent
 Resuscitation
 Inhalation
 Treatment
Burn depth
 First
 Second
 Third
 Fourth
Burn
 Second degree
 Pain
 Blister
 = partial
thickness
Burn
 Deep partial thickness
Burn
 Full thickness
 Dermal
Burn
 Fourth degree
Burn
 Estimation of
surface area
 Rule of nines
Burn
 Parkland formula
 % surface area as a whole #
 Weight in Kg.
 FUDGE FACTOR = 4
 If its not a big # you did the math wrong!!
Burn
 Always in Ringer’s lactate
 ½ in the first 8 hrs
 ½ in the next 16 hours
 Keep urine at 50 ml/hr
Burn
 Use ATLS
 Add resuscitation fluids
 Foley
 Oxygen
 Escharotomy
Burn
 Escharotomy
Burn
 Treatment
– Superficial partial will heal
– Deep partial ?
– Full need excision and skin graft
Burn
 Dressing
– Silver dressing
– To reduce the colony count which:
– Reduces the chance of invasive infection
Burn
 Inhalation
– Hot gas
– Chemical injury = ARDS
– C0 poisoning
Increases mortality appox. 50%
Burn
 excision
Burn
 graft
Wound healing
 Two standard
processes
– Re-epithlization
– Contraction
Wound Healing
 Phases
– Latent or Inflammatory
– Proliferative
– Maturation
Wound Healing
 Latent or Inflammatory
– Invasion of inflammatory cells
– The macrophage is the regulator
Wound Healing
 Proliferative
– Fibroblasts
– Endothelial cells
– Inflammatory cells
– = granulation tissue
Wound Healing
 Maturation
– Induced by coverage with epithelium
– Reduction of activity
– Realignment of collagen
Skin Cancer
 Basal cell carcinoma
 Squamous cell carcinoma
 Malignant melanoma
Skin cancer
 BCC
 Pearly
 Ulcer
 Telangiectas
ia
 3 mm.
Skin Cancer
 What is it?
Skin Cancer
 Keratoacanthoma
Skin Cancer
 SCC
 Punched
out
 5 mm.
 Metastasis
Skin Cancer
 Melanoma
 Colour
 Contour
 Ulcer
 Elevation
 Size
 Change
Skin Cancer
 Breslow versus Clark scale
 Greater than 1 mm = 2 cm
 Less than 1 mm = 1 cm
 Sentinel node bx. > 1 mm.
 Lymphatic and blood borne
Skin cancer
 Sentinel Node
 First node in
chain
 Likely to be
standard of care
Facial Injury
 Frontal sinus
 Midface = Lefort I II III
 Zygoma and Blow out
 Mandible #
 Nasoethmoid
Frontal Sinus
Frontal Sinus
Midface and Mandible
Midface and Mandible
Nasoethmoid Fractures
Nasoethmoid Fractures
Good Luck and Enjoy