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Plastic Surgery - Skin, Recon, Burns - Coggle Diagram

- - - - Regular
      - Irregular
      - Rolled
  - - - Common slow growing malignant epidermal tumour from thebasal layer of epithelium, rarely metastasis
    - - Most common skin cancer
      - Head and neck 90%
    - - Middle age / elderly
      - M>F 2:1
      - Fair skin
    - - Sun
      - Immunosuppression
      - Previous BCC
      - X rays
      - Arsenic
      - Gorlin syndrome (AD multiple BCC)
      - Xeroderma pigmentosa
    - - Macro raised rolled edges, pealy white, fine Blood vessels visible (telangiectasia) central ulceration, scabbing (dried serum and epithelial cells
    - - Nodular
      - Superficial
      - Morphoeic
      - Pigmented
    - - Slow steady in
  - - - Lips
      - EArs
    - - Transplant pts
      - Smoker
      - Chronic wounds
      - Elderly
  - - - Cluster of mature fat cells that have become overactive and distended with fat, slow growing
    - - Answhere there is fat
      - Trunk
      - Limbs
    - - Multiple lipomata
  - - - Genetics
      - M:F 5:1
      - Age > 50
      - Smoking
      - Trauma
      - Alcohol
      - Antiepiletics - phenobarbitone
      - Systemic conditions
        Cirrhosis
        DM
        TB
        Epilepsy
    - - Abdnormal thickening (benign prolideration) of palmar fascial tissue resulting in digital flexion contracture
    - - Plantar fibrosis - Ledderhose disease
      - Retroperitoneal fibrosis
      - Penile fibrosis - Peyronies disease
      - Garrod's knuckles pads
    - - FHx
      - Bilateral disease
      - Ectopic disease
      - Radial sided disease
      - Young age of onset
    - - Thickening of palmar fascia
  - - - 30-60 years old
      - 5:1 F:<
    - - Idiopathic / Primary
      - Secondary
        
        Local
        
        Anatomical malformation
        
        Tumours
        
        Infections
        
        Bone prominence / trauma
        
        Systemic
        
        Obesity
        
        Diabetes
        
        Thyroid dysfunction
        
        RA
        
        Pregnancy
        
        OCP
        
        Myxoedema
        
        Acromegaly
        
        Amyloid
        
        Sarcoid
- - - - Does not maintain original blood supply
    - - Maintains original blood supply
  - - - Split Thickness (Partial)
        
        Contains 100% of epidermis and porportion of dermis
      - FUll Thickness
        
        Contains 100% of epidermis and dermis
    - - Bed must be well vascularised
  - - - Component Parts
        
        Cutaneous
        
        Muscle
        
        Musculocutaneous
        
        Osseocutaneous
      - Relation to the defect
        
        Local
        
        Regional
        
        Distant
      - Nature of blood supply
        
        Random pattern
        
        Axial
        
        Advancement
      - Movememt of Flap
        
        Rotation
        
        Transpositional
        
        Advncement
      - Free Flap
        
        Flap disconnected from donor blood supply and anastomosed at recipient site
    - - Use
        
        Breast reconstruction
      - Examples
        
        Lat dorsi breast or lower limb recon
        
        Recturs abdominus perieneal recon
        
        Gastrocnemuis wonds around the kne
    - - USe
        
        Flap for radiotherapy
        Skin grafts don't tolerate radiotherapy
    - - Anticoagulation
      - Attention to wound care
      - Flap monitoring
      - Avoid compression on pedicle
      - Antibiotics
      - Haemoglobin / intravascular volume
      - Avoid vasocontrictors (pressors, nicotine, caffein) diuretic low flow
      - Keep warm and comfy
      - Positioning
    - - Tissue Colou
      - Warmth and Tugor
      - Assess blanching
      - Capillary refill time
- - - - Parkland formula
        
        3-4ml Hartmans / Kg/ % burn + maintenance for children
        
        Hald of calculated is given in first eight hours from time o burn, rest over next 16 hr
      - More than 10% TBSA in chil
        More than 15% TBSA in adult
  - - - % of pt burned
      - Lund and Browder
      - Rule of 9s
    - - Tissue damage is proportional o tempertature or strenght of injuring agent and Length of contact time