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ABSITE > 18 Plastics, Skin, Soft tissue flaps > Flashcards

18 Plastics, Skin, Soft tissue flaps Flashcards

1
Q

Keratinocytes

A

Main cell type in epidermis
Originate from basal layer
Provides mechanical barrier

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2
Q

Melanocytes

A

Neuroectodermal origin (neural crest cells)
In basal layer of epidermis
Transfer melanin to neighboring keratinocytes via melanosomes through dendritic processes
Density of melanocytes is the SAME amongst races - different rate of melanin production

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3
Q

Dermis

A

Structural proteins (collagen)

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4
Q

Langerhans cells

A

Antigen-presenting cells - MHC Class II
Originate from bone marrow
Contact hypersensitivity reactions (Type IV)

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5
Q

Pacinian corpuscles

A

Pressure

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6
Q

Ruffini’s endings

A

Warmth

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7
Q

Krause’s end-bulbs

A

Cold

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8
Q

Meissner’s corpuscles

A

Tactile sense

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9
Q

Eccrine sweat glands

A

Aqueous sweat - hypotonic

Thermal regulation

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10
Q

Apocrine sweat glands

A

Milky sweat
Most in palms and soles
Acetylcholine (BUT still sympathetic nervous system)

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11
Q

What type of drugs have best skin absorption?

A

Lipid-soluble drugs

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12
Q

Predominant type of collagen in skin?

A

Type I collagen
70% of dermis
Gives tensile strength

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13
Q

Definition - tension

A

Resistance to stretching

Collagen

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14
Q

Definition - elasticity

A

Ability to regain shape

Branched proteins that can stretch 2x normal length

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15
Q

Cushing’s striae

A

Caused by loss of tensile strength and elasticity

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16
Q

MCC of pedicled or anastomosed free flap necrosis?

A

venous thrombosis

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17
Q

How does tissue expansion occur?

A

Local recruitment
Thinning of the dermis and epidermis
MItosis

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18
Q

TRAM flaps

A

Transverse rectus abdominis myocutaneous
Complications: flap necrosis, ventral hernia, bleeding, infection, abdominal wall weakness
Blood supply - superior epigastric vessels

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19
Q

Most important determinant of TRAM flap viability?

A

Periumbilical perforators

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20
Q

Stage I pressure sore

A

Erythema and pain

No skin loss

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21
Q

Stage II pressure sore

A

Partial skin loss with yellow debris

Tx: Local, keep pressure off

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22
Q

Stage III pressure sore

A

Full-thickness skin loss, subcutaneous fat exposure

Tx: Sharp debridement; likely need myocutaneous flap

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23
Q

Stage IV pressure sore

A

Involves bony cortex, muscle

Tx: myocutaneous flap

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24
Q

UV radiation

A

Damages DNA and repair mechanisms
Both a promoter and initiator
Melanin is the single best factor for protecting skin from UV radiation

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25
Q

What radiation is responsible for chronic sun damage?

A

UV-B

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26
Q

Risk factors for melanoma?

A 
Dysplastic, atypical, large congenital nevi (10%)
Familial BK mole syndrome (100%)
Xeroderma pigmentosum
Fair complexion, easy sunburn, intermittent sunburns
Previous skin CA
Previous XRT
Immunosuppression
10% familial
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27
Q

Most common melanoma site on skin?

A

Men - back

Women - legs

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28
Q

Negative prognostic factors for melanoma?

A

Men
Ulcerated lesions
Ocular and mucosal lesions

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29
Q

Signs of melanoma?

A 
Asymmetry (angulations, indentation, notching, ulcerations, bleeding)
Borders irregular
Color change
Diameter increasing 
Evolving over time
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30
Q

Most omnious sign for melanoma?

A

Blue clor

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31
Q

Most common site for distant melanoma metastases?

A

Lung

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32
Q

Most common metastasis to small bowel?

A

Melanoma

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33
Q

Diagnosis of melanoma?

A

<2cm lesion - excisional biopsy

>2cm lesion (or cosmetically sensitive) - incisional biopsy (punch biopsy)

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34
Q

Thin lentigo maligna

A

Melanoma in situ, Hutchinson’s freckle
Just in superficial papillary dermis
0.5cm margins OK

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35
Q

Lentigo maligna melanoma

A

Least aggressive
Minimal invasion
Radial growth first
Elevated nodules

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36
Q

Superficial spreading melanoma

A

Most common
Intermediate malignancy
Originates from nevus/sun-exposed areas

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37
Q

Acral lentiginous

A

Very aggressive

Palms/soles of AA

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38
Q

Nodular melanoma

A

Most aggressive
Generally has metastasized at time of diagnosis
Vertical growth first
Bluish-black with smooth borders

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39
Q

Staging workup for melanoma?

A

For all melanoma >1mm deep:

  • Chest/abd/pelvic CT
  • LFTS
  • LDH
  • Examine all possible draining lymph nodes
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40
Q

Treatment for all stages of melanoma?

A

1) Resection of primary tumor with appropriate margins

2) Management of lymph nodes

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41
Q

Surgical margins for melanoma?

A

In situ (0.5-1.0cc)
<1.0mm (1.0cm)
1.1-2.0mm (1-2.0cm)
>2.0mm (2.0cm)

42
Q

Involved nodes in melanoma - signs?

A

Non-tender
Round
Hard
1-2cm

43
Q

When do you reset nodes in melanoma?

A

Clinical positive nodes

44
Q

When do you do a SLNB in melanoma?

A

Clinically negative nodes
Tumor >1mm deep
Tumors >0.72mm deep with worrisome factors

45
Q

What do you need to add with anterior head/neck mealnomas >1mm?

A

Superficial parotidectomy (20% met rate to parotid)

46
Q

Approach to axillary node melanoma with no other primary?

A

Complete axillary node dissection

Remove levels I, II and II - unlike breast CA

47
Q

Medical treatment for systemic melanoma disease?

A

IL-2

Tumor vaccines

48
Q

Most common malignancy in united states?

A

Basal cell carcinoma of the skin

49
Q

Origin of basal cell carcinoma?

A

EPidermis - basal epithelial cells and hair follicles

50
Q

Pearly appearance, rolled borders, slow and indolent growth

A

Basal cell carcinoma

51
Q

Path - peripheral palisading of nuclei, stromal retraction

A

Basal cell carcinoma

52
Q

Basal cell carcinoma - morpheaform type

A

More aggressive

Has collagenase production

53
Q

Treatment of basal cell carcinoma?

A

Margins - 0.3-0.5cm

XRT/chemo - inoperable disease, metastasis, neuro/lymph/vessel invasion

54
Q

Overlying erythema, papulonodular with crust/ulcers; red-brown

A

Squamous cell carcinoma

55
Q

Marjolin ulcer

A

Squamous cell carcinoma in post-XRT areas or old burn scars

56
Q

Risk factors for squamous cell carcinoma

A 
Actinic keratosis
Xeroderma pigmentosum
Bowen's disease
Atrophic epidermis
Arsenics
Hydrocarbons (coal tar)
Chlorophenols
HPV
Immunosuppresion
Sun exposure
Fair skin
previous XRT
Previous skin CA
57
Q

Risk factors for metastasis of squamous cell carcinoma

A

Poorly differentiated
Greater depth
Recurrent lesions
Immunosuppression

58
Q

Treatment of squamous cell carcinoma?

A

Margins 0.5-1cm
Mohs surgery (high risk)
Regional adenectomy for clinically positive nodes
XRT/Chemo - inoperable disease, mets, neuro/lymph/vessel invasion

59
Q

Most common soft tissue sarcomas?

A

1# Malignant fibrous histiosarcoma

2# Liposarcoma

60
Q

Symptoms of soft tissue sarcoma?

A

Symptomatic mass
GI bleed
Bowel obstruction
Neurologica deficits

61
Q

Work up of soft issue sarcoma?

A 
CXR - r/o lung mets
MRI - r/o vascular, neuro, bone invasion
Biopsy:
- < 4cm - excisional
- >4cm - longitudinal incisional
62
Q

Mets of soft tissue sarcomas?

A

Hematogenous spread
Rarely to LN
Most common site - lung

63
Q

Most common site of soft tissue sarcoma mets?

A

Lung

64
Q

Treatment of soft tissue sarcoma?

A

3cm margins and at least 1 uninvolved fascial plane

Place clips - if recurrence, XRT

65
Q

Indications for postop XRT for soft tissue sarcoma?

A

High-grade tumors
Close margins
Tumors >5cm

66
Q

Chemotherapy for soft tissue sarcoma?

A

Doxorubicin

67
Q

Indication for preop chemo-XRT with soft tissue sarcoma?

A

> 10cm

Possibility of limb-sparing resection

68
Q

Poor prognostic factors in soft tissue sarcoma?

A

Delay in diagnosis
Difficulty getting total resection
Difficulty getting XRT to pelvic tumors

69
Q

Head and neck sarcomas?

A

Pediatric - usually rhabdomyosarcoma

Post-op XRT for positive or close margins

70
Q

Visceral and retroperitoneal sarcomas?

A

Most common leiomyosarcoma and liposarcoma

71
Q

Risk factor for mesothelioma

A

Asbestos

72
Q

Risk factor for angiosarcoma

A

PVC and arsenic

73
Q

Risk factor for chronic lymhedema

A

Lymphangiosarcoma

74
Q

Kaposi’s sarcoma

A

Vascular sarcoma
Oral/pharyngeal mucosa most common - bleeding, dysphagia
Immunocompromised - AIDS
Tx: Palliation, HAART< XRT, Vinblastin, INF-a

75
Q

Childhood rhabdomyosrcoma

A 
#1 soft tissue sarcoma in kids
Head/neck, GU, extremities, trunk
Embryonal subtype - most common
Alveolar subtype - worst prognosis
Tx: Surgery, doxorubicin
76
Q

Osteosarcoma

A

Increased incidence around the knees
Originates - metaphyseal cells
CHildren

77
Q

Neurofibromatosis

A

CNS tumors, peripheral sheath tumors, pheochromocytoma

78
Q

Li-fraumeni syndrome

A

Childhood rhabdomyosarcoma and others

79
Q

Hereditary retinoblastoma

A

Includes other sarcomas

80
Q

Tuberous sclerosis

A

Angiomyolipoma

81
Q

Gardner’s syndrome

A

Familial adenomatous polyposis adn itnra-abdominal desmoid tumors

82
Q

Xanthoma

A

Yellow, contains histiocytes

Tx: Excision

83
Q

Warts

A

Verruca vulgaris
Viral, contagious, autoinoculable, painful
Tx: Liquid nitrogen

84
Q

Actinic keratosis

A

Premalignant sun-damaged areas

Tx: excisional biopsy if suspicious

85
Q

Seborrheic keratosis

A

NOT premalignant
Trunk on elderly
Can be dark

86
Q

Arsenical keratosis

A

Associated with squamous cell CA

87
Q

Merkel cell carcinoma

A

Neuroendocrine
Very aggressive - early regional and systemic spread
Red to purple papulonodule or indurated plaque
Neuron-specific enolase (NSE), cyutokeratin, neurofilament protein

88
Q

Glomus cell tumor

A

Painful tumor composed of blood vessels or nerves
Benign
Most common in terminal aspect of the digit
Tx: Tumor excision

89
Q

Desmoid tumors

A

Benign, but locally invasive
Occur in fascial planes
High risk of recurrence, no distance spread
Tx: Surgery, chemo (sulindac, tamoxifen)

90
Q

Most common location of desmoid tumors

A

Anterior abdominal wall

91
Q

Intraabdominal desmoid tumors

A

Gardner’s syndrome and retroperitoneal fibrosis

Encases bwoel

92
Q

Bowen’s disease

A

SCCA in-situ
10% progress to invasive SCCA
Associated with HPV
Tx: Imiquimod, cautery ablation, topical 5-FU

93
Q

Keratoacanthoma

A

Rapid growth, rolled edges, crater filled with keratin
NOT malignant, but difficult to differentiate from SCCA
Involutes spontanously over months
Tx:
- Small; excise
- Large; biopsy and observe

94
Q

Hyperhidrosis

A

Increased sweating - palms

Tx: thoracic sympathectomy if refractory to antiperspirants

95
Q

Hidradenitis

A

Infection of apocrine sweat glands - axilla and groin
Staph/strep
Tx:
- ABx, improved hygiene
- Surgeyr to remove skin and sweat glands

96
Q

Epidermal inclusion cyst

A

Most common

Mature epidermis with creamy keratin material

97
Q

Trichilemmal cyst

A

In scalp

No epidermis

98
Q

Ganglion cyst

A

Over tendons, commonly wrist

Filled with collagen material

99
Q

Dermoid cyst

A

Midline intra-abdominal and sacral lesions

Need resection due to malignancy risk

100
Q

Pilonidal cyst

A

Congenital coccygeal sinus with ingrown hair

If infected - needs excision

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