SURGERY
DIAGRAMS ARE NECESSARY
SHORT NOTES
(5 MARKS)
1) COMLICATIONS AND DEFORMITIES IN BURNS
Complications of deep or widespread burns can include:
Bacterial infection, which may lead to a bloodstream infection (sepsis)
Fluid loss, including low blood volume (hypovolemia)
Dangerously low body temperature (hypothermia)
Breathing problems from the intake of hot air or smoke
Scars or ridged areas caused by an overgrowth of scar tissue (keloids)
Bone and joint problems, such as when scar tissue causes the shortening and tightening of skin, muscles or tendons (contractures)
The most common deformities resulting from severe burns are contractures, and the scarring, or sticking together, of skin around joints. For example: TO PREVENT SCARRING TOGETHER OF THE SKIN AT JOINTS: TO HELP BURNS HEAL: When possible, leave the burns open to the air.
2) BURNS BY DEPTH AND SURFACE AREA
Burns are classified as first-, second-, third-degree, or fourth-degree depending on how deeply and severely they penetrate the skin's surface.
First-degree (superficial) burns. First-degree burns affect only the outer layer of skin, the epidermis. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and often consists of an increase or decrease in the skin color.
Second-degree (partial thickness) burns. Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful.
Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred.
Fourth-degree burns. Fourth-degree burns go through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone. There is no feeling in the area since the nerve endings are destroyed.
3) RULE OF NINE
Estimating burn size in adults
See a picture of the "rule of nines" for adults.
The front and back of the head and neck equal 9% of the body's surface area.
The front and back of each arm and hand equal 9% of the body's surface area.
The chest equals 9% and the stomach equals 9% of the body's surface area.
The upper back equals 9% and the lower back equals 9% of the body's surface area.
The front and back of each leg and foot equal 18% of the body's surface area.
The groin area equals 1% of the body's surface area.
Estimating burn size in babies and young children
See a picture of the "rule of nines" for babies and young children.
The front and back of the head and neck are 21% of the body's surface area.
The front and back of each arm and hand are 10% of the body's surface area.
The chest and stomach are 13% of the body's surface area.
The back is 13% of the body's surface area.
The buttocks are 5% of the body's surface area.
The front and back of each leg and foot are 13.5% of the body's surface area.
The groin area is 1% of the body's surface area.
The "rule of palm" is another way to estimate the size of a burn. The palm of the person who is burned (not fingers or wrist area) is about 1% of the body. Use the person's palm to measure the body surface area burned.
It can be hard to estimate the size of a burn. If you think a burn is a certain size but you are unsure, it is best to discuss the size of the burn with your doctor.
4) PRINCIPLES OF LASTIC SURGERY
The basic principles of plastic surgery are explained in this collection. An overview is given about the basic plastic surgery techniques including several options to close a wound defect and lengthening or replacement of scars, while maintaining the functionality and the esthetics of the area. The reconstructive ladder is explained. Several basic principles are explained about skin flaps such as the movement of the reconstruction flaps and the vascularisation of the flap. Lastly the different skin characteristics are explained and how to handle considering these characteristics.
5)HYPERTROPHIC SCAR/KELOID MANAGEMENT
Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. The latter is characterized by continuous and histologically localized inflammation. As a result, the reticular layer of keloids and hypertrophic scars contains inflammatory cells, increased numbers of fibroblasts, newly formed blood vessels, and collagen deposits. Moreover, proinflammatory factors, such as interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-α are upregulated in keloid tissues, which suggests that, in patients with keloids, proinflammatory genes in the skin are sensitive to trauma. This may promote chronic inflammation, which in turn may cause the invasive growth of keloids. In addition, the upregulation of proinflammatory factors in pathological scars suggests that, rather than being skin tumors, keloids and hypertrophic scars are inflammatory disorders of skin, specifically inflammatory disorders of the reticular dermis. Various external and internal post-wounding stimuli may promote reticular inflammation.
6) PRINCIPLES OF TENDON TRANSFER
Certain key elements play crucial roles in tendon transfer operations. [1, 2, 3, 4, 5, 6] Three important principles should be emphasized. [7] First, the transfer should not significantly decrease the remaining function of the hand. Second, the transfer should not create a deformity if significant return of function occurs following a nerve repair. Third, the transfer should be phasic or capable of phase conservation. For more information on tendon transfer in the hand,
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Tendon transfers provide a substitute, either temporary or permanent, when function is lost due to neurologic injury in stroke, cerebral palsy or central nervous system lesions, peripheral nerve injuries, or injuries to the musculotendinous unit itself. This article reviews the basic principles of tendon transfer, which are important when planning surgery and essential for an optimal outcome. In addition, concepts for coapting the tendons during surgery and general principles to be followed during the rehabilitation process are discussed.
SHORT ANSWERSÂ
(2 MARKS)
1) POSITIONING IN BURNS
Patients who are admitted to a burn center with significant burns should be positioned in what has been documented in the literature as the 'anti-deformity' position [1]. The body area affected by the burn should be positioned opposite the direction of potential burn scar contracture.
2) COLOSTOMY
A colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. During this procedure, one end of the colon is diverted through an incision in the abdominal wall to create a stoma. A stoma is the opening in the skin where a pouch for collecting feces is attached.
3) ILEOSTOMY
Ileostomy is a stoma (surgical opening) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an artificial external pouching system which is adhered to the skin. Ileostomies are usually sited above the groin on the right hand side of the abdomen.
4) PROSTATECTOMY
A prostatectomy is a surgical procedure for the partial or complete removal of the prostate. It may be performed to treat prostate cancer or benign prostatic hyperplasia. A common surgical approach to prostatectomy includes making a surgical incision and removing the prostate gland (or part of it)
5) HERNIORAPHY
Hernia repair refers to a surgical operation for the correction of a hernia—a bulging of internal organs or tissues through the wall that contains it. It can be of two different types: herniorrhaphy; or hernioplasty.[1] This operation may be performed to correct hernias of the abdomen, groin, diaphragm, brain, or at the site of a previous operation. Hernia repair is often performed as an ambulatory procedure.
6) ULCERS
An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robins pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing out of inflamed necrotic tissue." Common forms of ulcers recognized in medicine include: