Plastic and Reconstructive Surgery

Performed to change the size of the breast

Mammoplasty

Performed to reconstruct the breast without the use of implants

Mammoplasty

Performed to treat macomastia

Mammoplasty

Requires the use of a tissue expander under certain conditions

Mammoplasty

Marissa Walton is a 6 year old girl with full-thickness burns involving both lower legs, circumferentially, excluding her feet, over less than 2% of her body surface area (BSA) and partial-thickness burns over less than 15% of her BSA, after her clothes caught fire during a camping trip when she stepped into the campfire. Based on the American Burn Association and the "Rule of Nines" classifications, Marissa's burns would be classified as _______ with a burn surface area percentage of approximately ________. a. Minor; 17% b. Moderate; 17% c. Minor; 9% d. Major; 18%

Minor; 9%

Performed to excise the excess abdominal wall skin

Panniculectomy

The procedure performed to remove excess skin and adipose tissue from the abdominal wall is called a ______. a. Rhytidectomy b. Panniculectomy c. Blepharoplasty d. Mentoplasty

Panniculectomy

Usually performed after significant weight loss

Pannuculectomy

When performing a breast augmentation with an implant, the surgeon creates a pocket under the _______ to receive the implant. a. Trapezius b. Rectus c. Pectoralis minor d. Pectoralis major

Pectoralis major

Grafts are raised from the donor site but are not severed free are called _______ grafts. a. Pedicle b. Free c. Split-thickness d. Progressive

Pedicle

Microsurgery, a fundamental tool in reconstructive plastic surgery, allows an almost unlimited choice of reconstructive methods, a replacement of lost tissue with similar components, and optimal selection of donor sites with minimal morbidity. Reconstructive microsurgical procedures include replantation of amputated body parts, repair of facial nerves, repair of lacerated nerves and blood vessels, treatment of extensive trauma to extremities and hands, reconstruction following removal of extensive cancers, and female to male transsexual reassignment. Today's surgeons skilled in microsurgery can successfully anastomose the ends of a vessel or nerve measuring less than: a. 2mm b. 1.5mm c. 1mm d. 0.5mm

1 mm

When coverage for a defect cannot be achieved through skin grafting, plastic surgeons rely on other techniques to replace tissue. After mastectomy, reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap is one of the several options for nonsynthetic prosethetic reconstruction. Another descriptive term for the TRAM flap is the: a. Pedicle based flap b. Free flap c. Mastopexy d. Rotated tunneled flap

Pedicle based flap

During an open brow life, a _______ is used to elevate the periosteum off the cranium to the level of the superior orbital rims. a. Rigid cannula b. Periosteal elevator c. Retractor d. Pin cutter

Periosteal elevator

When performing an otoplasty, the incision is made in the _____ area. a. Lower jaw b. Temporal c. Postauricular d. Preauricular

Postauricular

Marissa Walton is transferred to the OR from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia. What important preparation for the procedure will the perioperative team need to perform before Marissa arrives to the OR? a. Procure the allograft skin from the freezer and begin the thaw process b. Procure a basic plastic instrument set plus a knife dermatome and sterile mineral oil c. Prewarm the OR to above ambient high temperature for an adult d. Collaborate with the anesthesia provider to determine fluid replacement requirements

Prewarm the OR to above ambient high temperature for an adult

There are approximately 1 million reported cases of skin cancer per year with the majority being the highly curable basal or squamous cell cancers, accounting for more than 50% of all cancers. Not as common is the most serious skin cancer, malignant melanoma, with an estimated 68,720 cases per year. Select the individual who is at the highest risk for skin cancer. a. An African-American outdoor sportsman and airline pilot b. A fair-complected surger and beach lifeguard who wears sunblock-protective clothing c. A fair-complected person testing positive for exposure to human papillomavirus d. A dark-complected person testing postitive for human immunodeficiency virus

A fair-complected person testing positive for exposure to human papillomavirus

Panniculectomy is performed to remove excess skin and adipose tissue from the ________. a. Arms b. Abdomen c. Cheeks d. Jowls

Abdomen

______ are grafts that were harvested from donors and preserved by the tissue bank until needed. a. Allografts b. Autografts c. Composite grafts d. Xenografts

Allografts

Replantation is an attempt to reattach a completely amputated digit or other body part. Revascularization is the procedure performed on incomplete amputations, when the part remains attached to the body by skin, artery, vein, or nerve. Good candidates or replantation are those with the following amputations: a. Almost any body part of a child b. Proximal portion of the hand at palm level c. Distal to middle foot d. Distal to middle thigh

Almost any body part of a child

The three most common skin cancers are basal cell, squamous cell, and melanoma. Treated early, skin cancers such as squamous cell and basal cell carcinomas may be cured by simple excision and closure (with pathologic diagnosis to ensure disease-free margins). Melanoma is treated much more aggressively because of its high mortality. The A-B-C-Ds of the warning signs for skin cancer stand for: a. Acute, borderline, color, dyplastic b. Asymmetry, blanching, cohesion, depth c. Aplastic, bilateral, chronic, dyplastic d. Asymmetry, border, color, diameter

Asymmetry, border, color, diameter

A broad range of implant materials are used in plastic and reconstructive surgery. Select the implant that represents a biologic composition of a surgical implant a. Autologous human tissue b. Medical grade sterile silicone c. Gold d. Polypropylene

Autologous human tissue

A graft derived from live tissue-human or animal is called a(n)_______. a. Autograft b. Allograft c. Biological graft d. Synthetic graft

Biological graft

Full-thickness skin graft (FTSG) contains _______. a. Only the dermis b. Both dermis and epidermis c. One remodeled structure d. Two or more types of tissues

Both dermis and epidermis

A malar augmentation is a procedure used to enlarge the ______. a. Lips b. Eyebrows c. Cheeks d. Chin

Cheeks

Mentoplasty is augmentation of the ______. a. Cheeks b. Forehead c. Chin d. Lips

Chin

The most superficial layer of the epidermis is called the stratum _____. a. Corneum b. Granulosum c. Spinosum d. Germinativum

Corneum

Aesthetic surgery, also called _____surgery, is performed to improve the appearance but does not always address function. a. Cosmetic b. Basic c. Mohs d. Synthetic

Cosmetic

________ is the surgical removal of dead skin, debris, and infection material from a wound. a. Debridement b. Escharotomy c. Fasciotomy d. Allograft

Debridement

Josh tremain, a 28-year-old firefighter, sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire. What surgical treatments may Josh need before he is discharged from the burn center to home? a. Debridement and monitoring of full-thickness skin regeneration b. Debridement, allograft placement during initial healing, and later split-thickness (ST) and full thickness (FT) skin grafting. c. Allograft and xenograft placement as temporary dressing until secondary granulation begins. d. Tangential excision of the burn wound with antibiotic-soaked dressings

Debridement, allograft placement during initial healing, and later split-thickness (ST) and full thickness (FT) skin grafting

During removal of the superficial lesion, the skin edges are retracted with a(n) ___________. a. Army-Navy retractor b. Beckman self-retraining retractor c. Double or single prong skin hook d. Gelpi self-retaining retractor

Double or single prong skin hook

The ______ is the outer layer of the skin a. Eschar b. Epidermis c. Keloid d. Dermis

Epidermis

One of the most popular lasers used in plastic and reconstructive surgery is attached to the water in the skin cells and ablates the cells at a predetermined depth. Collagen material beneath the skin surface is also heated, resulting in smoother and slightly tighter skin. Several lasers are attached to areas or darker pigmentation. This treatment has virtually replaced dermabrasion, because of its consistency in terms of depth of penetration and also because this techniwue is less dependent on laser technique or skill. Select the laser modality that would be the best option for ablation or removal of a pigmented red tattoo. a. CO2 laser b. Erbium:YAG laser c. Nd:YAG laser d. Excimer laser

Erbium:YAG laser

Third-Degree burns develop ______, which is devitalized, nonelastic tissue adhering to the wound site. a. Bilobate b. Eschar c. Plicate d. Imbricate

Eschar

A rhytidectomy is typically known as a _____. a. Scar revision b. Breast enhancement c. Face lift d. Nose job

Face lift

During cheek augmentation, the incision is ______. a. Intraoral b. Intranasal c. In the subcuticular space d. In the supratarsal crease

Intraoral

Facial fractures are classified according to a system developed by Rene Le Fort in the early 1900s. a fracture that starts at the nasal bones, crosses the frontal process of the maxilla and lacrimal bones, and extends through the orbital floor, infraorbital rim and lateral maxillary sinus wall is known as a: a. Le Fort I b. Le Fort II c. Le Fort III d. Le Fort IV

Le Fort II

The circulator should verify with the patient that all of the preoperative prescribed skin preparation regimens ordered by the surgeon have been performed. Al body jewelry that pierces the skin should be removed before the skin prep. Select the statement that reflects a true special consideration for skin preparation before facial surgery a. Use chlorhexidine gluconate (CHG) around the ears and eyes b. Leave the eyebrows and eyelashes intact to preserve facial appearance and expression c. Prep the skin graft and donor sites together with the same prep set and drape immediately d. Isolate rashes, open sores, cuts, or lesions in the prep site with a sterile, clear adhesive patch.

Leave the eyebrows and eyelashes intact to preserve facial appearance and expression

Mohs' surgery is a specialized excision used to treat basal and squamous cell skin cancers. Select the statement about Mohs surgery that best reflects the process, procedure, and outcome goal. a. Mohs' surgery is diagnostic, an ambulatory procedure, and a definitive treatment b. Lesions are mapped, excised, and examined by frozen section until clear margins are found c. The procedure can be very time-consuming to accomplish, but typically results in the preservation of the surrounding healthy tissue d. The segments are excised and microscopically examined and the defect is closed with a drain

Lesions are mapped, excised, and examined by frozen section until clear margins are found

Denise Michaelson, a 46-year-old woman with an early stage second primary cancer in her left breast, has elected to have a bilateral mastectomy with saline implants. She has requested that the surgeon also revise a small unsightly scar on her right knee and pierce her ears. While Denise's breast tumor could be treated with excisional biopsy, she had decided to have a mastectomy of both breasts, which is considered an appropriate preemptive (preventative) surgery for a woman of her age with two primary cancers of the breast. The saline implant insertion surgery is considered a ______ procedure, the scar revision is considered a _____ procedure, and the ear piercing is considered a ______ procedure. a. Reconstructive; reconstructive; reconstructive b. Reconstructive; cosmetic; reconstructive c. Cosmetic; reconstructive; cosmetic d. Reconstructive; cosmetic; cosmetic

Reconstructive; cosmetic; cosmetic

During the planning phase of a procedure for liposuction or post-bariatric contouring, the perioperative team will assemble and organize supplies and devices because the procedure may require: a. Repositioning one or more times during surgery b. Meticulous accounting of fluid loss and blood replacement c. Pressure dressings d. Patient transfer to an alternating-pressure bed

Repositioning one or more times during surgery

Performed to rejuvenate an aging face

Rhytidectomy

A variety of implantable devices are used in aesthetic and reconstructive plastic surgery procedures. Tracking of these devices is critical to patient safety. Institutions must report any incident of death or serious injury relating to the use of a medical device. What regulatory agency, commission, or act mandates this process when medical devices fail or cause injury? a. The joint commission agency for sentinel events b. Original equipment manufacturer device tracking commission c. Food and drug administration device failure and recall act d. Safe medical device act

Safe medical device act

Augmentation is a surgical procedure in which the ______ of a structure is _____. a. Shape; changed b. Size; enlarged c. Size; reduced d. Surface; aligned

Size; enlarged

A stent dressing is used

Skin graft

A dermatome is used to harvest a large _____ skin graft. a. Full thickness b. Split thickness c. Composite d. Biosynthetic

Split thickness

Skin grafts that consist of epidermis and a portion of the papillary dermis are called ____ grafts. a. Pedicle b. Split-thickness c. Full-thickness d. Composite

Split-thickness

Dermatomes are used for removing split-thickness skin grafts (stsgs) from donor sites. The perioperative team preparing for a procedure where STSGs will be taken to cover several large burn areas will need to have available. a. Sterile petroleum jelly and sterile impregnated gauze sheets b. Sterile mineral oil, tongue blades, and a mesher dermatome c. Sterile mineral oil and carriers d. A nitrogen tank, sterile gauze fluffs, and antibiotic ointment.

Sterile mineral oil, tongue blades, and a mesher dermatome

During a lower lid blepharoplasty, the initial incision is made in the _______. a. Canthi of the eye b. Cornea of the eye c. Supraciliary region d. Subciliary region

Subciliary region

Sharp dissection is performed with _____ or fine metzenbaum scissors and toothed tissue forceps a. Tenotomy b. Mayo c. Rongeur d. Elevator

Tenotomy

The science of plastic and reconstructive surgery, which means to mold or create form and shape, improves appearance and body image through an understanding of: a. Body geometry b. The anatomy and biology of tissue c. Form and function d. Body image

The anatomy and biology of tissue

A surgical technique in which a plane of tissue is created or an existing tissue plane is lifted, such as skin from the fascia, is called ________. a. Stent b. Pilcate c. Undermine d. Debridement

Undermine

Denise michaelson had a scar revision of her knee performed along with her bilateral mastectomy with saline implants and ear piercing procedures. The knee scar, before revision, was an 8-cm linear, think scar that extended obliquely across the anterior portion of her knee. The tension of the scar tissue met resistance when she would bend her knee. The surgeon opted to remove the scar with a procedure to break up the linear scar and rearrange the tissue direction to form a natural line. The proper name of this tissue transfer scar revision is the: a. Scar lysis b. Epidermolysis with remodeling c. Scarplasty d. Z-plasty

Z-plasty

Protecting underlying tissues and organs, excreting organic waste, and storing of nutrients are functions of _______. a. Adipose tissue b. Scar formation c. Mammary system d. The integumentary system

The integumentary system

Skin grafting provides an effective way to cover a wound if vascularity is adequate, infection is absent, and hemostasis is achieved. Skin from the donor site is detached from its blood supply and placed in the recipient site. The best description of a successful skin graft outcome is: a. The skin is a good color match b. The recipient site develops a new blood supply from the base of the wound c. Capillary refill returns within 24 hours d. A split-thickness graft is able to regenerate in an area of full-thickness loss.

The recipient site develops a new blood supply from the base of the wound