Home Work # 2 Plastic S.

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.

Lesions are mapped, excised, and examined by frozen section until clear margins are found. The procedure involves excising the lesion layer by layer and examining each layer under the microscope until all the abnormal tissue is removed. Mohs' surgery is usually completed on an ambulatory basis with the patient administered a local anesthetic. The procedure can be very time-consuming to accomplish, but it typically results in the preservation of the surrounding healthy tissue. Because the procedure is lengthy, patient preparation and comfort are essential to facilitate cooperation during the procedure. A horizontal layer of tissue is removed and divided into sections that are color-coded with dyes. A map of the surgical site is then drawn. Frozen sections are immediately prepared and examined microscopically for any remaining tumor. If a tumor is found, the location(s) are noted on the map, and another layer of tissue is resected. The procedure is repeated as many times as necessary to completely remove the tumor.

________ flaps are raised from the tissues that are in the immediate area of the defect.

Advancement An advancement flap is raised from the tissues in the immediate area of the defect. Rotation flaps are semicircular and require some degree of turning in order to reach and cover the recipient tissue defect.

____________are grafts that were harvested from donors and preserved by the tissue bank until needed.

Allografts An allograft is a graft transferred from one individual (human) to another. Allografts are harvested from donors and preserved by the tissue bank until needed. Skin, bone, and cartilage are commonly used allografts. Allografts and homografts are subject to partial reabsorption over time.

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.

Autologous human tissue The range of materials available for implantation and augmentation in the specialty of plastic and reconstructive surgery has benefited from ongoing research. Biologic materials (autogenous grafts) are preferred when available. Autologous human tissue successfully used includes fat, solid dermis, and collagen. A cellular collagen (regenerative tissue matrix) is a material that allows for a strong intact repair in breast reconstruction postmastectomy procedures by providing soft tissue reinforcement or replacement.

The condition causing the contraction of palmar fascia is known as ____.

Dupuytren's disease

Which type of donor skin graft includes the epidermis, dermis, and possibly subcutaneous tissue?

FTSG

Abdominoplasty procedures cannot be performed on patients who have undergone cesarean sections, due to excessive adhesions in the lower abdomen.

False

Severed digits should be kept tightly covered and warm to prevent clot formation and necrosis, preventing replantation.

False

Augmentation Mammoplasty the action or process of making or becoming smaller in size or amount.

False Augmentation Mammoplasty the action or process of making or becoming greater in size or amount.

During cheek augmentation, the incision is extraoral

False During cheek augmentation, the incision is intraoral

Melanocyte secrets black pigment is called Melatonin.

False Melanocyte secrets black pigment is called Melanin.

Papaverine is used to prevent Vasosdialation.

False Papaverine is used to prevent Vasospasm.

Pedicle flap is not attached to its blood supply.

False Pedicle flap (attached to its blood supply) free flap is not attached to its blood supply.

Rhinoplasty also known as face -lift.

False Rhytidectomy also known as face -lift.

The incision made for mentoplasty is subciliary incision.

False The incision made for mentoplasty is in Middle of the chin.

This picture shows Dupuytren's Disease

False This picture shows Ganglion Cyst.

This picture shows Dermatome.

False This picture shows Mesher.

This picture shows Polydactyl fixation

False This picture shows Syndactyl fixation

This picture shows cottle Osteotome.

False This picture shows cottle elevator

This picture shows mesher..

False This picture shows dermatome.

When Rhytidectomy Performed The trigeminal nerve should be avoided.

False When Rhytidectomy Performed The facial nerve should be avoided.

The perioperative nurse should verify with the patient that all of the preoperative prescribed skin preparation regimens ordered by the surgeon have been performed. All 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.

Leave the eyebrows and eyelashes intact to preserve facial appearance and expression. The eyebrows and eyelashes, in particular, are left intact to preserve facial appearance and expression. The surgical site is marked before surgery by the surgeon to designate the correct site and to define landmark areas. Either a povidone-iodine solution, an iodine-alcohol mixture, chlorhexidine gluconate (CHG), or another broad-spectrum agent may be selected for the antimicrobial skin prep. The use of CHG should be avoided around the ears and eyes. It is important to place shields on the eyes and/or eye ointment if prepping the periorbital site or performing an extensive head and neck prep, to place plugs in the ear canals, and prevent pooling of the prep agent.

A burn patient is transferred to the operating room (OR) from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia. What is the most important preparation the perioperative nurse should perform before the patient arrives in the OR?

Prewarm the OR to above the normal ambient temperature and humidity. Because patients who have sustained burns are vulnerable to hypothermia from the loss of body surface area (BSA), the perioperative nurse should ensure the temperature and humidity in the OR are increased and exposure is limited only to the areas related to the planned surgical event. Throughout the procedure, the temperature in the OR is constantly monitored to prevent hypothermia. The perioperative nurse will need to collaborate with the anesthesia provider in determining fluid replacement requirements.

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 several options for nonsynthetic prosthetic reconstruction. Another descriptive term for the TRAM flap is the:

pedicle-based flap Breast reconstruction options include alloplastic (artificial materials such as breast implants), autogenous (flaps), or a combination of both. Flaps may be pedicle-based or free flaps, requiring microsurgical techniques for their reconstruction. TRAM flaps are pedicle-based flaps used for breast reconstruction. The rectus muscle is the broad, wide abdominal muscle that reaches from under the ribs to the pubis, and either one or both sides of the muscle may be used for reconstruction. The blood supply (superior epigastric artery and vein) is carried within the muscle pedicle.

When performing an otoplasty, the incision is made in the _______ area.

postauricular Otoplasty is surgical creation of the external ear. An incision is made in the postauricular skin using a #15 blade. This exposes the cartilage.

What three nerves innervate the forearm, wrist, and hand?

radial, ulnar, median

A 46-year-old woman had a scar revision of her knee. The knee scar, before revision, was an 8-cm linear, thin 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:

Z-plasty Z-plasty is the most widely used method of scar revision. It breaks up linear scars, rearranging them so that the central limb of the Z lies in the same direction as a natural skin line. Scars that are parallel to skin lines are less noticeable than scars that are perpendicular to skin lines. A contracted scar line can also be lengthened with a Z-plasty.

Panniculectomy is performed to remove excess skin and adipose tissue from the _________.

abdomen Panniculectomy is performed to remove excess skin and adipose tissue from the abdominal wall.

in Mammoplasty Initial incision -------- and second incision ------------ -around the areolar, inframammary fold -inframammary fold , around the areolar -supramammary fold , inframammary fold -around the areolar,supramammary fold

around the areolar, inframammary fold

the picture shows

aufricht retractor

If skin is taken from an unburned area of the patient and used as a transplant, it is called a(n) ____.

autograft

The layer of the epidermis that undergoes mitosis is the stratum ____.

basale

A graft derived from live tissue—human or animal—is called a/an __________________.

biological graft There are two fundamental types of grafts: biological graft (those derived from living tissue) and the synthetic graft (derived from man-made materials).

A cosmetic procedure performed on the eyelid is a(n) ____.

blepharoplasty

Reimplantation of a digit begins with ____ attachment.

bone-to-bone

Which body site is not ideal for a split-thickness skin graft?

calf

A malar augmentation is a procedure used to enlarge the __________.

cheeks Malar augmentation is cheek augmentation.

Which of the following best describes the area of the skin preparation for a reduction mammoplasty?

chest and breast, chin to hips including axilla

The outermost layer of the epidermis that is composed of dead epidermal cells is the stratum ____.

corneum

The most superficial layer of the epidermis is called the stratum _________.

corneum Stratum corneum is the most superficial layer. It is relatively transparent and composed of dead keratinocytes that are filled with a protein called keratin. The stratum corneum is thicker on areas of the body that are weight-bearing or exposed to friction, such as the hands and feet.

this picture shows

cottle elevator

Debridement is the process of removing ____________ tissue.

damaged or infected Damaged or dead cells prevent the formation of fibrin, collagen, and other matrix tissue that binds the healing tissues. The process of removing the diseased, damaged, or infected tissue is called debridement.

The pictures shows the use of

dermatome

Full-thickness skin graft (FTSG) is composed of the epidermis and ____________.

dermis

Which layer contains hair follicles, sweat glands, sebaceous glands, and nerve fibers?

dermis

The perioperative nurse circulating for a skin contracture release of the ear on a 5-year-old boy transfers 0.25% bupivacaine via syringe to the scrub person's sterile back table. The scrub person questions why she is not giving him bupivacaine with epinephrine, because there may be bleeding expected at the incision site. The nurse's reply is based on the fact that:

epinephrine is contraindicated in areas with limited vascularity, such as the ears. Use of epinephrine is contraindicated in areas with limited vascularity, such as digits, the penis, nasal tip, and ears.

What burn classification involves only the epidermis?

first degree

A burn that destroys the epidermis, dermis, and accessory organs of the skin is a ____ burn.

full-thickness

Which of the following is a synovial fluid-filled cyst that can arise from a tendon sheath or wrist joint?

ganglion cyst

Which of the following best describes the perimeter of the skin preparation for a ganglion cystectomy?

hand and forearm circumferentially

What type of graft is skin harvested from a cadaver?

homograft

During cheek augmentation, the incision is ________.

intraoral After the patient is prepped and draped, an intraoral incision is made below the parotid duct with a #15 blade and extended to the periosteum.

The process by which strands of tough, fibrous proteins develop within the cell membrane is ____.

keratinization

The pigment that occurs in the epidermis and absorbs light energy is ____.

melanin

The epidermis is the ____________ layer of the skin.

outer The epidermis is the outer layer of the skin. The primary tissue cells of the epidermis are the keratinocytes.

What other pathology often occurs in conjunction with cheiloschisis?

palatoschisis

Which muscle is responsible for flexing the hand at the wrist?

palmaris longus

Grafts that are raised from the donor site but are not severed free are called ________ grafts.

pedicle A pedicle graft (also called flap graft) is raised from the donor site but not immediately severed free. The donor site tissue is partially severed and the flap brought into contact with the recipient site. The graft is sutured in place to cover the defect.

The TRAM flap allows the reconstruction of the breast without the use of implants.

True A transverse rectus abdominis myocutaneous (TRAM) flap is performed to reconstruct the breast without the use of implants.

A nipple reconstruction is done by performing a full-thickness skin graft from the medial thigh crease or postauricular region.

True The areola is constructed from a full-thickness graft taken from the medial thigh crease or postauricular region. The nipple is created with a full-thickness skin graft taken from the labia.

Aesthetic surgery, also called cosmetic surgery.

True

Augmentation Mammoplasty the action or process of making or becoming greater in size or amount.

True

De Quervain's disease caused by stenosing Tenosynovitis also know As washerwoman's sprain.

True

Dupuytren's Contracture A non-painful nodule in the palm of the hand, near the 4th or 5th digit.

True

For ganglion cystectomy Skin prep should include the hand and forearm circumferentially and the incision should be made over the cyst

True

Full-thickness (FTSG): Epidermis and all of the dermis,May include the underlying subcutaneous tissue.

True

Incisions made for endoscopic brow lifts and rhytidectomy are often placed within the hairline for camouflage.

True

K wire is used during reimplantation of a digit to attach Bone to bone .

True

Liposuction a technique in cosmetic surgery for removing excess fat from under the skin by suction.

True

Mammoplasty This surgery is performed to remove hypertrophic Breast tissue.

True

Mentoplasty is the technical name for surgery that changes the shape of the chin.

True

Otoplasty — also known as cosmetic ear surgery.

True

Palmaris longus is Responsible for flexing the hand at the wrist level.

True

Radial dysplasia Also known as(radial club hand, (radial longitudinal deficiency)

True

Subciliary Approach is done for Lower-Lid Blepharoplasty.

True

Sudoriferous gland in the axillae is called Apocrine

True

The deep layer of the dermis is called Reticular layer.

True

Third-degree :Affects the epidermis and the whole dermis and the underlying tissue it appear charred or pearly white referred to as ESCHAR.

True

This picture shows Blepharoplasty.

True

This picture shows Dupuytren's Disease

True

This picture shows Padgett dermatome

True

This picture shows the incision for Rhytidectomy surgery

True

stent dressing is used when we obtain skin graft.

True

to harvest the skin from the donor we use mineral oil to minimize friction between the dermatome and the graft.

True

A 46-year-old woman with a second early-stage 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 the patient's breast tumor could be treated with an excisional biopsy, she has 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.

reconstructive; cosmetic; cosmetic There are two different subspecialties of plastic surgery. Cosmetic surgery restores or reshapes normal structures of the body, to modify or improve appearance. Reconstructive surgery treats abnormal structures of the body caused by birth defects, developmental problems, disease, tumors, infection, or injury to restore function and correct disfigurement or scarring. Scar revision involves the rearranging or reshaping of an existing scar so that the scar is less noticeable. The simplest form of scar revision is excision of an existing scar and simple resuturing of the wound.

What surgical procedure is performed to remove hypertrophic breast tissue?

reduction mammoplasty

Plastic and reconstructive surgery is surgery performed to _______________.

restore form and function that has been lost Plastic and reconstructive surgery is involved with the treatment of congenital defects and anatomical abnormalities caused by disease and injury. Restoration of form and function is the primary goal in treatment.

Which procedure may involve the use of the local anesthetic cocaine?

rhinoplasty

What medical term refers to the surgical procedure commonly known as a face-lift?

rhytidectomy

What is a common method of determining the percentage of body surface burned?

rule of nines

Sebaceous glands secrete ____.

sebum

Augmentation is a surgical procedure in which the _____ of a structure is _____.

size; enlarged

A dermatome is used to harvest a large _____-thickness graft.

split A large split-thickness graft is removed with the dermatome.

Skin grafts that consist of the epidermis and a portion of the papillary dermis are called ________ grafts.

split-thickness Split-thickness skin grafts consist of the epidermis and a portion of the papillary dermis.

--------dressing is used when we obtain skin graft

stent

Dermatomes are used for harvesting split-thickness skin grafts (STSGs) from donor sites. The perioperative nurse, who is preparing for a procedure where STSGs will be taken to cover several large burn areas, will need to have available:

sterile mineral oil, tongue blades, a skin mesher, and a dermatome of choice. A plastic local procedure instrument set is required, with the addition of a dermatome of choice, a skin mesher, sterile tongue blades, mineral oil, and a sterile marking pen.

What layer binds the skin to the underlying structures?

subcutaneous

Which layer of skin functions best as a heat insulator?

subcutaneous

What medical term refers to the condition in which the digits of the hands or feet fail to separate?

syndactyly

A rhytidectomy is performed to rejuvenate ________ of the aging face.

the lower third A rhytidectomy, or face lift, is performed to rejuvenate an aging face, particularly the lower one third of the face, including the jaw-line and neck.