Review-Plastic-Surgery：回顧整形手術課件

1、Ottawa Review 2010Plastic SurgeryHand surgeryBurnsWound healingSkin CancerFacial injuries Murray W. Allen MD FRCSCOttawa Review 2010Plastic SurHand Surgery : Applied AnatomyNerveTendonVascularBone and jointLigamentHand Surgery : Applied AnatomyMedian NerveSensoryMedian NerveSensoryMedian NerveMotorM

2、edian NerveMotorMedian NerveCarpal tunnel syndromeMedian NerveCarpal tunnel syndMedian NerveLocationBlockMedian NerveLocationUlnar NerveSensoryUlnar NerveSensoryUlnar NervemotorUlnar NervemotorUlnar NerveMotor to the intrinsicsUlnar NerveMotor to Ulnar NerveFroments signUlnar NerveFroments signUlnar

3、 NerveCubital tunnel syndromeUlnar NerveCubital tunnel syndUlnar NerveLocationBlockUlnar NerveLocationRadial NerveSensoryLocationRadial NerveSensoryRadial NerveBlockRadial NerveBlockTendonsExtensorsTestingTendonsExtensorsTendonsFlexorsTestingTendonsFlexorsTendonsAnatomyTendonsAnatomyTendonsFlexor te

4、nosynovitisKanavalTendonsFlexor tenosynovitisTendonsRepairTendonsRepairTendonsRehabTendonsRehabVascularAnatomyAllens testVascularAnatomyBoneFracturesBoneFracturesJointsSeptic arthritisJointsSeptic arthritisLigamentsAnatomyLigamentsAnatomyLigamentsDislocationLigamentsLigamentsGamekeepers ThumbGrade 1

5、, 2 ,3Stener lesionLigamentsGamekeepers ThumbAmputationCool the partAvoid clamping vesselsTransport ASAPAmputationCool the partAmputationMany will contract on their own if the bone is still covered1 square cm rule?AmputationMany will contract oBurnsDepthExtentResuscitationInhalationTreatmentBurnsDep

6、thBurn depthFirstSecond ThirdFourthBurn depthBurnSecond degreePainBlister= partial thicknessBurnSecond degreeBurnDeep partial thicknessBurnDeep partial thicknessBurnFull thicknessDermalBurnFull thicknessBurnFourth degreeBurnFourth degreeBurnEstimation of surface areaRule of ninesBurnEstimation of su

7、rface areaBurnParkland formula% surface area as a whole #Weight in Kg.FUDGE FACTOR = 4If its not a big # you did the math wrong!BurnParkland formulaBurnAlways in Ringers lactate in the first 8 hrs in the next 16 hoursKeep urine at 50 ml/hrBurnAlways in Ringers lactateBurnUse ATLSAdd resuscitation fl

8、uidsFoleyOxygenEscharotomyBurnUse ATLSBurnEscharotomyBurnEscharotomyBurnTreatmentSuperficial partial will healDeep partial ?Full need excision and skin graftBurnTreatmentBurnDressingSilver dressingTo reduce the colony count which:Reduces the chance of invasive infectionBurnDressingBurnInhalationHot

9、gasChemical injury = ARDSC0 poisoningIncreases mortality appox. 50%BurnInhalationBurnexcisionBurnexcisionBurngraftBurngraftWound healingTwo standard processesRe-epithlizationContractionWound healingTwo standard procWound HealingPhasesLatent or InflammatoryProliferativeMaturationWound HealingPhasesWo

10、und HealingLatent or InflammatoryInvasion of inflammatory cellsThe macrophage is the regulatorWound HealingLatent or InflammWound HealingProliferativeFibroblastsEndothelial cellsInflammatory cells = granulation tissueWound HealingProliferativeWound HealingMaturation Induced by coverage with epitheli

11、umReduction of activityRealignment of collagenWound HealingMaturation Skin CancerBasal cell carcinomaSquamous cell carcinomaMalignant melanomaSkin CancerBasal cell carcinomSkin cancerBCCPearlyUlcerTelangiectasia3 mm.Skin cancerBCCSkin CancerWhat is it?Skin CancerWhat is it?Skin CancerKeratoacanthoma

12、Skin CancerKeratoacanthomaSkin CancerSCCPunched out5 mm.MetastasisSkin CancerSCCSkin CancerMelanomaColourContourUlcerElevationSizeChangeSkin CancerMelanomaSkin CancerBreslow versus Clark scaleGreater than 1 mm = 2 cmLess than 1 mm = 1 cmSentinel node bx. 1 mm.Lymphatic and blood borneSkin CancerBreslow versus ClarSkin cancerSentinel NodeFirst node in chainLikely to be standard of careSkin cancerSentinel NodeFacial InjuryFrontal sinusMidface = Lefort I II IIIZygoma and Blow outMandible #NasoethmoidFacial InjuryFrontal sinusFrontal SinusFrontal SinusFrontal SinusFrontal Sin