Deck 13: Plastic and Reconstructive Surgery

Question 1

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, 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:

A)scar lysis.
B)epidermolysis with remodeling.
C)scarplasty.
D)Z-plasty.

Answer 1

D
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. 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.

Question 2

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.

Answer 2

B
Plastic and reconstructive surgery is based on a thorough understanding of the anatomy and biology of tissue. Derived from the Greek word plastikos, which means to mold or give form, plastic surgery is a medical specialty that restores or gives shape to the body.

Question 3

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.

Answer 3

B
Le Fort I, or transverse maxillary, fracture-this horizontal fracture includes the nasal floor, septum, and teeth. Le Fort II, or pyramidal maxillary, fracture (unilateral or bilateral)-often involves the nasal cavity, hard palate, and the orbital rim. Le Fort III, or craniofacial dysjunction, fracture-includes fractures of both zygomas and the nose. Like a mandibular fracture, a maxillary fracture also produces malocclusion. In addition, depending on the severity of the fracture, it may produce considerable deformity of the middle of the face, usually perceived as a flattening or smashed-in appearance. Closed reduction with intermaxillary fixation suffices for treatment of Le Fort I and some Le Fort II fractures.

Question 4

One of the most popular lasers used in plastic and reconstructive surgery is attracted 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 attracted to areas of darker pigmentation. This treatment has virtually replaced dermabrasion, because of its consistency in terms of depth of penetration and also because this technique is less dependent on user 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

Question 5

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.

Question 6

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 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.

A)reconstructive; reconstructive; reconstructive
B)reconstructive; cosmetic; reconstructive
C)cosmetic; reconstructive; cosmetic
D)reconstructive, cosmetic and cosmetic

Question 7

Microsurgery, a fundamental tool in reconstructive plastic surgery, allows an almost unlimited choice of reconstructive methods, 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)2 mm.
B)1.5 mm.
C)1 mm.
D)0.5 mm.

Question 8

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%

Question 9

The circulator 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.

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.

Question 10

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, dysplastic.
B)asymmetry, blanching, cohesion, depth.
C)aplastic, bilateral, chronic, dysplastic.
D)asymmetry, border, color, diameter.

Question 11

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.

Question 12

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

Question 13

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 in 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 the ambient high temperature for an adult.
D)Collaborate with the anesthesia provider to determine fluid replacement requirements.

Question 14

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 dressings until secondary granulation begins
D)Tangential excision of the burn wound with antibiotic-soaked dressings

Question 15

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 surfer 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 positive for human immunodeficiency virus

Question 16

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.

Question 17

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

Question 18

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 for 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.

Question 19

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.

Question 20

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:

A)pedicle-based flap.
B)free flap.
C)mastopexy.
D)rotated tunneled flap.