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Ottawa Review 2010 Plastic Surgery Hand surgery Burns Wound healing Skin Cancer Facial injuries Murray W. Allen MD FRCSC Hand Surgery : Applied Anatomy Nerve Tendon Vascular Bone and joint Ligament Median Nerve Sensory Median Nerve Motor Median Nerve Carpal tunnel syndrome Median Nerve Location Block Ulnar Nerve Sensory Ulnar Nerve motor Ulnar Nerve Motor to the intrinsics Ulnar Nerve Froment’s sign Ulnar Nerve Cubital tunnel syndrome Ulnar Nerve Location Block Radial Nerve Sensory Location Radial Nerve Block Tendons Extensors Testing Tendons Flexors Testing Tendons Anatomy Tendons Flexor tenosynovitis Kanaval Tendons Repair Tendons Rehab Vascular Anatomy Allen’s test Bone Fractures Joints Septic arthritis Ligaments Anatomy Ligaments Dislocation Ligaments Gamekeepers Thumb Grade 1, 2 ,3 Stener lesion Amputation Cool the part Avoid clamping vessels Transport ASAP Amputation Many will contract on their own if the bone is still covered 1 square cm rule? Burns Depth Extent Resuscitation Inhalation Treatment Burn depth First Second Third Fourth Burn Second degree Pain Blister = partial thickness Burn Deep partial thickness Burn Full thickness Dermal Burn Fourth degree Burn Estimation of surface area Rule of nines Burn Parkland formula % surface area as a whole # Weight in Kg. FUDGE FACTOR = 4 If its not a big # you did the math wrong!! Burn Always in Ringer’s lactate ½ in the first 8 hrs ½ in the next 16 hours Keep urine at 50 ml/hr Burn Use ATLS Add resuscitation fluids Foley Oxygen Escharotomy Burn Escharotomy Burn Treatment – Superficial partial will heal – Deep partial ? – Full need excision and skin graft Burn Dressing – Silver dressing – To reduce the colony count which: – Reduces the chance of invasive infection Burn Inhalation – Hot gas – Chemical injury = ARDS – C0 poisoning Increases mortality appox. 50% Burn excision Burn graft Wound healing Two standard processes – Re-epithlization – Contraction Wound Healing Phases – Latent or Inflammatory – Proliferative – Maturation Wound Healing Latent or Inflammatory – Invasion of inflammatory cells – The macrophage is the regulator Wound Healing Proliferative – Fibroblasts – Endothelial cells – Inflammatory cells – = granulation tissue Wound Healing Maturation – Induced by coverage with epithelium – Reduction of activity – Realignment of collagen Skin Cancer Basal cell carcinoma Squamous cell carcinoma Malignant melanoma Skin cancer BCC Pearly Ulcer Telangiectas ia 3 mm. Skin Cancer What is it? Skin Cancer Keratoacanthoma Skin Cancer SCC Punched out 5 mm. Metastasis Skin Cancer Melanoma Colour Contour Ulcer Elevation Size Change Skin Cancer Breslow versus Clark scale Greater than 1 mm = 2 cm Less than 1 mm = 1 cm Sentinel node bx. > 1 mm. Lymphatic and blood borne Skin cancer Sentinel Node First node in chain Likely to be standard of care Facial Injury Frontal sinus Midface = Lefort I II III Zygoma and Blow out Mandible # Nasoethmoid Frontal Sinus Frontal Sinus Midface and Mandible Midface and Mandible Nasoethmoid Fractures Nasoethmoid Fractures Good Luck and Enjoy