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Plastic and Reconstructive Surgery Chapter 19 Plastic and Reconstructive Surgery Functions Skin or Cutaneous Membrane Protection from UV light Defense against disease Preservation of fluid balance Body temperature maintenance Excretion of waste (sweat) Sensory receptors Synthesis of Vitamin D Anatomy Epidermis Consists of epithelial cells but contains no blood vessels. Contains melanin and keratin 5 Layers Basale Spinosum Granulosum Lucidum Corneum Anatomy Dermis Connective tissue under the epidermis. Contains nerves, blood vessels, hair follicles, nails, sweat and oil glands. 2 layers Reticular Papillary Fingerprints Anatomy Dermis Sebaceous Gland Oil gland produces sebum Keeps skin and hair soft and pliable Sudoriferous Gland Sweat gland Merocrine Apocrine Ceruminous Anatomy Subcutaneous Layer Serves as an anchor and binds the skin to the underlying structures. Contains adipose tissue and provides insulation and protection. Anatomy Palate Roof of the mouth. Anterior portion is known as the hard palate. Posterior portion is known as the soft palate. Anatomy Hand That thing at the end of your arm! 3 regions Wrist Palm Fingers Volar - Palm Dorsal – Back of the hand Radial – Thumb side Ulnar – Medial side Bones of the Hand Carpals 8 bones of the wrist arranged in 2 rows of 4 bones. Metacarpals 5 Bones of the palm Numbered starting with the thumb Phalanges 14 bones of the fingers 3 each except for thumb Bones of the Hand Nerves of the Hand Radial nerve Median nerve Ulnar nerve Tendons/Muscles of the Hand Almost 40 muscles and tendons are responsible for movement of the hands, wrist, and fingers. Palmaris longus – Flexes the hand Transverse carpel ligament acts as a covering and tunnel for 9 tendons and the median nerve. Carpel tunnel syndrome Blood Vessels of the Hand Brachial artery divides into two main arteries supplying the hand and forearm with blood. Radial Artery Ulnar Artery Burns First-degree: Affects just the epidermis Second-degree: Affects epidermis and dermis Third-degree: Full thickness burn. Permanent tissue damage Fourth-degree: Char burns Burn Depth Rules of Nines Pathology Affecting the Skin Acne Aging Sun Exposure Neoplasms Pathology Affecting the Skin Cleft lip and palate Cheiloschisis (Cleft or hare lip) Palatoschisis (Cleft palate) Congenital deformity. May occur with just one or both areas affected. May cause difficulty in swallowing, sucking, and forming proper sounds. Plastic and Reconstructive Surgery CLEFT LIP AND PALATE Plastic and Reconstructive Surgery UNILATERAL CLEFT PALATE Plastic and Reconstructive Surgery Plastic and Reconstructive Surgery Pathology Affecting the Hand Carpel tunnel Syndactyly Webbed digits Polydactyly Pressure on the median nerve. Extra digits De Quervains Inflammation of the tendons of the wrist. Pathology Affecting the Hand Trigger Finger Dupuytrens Non-painful nodules usually at the 4/5th digits causing palmar contractions. Ganglion Inflammation of the tendon of the digits. Benign cyst filled with synovial fluid Arthritis Inflammation of the joint. Autoimmune disease Plastic and Reconstructive Surgery Plastic and Reconstructive Surgery Ganglion Cyst Pathology Affecting the Breast Males Gynecomastia Females Function of the breast is to produce milk for newborn. Aesthetic breast surgery has little to do with this function. Plastic and Reconstructive Surgery Instrumentation Oscillating Blade Type Dermatome Plastic and Reconstructive Surgery Instrumentation Electric or nitrogen powered. Uses a oscillating blade to cut thin slices of skin for grafting. STSR/surgeon can adjust width and depth of graft. Sterile mineral oil is used a skin lubricant to minimize friction. Plastic and Reconstructive Surgery Instrumentation Mesh Graft Device Plastic and Reconstructive Surgery Instrumentation Used to expand the size of the split thickness skin graft (STSG) Harvested skin is placed on a derma carrier and passes through a manual roller with sharp raised surfaces. Creates evenly spaced slits. Mesh Fishnet Skin Grafts Autologous: Patient’s own body. Homografts: Same species Cadaver Heterografts/Xenografts: Dissimilar species (pig, calf) Plastic and Reconstructive Surgery Skin Graft Categories Full-thickness Skin Graft Categories Epidermis and all of the dermis and may include the underlying subcutaneous tissue Split-thickness Epidermis, approximately half of the dermis Surgical Procedures Rhytidectomy Blepharoplasty Abdominalplasty Cheiloplasty/Palatoplasty Ganglion Cyst excision Reduction Mammoplasty Plastic and Reconstructive Surgery Eye Surgery Blepharoplasty Plastic and Reconstructive Surgery Abdominoplasty Plastic and Reconstructive Surgery Syndactyly Repair Plastic and Reconstructive Surgery Syndactyly Repair Plastic and Reconstructive Surgery Syndactyly Repair Plastic and Reconstructive Surgery Reduction Mammoplasty Plastic and Reconstructive Surgery Reduction Mammoplasty Plastic and Reconstructive Surgery Augmentation Mammoplasty Plastic and Reconstructive Surgery Augmentation Mammoplasty Plastic and Reconstructive Surgery QUESTIONS?