1、Ottawa Review 2010Plastic SurgeryHand surgeryBurnsWound healingSkin CancerFacial injuries Murray W.Allen MD FRCSCHand Surgery:Applied AnatomyNerveTendonVascularBone and jointLigamentMedian NerveSensoryMedian NerveMotorMedian NerveCarpal tunnel syndromeMedian NerveLocationBlockUlnar NerveSensoryUlnar
2、 NervemotorUlnar NerveMotor to the intrinsicsUlnar NerveFroments signUlnar NerveCubital tunnel syndromeUlnar NerveLocationBlockRadial NerveSensoryLocationRadial NerveBlockTendonsExtensorsTestingTendonsFlexorsTestingTendonsAnatomyTendonsFlexor tenosynovitisKanavalTendonsRepairTendonsRehabVascularAnat
3、omyAllens testBoneFracturesJointsSeptic arthritisLigamentsAnatomyLigamentsDislocationLigamentsGamekeepers ThumbGrade 1,2,3Stener lesionAmputationCool the partAvoid clamping vesselsTransport ASAPAmputationMany will contract on their own if the bone is still covered1 square cm rule?BurnsDepthExtentRes
4、uscitationInhalationTreatmentBurn depthFirstSecond ThirdFourthBurnSecond degreePainBlister=partial thicknessBurnDeep partial thicknessBurnFull thicknessDermalBurnFourth degreeBurnEstimation of surface areaRule of ninesBurnParkland formula%surface area as a whole#Weight in Kg.FUDGE FACTOR=4If its not
5、 a big#you did the math wrong!BurnAlways in Ringers lactate in the first 8 hrs in the next 16 hoursKeep urine at 50 ml/hrBurnUse ATLSAdd resuscitation fluidsFoleyOxygenEscharotomyBurnEscharotomyBurnTreatment Superficial partial will heal Deep partial?Full need excision and skin graftBurnDressing Sil
6、ver dressing To reduce the colony count which:Reduces the chance of invasive infectionBurnInhalation Hot gas Chemical injury=ARDS C0 poisoningIncreases mortality appox.50%BurnexcisionBurngraftWound healingTwo standard processes Re-epithlization ContractionWound HealingPhases Latent or Inflammatory P
7、roliferative MaturationWound HealingLatent or Inflammatory Invasion of inflammatory cells The macrophage is the regulatorWound HealingProliferative Fibroblasts Endothelial cells Inflammatory cells =granulation tissueWound HealingMaturation Induced by coverage with epithelium Reduction of activity Re
8、alignment of collagenSkin CancerBasal cell carcinomaSquamous cell carcinomaMalignant melanomaSkin cancerBCCPearlyUlcerTelangiectasia3 mm.Skin CancerWhat is it?Skin CancerKeratoacanthomaSkin CancerSCCPunched out5 mm.MetastasisSkin CancerMelanomaColourContourUlcerElevationSizeChangeSkin CancerBreslow
9、versus Clark scaleGreater than 1 mm=2 cmLess than 1 mm=1 cmSentinel node bx.1 mm.Lymphatic and blood borneSkin cancerSentinel NodeFirst node in chainLikely to be standard of careFacial InjuryFrontal sinusMidface=Lefort I II IIIZygoma and Blow outMandible#NasoethmoidFrontal SinusFrontal SinusMidface and MandibleMidface and MandibleNasoethmoid FracturesNasoethmoid FracturesGood Luck and Enjoy
