CWS - Etiological Considerations - Part II (Surgical, Atypical wounds,
Dermatological, Infectious, Burns, Edema, Pediatric) Qs & As
Causes of surgical dehiscence Correct Ans-- infection
- poor incision placement
- operative tissue trauma
- significant post-op edema
Who is at increased risk of dehiscence? Correct Ans-- DM
- poor skin integrity
- poor nutrition
- chronic steroid use
- geriatrics
Reliable measures of post-op infection Correct Ans-- body temperature fluctuations
- incr WBC count
, CWS - Etiological Considerations - Part II (Surgical, Atypical wounds,
Dermatological, Infectious, Burns, Edema, Pediatric) Qs & As
- wound drainage quantity/quality
--> if contained and fluctuant-- may be hematoma, seroma, or abscess
- erythema
- malodor
- pain out of proportion for the wound
Marjolin's ulcer Correct Ans-- aggressive, ulcerating squamous cell carcinoma that is often
associated with trauma in areas of previous burns
- histologically presents as a well-differentiated squamous cell carcinoma that spreads locally
and is associated with a poor prognosis
- malignant changes seen in the wound happen some time later after initial trauma (10+
years)
- dx: wedge biopsy
, CWS - Etiological Considerations - Part II (Surgical, Atypical wounds,
Dermatological, Infectious, Burns, Edema, Pediatric) Qs & As
Tx: wide surgical excision of the lesion with a 1 cm margin
Basal cell carcinoma Correct Ans-- most common form of skin cancer (50%)
(squamous cell - 25% and melanoma = 15%)
- 2/3 of all basal-cell carcinomas occur on areas of the body exposed to the sun
- 1/3 can occur on non-sun exposed areas which suggest a genetic predisposition
- typically presents as a shiny, pearly nodule although superficial lesions can have a red patch
appearance similar to eczema
- does not metastasize but can relentlessly invade the local tissue and result in death
Melanoma Correct Ans-- develops in the pigment containing cells
- usually caused by DNA damage resulting from UV exposure (to the mealanocytes)
, CWS - Etiological Considerations - Part II (Surgical, Atypical wounds,
Dermatological, Infectious, Burns, Edema, Pediatric) Qs & As
- most common on the back in men and legs in women
*strong association with socioeconomic conditions (outdoor occupations more susceptible)
*increased risk with increased duration of sun exposure and age of exposure. Individuals
exposed since childhood and those with repeated episodes of sunburn are at greater risk
(plus tanning beds)
List etiological factors that can cause the failure of a graft Correct Ans-- hematoma
- seroma
- infection
- shearing
- inadequate blood supply
- surgeon error
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