Differences

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--- resident:pimp_questions [2021/04/05 10:29] – [Dr. Mathes] vincent
+++ resident:pimp_questions [2022/12/14 10:09] (current) – [Dr. Kaoutzanis] jerry
@@ Line 1: / Line 1: @@
 ==== Dr. Chong ====
-Why leave the fascia on the muscle during the dissection? So you will have a strong layer of tissue to suture too.\\
+^ Question ^ Pearl ^
-What suture style do you use for weaker tissue? Figure of 8 because it has greater surface area and won't "cheese wire" the tissue.\\
+| Why leave the fascia on the muscle during the dissection? | So you will have a strong layer of tissue to suture too. |
-What is Red Breast Syndrome? Type IV hypersensitivity (delayed) reaction to acellular dermal matrix.\\
+| What suture style do you use for weaker tissue? | Figure of 8 because it has greater surface area and won't "cheese wire" the tissue. |
-What is the incidence of Tissue Expander infections? 7-10%\\
+| What is Red Breast Syndrome? | Type IV hypersensitivity (delayed) reaction to acellular dermal matrix. |
-What is the blood supply to the pectoralis major muscle? Type V Mathes and Nahai flap. Dominant supply pectoral branch of thoracoacromial trunk. Segmental supply of IMA perforators.\\
+| What is the incidence of Tissue Expander infections? | 7-10% |
-What is pitanguys line?\\
+| What is the blood supply to the pectoralis major muscle? | Type V Mathes and Nahai flap. Dominant supply pectoral branch of thoracoacromial trunk. Segmental supply of IMA perforators. |
-What is pitanguys point?\\
+| What is Pitanguy's line? | {{ https://www.theplasticsfella.com/content/images/2021/03/Facial-Nerve-Branching-Patterns-1.png?200 }} |
-Why is this patient going to bleed? Patients with uremia have platelet dysfunction. \\
+| What is Pitanguy's point? | FIXME |
-Why smooth expanders? Because smooth implants have been associated with ALCL and the only link is previous textured tissue expanders?\\
+| Why is this patient going to bleed? | Patients with uremia have platelet dysfunction. |
-What are the aesthetic units of the breast?\\
+| Why smooth expanders? | Because smooth implants have been associated with ALCL and the only link is previous textured tissue expanders? |
+| What are the aesthetic units of the breast? | FIXME |
+| Primary venous drainage system of abdomen? | superficial system |
+| What is blood supply to pectoralis major? | pectoral branch from thoracoacromial trunk, IMA perforators |
+| What is dual plane for breast implants? | FIXME |
+| Source of hematoma? | Hematoma could be from surrounding tissue or from a vein clot and now leaking from flap |
+| Larger angle of diversion increases the amount of coning or projection of the breast. ||
-Primary venous drainage system of abdomen? - superficial system\\
+|Liposuction ||
-What is blood supply to pectoralis major? pectoral branch from thoracoacromial trunk, IMA perforators\\
+^ Question ^ Pearl ^
-What is dual plane for breast implants?\\
+| Will ask to thoroughly explain procedure. ||
-Hematoma could be from surrounding tissue or from a vein clot and now leaking from flap\\
+| If you are doing liposuction on neck and abdomen, which do you infiltrate first? | Neck first, because it is highly vascular (>>abdomen) and will absorb local anesthesia before you get to abdomen. This way you are not having peak absorption of local anesthesia at the same time. |
+| Why wait after infiltrating to start liposuction? | For the onset of epinephrine. Onset time 8 minutes. Peak effect 26 minutes. |
+| What does 1% solution mean? | This is 1000 milligrams in 100 milliliters of water. Which converts down to 10 mg per cc of solution. |
+| How much epinephrine can you use? | This is an important question for cleft palate. It is a highly vascular region and absorbs quickly. It is rec that 10 μg/kg at 30 minute intervals be used. |
+| How much lidocaine can you infiltrate? | 5mg/kg without epi\\ 7mg/kg with epi |
+| How much lidocaine can you use as tumescent? | 35-55mg/kg. Reasons for higher concentration is low vascularity/absorptivity of fat, dilute, physical compression of blood vessels from fluid. |
+| High volume liposuction is >5L and a hospital admission should be considered. Remember peak toxicity risk is approximately 12-20 hours after surgery. ||
-Strongest suture tech? vertical mattress \\
+| Sutures ||
-best suture tech for everting? horizontal mattress\\
+^ Question ^ Pearl ^
-Most ischemic stitch? horizontal mattress\\
+| Strongest suture technique? | Vertical mattress |
+| Best suture tech for everting? | Horizontal mattress |
-Liposuction -- Will ask to thoroughly explain procedure. Asks if you are doing liposuction on neck and abdomen which do you infiltrate first? Neck first, because it is highly vascular (>>abdomen) and will absorb local anesthesia before you get to abdomen. This way you are not having peak absorption of local anesthesia at the same time.\\
+| Most ischemic stitch? | Horizontal mattress |
-Why wait after infiltrating to start liposuction? For the onset of epinephrine. Onset time 8 minutes. Peak effect 26 minutes.\\
-What is 1% solution mean? this is 1000 milligrams in 100 milliliters of water. Which converts down to 10 mg per cc of solution.\\
-How much epinephrine can you use? This is an important question for cleft palate. It is a highly vascular region and absorbs quickly. It is rec that 10 μg/kg at 30 minute intervals be used.\\
-Amides vs Esters:  Amides need to be broken down by amidases, which aren't in the blood. Esterases are in the blood and amides can cause more anaphylactic shock than or have a higher chance of causing anaphylactic shock than esters.
-How much lidocaine can you infiltrate? 5mg/kg without epi, 7mg/kg with epi
-How much lidocaine can you use as tumescent? 35-55mg/kg. Reason for higher concentration is low vascularity/absorptivity of fat, dilute, physical compression of blood vessels from fluid.
-High volume liposuction is >5L and a hospital admission should be considered. Remember peak toxicity risk is approximately 12-20 hours after surgery.
-"Primary venous drainage system of abdomen? - superficial system
+**Amides vs Esters**\\
-What is blood supply to pectoralis major? pectoral branch from thoracalacromial trunk, IMA perforators
+Amides need to be broken down by amidases, which aren't in the blood. \\ Esterases are in the blood and amides can cause more anaphylactic shock than or have a higher chance of causing anaphylactic shock than esters.
-What is dual plane for breast implants?"
-Larger angle of diversion increases the amount of coning or projection of the breast.
+**Order of preferred vessels for Scalp Reconstruction**
+  - STA for scalp or Facial for mid face
+  - Superior thyroid artery
+  - Carotid (need vein graft)
+  - Transverse Cervical
+  - Go into previous flap pedicle
-Order of preferred Vessels for Scalp Reconstruction: 1. STA for scalp or Facial for mid face. 2. Superior thyroid artery. 3. Carotid (need vein graft). 4. Transverse Cervical. 5. Go into previous flap pedicle.\\
+----
 ==== Dr. Mathes ====
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 **What is the (Mathes and Nahai) Reconstructive Triangle?**\\
 This is the idea that rather than a ladder or an elevator, you can apply different principles to treat different wounds as well as combinations of these principles. The triangle consists of (Local) Flaps - Microsurgery - Tissue Expansion. Really this is meant to instill in the young plastic surgeon a sense of choices. Dr. Janis published a paper called [[http://www.drjeffreyjanis.com/wp-content/uploads/2014/04/The-New-Reconstructive-Ladder-PMID21200292.pdf|The New Reconstructive Ladder]] which further expands this idea. He adds some of the new concepts such as use of negative pressure wound vac therapy and dermal matrices. Others have suggested adding distraction osteogenesis. (While first introduced by Dr. Ilizarov, this technique was adopted by the plastic surgeon Dr. McCarthy for Craniofacial Surgery.)\\
+----
 ==== Dr. Iorio ====
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 | A favorite question is the dorsal extensor compartments. Will ask you "what's this" in the OR. ||
+----
 ==== Dr. Malliaris ====
 ^ Question ^ Pearl ^
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 | Lumbrical innervation? | Radial two from median off common digital nerve. Ulnar two off ulnar common digital nerve. |
 | How does the median nerve arborize in the hand? | Variable but usually splits into into radial and ulnar components before forming the common digital nerves. |
-| What is a Stenner lesion? |  |
+| What is a Stenner lesion? | FIXME |
 | What does FPL lay in hand? | Between adductor and abductor policis brevis. |
 | What is order of intrinsic muscles in hand from volar to dorsal for thenar and hypothenar eminence? | AFO |
-==== Kaoutzanis ====
+----
+==== Dr. Kaoutzanis ====
 ^ Question ^ Pearl ^
 | For thigh lifts or mass excisions, how do you prevent labial spreading? | Suture advanced dermis to Colle’s fascia. |
+| For mandibular contouring, what structure on buccal mucosa near the first molar must avoid |Stenson/parotid duct |
+----
+==== Dr. French ====
+^ Question ^ Pearl ^
+| Approaching the end of cleft lip surgery, the patient begins to bleed while final sutures are placed. Why? | The cleft palate is a highly vascular region, and blood pressure rises as anesthesia becomes less deep. |
+| At what age does the sphenoid sinus complete pneumatization? | 7-8 years; MRI after this age will show complete pneumatization. |
+| How to differentiate deformational plagiocephaly from mechanical forces vs craniostosis? | - Parallelogram vs Trapezoidal vertex shape\\ - Position of ears relative to flattening\\ {{ https://obgynkey.com/wp-content/uploads/2016/07/B9780323079327000235_f022-005ab-9780323079327.jpg }} |
+| On which side is cleft lip/palate more common? | Left. It is thought that the right side fuses first in development. |
+----
+==== Dr. Khechoyan ====
+^ Question ^ Pearl ^
+| What are the layers of the scalp? | **S** Skin\\ **C** Connective Tissue\\ **A** Aponeurosis of Galea \\ **L** Loose Areolar Tissue\\ **P** Periosteum/Pericranium |
+| When reflecting the scalp for calvarial procedures, what layer is separated? | Separate at layer of loose areolar tissue, reflect the scalp, then elevate the pericranium. |