Ancef-Cefazolin

1st generation cephalosporin

What type of carcinoma is this?

common over 50

Non-healing ulcer/warty nodule

Cutaneous horn

Surgical resection/excision

Mohs microscopic surgery

Sentinal node biopsy

Used only when tumor is in critical anatomical site

Eyelid

Nose

Lip

resection margin is often reduced to 3-6 mm

What type of carcinoma is this?

Grows slowly

Ulcerated pink shiny nodule

central scab/umbilication

Telegiectasis

Most common form of cancer in fair skinned who do not tan well

1.2 million cases

ultraviolet light exposure cause

Excision

Radiotherapy

Type of benign lesion?

Flattened papule

Covered by dry scale

TAN/ PINK/ GRAYISH

Round/Irregular

Actinic Keratosis

Remember this goes into SCC

Type of benign lesion?

Yellowish-Brown raised Lesion

"Stuck On"  apperance

Feels:  Greasy, Velvety/Warty

Type of benign lesion?

Congenital

Black/Brown growth OR Mark on skin

<6mm diameter

Usually appears in 1st decade of life

Follow: ABCDE guidelines

Nevi

"Freckle"

Actinic Keratosis (can lead to SCC)

Seborrheic Keratosis

Nevi

A-Asymmetry

B-Borders irregular

C-Color variation (mixture of black, blue, red)

D-Diameter >6mm

E-Elevation (may be flat)

??

Benign tumor consisting of fat

Most common human neoplasm

Little potential for malignancy

Between skin & muscle

Neck

Shoulders

Back

Abdomen

Arms

Thigh

Doughy like

move readily

NON-TENDER

??

collection of liquefied tissue "pus" somewhere in the body

Results from body's defense reaction to foreign material

Ultrasound/Flouroscopy

CT

Staphlococcus Aureus

remember in some areas/cities:  MRSA is presenting

Painful

Warm to touch

Swollen

Erythemic

Tooth

Armpits

Base of spine

Groin

Vagina

Anus

??

Folliculitis

Furnuncle

Carbuncle

Folliculitis:  Inflammation of hair follicle

Furnuncle:  Inflammation around hair follicle w/ central plugging  "Boil"

Carbuncle:  Collection of furnuncles

I & D  (incision & drainage)

1. Numb area w/ Lidocaine

2. Create opening w/ 11inch blade

3. Express pus w/ lite pressure

4. Sterile dressing

5. ABX if immunocompromised

??

Small pit or sinus located in the midline superficial to coccyx or lower sacrum

??

Cystic cavity containing keratin & hair in the subcutaneous tissue of natal cleft?

Presentation of Pilonidal Cyst??

Acute

Chronic

Acute:  Abscess, Red, Warm, Swelling, may have fluctuance

Chronic:  Sinus felt in natal cleft

Occasional discomfor/drainage

Fever, Pus, Inc WBCs

Management of Pilonidal Cyst??

Medical

Surgical

Medical:  Sitz bath, ABX, Analgesics, Hydrocodone, Codeine, NSAIDS

Surgical:  Abscess I&D

Dark thick hair

Obesity

Sedentary

Prolonged w/ sitting

Local hirtusism

Poor hygiene

Inc Sweating

Hand & Wrist

Usually dorsal-back of hand located over scapholunate ligament

Can be volar

More common in FEMALES

??

Soft/firm, Mobile, Non-tender round mass

Inside:  Thick, sticky, clear, colorless jelly like material

Dx Ganglion Cyst??

Large bore needle aspiration

US

PE

MRI

Most:  Resolve spontaneously

Non-operative

IF: Painful, Limits activity, Cosmetically unacceptable

Surgical excision

??

Tear of skin caused by a blunt force, not a sharp instrument

Laceration

Usually d/t crushing force

Pain at site of injury

Bleeding

Deformity at injury

Bridging intact blood vessels

Clean area w/ soap & water

Bacitracin-antibiotic ointment

Steri strips/ band aids/ left open for secondary healing

Operative: Sutures

Silver sulfadizene applied to clean area

Trauma to skin causing a disruption in the DERMAL layers

Surgical OR Traumatic

??

Phases of wound healing

1. Inflammatory

2. Proliferative

3. Maturation/Remodeling

Inflammatory Phase:

1. Vasoconstriction

2. Hemeostasus

3. Vasodilation/Epithelization

4. Migration of Fibroblasts

Proliferation Phase:

1. Fibroblasts arrive & secrete collagen

2. Angiogenesis

3. Contraction

Wound is filling up with granulation tissue, margins contract, decrease wound surface area

Maturation/Remodeling Phase:

1. Collagen deposits reduced

2. Collagen is becoming more organized & cross-linked

-increased strengthtile

3. Wounds contract

What are the 4 classifications of wounds??

1. Clean

2. Clean-contaminated

3. Contaminated

4. Infected

Incision made during a surigical procedure w/ aseptic techniques.

No GI, Respiratory, Gu tract involved

Similar to clean

Surgical procedure with aseptic technique

GI, Respiratory, GU INVOLVED

Similar to clean & clean-contaminated

EXCEPT Gross spillage (bile, stool)

Traumatic wound

Established infection before wound is made

(incision of an abscess)

OR

 heavily contaminated  wound

Clean:  2%

Clean-Contaminated:  10%

Contaminated: 20%

Infected:  50%

Primary intention

Secondary intention

Third intention

ALL layers closed

Best chance for minimal scarring

Usually for Clean & Clean contaminated wounds

Wound edges brought together by:

Sutures, Tape, Staples

Deep layers CLOSED

Superficial layers are left OPEN to granulate from the inside to out

Often leaves wide scar & frequent wound care

Prolonged process

Reason to use:  Excessive tissue loss & INFX

??

Deep layers CLOSED

Superficial layers are left OPEN to granulate from the inside to out

Often leaves wide scar & frequent wound care

Prolonged process

Reason to use:  Excessive tissue loss & INFX

??

ALL layers closed

Best chance for minimal scarring

Usually for Clean & Clean contaminated wounds

Wound edges brought together by:

Sutures, Tape, Staples

WOUND is:

1. > 6 hrs

2. > 24hrs on face

3. Infected

4. Highly contaminated

5. Excessive tensile (joint)

6. Retained foreign body

Deep layers closed

Superficial layer left OPEN until 4th/5th day inspected for

Is it clean & begun to granulate:

IRRIGATE & CLOSE

If it looks infected:

LEAVE OPEN & HEAL BY SECONDARY INTENTION

These wounds are usually from contaminted wounds

??

Deep layers closed

Superficial layer left OPEN until 4th/5th day inspected for

Is it clean & begun to granulate:

IRRIGATE & CLOSE

If it looks infected:

LEAVE OPEN & HEAL BY SECONDARY INTENTION

These wounds are usually from contaminted wounds

Separation of surgical incision/Rupture of closed wound

Premature bursting open/splitting along natural surgical suture lines

COMPLICATION of surgery d/t poor wound healing

??

Separation of surgical incision/Rupture of closed wound

Premature bursting open/splitting along natural surgical suture lines

COMPLICATION of surgery d/t poor wound healing

Dehiscence:

Most common site

Usually occure when

Early signs

Most common site:  Abdominal/Pelvic Regions

Usually occure when:  7-10 days post closure

Early signs: Pink Serous discharge from wound

INFECTIONS:

? most vulnerable

systemic signs

dx studies

? most vulnerable:  Immunocompromised

systemic signs:  Fever, Chills, Loss of appetite, N, V

dx studies: CT scan, FNA, Open wound

Management of infections of wounds?

Mild erythema may resolve after suture/staple removal

If infx persists beyond 48 hrs w/ ABX tx:

Wound is OPENED & DRAINED

Suspect ABSCESS

Usually infected by Staph

1st generation cephalsporin

Enteric Pathogens-  Gentamycin

Aerobic Gram NEG.-  3rd gener. Cephalasporin

Anaerobic-Metronidazole

??

Decubiti Ulcer

Chronic ulcer that appears in PRESSURE areas in debilitated pts that are confined to their beds/immobile

D/T:  Excessive prolonged pressure causing ISCHEMIA & eventually NECROSIS of skin & sub Q tissue or from FRICTION

Early: RED/PURPLE

Late:  DARK BLUE/BLACK necrosis

Cellulitis

Fascitis

Osteomyelitis

Sepsis

Rare-Bleeding

STAGE:

I-reddness of skin, NO SKIN BROKEN

II-Blister, PARTIAL thickness skin loss

III-FULL thickness skin loss w/ damage to sub Q tissue

IV-FULL thickness w/destruction to Muscle, Bone, & supporting structures

1. Medical: Correct underlining disorders & improve nutrition

2. Local wound care:  avoid pressure, water mattress, cushions, pads;  dressings

3. Surgery:  Drain & Debridement

Cover w/ healthy tissue-skin grafts