September 2024 Edition
- thestitchprs
- Sep 2, 2024
- 4 min read
Welcome to the September edition of The Stitch! We appreciate your continued support and readership. Don't miss our Breast and Anterior Trunk Anatomy Review Quiz!!
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The Stitch Editorial Board
Breast and Anterior Thoracic Anatomy Review Quiz
1. Blood supply to the rectus abdominis is primarily from which vessel?
2. Injury to this nerve will cause a “winged scapula”
3. What is polymastia?
Bonus: Are most accessory or ectopic?
4. What are the 3 main arterial supplies to the breast?
5. Which lymph nodes receives ~75% of the lymph from the breast?
6. These ligaments provide support for the breast tissue:
Retrospective Study of 1508 Patients Shows Deep Infection Risk Prevention with Antibiotic Irrigation: Hoax or not?
Article Review by Matthew Henn, Oregon Health and Science University
Published in Plastic and Reconstructive Surgery, July 2024
Little has been studied regarding the clinical effect of antibiotic irrigation following breast reconstruction with implants. A recent retrospective study out of Denmark compared the deep infection risk in patients who received antibiotic implant irrigation with vancomycin or gentamicin compared to no irrigation.
Of the 1508 patients studied, 500 patients received gentamicin irrigation, 304 patients received vancomycin irrigation, and 704 patients received no irrigation. Univariable risk analysis demonstrated a significant decreased risk of deep infection using gentamicin compared to no irrigation, but when adjusting for infection risk factors, there was no significant decrease in risk with either gentamicin or vancomycin when comparing the control group.
While this study includes a large patient pool, improvements can be made with study design. A randomized, placebo-controlled trial would help to get a better understanding of both the preventative aspect and potential side-effects. As medical students, we should remain critical and curious when analyzing studies. Ask yourselves how this could impact patient care, and what limitations of the study contribute to how you might provide patient care.
Skin Grafts and Flaps
Pimp Questions of the Month by Chandler Hinson, Research Fellow at the Department of Plastic Surgery at the University of Texas Southwestern Medical Center
1. What are some factors that can affect the final appearance of a scar?
2. What are the different reconstructive options in the reconstruction ladder?
3. What are the different modes of flap movement?
4. How does the donor site of a split-thickness skin graft heal?
5. How are allografts derived?
6. How are split-thickness skin grafts different from full-thickness skin grafts?
7. What is the recommended wound coverage for patients with extensive burns?
8. What is the difference between rotation flaps and transposition flaps?
9. Where are bilobed flaps commonly used?
10. What are fasciocutaneous flaps supplied by?
Answers:
1. The final appearance of a scar can be affected by factors such as differences between individual patients, type of skin and location on the body, tension on the closure, direction of the wound, other local and systemic conditions, and surgical technique.
2. The different reconstructive options in the reconstruction ladder include free flap, tissue expansion, distant flaps, local flaps, primary closure, dermal matrices, healing by secondary intention, skin graft, and negative pressure wound therapy.
3. The different modes of flap movement include transposition, rotation, advancement, and interpolation.
4. The donor site of a split-thickness skin graft heals by re-epithelialization and usually takes around 7 days.
5. Allografts are derived either from cadavers and cryopreserved or from living human donors.
6. Split-thickness skin grafts contain varying amounts of dermis, whereas full-thickness skin grafts contain the entire dermis.
7. For patients with extensive burns, wound coverage with a skin substitute comprising both dermis and epidermis is the recommended alternative to a split-thickness graft.
8. Rotation flaps are semicircular and rotate about a pivot point into the defect to be closed, while transposition flaps are rotated laterally about a pivot point into an immediately adjacent defect.
9. Bilobed flaps are commonly used on the nose.
10. Fasciocutaneous flaps are supplied by the fasciocutaneous plexus.
Breast and Anterior Trunk Anatomy Review Quiz Answers
1. Blood supply to the rectus abdominis is primarily from which vessel? deep inferior epigastric vessel
2. Injury to this nerve will cause a “winged scapula”? long thoracic nerve, supplies serratus anterior muscle
3. What is polymastia? more than 2 breasts
Bonus: Are most accessory or ectopic? accessory (lie on the embryonic milk line—ventrolateral aspect of trunk from axilla to groin)
4. What are the 3 main arterial supplies to the breast? internal thoracic artery, branches of axillary artery (supreme thoracic artery, pectoral branch of thoracoacromial artery, lateral thoracic artery), and branches of 3rd, 4th, and 5th posterior intercostal arteries
5. Which lymph nodes receives ~75% of the lymph from the breast? Axillary lymph nodes
6. These ligaments provide support for the breast tissue: suspensory ligaments of Cooper
RESOURCES: Netter’s Anatomy, https://plasticsurgerykey.com/anatomy-for-plastic-surgery-of-the-breast/, Plastic Surgery A Core Curriculum
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