Dermatological Procedures

Dermatological Procedures Indian Medical PG Question 1: Which of the following statements about mesh skin grafts is not correct?

• A. They allow egress of fluid collections under the graft.
• B. They permit coverage of large areas.
• C. They “take” satisfactorily on granulating bed.
• D. They contract to the same degree as a grafted sheet of skin. (Correct Answer)

Dermatological Procedures Explanation: ***They contract to the same degree as a grafted sheet of skin.*** - This statement is incorrect because **meshed skin grafts** undergo **greater primary and secondary contraction** compared to unmeshed, full-thickness sheet grafts. - The fenestrations in the meshed graft allow for stretching and expansion, but this also contributes to increased contraction as the graft heals and remodels. *They allow egress of fluid collections under the graft.* - The **fenestrations** created by the meshing process provide small openings that facilitate the **drainage of seroma or hematoma** from beneath the graft. - This feature is crucial for graft survival as fluid accumulation can lift the graft, impairing nutrient diffusion and leading to graft failure. *They permit coverage of large areas.* - Meshing a skin graft allows it to be **expanded to cover an area up to 1.5 to 9 times larger** than the original harvested skin. - This is particularly useful in managing **large burn wounds** or extensive skin defects where donor sites are limited. *They “take” satisfactorily on granulating bed.* - Meshed grafts tend to tolerate **less ideal recipient beds**, such as those with some granulation tissue or minor contamination, better than sheet grafts. - The fenestrations allow for drainage and better adherence, which can compensate for a suboptimal underlying bed.

Dermatological Procedures Indian Medical PG Question 2: In Split thickness graft, which part of the skin is/are included?

• A. Epidermis and dermis
• B. Epidermis only
• C. Epidermis and part of dermis (Correct Answer)
• D. Epidermis, dermis and part of subcutaneous tissue

Dermatological Procedures Explanation: ***Epidermis and part of dermis*** - A **split-thickness skin graft** includes the entire **epidermis** and only a **portion of the dermis**. - This allows for easier engraftment and donor site healing due to less deep tissue removal. *Epidermis and dermis* - This describes a **full-thickness skin graft**, which includes the entire epidermis and the entire dermis. - While it provides better cosmetic results and less contraction, it requires a more complex donor site closure. *Epidermis only* - A graft consisting only of the epidermis would be too thin to be clinically useful and would likely not survive. - The dermis provides structural support and a blood supply critical for graft viability. *Epidermis, dermis and part of subcutaneous tissue* - This typically refers to a **composite graft** or a **flap**, not a split-thickness skin graft. - These grafts include deeper tissues, such as subcutaneous fat, to provide bulk and specialized structures.

Dermatological Procedures Indian Medical PG Question 3: Concentrated alcohol-based antiseptics for skin preparation of the operative site lead to

• A. >95% reduction in bacterial count (Correct Answer)
• B. >50% reduction in bacterial count
• C. <50% reduction in bacterial count
• D. Contraindicated for operative site

Dermatological Procedures Explanation: ***>95% reduction in bacterial count*** - Concentrated **alcohol-based antiseptics**, particularly those containing concentrations like **70% isopropyl alcohol**, are highly effective in achieving a **significant log reduction** of bacterial flora on the skin. - This **high bactericidal activity** is crucial for minimizing surgical site infections by rapidly destroying bacterial cell membranes. * >50% reduction in bacterial count - While a >50% reduction is positive, it underestimates the actual efficacy of properly applied **concentrated alcohol-based antiseptics**. - These agents are known to provide a much more substantial and rapid reduction in **bacterial load** than just over half. * <50% reduction in bacterial count - This option is incorrect because **alcohol-based antiseptics** are well-established to provide a very high level of **skin decolonization** when used correctly. - A reduction of less than 50% would indicate a product with poor efficacy, which is contrary to the known properties of these solutions. * Contraindicated for operative site - This is incorrect; **alcohol-based antiseptics** are the **standard of care** for **surgical site preparation** due to their rapid and broad-spectrum antimicrobial activity. - They are contraindicated in specific situations (e.g., mucous membranes, open wounds, patients with alcohol sensitivity), but not for the general operative site.

Dermatological Procedures Indian Medical PG Question 4: Which one of the following regarding management of acute wounds is NOT true?

• A. Wounds should be examined, taking into consideration site and structures damaged
• B. Bleeding wounds should be elevated and a pressure pad applied
• C. The whole patient should be examined according to ATLS principles
• D. Clamps should be used to stop all bleeding vessels (Correct Answer)

Dermatological Procedures Explanation: ***Clamps should be used to stop all bleeding vessels*** - While **hemostasis** is crucial, using clamps on *all* bleeding vessels, especially small ones, is generally discouraged as it can cause **tissue damage** and may not be necessary for effective bleeding control in many acute wound settings. - The primary initial goal is to achieve **hemostasis** safely, often through direct pressure, elevation, and pressure dressings, before more invasive measures. *Wounds should be examined, taking into consideration site and structures damaged* - A thorough examination is fundamental to identify the **extent of the injury**, including potential damage to underlying structures like nerves, tendons, vessels, or joints. - This assessment guides the appropriate cleaning, debridement, and repair strategies to optimize **healing and function**. *Bleeding wounds should be elevated and a pressure pad applied* - **Elevation** helps reduce hydrostatic pressure, thereby decreasing blood flow to the injured area. - Applying **direct pressure** with a pressure pad is the most immediate and effective method for controlling venous and capillary bleeding, and often arterial bleeding as well. *The whole patient should be examined according to ATLS principles* - The **Advanced Trauma Life Support (ATLS)** principles prioritize a systematic approach to trauma care, starting with the primary survey (ABCDE) to identify and manage life-threatening injuries. - This ensures that hidden or more critical injuries are not missed amidst the focus on the visible wound, maintaining a **holistic view** of the patient's condition.

Dermatological Procedures Indian Medical PG Question 5: True about eschar is all except

• A. Thrombosed superficial veins
• B. Charred, denatured full thickness burn
• C. Sensitive to touch (Correct Answer)
• D. Contracted dermis

Dermatological Procedures Explanation: ***Sensitive to touch*** - An eschar forms in **full-thickness burns** where nerve endings are destroyed, rendering the tissue **insensate** or numb to touch. - The presence of sensitivity would indicate a more superficial burn, not a full-thickness injury characterized by an eschar. *Thrombosed superficial veins* - **Thrombosed superficial veins** are a characteristic finding within an eschar, indicating the extent of vascular damage in a full-thickness burn. - The extreme heat causes coagulation of blood within vessels, leading to their obstruction and contributing to the avascular nature of the eschar. *Charred, denatured full thickness burn* - An eschar is indeed a defining feature of a **full-thickness burn**, where the skin is extensively damaged, often appearing **charred** or leathery. - The denaturing of proteins and destruction of cellular structures contribute to the characteristic appearance and consistency of the eschar. *Contracted dermis* - The **dermis** within an eschar becomes **contracted** and rigid due to the thermal injury, leading to a loss of elasticity [1]. - This contraction can result in a tourniquet effect, impairing circulation to underlying or distal tissues, especially in circumferential burns [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 119.

Dermatological Procedures Flashcard 1 of 5

Question: _____ surgery involves sequential horizontal excision of the BCC with immediate pathologic margin assessment.

Answer: Mohs micrographic

Dermatological Procedures Flashcard 2 of 5

Question: Glycolic acid 70% for 3-30 mins is an example of _____ chemical peel

Answer: Medium (papillary dermal)

Dermatological Procedures Flashcard 3 of 5

Question: 4-10 coats of Jessner's solution or TCA (10-30%) is an example of _____ chemical peel

Answer: Superficial (epidermal)

Dermatological Procedures Flashcard 4 of 5

Question: _____ involves pressing a glass slide onto the skin to compress blood out of small vessels, in order to allow evaluation of other colors.

Answer: Diascopy

Dermatological Procedures Flashcard 5 of 5

Question: Phenol 88% is an example of _____ chemical peel

Answer: Deep (reticular dermal)