Exam 22: Reconstructive and Aesthetic Plastic Surgery

A 6-year-old girl's clothes caught fire during a camping trip when she fell into the campfire.She is admitted with full-thickness burns involving the left lower leg,circumferentially,excluding her foot,over less than 2% of her body surface area and partial-thickness burns over less than 15% of her BSA.Based on the American Burn Association and the "Rule of Nines" classifications,the patient's burns would be classified as ______________ with a burn surface area percentage of approximately ______________.

A burn patient is transferred to the operating room (OR)from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia.What is the most important preparation the perioperative nurse should perform before the patient arrives in the OR?

Mohs' surgery is a specialized excision used to treat basal and squamous cell skin cancers.Select the statement about Mohs' surgery that best reflects the process,procedure,and outcome goal.

A 28-year-old firefighter sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire.Which of the following best describes the surgical treatments he will most likely need before he is discharged from the burn center to home?

The perioperative nurse circulating for a skin contracture release of the ear on a 5-year-old boy transfers 0.25% bupivacaine via syringe to the scrub person's sterile back table.The scrub person questions why she is not giving him bupivacaine with epinephrine,because there may be bleeding expected at the incision site.The nurse's reply is based on the fact that:

Dermatomes are used for harvesting split-thickness skin grafts (STSGs)from donor sites.The perioperative nurse,who is preparing for a procedure where STSGs will be taken to cover several large burn areas,will need to have available:

A 52-year-old woman with a left mastectomy followed by a TRAM flap reconstruction was beginning to emerge from anesthesia after her procedure.The perioperative nurse gently moved her arms from the abducted position on the arm boards in preparation for her transfer to her postoperative bed and admission to the postanesthesia care unit (PACU).What risk reduction maneuver did the nurse employ to the patient's bed before transferring her?

Skin grafting provides an effective way to cover a wound if vascularity is adequate,infection is absent,and hemostasis is achieved.Skin from the donor site is detached from its blood supply and placed in the recipient site.The best description of a successful skin graft outcome is:

A variety of implantable devices are used in aesthetic and reconstructive plastic surgery procedures.Tracking of these devices is critical to patient safety.Institutions must report any incident of death or serious injury relating to the use of a medical device.What regulatory agency,commission,or act mandates this process when medical devices fail or cause injury?

Facial fractures are classified according to a system developed by Rene Le Fort in the early 1900s.A fracture that starts at the nasal bones; crosses the frontal process of the maxilla and lacrimal bones; and extends through the orbital floor,infraorbital rim,and lateral maxillary sinus wall is known as a:

The science of plastic and reconstructive surgery,improves appearance and body image through an understanding of:

A broad range of implant materials are used in plastic and reconstructive surgery.Select the implant that represents a biologic composition of a surgical implant.

A 46-year-old woman with a second early-stage primary cancer in her left breast has elected to have a bilateral mastectomy with saline implants.She has requested that the surgeon also revise a small unsightly scar on her right knee and pierce her ears.While the patient's breast tumor could be treated with an excisional biopsy,she has decided to have a mastectomy of both breasts,which is considered an appropriate preemptive (preventative)surgery for a woman of her age with two primary cancers of the breast.The saline implant insertion surgery is considered a _______________ procedure,the scar revision is considered a ___________ procedure,and the ear piercing is considered a _______________ procedure.

There are approximately 1 million reported cases of skin cancer per year with the majority being the highly curable basal or squamous cell cancers.Not as common is the most serious skin cancer,malignant melanoma.Select the individual who is at the highest risk for skin cancer.

In addition to the individualized nursing diagnoses that apply to surgical patients,the patient scheduled for plastic or reconstructive surgery can typically be expected to have which nursing diagnosis?

During the planning phase of a procedure for liposuction,the perioperative nurse will assemble and organize supplies and devices,because the procedure may require:

Autologous skin grafts,such as full- and split-thickness,have long been part of the reconstructive ladder as an option to close skin defects.Although they are effective in providing coverage,they require the need for a trained surgeon,use of anesthesia and operating room,and creation of a wound at the donor site.These drawbacks can be overcome with the use of epidermal skin grafts (ESGs).Which of the following statements is true of ESGs?

Microsurgery,a fundamental tool in reconstructive plastic surgery,allows an almost unlimited choice of reconstructive methods,replacement of lost tissue with similar components,and optimal selection of donor sites with minimal morbidity.Today's surgeons skilled in microsurgery can successfully anastomose the ends of a vessel or nerve measuring less than:

The perioperative nurse should verify with the patient that all of the preoperative prescribed skin preparation regimens ordered by the surgeon have been performed.All body jewelry that pierces the skin should be removed before the skin prep.Select the statement that reflects a true special consideration for skin preparation before facial surgery.

When coverage for a defect cannot be achieved through skin grafting,plastic surgeons rely on other techniques to replace tissue.After mastectomy,reconstruction with a transverse rectus abdominis myocutaneous (TRAM)flap is one of several options for nonsynthetic prosthetic reconstruction.Another descriptive term for the TRAM flap is the: