Pressure Sores

Front 1

spinal cord ends at what level?

Back 1

L1

Front 2

injury below L1 results in xxxxx

Back 2

flaccid paralysis

Front 3

the most common location of pressure sore

Back 3

ischial tuberosity

Front 4

2nd & 3rd most common locations of pressure sore

Back 4

sacral and trochanteric

Front 5

what the most popular grading system of pressure sores?

Back 5

Shea's grading system

Front 6

describe Shea's grading system

Back 6

I: confined to skin
II: into the subcutaneous fat
III: into the muscle
IV: into the bone

Front 7

what are the treatments for spasticity?

Back 7

neurosurgical ablation or chemodenervation, or muscle relaxants - baclofen, dantrolene, diazepam

Front 8

what's the mechanism of baclofen?

Back 8

GABA receptor agonist

Front 9

what's the recurrence rate of pressure sore after reconstruction?

Back 9

> 50%

Front 10

what's most indicative of bone viability?

Back 10

bleeding from bone

Front 11

Name first, 2nd, and 3rd flap choices for sacral sores

Back 11

VY gluteus maximus, contralat VY glut. max, readvancement of bilateral glut. max.

Front 12

Name first, 2nd, and 3rd flap choices for ischial sores

Back 12

inferior gluteus max island flap, inferior gluteal thigh, readvance IGT

Front 13

Name first, 2nd, and 3rd flap choices for trochanteric sores

Back 13

TFL w/ VY modification, readvance TFL, vastus lateralis

Front 14

why is the VY TFL superior to the classic TFL?

Back 14

more muscular, better perfused portion of TFL covering the sore, can be readvanced more easily

Front 15

what are other choices to cover trochanteric sores?

Back 15

rectus femoris, inferior gluteal thigh flap, rectus abdominis

Front 16

blood supply to TFL

Back 16

ascending branch of lateral circumflex from profunda

Front 17

anterior margin of skin island of TFL

Back 17

a line from ASIS to lateral epicondyle of femur

Front 18

how to design the TFL skin island for trochanteric sore?

Back 18

draw a line from ASIS to mid-lateral thigh, then to posterior rim of the sore

Front 19

posterior margin of skin island of TFL

Back 19

a line from trochanter to fibular head

Front 20

inferior margin of TFL skin island

Back 20

8 cm above lateral epicondyle of femur

Front 21

what structure courses at the anterior margin of TFL skin island?

Back 21

lateral femoral cutaneous nerve

Front 22

orgin of vastus lateralis

Back 22

greater trochanter, intertrochanteric line

Front 23

insertion of vastus lateralis

Back 23

patellar tendon

Front 24

blood supply to vastus lateralis

Back 24

lateral branch of lateral circumflex femoral artery, 10cm from ASIS

Front 25

where do you place the skin island of inferior gluteus maximus flap

Back 25

over gluteal crease between ischial tuberosity and greater trochanter

Front 26

what's the landmark of midportion of gluteus maximus

Back 26

piriformis muscle

Front 27

how far should the gluteus max be divided in the inferior gluteus max flap?

Back 27

as far as needed to swing the flap easily into the sore

Front 28

what's the blood supply to inferior gluteal thigh flap?

Back 28

descending branch of inferior gluteal artery

Front 29

what's the land mark to find the descending branch of inferior gluteal artery?

Back 29

midline between ischial tuberosity and greater trochanter

Front 30

what is the highest level bony debridement can be performed on sacrum without entry into dural space?

Back 30

s2-3

Front 31

procedure of choice for sacral sore in ambulatory pts

Back 31

gluteal perforator flap; do not use myocutaneous flap due to loss of function

Front 32

intergluteal cleft

Back 32

butt crack

Front 33

gluteal fold

Back 33

inferior boundary of the buttock

Front 34

origin & insertion of gluteus maximus

Back 34

gluteal line of ilium & sacrum & coccyx; iliotibial tract of fascia lata & gluteal tuberosity

Front 35

is ischial tuberosity subcutaneous or submuscular?

Back 35

both. when thigh is flexed, gluteus maximus shifts superiorly, exposing the ischial tuberostiy

Front 36

function of gluteus maximus

Back 36

thigh extension & lateral rotation

Front 37

name 3 gluteal bursae associated with gluteus maxius

Back 37

trochanteric bursa, ischial bursa, gluteofemoral bursa

Front 38

name the locations of the 3 gluteal bursae

Back 38

superficial to greater trochanter, superficial to ischial tuberosity, between vastus lateralis & iliotibial tract

Front 39

name origin & insertion of piriformis

Back 39

anterior surface of sacrum, superior border of greater trochanter

Front 40

what separates the greater and lesser sciatic foramina?

Back 40

sacrospinous ligament

Front 41

name the posterior thigh muscles from medial to lateral direction

Back 41

adductor magnus, semimembranosus, semitendinosus, biceops femoris, vastus lateralis

Front 42

describe the course of superior gluteal nerve

Back 42

originates from sacral plexus, passes through greater sciatic foramen, travels between gluteus medius & minimis to innervate these muscles & tensor fascia lata

Front 43

describe the course of inferior gluteal nerve

Back 43

exits through greater sciatic foramen, inferior to the piriformis & superficial to sciatic nerve

Front 44

describes the course of sciatic nerve

Back 44

exits through greater sciatic foramen under piriformis, runs superficial to superior/inferior gemelli & obturator internus, then superficial to quadratus femoris, then descends in posterior thigh deep to biceps femoris

Front 45

what does sciatic nerve supply?

Back 45

posterior thigh muscles, all of leg & foot muscles, sensation of leg & foot

Front 46

what nerve could be injured when working at the inferior border of gluteus maximus?

Back 46

posterior cutaneous nerve of thigh. it's just deep to the gluteus maximus, and unlike the sciatic nerve, runs superficial to the biceps femoris

Front 47

what's the difference between posterior thigh flap and gluteal thigh flap?

Back 47

gluteal thigh includes inferior half of gluteus maximus whereas posterior thigh is just a fasciocutaneous flap

Front 48

Define superior border of gluteus maximus

Back 48

from superior posterior iliac spine to greater trochanter

Front 49

define inferior border

Back 49

from coccyx passing through ischial tuberosity to gluteal tuberosity on femor

Front 50

how is piriformis identified during flap elevation?

Back 50

expose superficial surface of the muscle, split at the projected midportion for 3-4 cm & detach it fromthe insertion.