Flaps and grafts are used in reconstructive surgery to restore form and function. A flap maintains its blood supply, and can be skin, muscle, bone or composite tissue transferred from a donor site. Key differences between flaps and grafts are discussed. Various flap types - local, regional, free etc. - are characterized by their components and blood supply. Reconstructive goals include separating cavities, restoring function and swallowing. Literature on fistula and stricture rates after pharyngeal reconstruction with different flaps is reviewed. Mandible and tongue reconstruction examples using flaps are provided.
Basal cell carcinoma is the most common type of skin cancer. It is caused by chronic sun exposure and is most common in areas with high UV exposure like the head and neck. The incidence is highest in Australia. Histologically, it presents as nests of basaloid cells in the epidermis and dermis. Treatment involves surgical excision with adequate margins to minimize recurrence risk. Mohs micrographic surgery provides the highest cure rates, particularly for recurrent or high risk tumors. Long term follow up is important due to the risk of new primary tumors developing over time.
The document discusses common hand tumours such as ganglion, giant cell tumour of tendon sheath, and epidermoid inclusion cysts. It provides details on clinical presentation, investigations, classification systems, and treatment approaches for various bone and soft tissue tumours that can occur in the hand. Common malignant tumours of the hand discussed include synovial sarcoma, clear cell sarcoma, chondrosarcoma, and osteosarcoma.
The document discusses emergency management of burns. It provides information on common causes of burns, pathophysiology involving initial and secondary tissue damage, burn wound classification models, and initial management following the EMSB (airway, breathing, circulation, disability, exposure, fluids) protocol. Key points include fluid resuscitation using the Parkland formula, monitoring for signs of circulatory obstruction in limbs, considering escharotomy if needed, and criteria for burn patient transfer to a specialized burn unit.
Flaps and grafts are used in reconstructive surgery to restore form and function. A flap maintains its blood supply, and can be skin, muscle, bone or composite tissue transferred from a donor site. Key differences between flaps and grafts are discussed. Various flap types - local, regional, free etc. - are characterized by their components and blood supply. Reconstructive goals include separating cavities, restoring function and swallowing. Literature on fistula and stricture rates after pharyngeal reconstruction with different flaps is reviewed. Mandible and tongue reconstruction examples using flaps are provided.
Basal cell carcinoma is the most common type of skin cancer. It is caused by chronic sun exposure and is most common in areas with high UV exposure like the head and neck. The incidence is highest in Australia. Histologically, it presents as nests of basaloid cells in the epidermis and dermis. Treatment involves surgical excision with adequate margins to minimize recurrence risk. Mohs micrographic surgery provides the highest cure rates, particularly for recurrent or high risk tumors. Long term follow up is important due to the risk of new primary tumors developing over time.
The document discusses common hand tumours such as ganglion, giant cell tumour of tendon sheath, and epidermoid inclusion cysts. It provides details on clinical presentation, investigations, classification systems, and treatment approaches for various bone and soft tissue tumours that can occur in the hand. Common malignant tumours of the hand discussed include synovial sarcoma, clear cell sarcoma, chondrosarcoma, and osteosarcoma.
The document discusses emergency management of burns. It provides information on common causes of burns, pathophysiology involving initial and secondary tissue damage, burn wound classification models, and initial management following the EMSB (airway, breathing, circulation, disability, exposure, fluids) protocol. Key points include fluid resuscitation using the Parkland formula, monitoring for signs of circulatory obstruction in limbs, considering escharotomy if needed, and criteria for burn patient transfer to a specialized burn unit.
The document discusses the anatomy of the mandible including the muscles of mastication, temporomandibular joint, nerve supply, and classifications of fractures. It examines the physical exam for mandibular fractures including assessing occlusion, trismus, and neurovascular status. Finally, it reviews treatment principles and options for mandibular fractures including maxillomandibular fixation, open reduction with rigid or non-rigid fixation, and external pin fixation.
Squamous cell carcinoma (SCC) is the second most common skin cancer. It has a propensity to metastasize, making it responsible for most skin cancer deaths. Risk factors include UV exposure, age, immunosuppression, and primary dermatoses. Histological subtypes include pleomorphic, adenoid, small cell, verrucous, and keratoacanthoma. Tumor size greater than 2 cm and depth greater than 6 mm increase metastatic risk. Treatment involves surgical excision with adequate margins or other modalities like radiation for high risk cases.
Z-plasty is a surgical technique used to close wounds where two triangular flaps based on a shared limb are transposed to close each other's defects, increasing the length of scars. The degree of elongation depends on the angle of the flaps, with greater angles providing more lengthening up to 125% for 90 degree flaps. Multiple opposing or adjacent Z-plasties can be combined for even greater lengthening effect.
The radial nerve originates from cervical and thoracic nerve roots and is the largest branch of the brachial plexus. It provides cutaneous innervation to the posterior arm and forearm and motor innervation to triceps, brachioradialis, and extensor muscles of the forearm and hand. The radial nerve is vulnerable to compression at the radial tunnel as it travels through the forearm. Compression can cause radial tunnel syndrome. The superficial branch of the radial nerve can be affected by Wartenberg syndrome. Radial nerve palsy can result from fractures, injuries, tumors, or iatrogenic causes.
This document discusses different methods for classifying flap procedures. It describes classification based on composition, proximity to the defect, method of movement, and vascular anatomy. Specific flap types are also outlined, including fascio/cutaneous flaps classified by pedicle type and musculocutaneous flaps classified by their vascular supply patterns. Common examples of specific flap procedures are provided.
This document discusses principles of tendon transfers. Tendon transfers involve reattaching a functioning tendon to replace a paralyzed or injured tendon. Key points include indications such as nerve injuries or ruptured tendons. Donor tendons should match the amplitude, power, and function needed. Proper tensioning and protection are important surgically and post-operatively in rehabilitation to train the tendon and patient. Overall, tendon transfers aim to restore function through redistributing muscle forces.
Brachial plexus injuries can occur in both children during birth due to shoulder dystocia and in adults due to high-energy trauma. Examination of brachial plexus injuries involves assessing muscle strength, sensation, and reflexes to determine the level and severity of injury. Treatment may include physical therapy, nerve grafts, nerve transfers, or tendon transfers depending on the specific nature of the injury.
Perineal reconstruction after pelvic resection for cancer often requires flaps to close defects and reduce complications. The rectus abdominis flap has fewer complications than thigh flaps for immediate reconstruction after abdominoperineal resection or pelvic exenteration due to its reliable vascularity and bulk. Gracilis, posterior thigh, and anterolateral thigh flaps are also options but have higher rates of complications compared to the rectus flap. Proper postoperative care including avoiding pressure on the flap is important for successful reconstruction.
The document discusses hand infections, including their history and treatment principles. It covers topics like felons, paronychia, tenosynovitis, and other specific types of hand infections. Some key points:
- Prior to antibiotics, many hand deformities and disabilities resulted from minor injuries becoming infected. Careful surgical techniques helped treatment.
- Penicillin revolutionized treatment by making severe infections less common today. Early diagnosis and treatment with antibiotics, splinting and elevation can help cure some infections.
- Surgical drainage and debridement may be needed for established infections to prevent complications like joint stiffness or contractures. Appropriate antibiotic use and incision placement are important for optimal outcomes.
คู่มือแนวทางเวชปฏิบัติ
(Clinical Practice Guideline)
การดูแลผู้ป่วยระยะกลาง (Intermediate Care)
ด้านการแพทย์แผนไทยและการแพทย์ทางเลือก โดยกรมการแพทย์แผนไทยและการแพทย์ทางเลือก
Department of Thai Traditional and Alternative Medicine
รายการตำรับยาแผนไทยแห่งชาติ
ฉบับ พ.ศ. ๒๕๖๔
National Thai Traditional Medicine Formulary 2021 Edition
กองคุ้มครองและส่งเสริมภูมิปัญญาการแพทย์แผนไทยและแพทย์ฟื้นบ้านไทย
กรมการแพทย์แผนไทยและการแพทย์ทางเลือก
กระทรวงสาธารณสุข
ตำราโอสถพระนารายณ์
จากอนุสรณ์งานฌาปนกิจศพ ลิขสิทธิ์ของกรมศิลปากร
All rights reserved
No part of this book may be reproduced in any
form or by any mean without prior written permission
from the Fine Arts Department.
The document provides 7 tips to improve English skills: 1) Help correct each other's mistakes, 2) Read to improve English, 3) Listen to well-spoken English, 4) Read aloud to build confidence, 5) Check and double check work, 6) Speak clearly to be understood, 7) Make good use of available resources. It then covers various grammar rules including countable and uncountable nouns, pronouns, adjectives, tenses, subject-verb agreement, prepositions, adverbs, conjunctions and common errors.
The document discusses the anatomy of the mandible including the muscles of mastication, temporomandibular joint, nerve supply, and classifications of fractures. It examines the physical exam for mandibular fractures including assessing occlusion, trismus, and neurovascular status. Finally, it reviews treatment principles and options for mandibular fractures including maxillomandibular fixation, open reduction with rigid or non-rigid fixation, and external pin fixation.
Squamous cell carcinoma (SCC) is the second most common skin cancer. It has a propensity to metastasize, making it responsible for most skin cancer deaths. Risk factors include UV exposure, age, immunosuppression, and primary dermatoses. Histological subtypes include pleomorphic, adenoid, small cell, verrucous, and keratoacanthoma. Tumor size greater than 2 cm and depth greater than 6 mm increase metastatic risk. Treatment involves surgical excision with adequate margins or other modalities like radiation for high risk cases.
Z-plasty is a surgical technique used to close wounds where two triangular flaps based on a shared limb are transposed to close each other's defects, increasing the length of scars. The degree of elongation depends on the angle of the flaps, with greater angles providing more lengthening up to 125% for 90 degree flaps. Multiple opposing or adjacent Z-plasties can be combined for even greater lengthening effect.
The radial nerve originates from cervical and thoracic nerve roots and is the largest branch of the brachial plexus. It provides cutaneous innervation to the posterior arm and forearm and motor innervation to triceps, brachioradialis, and extensor muscles of the forearm and hand. The radial nerve is vulnerable to compression at the radial tunnel as it travels through the forearm. Compression can cause radial tunnel syndrome. The superficial branch of the radial nerve can be affected by Wartenberg syndrome. Radial nerve palsy can result from fractures, injuries, tumors, or iatrogenic causes.
This document discusses different methods for classifying flap procedures. It describes classification based on composition, proximity to the defect, method of movement, and vascular anatomy. Specific flap types are also outlined, including fascio/cutaneous flaps classified by pedicle type and musculocutaneous flaps classified by their vascular supply patterns. Common examples of specific flap procedures are provided.
This document discusses principles of tendon transfers. Tendon transfers involve reattaching a functioning tendon to replace a paralyzed or injured tendon. Key points include indications such as nerve injuries or ruptured tendons. Donor tendons should match the amplitude, power, and function needed. Proper tensioning and protection are important surgically and post-operatively in rehabilitation to train the tendon and patient. Overall, tendon transfers aim to restore function through redistributing muscle forces.
Brachial plexus injuries can occur in both children during birth due to shoulder dystocia and in adults due to high-energy trauma. Examination of brachial plexus injuries involves assessing muscle strength, sensation, and reflexes to determine the level and severity of injury. Treatment may include physical therapy, nerve grafts, nerve transfers, or tendon transfers depending on the specific nature of the injury.
Perineal reconstruction after pelvic resection for cancer often requires flaps to close defects and reduce complications. The rectus abdominis flap has fewer complications than thigh flaps for immediate reconstruction after abdominoperineal resection or pelvic exenteration due to its reliable vascularity and bulk. Gracilis, posterior thigh, and anterolateral thigh flaps are also options but have higher rates of complications compared to the rectus flap. Proper postoperative care including avoiding pressure on the flap is important for successful reconstruction.
The document discusses hand infections, including their history and treatment principles. It covers topics like felons, paronychia, tenosynovitis, and other specific types of hand infections. Some key points:
- Prior to antibiotics, many hand deformities and disabilities resulted from minor injuries becoming infected. Careful surgical techniques helped treatment.
- Penicillin revolutionized treatment by making severe infections less common today. Early diagnosis and treatment with antibiotics, splinting and elevation can help cure some infections.
- Surgical drainage and debridement may be needed for established infections to prevent complications like joint stiffness or contractures. Appropriate antibiotic use and incision placement are important for optimal outcomes.
คู่มือแนวทางเวชปฏิบัติ
(Clinical Practice Guideline)
การดูแลผู้ป่วยระยะกลาง (Intermediate Care)
ด้านการแพทย์แผนไทยและการแพทย์ทางเลือก โดยกรมการแพทย์แผนไทยและการแพทย์ทางเลือก
Department of Thai Traditional and Alternative Medicine
รายการตำรับยาแผนไทยแห่งชาติ
ฉบับ พ.ศ. ๒๕๖๔
National Thai Traditional Medicine Formulary 2021 Edition
กองคุ้มครองและส่งเสริมภูมิปัญญาการแพทย์แผนไทยและแพทย์ฟื้นบ้านไทย
กรมการแพทย์แผนไทยและการแพทย์ทางเลือก
กระทรวงสาธารณสุข
ตำราโอสถพระนารายณ์
จากอนุสรณ์งานฌาปนกิจศพ ลิขสิทธิ์ของกรมศิลปากร
All rights reserved
No part of this book may be reproduced in any
form or by any mean without prior written permission
from the Fine Arts Department.
The document provides 7 tips to improve English skills: 1) Help correct each other's mistakes, 2) Read to improve English, 3) Listen to well-spoken English, 4) Read aloud to build confidence, 5) Check and double check work, 6) Speak clearly to be understood, 7) Make good use of available resources. It then covers various grammar rules including countable and uncountable nouns, pronouns, adjectives, tenses, subject-verb agreement, prepositions, adverbs, conjunctions and common errors.
This chapter provides a brief history of psilocybin mushroom cultivation. It describes how early methods for cultivating the common button mushroom involved collecting wild mushroom mycelium and transferring it to manure beds with limited success due to contamination. In the late 18th century, improvements were made such as using a casing layer to improve yields. In the 1960s, methods were developed for reliably cultivating psilocybin mushrooms using sterile techniques with agar and grain spawns, setting the stage for modern cultivation methods.
ประกาศกรมฯ เรื่อง มาตรฐานการปลูกและการเก็บเกี่ยวที่ดีของพืชกัญชา (Thailand guidelines on Good agricultural and collection practices (GACP) for medical plants) พ.ศ.2566
The document summarizes Thailand's experience in addressing malnutrition from the 1980s to present. Key points include:
1) Thailand successfully reduced undernutrition in the 1980s through multisectoral policies and community-based actions focused on improving nutrition of vulnerable groups.
2) More recently, overnutrition and non-communicable diseases have emerged as major challenges due to lifestyle changes and increased processed food consumption.
3) In 2008, Thailand established the National Food Committee to coordinate multisectoral food and nutrition policies and strategies through a Strategic Framework for Food Management.