<p><span>Highlighting </span><span>new and highly sought-after procedures in day-to-day plastic surgery practice</span><span>, </span><span>Core Procedures in Plastic Surgery, 2nd Edition</span><span>, covers key areas of reconstructive, aesthetic, hand, and pediatric plastic surgery―all </span><spa
Core Procedures in Plastic Surgery
✍ Scribed by Peter C. Neligan, Donald W. Buck ll
- Publisher
- Elsevier
- Year
- 2019
- Tongue
- English
- Leaves
- 527
- Edition
- 2
- Category
- Library
No coin nor oath required. For personal study only.
✦ Synopsis
Highlighting new and highly sought-after procedures in day-to-day plastic surgery practice, Core Procedures in Plastic Surgery, 2nd Edition, covers key areas of reconstructive, aesthetic, hand, and pediatric plastic surgery―all modified to provide streamlined detail of anatomy, workup, and procedural steps. This unique reference, derived from Dr. Peter C. Neligan’s 6-volume award-winning masterwork, Plastic Surgery, 4th Edition, provides the high-yield, highly visual guidance you need to confidently perform these procedures and achieve optimal outcomes.
Covers key concepts of anatomy, relevant techniques, and information about preoperative and postoperative care and potential complications.
Provides quick access to highly templated, bulleted procedures, as well as full-color photos and new procedural videos, including lipoabdominoplasty, post-bariatric, and a variety of facelift techniques.
Features new chapters covering the forehead, body contouring, and liposuction and fat grafting, reflecting a growing demand for aesthetic procedures and excellent outcomes.
Includes fundamental procedures such as open and closed rhinoplasty, abdominal wall reconstruction, expander/implant reconstruction of the breast, local flaps for facial coverage (including cheek and lip reconstruction), cleft lip and cleft palate repair, flexor tendon reconstructions, and more.
Enhanced eBook version included with purchase, which allows you to access all of the text, figures, and references from the book on a variety of devices
✦ Table of Contents
Front Cover
IFC_Expert Consult PIN page
Core Procedures in Plastic Surgery
Copyright Page
Table Of Contents
Preface
List of Contributors
Acknowledgments
Video Contents
Video Contributors
1 Blepharoplasty
Synopsis
Brief introduction
Anatomical pearls
Osteology and periorbita
Lateral retinaculum
Medial orbital vault
Forehead and temporal region
Eyelids
Upper eyelid
Septal extension
Lower eyelid
Retaining ligaments
Blood supply
Innervation: trigeminal nerve and facial nerve
Youthful, beautiful eyes
Preoperative considerations
Operative techniques (Video 1.1)
Simple skin blepharoplasty
Anchor (or invagination blepharoplasty)
Orbital fat excision
Blepharoptosis
Lower lid blepharoplasty
Transconjunctival blepharoplasty
Transcutaneous blepharoplasty
Orbital fat transposition
Orbital septum plication
Capsulopalpebral fascia plication
Orbicularis suspension
Canthopexy
Midface lifting
Postoperative considerations
Complications and outcomes
Further reading
2 Facelift
Synopsis
Brief introduction
Preoperative considerations
Operative techniques
Subcutaneous facelift
Facelift incisions (Video 2.1; Video 2.2)
Midfacelift (blepharoplasty approach)
SMAS plication (Video 2.4)
MACS-lift (Chapter 6.4) (Video 2.5)
Lateral SMASectomy (Chapter 6.5)
Extended SMAS technique (Chapter 6.6)
SMAS with skin attached – the “high SMAS technique” (Chapter 6.7) (Video 2.6)
Subperiosteal midfacelift (Chapter 6.8) (Video 2.7; Video 2.8)
Postoperative considerations
Complications and outcomes
Hematoma
Sensory nerve injury
Motor nerve injury
Unsatisfactory scars
Alopecia
Skin loss
Infection
Further reading
3 Forehead rejuvenation
Synopsis
Brief introduction
Anatomical pearls
Preoperative considerations
Operative techniques
Open coronal approach (Figs. 3.14–3.16)
Anterior hairline approach
Endoscopic approach
Temple approach
Transpalpebral approach – muscle modification
Lateral brow approach
Direct suprabrow approach
Suture suspension brow pexy
Postoperative considerations
Complications and outcomes
Secondary procedures
4 Rhinoplasty
Synopsis
Open rhino
Closed rhino
Brief introduction
Preoperative considerations
Anatomical pearls
Upper cartilaginous vaults
Middle and lower cartilaginous vaults
Dorsum and tip
Operative techniques
Open rhinoplasty (Video 4.1)
Component dorsal hump reduction
Septal reconstruction
Septal graft harvest
Ear cartilage
Costal cartilage
The nasal tip
Columellar strut graft
Nasal tip suturing techniques (Fig. 4.17)
Nasal tip grafting techniques
Alar contour grafts
Lateral crural strut grafts
The alar–columellar relationship
Percutaneous lateral nasal osteotomies
Closure
Alar base surgery
Closed rhinoplasty
Access
Dorsal resection
Nasal spine–caudal septum
Alar cartilage resection
Upper lateral cartilages: shortening the nose
Septoplasty, spreader graft tunnels
Turbinectomy
Graft placement and wound closure
Osteotomy
Alar wedge resection
Spreader grafts
Lateral wall and columellar grafts
Tip grafting
Postoperative considerations
Complications and outcomes
Further reading
5 Otoplasty
Synopsis
Brief introduction
Preoperative considerations
Anatomical/technical pearls
Operative techniques
Standard otoplasty for prominent ears of normal size
Otoplasty for large ears or ears with inadequate helical rim definition
Incision
Otoplasty for constricted ears
Otoplasty for cryptotia
Otoplasty for Stahl’s ears
Correction of aging, elongated ear lobes
Correction of earring-related complications
Correction of facelift deformities around the ear
Postoperative considerations
Complications and outcomes
Further reading
6 Abdominoplasty and lipoabdominoplasty
Synopsis
Brief introduction
Preoperative considerations
Anatomical pearls
Operative technique (Video 6.1, Video 6.2, Video 6.3)
Marking and positioning
Mini abdominoplasty
Abdominoplasty with umbilical transection (Fig. 6.8 and Table 6.1)
Standard abdominoplasty (Fig. 6.9)
High-lateral-tension abdominoplasty
Fleur-de-lis abdominoplasty
Reverse abdominoplasty
Vertical abdominoplasty
Lipoabdominoplasty
Postoperative considerations
Complications and outcomes
Further reading
7 Body contouring
Synopsis
Brief introduction
Preoperative considerations
Common presentation of the massive weight loss patient
Patient selection criteria
Preoperative evaluation
Anatomical pearls
Operative techniques (Video 7.1)
Belt lipectomy
Anterior surgical markings
Posterior surgical markings
Vertical alignment marks
Positioning sequence
Anesthesia and deep vein thrombosis/pulmonary embolism prophylaxis
Surgical technique
Lower bodylift
Autoaugmentation of the buttocks
Postoperative considerations
Complications and outcomes
8 Liposuction and fat grafting
Synopsis
Fat grafting
Brief introduction
Preoperative considerations
Anatomical pearls
Classification
Operative technique
Marking and positioning (Fig. 8.4)
Anesthesia technique/location of operation
Patient positioning
Prone/supine
Wetting solutions and perioperative fluid management
Liposuction techniques
Non-invasive devices
Surgical endpoints
Cannulas and probes
Treatment areas
Arms
Back
Abdomen
Hips/flanks
Buttocks
Thighs
Knees/ankles
Neck
Postoperative considerations
Complications and outcomes
Brief introduction
Preoperative considerations
Common breast deformities
Operative techniques (Video 8.1)
Postoperative considerations
Complications and outcomes
9 Facial injuries
Synopsis
Brief introduction
Preoperative considerations
Frontal bone and sinus injury patterns
Brief introduction
Preoperative considerations
Anatomical pearls
Key technical considerations
Outcomes and complications
Orbital fractures
Brief introduction
Preoperative considerations
Anatomical pearls
Key technical considerations
Complications and outcomes
Nasal fractures
Brief introduction
Preoperative considerations
Anatomical pearls
Technical considerations
Complications and outcomes
Zygoma fractures
Brief introduction
Preoperative considerations
Anatomical pearls
Technical considerations
Complications and outcomes
Midface fractures
Brief introduction
Technical considerations
Postoperative considerations
Complications and outcomes
Mandible fractures
Brief introduction
Preoperative considerations
Anatomical pearls
Technical considerations
Operative techniques
Complications and outcomes
The panfacial injury
Brief introduction
Preoperative considerations
Technical considerations
Complications and outcomes
Ballistics injuries to the face
Brief introduction
Technical considerations
Further Reading
10 Local flaps for facial coverage
Synopsis
Cheek reconstruction
Lip reconstruction
Brief introduction
Forehead and scalp
Technical pearls
Eyebrow reconstruction
Technical pearls
Nasal reconstruction
Technical pearls
Eyelids
Technical pearls
Partial lower lid defects
Partial upper lid defects
Advancement flap
Lid-switch flap (Abbé flap) (Fig. 10.14)
Free grafts
Large and total upper lid defects
Total lower lid defects
Medial canthal defects
Cheek
Cheek rotation flap
Advancement flaps
Transposition flaps
Finger flap
Island flap
The submental artery flap (Fig. 10.19)
Free tissue transfer
Scapular and parascapular flaps
Anterolateral thigh flap
Other flap options
Lips
Technical pearls
Operative techniques
Wedge resection (Figs. 10.23, 10.24)
Lip switch flaps: Abbé (Fig. 10.25) and Estlander flaps (Fig. 10.26)
Large, composite, or total lip defects
Ear
Rim defects
Anterior concha
Further reading
11 Cleft lip repair
Synopsis
Bilateral lip repair
Brief introduction
Preoperative considerations
Anatomical/technical pearls
Operative techniques
Unilateral cleft lip (Video 11.1; Video 11.2)
Alveolar molding: external taping
Nasoalveolar molding
Rotation advancement cheiloplasty for complete clefts
Medial incisions
Closure
Addressing the cleft nasal deformity
Adjustments at cheiloplasty
Rotation advancement cheiloplasty for incomplete clefts
Microform cleft lip
Bilateral cleft lip (Video 11.3)
Bilateral, complete cleft lip and palate
Markings
Labial dissection
Alveolar closure
Labial closure
Final touches
Late presentation of bilateral complete cleft lip/palate
Bilateral incomplete cleft lip
Asymmetrical bilateral (complete/incomplete) cleft lip
Postoperative considerations
Complications and outcomes
Further reading
12 Cleft palate
Synopsis
Brief introduction
Preoperative considerations
Submucous cleft palate
Pierre Robin sequence
Syndromes
Growth
Feeding and swallowing
Speech
Maxillary growth
Anatomical considerations
Operative techniques
General technical considerations
von Langenbeck
V-Y pushback (Veau–Wardill–Kilner)
Two-flap palatoplasty
Vomer flaps
Double-opposing Z-plasty (Furlow)
Two-stage palate repair
Postoperative considerations
Complications and outcomes
Further reading
13 Lower extremity reconstruction
Synopsis
Brief introduction
Preoperative considerations
Anatomical/technical pearls
Skin grafts and substitutes
Approach by location (local flaps)
Thigh
Lower leg
Microvascular free tissue transfer
Primary limb amputation
Debridement
Timing of reconstruction
Selection of recipient vessel
Special considerations
Osteomyelitis
Diabetes
Coverage after tumor ablation
Exposed prosthesis
Soft tissue expansion
Operative techniques
Muscle/musculocutaneous flaps
Tensor fascia lata
Rectus femoris
Biceps femoris
Gracilis
Soleus
Gastrocnemius
Fasciocutaneous/perforator flap
Groin/superficial circumflex iliac perforator
Medial thigh/anteromedial perforator and gracilis perforator
Lateral thigh/profunda femoris perforator
Anterolateral thigh perforator (Video 13.1)
Sural
Tap (thoracodorsal artery perforator)
Compound flaps
Supermicrosurgery
Postoperative considerations
Complications and outcomes
Further reading
14 Chest reconstruction
Synopsis
Brief introduction
Preoperative considerations
Operative techniques
Mediastinitis/sternal wound infection
Common flaps for reconstruction
Pectoralis major
Latissimus dorsi
Serratus anterior
Rectus abdominus
External oblique
Omentum
Postoperative considerations
Complications and outcomes
Further reading
15 Back reconstruction
Synopsis
Brief introduction
Preoperative considerations
Midline back wounds
Non-midline back wounds
Technical pearls
Flap selection by region
Cervical region
Thoracic region
Lumbar region
Lumbosacral region
Wounds of the lateral back
Operative techniques
Local wound care
Operative debridement
Flap closure
Principles
Possible flap choices for spine closure
Erector spinae muscle flaps
Latissimus muscle or myocutaneous flap
Trapezius muscle flap
Superior gluteal artery
Omentum
Adjacent tissue transfers/perforator flaps
External oblique flap
Tissue expansion
Free flap coverage of the back
Soft tissues
Bone
Vascularized bone reconstruction of the spine
Special clinical situations
Esophageal fistula after spine procedures
“Tethered cord surgery” or “lipomas of the spine”
Pseudomeningocele repair and cerebrospinal fluid leaks
Postoperative considerations
Further reading
16 Abdominal wall reconstruction
Synopsis
Brief introduction
Preoperative considerations
Technical pearls
Bioburden reduction
Negative-pressure wound therapy
Operative techniques
Primary suture technique
Component separation method (Video 16.1)
Regional and distant autologous tissue repair
Tissue expansion
Parastomal hernia repair
Abdominal wall transplantation
Postoperative considerations
Complications and outcomes
Further reading
17 Breast augmentation
Synopsis
Brief introduction
Preoperative considerations
Anatomical/technical pearls
Pocket position
Implant selection basics
Operative techniques
Inframammary incision
Periareolar incision
Transaxillary incision (Video 17.1; Video 17.2)
Transumbilical
Postoperative considerations
Complications and outcomes
Breast implant–associated anaplastic large cell lymphoma
Further reading
18 Mastopexy and augmentation mastopexy
Synopsis
Brief introduction
Preoperative considerations
Anatomical/technical pearls
Operative techniques
Concentric mastopexy without parenchymal reshaping
Periareolar Benelli mastopexy
The Goes periareolar technique with mesh support
Grotting sculpted vertical pillar mastopexy (Video 18.1)
Inverted-T technique
Augmentation mastopexy (Video 18.2)
Mastopexy postexplantation
Postoperative considerations
Complications and outcomes
Further reading
19 Reduction mammaplasty and gynecomastia
Synopsis
Brief introduction
Preoperative considerations
Anatomical pearls
Operative techniques (Video 19.1; Video 19.2; Video 19.3)
General concepts
Specific techniques
Postoperative considerations
Complications and outcomes
Gynecomastia
Further reading
20 Implant-based breast reconstruction
Synopsis
Implant-based reconstruction
Latissimus flap reconstruction
Brief introduction
Preoperative considerations
For expander/implant reconstructions
For latissimus flap reconstructions
Anatomical/technical pearls
Expander/implant selection
Latissimus flap anatomy
Operative techniques
Two-stage expander/implant reconstruction
Stage I: expander insertion (Video 20.1)
Stage II: expander/implant exchange (Video 20.2)
One- and two-stage prosthetic reconstruction in nipple-sparing mastectomy
Surgical steps
Postoperative considerations
Expander/implant reconstruction
Outcomes and complications
Expander/implant reconstruction
Operative technique
Latissimus dorsi flap reconstruction (Video 20.6)
Immediate reconstructions
Delayed reconstructions
Postoperative considerations
Latissimus flap reconstruction
Outcomes and complications
Latissimus flap reconstruction
Further reading
21 Autologous breast reconstruction using abdominal flaps
Synopsis
Pedicled TRAM
Free TRAM
DIEAP
Brief introduction
The pedicled versus free TRAM/DIEAP
Preoperative considerations
Procedure selection
Anatomical pearls
Operative techniques
Pedicled TRAM (Fig. 21.5; Video 21.1)
Abdominal closure
Flap inset/breast shaping
Free TRAM (Fig. 21.21; Video 21.2)
Flap insetting
DIEP flap (Figs. 21.28 and 21.29; Video 21.4)
Abdominal closure
Flap inset
Postoperative considerations
Complications and outcomes
Secondary procedures
Further reading
22 Essential anatomy of the upper extremity
Synopsis
Brief introduction
Skin, subcutaneous tissue, and fascia
Bones and joints
The wrist
Wrist motion
Extrinsic carpal ligaments
Intrinsic carpal ligaments
Hand/joint motion
The thumb
Muscles and tendons
Extrinsic extensors
Pronators and supinators
Extrinsic flexors
The retinacular system
Intrinsic muscles
Blood supply
Peripheral nerves
Radial nerve
Median nerve
Ulnar nerve
Further reading
23 Examination of the upper extremity
Synopsis
Patient history
Physical examination of the hand
Inspection
Palpation
Range of motion assessment
Stability assessment
Musculotendinous assessment
Tests for specific muscles
Extrinsic muscles
Intrinsic muscles
Nerve assessment
Vascular assessment
Additional special provocative tests for the hand
Physical examination specific to the forearm
Physical examinations specific to the elbow
Physical examination of thoracic outlet syndrome
Important TOS anatomy
Provocative maneuvers
Physical examination of the upper extremity in children
Further reading
24 Flexor tendon injury and reconstruction
Synopsis
Brief introduction
Preoperative considerations
Anatomical/technical pearls
Flexor tendon healing
Biomechanics of tendon repair and gliding
Operative techniques
Zone 1 injuries
Zone 2 injuries (Videos 24.1–24.5)
Zone 3, 4, and 5 injuries
FPL injuries
Partial tendon lacerations
Closed tendon rupture
Postoperative considerations
The modified Kleinert method
Duran–Houser method
Early active motion
Author’s preferred combined active–passive method (Nantong regimen)
Complications and outcomes
Further reading
25 Nerve transfers
Synopsis
Brief introduction
Preoperative considerations
Patient selection
Anatomical/technical pearls for specific injury patterns
Upper plexus injury
Specific patient exam findings
Specific operative techniques
Use of spinal accessory nerve (cranial nerve XI) to suprascapular nerve transfer (motor)
Use of triceps to axillary nerve transfer (motor component)
Use of the double fascicular (ulnar/median redundant branches to biceps brachii and brachialis branches of the musculocutaneous) nerve transfer (motor)
Other potential donors (medial pectoral nerve and thoracodorsal nerve)
Lower plexus injury
Specific patient exam findings
Specific operative techniques
Complete/near-complete plexus injury
Specific patient exam findings
Specific operative techniques
Use of spinal accessory and intercostal nerves as donors (motor)
Median nerve injury
Specific patient exam findings
Specific operative techniques
Use of radial to median branch nerve transfers (motor)
Use of brachialis branch to AIN branch nerve transfer
Use of adjunct tendon transfers to augment nerve transfers
Ulnar nerve injury
Specific patient exam findings
Specific operative techniques
Use of median to ulnar branch nerve transfers (motor)
Use of adjunct tendon transfers to augment nerve transfers
Radial nerve injury
Specific patient exam findings
Specific operative techniques
Use of median to radial branch nerve transfers
Use of adjunct tendon transfers to augment nerve transfers
Sensory nerve injury
Restoration of key sensory functions
Specific operative techniques
Use of ulnar to median branch nerve transfers (sensory)
Use of median to ulnar branch nerve transfers (sensory)
Use of median and ulnar nerve transfers to restore first webspace sensation in C5–C6 root level brachial plexus injury (sensory)
Use of lateral antebrachial cutaneous nerve to radial nerve transfers (sensory)
Use of radial to axillary nerve transfers (sensory)
Postoperative considerations
Complications and outcomes
Further reading
26 Tendon transfers in the upper extremity
Synopsis
Brief introduction
Preoperative considerations
Anatomical/technical pearls
Operative techniques for specific nerve injuries
Radial nerve palsy
Specific operative techniques
Standard flexor carpi ulnaris transfer
Flexor carpi radialis transfer
Boyes superficialis transfer
Low median nerve palsy (distal to innervations of the extrinsic forearm flexors)
Preoperative considerations
Specific operative techniques
Bunnell ring finger flexor digitorum superficialis transfer
Camitz palmaris longus transfer
Other opposition tendon transfers
High median nerve palsy (proximal to innervations of extrinsic forearm flexors)
Specific operative techniques
Low ulnar nerve palsy (distal to the innervation of the ring and small finger flexor digitorum profundus and flexor carpi ulnaris)
Specific operative techniques
Tendon transfers to correct clawing
Modified Stiles–Bunnell transfer
Brand EE4T transfer
Brand EF4T transfer
Fritschi PF4T transfer
Tendon transfer to correct ulnar deviation of the small finger
Tendon transfers to provide adduction of the thumb
Ring finger flexor digitorum superficialis transfer
Smith extensor carpi radialis brevis transfer
Tendon transfers to provide index finger abduction
Neviaser accessory abductor pollicis longus and free tendon graft
High ulnar nerve palsy
Specific operative techniques
Tendon transfers for combined nerve injuries
Tendon transfers for low median–low ulnar nerve palsy
Tendon transfers for high median–high ulnar nerve palsy
Tendon transfers for reconstruction after trauma
Tendon transfers to restore thumb extension
Tendon transfers to restore finger extension
Tendon transfers to restore thumb flexion
Tendon transfers to restore finger flexion
Postoperative considerations
Complications and outcomes
Further reading
27 Extensor tendon injuries
Synopsis
Brief introduction
Preoperative considerations
Anatomical pearls
Extrinsic muscles
Intrinsic muscles
Functional anatomy
Mechanisms of joint extension
Operative techniques
Suturing techniques
Zone I
The mallet finger
Zone II
Zone III
Zone IV
Zone V
Human bite injuries
Sagittal band injuries
Zone VI
Zone VII
Zones VIII/IX
Secondary procedures
The hanging fingertip
The swan-neck deformity
The boutonnière deformity
Delayed sagittal band reconstruction (Video 27.1)
The missing tendon: tendon transfers versus tendon grafting (Video 27.2)
Soft tissue management and staged reconstruction in combined injuries
Postoperative considerations
Complications and outcomes
Further reading
Index
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B
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D
E
F
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