Plastic Surgery - Principles and Practice

✍ Scribed by Rostam Farhadieh BSc(Med)(Hons) MBBS MD EBOPRASF FRACS(Plast) FRCS(Plast) (editor), Neil Bulstrode BSc(Hons) MBBS MD FRCS(Plast) (editor), Babak J. Mehrara MD (editor), Sabrina Cugno MD MSc FRCSC FACS FAAP (editor)

• Publisher: Elsevier
• Year: 2021
• Tongue: English
• Leaves: 1163
• Edition: 1
• Category: Library

✦ Synopsis

With detailed, expert guidance on each essential topic, Plastic Surgery: Principles and Practice offers single-volume convenience without sacrificing complete coverage of this multi-faceted field. Written by global leading authorities, it provides concise, easy-to-follow instruction with the clinical details and supportive data needed to achieve optimal patient outcomes.

• Offers thorough coverage of facelift procedures, rhinoplasty, otoplasty and more, along with clinical pearls from masters in the field. 

• Features hundreds of high-quality images including anatomical line art, case photos, and procedural operative photos. 

• I Includes a superb selection of procedural videos of global experts performing key techniques within operating room and close-up clinical pearls. 

• An ideal resource for residents, fellows, and practitioners in plastic surgery, as well as those in otolaryngology, vascular surgery, and cosmetic dermatology.  

• Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

✦ Table of Contents

Plastic Surgery-Principles and Practice
Cover
Front Matter.pdf
Plastic Surgery: Principles and Practice
Copyright.
Copyright
Dedication.
Dedication
Foreword
Foreword
Preface
Preface
List of Contributors
List of Contributors
1-Skin Structure and Function
1 - Skin Structure and Function, Wound Healing and Scarring
Skin Structure and Function
Epidermis
Keratins
The Dermo-Epidermal Junction (Basement Membrane Zone)
Dermis
Fibroblasts
The Extracellular Matrix
Mesenchymal Stem Cells
Epithelial/Mesenchymal Interactions
Skin Aging
Type 1 – Classical Cutaneous Wound Healing
Wound Healing Classifications
Phases of Wound Healing
Coagulation
Inflammation
Fibroplasia
Remodeling
Repair vs. Regeneration
Acute vs. Chronic Wound Healing
Epithelial/Epidermal vs. Mesenchymal/Dermal Wound Healing
Wound Healing and Scarring
Epidermal Wound Healing
Acute Activation
Early Activation
Restitution
Dermal Wound Healing
“Normal”/Primary Incisional Wound Healing (Type 1a)
Early Closure (Type 1ai)
Late Closure (Type 1aii)
No Closure (Type 1aiii)
“Normal”/Secondary Excisional Wound Healing (Type 1b)
Above Mid-Dermis (Type 1bi)
Below Mid-Dermis (Type 1bii)
Abnormal Wound Healing
Systemic Factors
Local Factors
Mechanotransduction
Type 2 – Neoclassical Cutaneous Wound Healing
“Supranormal” Healing by Skin Replacement (Type 2a)
Early Split-Thickness or Full-Thickness Skin Grafting of Type 1bii (Type 2ai)
Biotechnological Skin Replacements (Type 2aii)
“Supranormal” Healing with Apparent Acceptance of Tissue Loss (Type 2b)
Type 1bi Treated with Cultured Keratinocyte Allograft or Biological Dressing (Type 2bi)
Chronic Full-Thickness Wound Treated with Cultured Keratinocyte Allograft or Biological Dressing (Type 2bii)
Bone Healing
Fat
Lymphedema
The Future
2-Basic Skin Flaps and Blood Supply
2 - Basic Skin Flaps and Blood Supply
Introduction
Evolution of Flap Surgery
Physiology and Anatomy of Skin Blood Supply
Indications for Skin Flaps
Design and Application of Flaps
Flap Design and Blood Supply
Flap Design and Movement
Flaps In-continuity
Transposition Flaps
Rotation Flaps
Advancement Flaps
3-Biomaterials and Structural Fat Grafting
3 - Biomaterials and Structural Fat Grafting
General Principles
Autologous Grafts
Skin Autografts
Adipose Tissue Autografting
Donor Site
Extraction Techniques
Infiltration with Local Anesthetic Agents
Preparation
Application
Complications
Bone Autografts
Autologous Cancellous Bone Grafts
Autologous Cortical Bone Grafts
Autologous Vascularized Bone Grafts
Cartilage Autografts
Autologous Cartilage Grafts
Osteochondral Autograft Transfer
Autologous Chondrocyte Implantation
Allografts and Xenografts
Bone Allografts
Fascia Allografts
Dermal Matrices
Integra
AlloDerm
Strattice
Alloplastic Materials
Metals
Stainless Steel
Cobalt Alloys
Titanium (Ti)
Gold
Ceramics
Bioinert Ceramics
Bioactive Ceramics
Polymers
Silicone
Polyethylene
PEEK
Conclusion
4-Local Anesthetics
4 - Local Anesthetics
Introduction
Mechanism of Action of Local Anesthetics
Nerve Fiber Characteristics and Differential Blockade
Physiochemical Properties of Local Anesthetics
Chemistry
Potency
Duration of Action
Onset of Action
Pharmacokinetics of Local Anesthetics
Absorption
Distribution
Clearance and Metabolism
Local Anesthetics in Clinical Practice
Concentration of Local Anesthetics
Clinically Useful Adjuncts
Topical Local Anesthetics
Cutaneous Agents
Mucosal Agents
Transdermal Local Anesthetic Delivery
Liposomal Drug Delivery
Tumescent Anesthesia
Iontophoresis
Microporation
Electroporation
Sonophoresis
Local Anesthetic Systemic Toxicity (LAST)
Symptoms and Signs
Central Nervous System Effects
Cardiovascular Effects
Prevention of LAST
Management of LAST
Start Treatment
Post-resuscitation Management
Methemaglobinemia
Sedation
Basic Principles of Sedation
Safety
Regional Techniques of Relevance to Plastic Surgery
Intravenous Regional Anesthesia (Bier Block)
Principle
Technique
Complications
Nerve Blocks for the Face
General Considerations
Supraorbital Nerve Block
Anatomy
Landmark
Technique
Supratrochlear Nerve Block
Anatomy
Landmark
Technique
Infraorbital Nerve Block
Anatomy
Landmark
Technique
Mental Nerve Block
Anatomy
Landmark
Technique (Intraoral Approach)
5-Lasers
5 - Lasers
General Principles
Laser Physics
Laser Therapy in Cutaneous Treatment
Laser Modality
Laser Safety
Types of Laser
Fractionated Lasers
Intense Pulsed Light
Cutaneous Side Effects of Laser Treatment
Temporary
Long Term
Laser Treatment by Lesion Type
Vascular Lesions
Technical Tips
Pigmented Lesions
Tattoos
Esthetic Applications
Laser Resurfacing
CO2 Lasers
Erbium:YAG Lasers
Fractionated CO2 Lasers
Preoperative Consultation
Postoperative Care
Complications
Laser Hair Removal
Other Indications for Laser Therapy
. Flat warts can be treated with the pulsed dye laser. Thick warts can be treated with ablative lasers. In the case of recurrenc...
. Erbium laser ablation, followed by regular Adcortyl injection
. Fractionated CO2 laser as per esthetic resurfacing
. Premalignant conditions such as actinic keratosis and Bowen’s disease respond well to laser ablation, especially with the erbi...
. Pulsed dye laser, photodynamic therapy (PDT), Nd:YAG and CO2 lasers have been used with varying success to treat Kaposi’s sarc...
Conclusion
6-Tissue Expansion
6 - Tissue Expansion
Background
Viscoelastic Properties of Skin
Tissue Changes during Expansion Techniques
Evolution of Tissue Expansion Devices
Surgical Technique: Basic Incision and Design Plan
External Volume Expansion with BRAVA
Advantages and Disadvantages of Tissue Expansion
Complications
Future of Tissue Expansion
Ten Golden Rules of Expanders
7-Tissue Engineering
7 - Tissue Engineering
Introduction
Experimental Tissue Engineering
Tissue Engineering as a Tool to Further Scientific Discovery
Applied Tissue Engineering – a Team-Based Discipline
Tissue Engineering in Plastic Surgery
Targeted Tissue Engineering Strategies
Neovascularization in Tumorigenesis and Organogenesis
Seed versus Soil Hypothesis
Stem and Progenitor Cells in Tissue Engineering
Induced Pluripotent Stem Cells (iPS Cells)
Crispr-Cas9, Gene Editing and Expression Technology
Cell-Based Approaches
Vascularization and Use of Flaps in Tissue Engineering
Cell-Based Extracorporeal Support Devices and Extracorporeal Flap Perfusion Bioreactors
Bioreactors
Microenvironmental Approaches to Tissue Engineering
Supporting Cells in Tissue Engineering
Matrices and Scaffolds in Tissue Engineering
Inflammation and the Role of the Immune System in Tissue Engineering
Growth Factors and Chemokines in Tissue Engineering
Tissue Engineering in Practice: Tissue Engineered Breast Reconstruction
Regulation of Regenerative Medicine Therapies
Conclusion
8-Melanoma
8 - Melanoma
Epidemiology
Risk Factors
Clinical Diagnosis
Biopsy
Histology
Staging
Wide Excision
Sentinel Lymph Node Biopsy
Lymphadenectomy
Adjuvant Therapy
Locoregional Treatment
Distant Metastases
Noncutaneous Melanomas
9-Nonmelanoma Skin Cancer
9 - Nonmelanoma Skin Cancer
Introduction
Basal Cell Carcinoma
Epidemiology
Risk Factors
Genetics
Pathogenesis
Clinical Presentation and Classification
Diagnosis and Staging
Dermoscopy
Biopsy
Staging: TNM and Imaging
Management
Nonoperative Management
Topical Therapies
Oral Therapy
Photodynamic Therapy
Radiotherapy
Operative Management
Standard Surgical Excision
Mohs Micrographic Surgery (MMS)
Electrodessication and Curettage
Pulsed Dye Laser
Squamous Cell Carcinoma
Epidemiology
Risk Factors
Genetics
Pathogenesis
Clinical Presentation and Classification
Clinical Presentation
Classification
Diagnosis and Staging
Dermoscopy
Biospy
Staging
TNM
Management
Nonoperative Management
Topical Therapy
Oral Therapy
Photodynamic Therapy
Radiotherapy
Operative Management
Standard Surgical Excision
Mohs Micrographic Surgery
Electrodessication and Curettage
Excision and Reconstruction, and the MDT
10-Atypical Skin Lesions
10 - Atypical Skin Lesions
Introduction
Benign Lesions
Cysts
Epidermoid Cysts (Keratin Cysts)
Tricholemmal (Pilar) Cysts
Dermoid Cysts
Benign Lesions Associated with Epidermis
Acrochorda
Warts
Benign Lesions Associated with Hair Follicles
Pilomatrixoma
Trichoepithelioma
Trichofolliculoma
Tricholemmoma (Trichilemmoma)
Sebaceous Hyperplasia
Benign Sebaceous Adenoma
Nevus Sebaceous of Jadassohn
Hidradenoma Papilliferum
Poroma
Benign Lesions Associated with Sweat Ducts
Syringoma
Cylindroma
Spiradenoma
Benign Dermal Tumors
Dermatofibroma
Unusual Malignancies of Skin
Merkel Cell Carcinoma
Adnexal Carcinomas
Microcystic Adnexal Carcinoma (MAC)
Sebaceous Carcinoma
Porocarcinoma
Extramammary Paget’s Disease
Other Rare Adnexal Carcinomas
Soft Tissue Sarcomas of Skin
Atypical Fibroxanthoma (AFX)
Pleomorphic Dermal Sarcoma (PDS)
Dermatofibrosarcoma Protuberans (DFSP)
Leiomyosarcoma (LMS)
Cutaneous Angiosarcoma
Conclusion
11-Vascularized Composite Allotransplantation
11 - Vascularized Composite Allotransplantation
Historical Background
Nomenclature
Basic Transplantation Immunology
Experimental Models of VCA Transplantation
Animal Models
Skin and Soft Tissue VCA Models
Hindlimb Allotransplantation Models
Facial Allograft Transplantation Models
Immunomodulatory VCA Models
Large Animal Models and Other VCA Models
Cadaver Studies for VCA Transplantation
Lower Central Facial Allograft (Type I)
Midfacial Allograft (Type II)
Upper Facial Allograft (Type III)
Clinical Applications of VCA Transplantation
Upper Extremity Transplantation
Face Transplantation
Other Clinical VCA Applications
Laryngotracheal Transplantation
Knee and Femur Transplantation
Lower Extremity Transplantation (LET)
Abdominal Wall Transplantation
Peripheral Nerve Transplantation
Uterus Transplantation
Penis Transplantation
Pediatric VCA
VCA Outcomes
Future VCA Perspectives
12-Radiation Therapy and Soft Tissue Response
12 - Radiation Therapy and Soft Tissue Response
Radiation Principles
Alpha Particle Radiation
Beta Particle Radiation
Gamma Radiation
X-Rays
Mode of Action in Malignancies
Indirect Effect
Direct Effect
Biological Effect on the Cell Cycle
Radiation Injury
Modes of Delivery
External Beam Radiotherapy
Brachytherapy
Fractionation
Dose and Dose Rate
Effects of Oxygen and Radiotherapy
Treatment Parameters
Total Dose
Dose Fraction Size
Volume Treated
Time Elapsed
Radiation Effects
Acute Toxicity
Late Toxicity
Osteoradionecrosis
Radiation Therapy and Wound Healing
Supportive Management
Carcinogenesis
Radiation-Induced Sarcoma
Hereditary Cancer Syndromes
13-Burns- Acute Care and Reconstruction
13 - Burns: Acute Care and Reconstruction
Introduction
Burn Assessment
Pathophysiology of Burn
Types of Burns
Inhalation Injury
Fluid Resuscitation
Systemic Effects
Timing of Reconstruction
Acute Techniques to Limit Subsequent Reconstruction
Biologic Skin Substitutes
Cultured Skin Substitutes
Adjacent Tissue Rearrangements
Occupational Therapy
Acute Reconstructive Needs
Intermediate and Late Reconstruction
Topical Scar Treatments
Surgical Techniques for Reconstruction
Scar Release
Z-Plasty
Grafting
Biologics
Tissue Expansion
Autologous Tissue Reconstruction
Nonsurgical Techniques
Lasers
Fat Grafting
Anatomical Considerations
Face
Eyebrow/Eyelid
Nose
Ear
Neck and Chin
Scalp
Breast
Axilla
Elbow/Hand
Lower Extremity
14-Congenital Melanocytic Nevi
14 - Congenital Melanocytic Nevi
Incidence of Phenotypic Classification
Histological and Clinical Appearances of CMN
Neurological Associations of CMN
Other Associated Features of CMN
Melanoma and CMN
Genetics of CMN and Implications for Treatment of Melanoma
Surgical Management of CMN
Conclusion
15-Vascular Anomalies
15 - Vascular Anomalies
Introduction
Vascular Tumors
Vascular Malformations
16-Cleft Lip
16 - Cleft Lip
Embryology
Clinical Anatomy
Preoperative Assessment
Presurgical Orthopedics
Unilateral Cleft Lip Repair
Principles of Surgical Repair
Operative Technique: Tennison–Randall Inferior Triangle Repair
Operative Technique: Millard Rotation-Advancement Repair
Operative Technique: Fisher Anatomical Subunit Approximation Repair
Bilateral Cleft Lip Repair
Primary Nasal Correction
Postoperative Care
Complications and Revision Surgery
Outcomes
Conclusion
17-Cleft Palate and Velopharyngeal Dysfunction
17 - Cleft Palate and Velopharyngeal Dysfunction
Embryology
Anatomy
Submucous Cleft Palate
Associated Syndromes
Pierre Robin Sequence
Stickler Syndrome
Van der Woude Syndrome
22q11.2 Deletion (Velocardiofacial) Syndrome
Palatoplasty
Timing of Repair
Preoperative Assessment
History of Palatoplasty
Sommerlad Technique for Palate Repair
Repair of Submucous Cleft Palate
Complications of Palatoplasty
Velopharyngeal Dysfunction
Assessment of Velopharyngeal Function
Surgical Management of Velopharyngeal Dysfunction
Pharyngeal Flap
Pharyngoplasty
Prosthetic Management
Management of Unilateral or Asymmetric VPI
18-Congenital Ear Anomalies
18 - Congenital Ear Anomalies
Ear Development
Prominent Ears
Other Auricular Anomalies
Microtia
Reconstruction
Oculo-auriculo-vertebral Spectrum
Complications
Alternative Reconstructive Options
19-Rare Craniofacial Clefts
19 - Rare Craniofacial Clefts
Etiology
Classification
Management
Skin
Eyelids
Nose
Cheek
Skeletal Reconstruction
Orbit
Maxilla
Mandible
Prevention
Conclusion
20-Craniosynostosis
20 - Craniosynostosis
History
Skeletal Development
Normal Calvarial Growth
Craniosynostosis
Classification of Craniosynostosis
Genes and Clinical Presentation: Nonsyndromic Craniosynostosis
Genes and Clinical Presentation: Syndromic Craniosynostosis
Diagnostics
Most Common Syndromes
Muenke Syndrome
Genetics
Clinical Features
Crouzon Syndrome
Genetics
. Brachycephaly due to fusion of bicoronal ± sagittal and lambdoid sutures (can be absent or delayed)
Pfeiffer Syndrome
Genetics
Clinical Features
Apert Syndrome
Genetics
Clinical Features
Saethre–Chotzen Syndrome
Genetics
. 20.6)
Rare Syndromes
Parameters of Care for Craniosynostosis
Craniofacial Assessment
Prenatal Diagnosis
Initial History and Examination from Birth to Age 3 Months
Deformational Posterior Plagiocephaly
. Deformational plagiocephaly can occur due to prematurity, or intrauterine constraint, such as twin pregnancy
. Deformational plagiocephaly can occur due to assisted delivery with, for example, the use of a forceps
. Deformational plagiocephaly has become increasingly common after the “Back to Sleep” campaign. In 1992, the American Academy o...
Radiographic Imaging
Sagittal Synostosis
Metopic Synostosis
Coronal Synostosis
Unicoronal Synostosis
Bicoronal Synostosis
Lambdoid Synostosis
Multisuture Synostosis and Cloverleaf Skull
Treatment of Nonsyndromic Craniosynostosis
Functional Problems
Neurosurgical Problems
Neurodevelopmental Problems
Psychological Problems and Social Function
Surgical Treatment of Nonsyndromic Craniosynostosis
“Early” Treatment: Up to 6 Months of Age
Strip Craniectomy
Endoscopic-Assisted Suturectomy with or without an Orthotic Helmet Device
Spring-Assisted Cranioplasty
Distraction Osteogenesis
“Late” Treatment: Age 6 Months to 3 Years
Fronto-orbital Remodeling
Calvarial Remodeling
Pi Procedure
Posterior Cranial Vault Remodeling
Total and Subtotal Calvarial Remodeling
Treatment of Syndromic Craniosynostosis
Functional Problems
Neurosurgical Problems
Ocular Problems
Otological Problems
Airway and Feeding Problems
Congenital Heart Defects
Psychological Problems and Social Function
Surgical Treatment of Syndromic Craniosynostosis
Management in Infancy
Management of Midface Deformity in Childhood and Adolescence
Orthognathic Procedures for Definitive Occlusal Correction
Complications of Surgery for Syndromic Craniosynostosis
Conclusion
21-Orthognathic Surgery and Genioplasty
21 - Orthognathic Surgery and Genioplasty
ORTHOGNATHIC SURGERY
History
Dentofacial Relationships and Terminology
Clinical Evaluation
Radiography and Cephalometrics
Orthodontics
Surgical Anatomy, Treatment Planning, and Operative Management
Case Examples
Case 1: Mandibular Hypoplasia
Case 2: Mandibular Prognathism
Case 3: Mandibular Asymmetry
Case 4: Maxillary Transverse Deficiency
Special Considerations
GENIOPLASTY
Introduction
Surgical Anatomy
Indications for Genioplasty
Surgical Technique
Complications
22-Facial Reanimation
22 - Facial Reanimation
Introduction
Anatomy of the Facial Nerve
Intracranial Course
Extracranial Course
Anatomy of Potential Donor Nerves for Facial Reanimation
Masseteric Nerve
Hypoglossal Nerve
Spinal Accessory Nerve
Vascular Supply of the Face
Etiology of Facial Paralysis
Congenital
Birth Trauma
Möbius Syndrome
CHARGE Syndrome
Hemifacial Microsomia
Infectious
Bell’s Palsy
Ramsay Hunt Syndrome
Otitis Media/Mastoiditis
Cholesteatoma
Lyme Disease
Traumatic
Neoplastic
Systemic and Neurological
Clinical Examination
Diagnostic Studies
Management
Nonoperative Management
Operative Management
Management of the Brow
Management of the Eye
Management of the Mid- and Lower Face
Treatment in Children
Management in Adults
Isolated Marginal Branch Palsy
Conclusion
The Future
23-Head and Neck Malignancies
23 - Head and Neck Malignancies
Introduction
Evaluation of the Patient with Head and Neck Cancer
Medical History
Clinical Examination
Imaging Examination
Biopsy
Staging
Oral Cavity
Nasopharynx
Oropharynx
Hypopharynx
Larynx
Nasal Cavity and Paranasal Sinuses
Major Salivary Glands
N Staging for Tumors of the Head and Neck
TNM Stage Grouping for Primary Tumors of the Head and Neck Region
Neck Dissections
Cervical Lymph Node Levels
Patterns of Metastasis
Indications for Neck Dissection
Types of Neck Dissection
Radical Neck Dissection
Extended Radical Neck Dissection
Modified Radical Neck Dissection
Selective Neck Dissection
Sentinel Lymph Node Biopsy
Management of the Neck after Chemoradiotherapy
Postoperative Complications
Radiotherapy
24-Oral Tongue and Mandibular Reconstruction
24 - Oral Tongue and Mandibular Reconstruction
Introduction
Normal Anatomy and Function of Oral Tongue and Mandible
Anatomy of the Tongue
Function of the Tongue
Anatomy of the Mandible
Etiology and Classification System
Etiology
Classification of Oral Tongue Defects
Classification of Mandibular Defects
Reconstruction Principles
Patient Evaluation
Reconstruction Preparation and Logistics
Tongue Reconstruction Goals and Surgical Pearls
Mandibular Reconstruction Goals and Surgical Pearls
Surgical Options
Tongue Reconstruction with Non-Flap Options
Tongue Reconstruction with Intraoral Flap Techniques
Mandible Reconstruction with Nonmicrosurgical Techniques
Regional Flap Reconstruction for Oral Tongue and Mandibular Defects
Soft Tissue Regional Flaps
Submental Artery Flap
Pectoralis Major Myocutaneous Flap
Supraclavicular Artery Island Flap
Bone-Bearing Regional Flaps
Pectoralis Major Osteomusculocutaneous Flap
Microsurgical Reconstructions of Oral Tongue and Mandible
Soft Tissue Free Flaps
Radial Forearm Free Flap
Gracilis Flap
Anterolateral Thigh (ALT) Flap
Profunda Artery Perforator (PAP) Flap
Medial Sural Artery Perforator (MSAP) Flap
Thoracodorsal Artery Perforator (TDAP) Flap
Fibula Flap
Deep Circumflex Iliac Artery (DCIA) Flap
Scapular Osteomusculocutaneous Flap
Defect-Directed Reconstruction
Tongue Reconstruction
Tongue-Only Defect Reconstruction
Small Tongue Defects
Presulcal Glossectomies with No Tongue Base or Floor of Mouth Involvement
Glossectomies Involving the Tongue Base
Glossectomies Involving the Floor of Mouth
Free Flap Selection for Segmental Mandibular Reconstruction
Technique of Mandibular Reconstruction with Free Fibula Osteoseptocutaneous Flap
Soft Tissue Reconstruction in Composite or Compound Mandibular Defects
Marginal Mandibulectomy Reconstruction
Reconstruction of Extensive Oromandibular Defect
Osseointegration
Postoperative Complications and Management Approach
Computer-Assisted Surgery and Jaw-in-a-Day
Conclusion
25-Midface Reconstruction
25 - Midface Reconstruction
Introduction
Reconstructive Approach
Reconstruction of the Palate and Alveolus
Posterior Defects
Hemipalatoalveolar Defects
Bilateral Palatoalveolar Defects
Reconstruction of the Orbital Walls
Orbitomaxillectomy (Maxillectomy with Orbital Exenteration)
Complications
Outcomes and Conclusions
26-Pharyngeal Reconstruction
26 - Pharyngeal Reconstruction
Introduction
Pathology
Anatomy
Indications for Surgery and Reconstruction
Classification of Pharyngeal Defects
Historical Perspectives
Assessment and Planning
Reconstruction
Reconstructive Options
Local Flaps
Regional Flaps
Pectoralis Major
Free Flaps
Free Jejunum
Free Skin Flaps
Tubed Anterolateral Thigh Flap
Tubed Radial Artery Forearm Flap
Miscellaneous Flaps
Complications
Radiotherapy
Flaps
Pectoralis Major
Free Jejunum Flaps
Radial and ALT Flaps
Voice
Voice Rehabilitation Devices
Neoglottis
Tracheoesophageal Puncture and Prosthesis
Visceral Voice Tube Reconstruction
Complications and Clinical Outcomes
Study Results
Management Strategies for Major Flap Complications
Fistulae and Strictures
Flap Type
Flap Failure
Future Directions and Tissue Engineering
27-Reconstruction of the Skull Base
27 - Reconstruction of the Skull Base
Introduction
Anatomy
Reconstructive Approach
Region I
Region II
Region III
Technical Points
Postoperative Care and Management of Complications Specific to Skull Base Reconstruction
28-Cheek Reconstruction
28 - Cheek Reconstruction
Introduction
Anatomy
Esthetic Subunits
Skeletal
Layers
Fascia
Muscles
Arteries
Veins
Lymphatics
Nerves
Management
Secondary Intention
Direct Closure
Tissue Expansion
Local Flaps
Cheek Rotation-Advancement and Cervicofacial Flaps
Regional Flaps
Skin Grafts
Free Flaps
Prefabrication and Allotransplantation
Complications
Contour Defects
Conclusion
29-Lip Reconstruction
29 - Lip Reconstruction
Introduction
Anatomy
Embryology
Musculature
Vasculature
Lymphatic Drainage
Innervation
Etiology of Lip Defects
Reconstruction: General Principles
Goals
Anesthesia
Analysis of the Defect
Site
Size
Depth
Involvement of Commissure
Algorithm for Reconstruction
Vermilion Defects
Full-Thickness Lower Lip Defect
Defects Less than One-Third Width
Defects between One- and Two-Thirds Width
Defects More than Two-Thirds Width or Total Lip Defect
Full-Thickness Upper Lip Defect
Defects Less than One-Third Width
Defects between One-Third and Two-Thirds Width
Defects More than Two-Thirds Width or Total Lip Defect
Commissuroplasty
Conclusion
30-Nasal Reconstruction
30 - Nasal Reconstruction
Introduction
Surgical Anatomy
Nasal Skeleton
Nasal Lining
Nasal Cover
Blood Supply
Innervation
Principles of Reconstruction
Presurgical Evaluation
Defect Analysis
Three-Layered Reconstruction
Subunit Principle
Small and Superficial Defects
Secondary Intention Healing
Direct Closure
Full-Thickness Graft
Local Skin Flaps
Dorsal Nasal Flap (Rieger’s Flap)
Bilobed Flap
V–Y Flap Based on Perforators from the Facial Artery
Single-Stage Regional Skin Flaps
Glabellar Flap
Single-Stage Nasolabial Flap
Large and/or Deep Defects
Skin Replacement
Two-Stage Nasolabial Flap
First Stage
Second Stage
The Two-Stage Paramedian Forehead Flap
Vascular Supply of the Forehead Flap
First-Stage
Second Stage
The Three-Stage Paramedian Forehead Flap
Lining Restoration
Full-Thickness Skin Graft
Prefabricated Forehead Flap
“Classical” Skin Graft
Hingeover Flaps
Intranasal Lining Flaps
Residual Nasal Lining Advancement
Bipedicle Flap
Ipsilateral Septal Flap
Contralateral Septal Flap
Septal Pivot Composite Flaps
Alloplast
Regional Flaps
Three-Stage Folded Forehead Flap
Distant Free Flaps
Structural Support
Midline Support
Hinged Septal Flap
Septal Pivot Flap
Cantilever Rib Graft
Lateral Support
Free Cartilage Graft
Composite Cartilage Graft
Alloplasts
Composite and Extended Defects
Use of an Algorithm for Flap Selection for Nasal Reconstruction
Proximal Third
Medial Third
Distal Third
31-Eyelid Reconstruction
31 - Eyelid Reconstruction
Introduction
Periocular Physiology
Periocular Anatomy: Fundamentals of Eyelid Anatomy
General Principles of Reconstruction
Techniques
Anterior Lamellar Defects
Primary Closure
Local Flaps
Advancement Flaps
Transposition Flaps
.8 A bipedicled flap designed to reconstruct a lower eyelid defect using upper eyelid tissue in patients who have adequate upper...
Technique
Postoperative Management. Topical ophthalmic ointment and ice packs are applied three times daily. Sutures are removed in 5–7 da...
. The Fricke flap is a similar, though less frequently utilized, transposition cutaneous flap from the supraorbital area for bot...
Rhomboid Flap
Full-Thickness Skin Grafts (Fig. 31.6)
Technique
Mustardé Cheek Rotation Flap11 (Fig. 31.7)
Technique
Full-Thickness Eyelid Defects
Primary Eyelid Margin Closure
Technique (Fig. 31.8)
The Tenzel Semicircular Advancement Flap12–14
The Tarsoconjunctival Advancement Flap: Hughes15–17
Technique
Postoperative Management. Topical ophthalmic ointment is applied three times daily. The conjunctival flap is divided in 2–6 week...
Technique
The Tarsoconjunctival Advancement Flap: Cutler–Beard20
Posterior Lamellar Grafting
32-Ear Reconstruction
32 - Ear Reconstruction
Introduction
Initial Assessment Concerning a Posttraumatic Amputation
Mechanism of Ear Amputation
Clean Amputations
Crush Injury
Burn Injury
Analysis of the Defect
Analysis of the Skin Potential
Reconstruction in Partial Amputations
Reconstruction Using Fibrocartilage
Harvesting the Fibrocartilage Graft
Case 1 (Fig. 32.2). Reconstruction in one stage using ipsilateral conchal graft. The defect is secondary to chondritis after tra...
Reconstruction Using Costal Cartilage
Cases with Normal Antihelix
Case 3 (Fig. 32.4). Clean amputation with a defect that is no more than two adjacent planes but more than a quarter of the ear o...
Case 4 (Fig. 32.5). The amputation is secondary to a human bite. An unsuccessful replantation has left a defect involving half o...
Case 5 (Fig. 32.6). Using a rib cartilage graft on a 60-year-old patient is possible as there is no correlation between the age ...
Case 6 (Fig. 32.7). The amputation is secondary to a dog bite. It is clear that part of the antihelix is missing and that the en...
Total and Subtotal Amputation
Technique
First Stage: Reconstruction of the Ear Contours
Harvesting Rib Cartilage
Carving the Framework
. We have established a classification for the different types of cartilaginous frameworks3
Insertion of the Framework Under the Auricular Skin
. If the retroauricular skin has not been damaged and has not been sutured under tension it can be used to cover the framework. ...
Case 7 (Fig. 32.10). Total amputation preserving the tragus on an adult patient 55 years old. A preoperative computed tomography...
. It is very important to appreciate the elasticity of the retroauricular skin to decide if it can adapt to a 3D framework witho...
Case 8 (Fig. 32.11). In this case a type III framework was carved as tragus and antitragus have been preserved. To avoid excessi...
. When there are scars in the retroauricular area that impair skin vascularity making it impossible to cover the framework witho...
Case 9 (Fig. 32.12). After a road traffic accident, the auricular region had been grafted. A temporoparietal fascia is indicated...
Second Stage: Reconstruction of the Retroauricular Sulcus
Prosthesis
Complications
Infection
Skin Necrosis
Case 11 (Fig. 32.14). A small exposure can be managed with correct local treatment inducing spontaneous healing
Case 12 (Fig. 32.15). When skin necrosis is responsible for a large exposure of the framework, a fascial flap can save the situa...
Algorithm
33-Scalp and Calvarial Reconstruction
33 - Scalp and Calvarial Reconstruction
Introduction
Anatomy of the Scalp
Anatomical Layers
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
Motor Nerves
Sensory Nerves
Reconstructive Principles
Patient Evaluation and Examination
Reconstruction Goals
Reconstruction Options
Healing by Secondary Intention
Primary Closure
Skin Grafts, Adjuvant Techniques, Dermal Matrix and Dermal Substitutes
Locoregional Flaps
Tissue Expander
Microsurgical Free Tissue Transfer
Scalp Replantation
Minimization of Iatrogenic Alopecia
Hair Restoration
Allotransplantation
Conclusion
34-Facial Trauma
34 - Facial Trauma
Introduction
Frontal Bone and Naso-orbital Fractures
Anatomy
Management Principles
Initial Management
Emergency Assessment and Resuscitation
Airway
Breathing
Circulation
Clinical Assessment
Imaging
Early Imaging
Later Imaging
Definitive Management
Operative Surgical Principles
Bone Grafting
Donor Sites
Operative Management
Naso-orbito-ethmoid Fractures
Classification
Principles of Treatment
Operative Management
Zygomatico-maxillary Fractures
Anatomy
Classification
Clinical Assessment
Imaging
Principles of Management
Isolated Zygomatic Arch Fractures
Orbitozygomatic Fractures
Complications
Zygoma
The Maxillae
Orbital Fractures
Anatomy
Surgical Pathology and Pathogenesis
Clinical Assessment
Imaging
Management
Complications of Orbital Fractures
Mandible Fractures
Anatomy
Clinical Assessment
Imaging
Early Management
Timing of Definitive Treatment
Conservative Management
Principles of Operative Fixation
Miniplate Osteosynthesis
Compression Plates
Operative Management According to Champy
Complications of Fractures of the Body and Angle of the Mandible
Infection
Nonunion
Malocclusion and Malunion
Plate Exposure
Nerve Injury
Fractures and Fracture Dislocations of the Condyle
Surgical Pathology
Attempts at Classification
Clinical Assessment
Radiological Assessment
Principles of Treatment
Operative Management
Complications of Condylar Fractures
Growth Disturbance
Avascular Necrosis
Ankyloses of the Temporomandibular Joint
Malunion and Other Temporomandibular Joint Dysfunctions
35-Breast Augmentation
35 - Breast Augmentation
Introduction
Implant Evolution
Indications
Assessment and Implant Selection
Operative Techniques
Preoperative Markings
Access Incisions
Periareolar
Transaxillary
Transumbilical
Pocket Creation
Submuscular
Dual Plane
Subfascial
Authors’ Preference
Complications and Treatment
Surgical Complications
Device Failure
Infection and Exposure
Late Seromas
Esthetic Outcomes Complications
Rotation
Malposition
Wrinkling/Rippling
Asymmetries
NAC Sensory Changes
Scar Formation
Capsular Contracture
Pathophysiology and Study Outcomes
Access Incision
Implant Type
Surgical Pockets
. A systemic review published in 2018 reviewed the results of various trials comparing polyurethane, textured, and smooth implan...
. A study of 55 breasts, the only randomized trial of this kind, compared silicone implants placed in the submuscular pocket. Th...
Periprosthetic Drains
Perioperative Antibiotics and Pocket Irrigation
Treatment of Capsular Contracture
Breast Implant-Associated Illnesses
Breast Implant-Associated Anaplastic Large Cell Lymphoma
Incidence
Pathophysiology
Management
Prognosis
Patient Counseling
Autologous Fat Grafting
Basic Sciences and Oncogenesis
Efficacy
36-Breast Reconstruction
36 - Breast Reconstruction
Introduction
Reconstructive Goals
Mastectomy Incisions
Nipple-Sparing Mastectomy
Skin-Sparing Mastectomy
Non-Skin-Sparing Mastectomy or Delayed Reconstruction
Wise Pattern Mastectomy
Autologous Tissue Breast Reconstruction
Abdominally-Based Flaps
Pedicled Transverse Abdominis Myocutaneous Flap (pTRAM)
History
Patient Selection
Surgical Technique
Outcomes
Patient Selection
Surgical Technique
Outcomes
Patient Selection
Surgical Technique
Outcomes
Patient Selection
Surgical Technique
Outcomes
Thigh-Based Flaps
Gracilis Flaps
Transverse Upper Gracilis (TUG)/Transverse Myocutaneous Gracilis (TMG) Flap
History
Patient Selection
Surgical Technique
Outcomes
Diagonal Upper Gracilis (DUG) Flap
History
Surgical Technique
Outcomes
Profunda Artery Perforator (PAP) Flap
History
Patient selection
Surgical Technique
Outcomes
Lateral Thigh Perforator (LTP) and Septocutaneous Tensor Fascia Lata (scTFL) Flap
History
Patient Selection
Surgical Technique
Outcomes
Gluteal Flaps
Patient Selection
Surgical Technique
Outcomes
Implant Breast Reconstruction
History
Types of Implants
Patient Selection
Implant Reconstruction Surgical Technique
Direct to Implant (DTI) Reconstruction
Tissue Expander/Implant (TE-I) Reconstruction
Prepectoral Tissue Expander Technique
Subpectoral Tissue Expander Technique
Outcomes
Overall Complications
Implant Leak and Capsular Contracture
Implants and Radiation
Latissimus Dorsi Flap
History
Patient Selection
Surgical Technique
Outcomes
Conclusions
37-Congenital Breast Anomalies
37 - Congenital Breast Anomalies
Embryology
Polythelia and Polymastia
Gynecomastia
Virginal Hypertrophy
Athelia and Amastia
Tuberous Breast
Poland Syndrome
Breast Hypoplasia
38-Mastopexy and Breast Reduction
38 - Mastopexy and Breast Reduction
Introduction
Macromastia
Assessment
History
Examination and Photographs
Management Principles and Operative Options
Reduction/Mastopexy
Pedicle Design
Skin Resection Pattern
Indications
Operative Technique for Superomedial Vertical Breast Reduction
Assessment
Markings
Positioning
Infiltration
Technique (Fig. 38.831)
De-epithelialization
Pedicle Creation
Parenchymal Resection
Pillar Closure
Skin Closure
Areolar Closure
Liposuction for Tailoring
Drains
Antibiotics
Taping and Garments
Operative Technique for Vertical Mastopexy
Operative Technique for Vertical Augmentation-Mastopexy
Complications
39-Chest Wall Reconstruction
39 - Chest Wall Reconstruction
Overview of the Thoracic Cage
Congenital Defects
Pectus Deformities
Pectus Excavatum
Morphologic Varieties
Epidemiology
Clinical Evaluation
Imaging
Functional Assessment
Surgery for Pectus Excavatum
Timing
Influence of Morphology
Nuss Procedure
. We elect to remove the bar anywhere between 2 and 3 years. Although the bar can be left in for 4 years without problems, the l...
Pectus Carinatum
Surgery for Pectus Carinatum
Timing of Operations
Reconstructive Aims
Technique of Repair
Poland Syndrome
Epidemiology and Etiology
Reconstructive Aims and Indications for Surgery
Surgical Management
Sternal Cleft
Jeune Syndrome: Asphyxiating Thoracic Dystrophy
Epidemiology and Clinical Features
Chest Wall Surgery
Acquired Defects
Sternal Wound Dehiscence
Etiology
Preoperative Management
Debridement
Negative-Pressure Therapy
Neoplasms
Chest Wall Radiation
Chest Wall Trauma
Reconstruction of Chest Wall Defects
Restoring Stability of the Thoracic Cage
Choice of Structural Support
Soft Tissue Coverage
Pectoralis Major Flap
Omental Flap
Latissimus Dorsi (LD) Flap
Rectus Abdominis
Congenital Chest Wall Defects in the Adult Patient
40-Abdominal Wall Reconstruction
40 - Abdominal Wall Reconstruction
Anatomy
Skin, Subcutaneous Fat, and Fascia
Muscles
Blood Supply
Innervation
Fascia
Etiology and Classification of Abdominal Wall Hernia Defects
Assessment of the Abdominal Wound
Clinical
Imaging
Goals of Reconstruction
Management of Abdominal Wounds
Acute Wounds
Chronic Wounds
Management of Fascial Defects
Synthetic Mesh
Biologic Mesh
Surgical Techniques for Mesh Placement
Components Separation
Soft Tissue Reconstruction in Abdominal Wall Reconstruction
Skin Advancement and Direct Closure
Flap Reconstruction
Abdominal Wall Transplantation
Management of the Postoperative Bulge
Conclusion
41-Genitourinary and Perineal Reconstruction
41 - Genitourinary and Perineal Reconstruction
Perineal Reconstruction
Introduction
Anatomy of the Blood Supply of the Perineum
Reconstruction of the Perineum
Reconstructing the Perineal Body
Regional Flaps
Deep Inferior Epigastric Artery-Based Flaps
Lateral Circumflex Femoral Profunda Artery-Based Flaps
Gluteal Artery-Based Flaps
Posterior Thigh Flap
Medial Circumflex Femoral Profunda Artery-Based Flaps
Discussion
Genital Reconstruction
Introduction
Vaginal Reconstruction
Nonsurgical Options
Surgical Options
Complications
Penile Reconstruction
Surgical Options
Subtotal Reconstruction
Total Reconstruction
Gender-Affirming Surgery
Conclusion
Hypospadias
Introduction
Classification
Incidence and Etiology
Associated Anomalies
Management
Nonoperative Management
Surgical Principles
Correction of Chordee
Reconstruction of the Urethra
Reconstruction of the Penile Shaft Skin
Surgical Techniques
Tubularised Incised Plate (Snodgrass) Repair
Operative Technique
Degloving the Penis and Chordee Correction
Urethroplasty
Skin Closure and Dressing
Skin Closure and Dressing
Outcomes
First-Stage Operative Technique
Degloving and Chordee Correction
Harvesting the Graft
Securing and Immobilizing the Graft
Postoperative Care
Second-Stage Operative Technique
Outcomes
Complications
Bleeding
Infection
Meatal Stenosis
Urethrocutaneous Fistula
Urethral Stricture
42-Pressure Injuries
42 - Pressure Injuries
Introduction
Epidemiology
Pathophysiology
Prevention
Assessment of Risk
Prevention Strategies
Assessment of the Patient with a Pressure Sore
Patient Assessment
Wound Assessment
Initial Management
Wound Care
Pain Control
Nutrition
Adjunctive Treatments
Surgical Debridement
Reconstruction
Preoperative Management
Reconstructive Ladder
Reconstructive Techniques by Location
Sacral
Ischial
Trochanteric
Heel and Lateral Malleolus
Last Resort
Postoperative Care
Conclusion
43-Lower Limb Reconstruction
43 - Lower Limb Reconstruction
Introduction
History
Initial Management
Injury Classification
Orthoplastic Approach
Compartment Syndrome
Vascular Injury
Antibiotics
Wound Debridement
Principles of Skeletal Fixation
External Fixation
Plates and Screws
Intramedullary Nailing
Principles of Soft Tissue Reconstruction
Timing
Reconstructive Ladder versus Reconstructive Elevator
Rule of Thirds
Locoregional Flaps
Local Muscle Flaps
Gastrocnemius Flap
Soleus Flap
Other Muscle Flaps
Local Fasciocutaneous Flap
Perforator Flaps
Free Flaps
Choice of Muscle versus Fasciocutaneous Flaps
Skeletal Reconstruction
Amputation
Outcomes, Patient Satisfaction, Cost–Utility
Amputation Surgery
Complications
Wound Complications
Infection/Osteomyelitis
Key Points
44-Lymphedema
44 - Lymphedema: Anatomy, Pathophysiology, Evaluation, and Treatment
Introduction
Anatomy of the Lymphatic System
Lymphatic Capillaries and Collectors
Lymph Nodes
Etiology of Lymphedema
Primary Lymphedema
Secondary Lymphedema
Risk Factors for Lymphedema
Pathophysiology of Secondary Lymphedema
Lymphedema Diagnosis
Physical Examination
Quantification of Swelling and Diagnosis of Lymphedema
Bioimpedance and Estimation of Fluid Content
Imaging
Lymphoscintigraphy
Magnetic Resonance Imaging/Angiography
Indocyanine Green Lymphography
Lymphedema Classification
International Society of Lymphology (ISL) Staging
NECST Classification System
Koshima ICG Classification System
MD Anderson ICG Classification System
Lymphedema Treatment
Medical Treatments
Weight Loss and Exercise
Decongestive Therapy, Compression, Intermittent Pneumatic Pumps
Low-Level Laser Therapy
Stem Cells
Lymphangiogenic Growth Factors
Antiinflammatory Treatments
Surgical Treatments
Reductive Methods
Physiological Methods
Lymphovenous Bypass
Vascularized Lymph Node Transplantation (VLNT)
Conclusions
45-Congenital Hand Differences
45 - Congenital Hand Differences
Embryology
Timeline
Limb Patterning
Classification
Syndactyly
Classification
Clinical Examination
Surgical Principles and Management
Timing of Surgery
Technique
Web Reconstruction
Reconstruction of the Sides of Digits
Tips
Clinodactyly
Clinical Assessment
Surgical Principles and Management
Camptodactyly
Pathology
Clinical Assessment
Surgical Principles and Management
Preferred Method of Surgical Correction
Duplication
Radial Polydactyly
Clinical Examination
Surgical Principles and Management
Unbalanced Distal Duplications
Balanced Distal Duplications
Correction of Type IV Duplications
Correction of Proximal Duplications (Wassel Types V, VI, and VII)
Ulnar Polydactyly
Classification
Clinical Examination
Surgical Principles and Management
Type II (Fig. 45.12C)
Type III (Fig. 45.12D, E)
Central Polydactyly
Macrodactyly
Surgical Principles and Management
Thumb Hypoplasia
Classification
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Surgical Principles and Management
Pollicization
Radial Longitudinal Deficiency
Etiology
Associated Syndromes
Hematological
Cardiac
Vacterl Association
Classification
Clinical Findings
Upper Arm
Elbow
Forearm
Carpus
Hand
Surgical Principles and Management
Soft Tissue Distraction
Wrist Correction
Alternative Procedures in Radial Dysplasia
Constriction Ring Syndrome
Etiology
Clinical Presentation
Classification
Surgical Principles and Management
Method of Constriction Ring Correction
Toe-to-Hand Transfers
Distraction Lengthening
Digital Transposition
Arthrogryposis
Etiology
Clinical Findings
Upper Limbs (Fig. 45.24)
Lower Limbs
Other Common Features
Surgical Principles and Management
Timing of Surgery
Aims of Treatment of the Upper Limb
Surgical Options by Region
Shoulder
Elbow
Wrist
Thumb
Fingers
Trigger Thumb
Etiology and Presentation
Surgical Principles and Management
46-Fingertip Injuries
46 - Fingertip Injuries
Introduction
Assessment
Healing by Secondary Intention
Surgical Options for Cover
Amputation
Options for Skin Cover
Skin Grafts
Points of Technique
Split-Thickness Skin Graft
Full-Thickness Skin Graft
Flap Cover
Flaps with Less than Pulp-Quality Sensation
The Kite Flap
Important Points of Technique
Advantages
Disadvantages
Delayed, Staged, Flaps
The Principle of Delay
The Cross Finger Flap
Important Points of Technique
Advantages
Disadvantages
Distant, Delayed Flaps
Flaps with Pulp-Quality Sensation
The Atasoy Flap17
Important Points of Technique
The Thenar Advancement Flap
Important Points of Technique
The Advancement Rotation Flap
Important Points of Technique
The Island Flaps, Homodigital and Heterodigital
Important Points of Technique
Free Pulp Transfer
Important Points of Technique
The Bank Digit
Venous Flaps
Advantages
Disadvantages
Points of Technique
The Nail
Psychological Aspects of Hand Injuries
Conclusions
47-Flexor Tendon Injuries
47 - Flexor Tendon Injuries
Introduction
Anatomical Features
Zones and Subzones of Flexor Tendons
Biomechanical Considerations
Factors Affecting the Strength of Repaired Tendons
Factors Affecting the Resistance to Tendon Gliding after Surgery
Clinical Diagnosis
Primary and Delayed Primary Repair
Repair in Zone 2
Exposure and Finding Tendon Ends in Zone 2
Surgical Repair Techniques
Venting of the Critical Pulleys
Performing Digital Extension–Flexion Test
Postoperative Active Motion Protocols
More Recent Evolution of Methods
Repair in Other Zones and the Thumb
Zone 1
Zone 3, 4, and 5
Thumb Flexor Tendon
Repair of Partial Tendon Laceration
Flexor Tendon Repairs in Children
Closed Rupture of the Flexor Tendons
Outcomes
Tenolysis
Anesthesia
Operative Techniques
Intraoperative Judgment of Tendon and Pulley Quality
Tendon Grafting, Pulley Reconstruction, and Staged Reconstruction
One-Stage Tendon Grafting
Pulley Reconstructions
Staged Tendon Reconstruction
The Surgery at the First Stage
The Surgery at the Second Stage
Postoperative Care
48-Extensor Tendon Injuries
48 - Extensor Tendon Injuries
Extensor Tendon Injuries
Extensor Tendon Injuries
Extensor Tendon Injuries
Anatomy
Wrist and Hand
Fingers
Thumb
Presentation and Management by Zone
Zone I: Dorsal Interphalangeal Joint
Zone II Injuries: Middle Phalanx
Zone III Injuries: Proximal Interphalangeal Joint
Acute Closed Injuries
Acute Open Injuries
Chronic Closed Injuries
Zone IV Injuries: Proximal Phalanx
Zone V Injuries: MCP Joint
Closed Injuries
Open Injuries
Zone VI: Dorsum of Hand
Zone VII: Wrist
Acute Injuries
Chronic/Attrition Injuries
Zone VIII: Proximal and Distal Forearm
Injuries to Extensor Tendons of the Thumb
Zone TI: Interphalangeal (IP) Joint
Open Injuries
Closed Injuries
Zone TII: Proximal Phalanx of the Thumb
Zone TIII: Metacarpophalangeal (MCP) Joint of the Thumb
Zones TIV and TV: First Metacarpal and Carpometacarpal Joint
Open Injuries
Closed Injuries
Summary
49-Tendon Transfers
49 - Tendon Transfers
Introduction
Indications
Biomechanics
Power and Leverage
Tendon Excursion
Tensioning
Principles
General Approach
Surgical Technique
Radial Nerve Palsy
Anatomy5,10,12
Clinical Findings12
Approach5,12,13
Wrist Extension
Metacarpophalangeal Joint Extension
Thumb Extension
Median Nerve Palsy
Anatomy5,10,15
Clinical Findings15–17
Approach13,15–17
Thumb Opposition (Opponensplasty)
Thumb IP and Index DIP Joint Flexion
Ulnar Nerve Palsy
Anatomy5,10,15
Clinical Findings15–17
Approach13,15–17
Thumb Adduction (Adductorplasty)
Correction of Clawing
Combined Palsy
Tetraplegia
Classification
Multidisciplinary Team
Timing of Surgery
Assessment
Examination
Preparation
Approach
Elbow Extension
Forearm Reconstruction
Recent Advances
Postoperative Care
Conclusion
50-Digital Replantation and Thumb Reconstruction
50 - Digital Replantation and Thumb Reconstruction
Introduction
Indications for Replantation
Functional Loss Assessment
Normal Hand Function
Assessment of the Functional Capacity of the Amputated Part
Contraindications
Patient Factors
Digit Factors
Technique and Principles
Multiple Digital Replantation
Ring Avulsion Injury
Postoperative Care
Monitoring and Reexploration
Smoking
Anticoagulation
Rehabilitation
Psychosocial Aspects of Replantation
Complications
Early
Late
Thumb Reconstruction
Soft Tissue Loss
Dorsal
Volar
Total Degloving
Amputation Level
Principles of Reconstruction
Distal Thumb Reconstruction
Mid-thumb Reconstruction
Proximal Thumb Reconstruction
Toe Transfer Technique
Whole Toes
Hemi-pulps
Wrap-around Flap
Distraction Lengthening
Pollicization
Phalangization
Web Space Reconstruction
Metacarpal Hand
51-Compartment Syndrome in the Extremities
51 - Compartment Syndrome in the Extremities
Introduction
Anatomy
Fascia
Upper Extremity
Forearm
Hand
Lower Extremity
Lower Leg
Foot
Pathophysiology
Subjective
Objective
Intracompartmental Pressure
Near‐Infrared Spectroscopy
Treatment
Upper Extremity
Forearm
Hand and Wrist
Lower Extremity
Lower Leg
Two‐Step Anterolateral and Posteromedial Approach
Recommendation
Foot
Late Sequelae
Volkmann’s Contracture of the Upper Extremity
Volkmann’s Contracture of the Lower Leg
52-Nerve Injury
52 - Nerve Injury, Repair, and Reconstruction
Introduction
Nerve Injury Classification
Clinical Classification of Nerve Injuries by Mechanism
Crush Injuries
Traction and Avulsion Injuries
Penetrating Injuries
Evaluation of Nerve Injuries
Factors Affecting Nerve Recovery in Nerve Repair
Type of Injury
Timing of Repair
Tension and Nerve Repair
Techniques: Epineural versus Fascicular Repair
Technology: Intraoperative Nerve Stimulation
Nerve Reconstruction
Nerve Grafting
Short Nerve Gaps (≤6 cm)
Long Nerve Gaps (>6 cm)
Nerve Transfers
End‐to‐Side and Reverse End-to-Side Nerve Transfers
Postoperative Management and Long-Term Sequelae
Postoperative Mobilization
Postoperative Neuropathic Pain
Neuroma
Complex Regional Pain Syndrome
Clinical Features and Diagnosis
Pathophysiology
Treatment
Acute Treatments
CRPS Persisting Greater than 6 Months
Treatment of Chronic Persistent CRPS
Summary
53-Brachial Plexus Injuries and Reanimation
53 - Brachial Plexus Injuries and Reanimation
Roots
Trunks
Divisions
Cords
Branches
Clinical History and Assessment
Etiology
Traumatic
Iatrogenic
Compression
Neuralgic Amyotrophy
Radiation
Investigations
Imaging
Electrodiagnostic Studies
Patterns of Injury
Upper Plexus Injuries
Lower Plexus Injuries
Posterior Cord Injury
Pan-Plexus Injuries
Obstetrical Brachial Plexus Injuries
Management Principles and Operative Approach
Timing
Priorities to Establishing Function
Exploration of the Brachial Plexus
Restoring Elbow Flexion
Restoring Shoulder Function
Restoring Hand Function
Restoring Function after Obstetrical Brachial Plexus Palsy
Restoring Sensation
Postoperative Care
Complications
Outcomes
Summary
54-Nerve Compression
54 - Nerve Compression
Pathophysiology
Response to Chronic Compression
Classification of Nerve Injury
Clinical Evaluation
Investigations
Electrodiagnostic Studies
Imaging
Median Nerve Compression
Anatomy
Carpal Tunnel Syndrome
Clinical Presentation
Management
Open Carpal Tunnel Release (Fig. 54.3)
Pronator Syndrome
Clinical Presentation
Management
Median Nerve Decompression in the Forearm (Fig. 54.4)
Anterior Interosseous Nerve Syndrome
Palmar Cutaneous Nerve Compression
Ulnar Nerve Compression
Anatomy
Cubital Tunnel Syndrome
Clinical Presentation
Management
Ulnar Nerve Transposition (Fig. 54.6)
Guyon’s Canal Syndrome
Clinical Presentation
Management
Guyon’s Canal Release (Fig. 54.7)
Radial Nerve Compression
Anatomy
Radial Tunnel/Posterior Interosseous Nerve Syndrome
Clinical Presentation
Radial Tunnel Syndrome
PIN Syndrome
Management
Radial Tunnel Decompression (Fig. 54.8)
Superficial Radial Nerve Compression
Clinical Presentation
Management
Superficial Radial Nerve Decompression (Fig. 54.9)
Proximal Radial Nerve Compression
Clinical Presentation
Management
Radial Nerve Decompression at the Spiral Groove
55-Dupuytren Disease
55 - Dupuytren Disease
Introduction
Definition
Impact of DD and its Reflection in Patient-Rated Outcome Measures
Variable Disease Course of DD
Surgical Anatomy of the Palmar Fascia and Changes Found in DD
Palmar and Digital Fascias
Band and Cords
Etiology
Pathophysiology and Histology
Clinical Assessment and Differential Diagnosis
Grading Systems
Management Principles, Operative and Nonoperative Options, and their Outcome
Operative Treatments
Skin Management
Fascia Management: Transsection, Partial Excision, Total Excision
Combined Removal of Skin and Fascia
PIP Joint Management
Postoperative Management
Early Outcome, Complications, and Reconvalescence Time After Surgery
Medicinal Treatment as Adjunct to Surgery: Interposition Materials after SF
Nonoperative Treatments: Steroid and Collagenase Injections, Radiotherapy, Splinting
Long-Term Outcome
Definition of Recurrence
Durability of Operative Treatments
Long-Term Outcome of Nonoperative Treatments
Efficacy and Durability of Surgical Methods in Comparative Studies
Treatment of Recurrence
Rehabilitation
Conclusions/Personal View
56-Fractures and Dislocations in the Hand
56 - Fractures and Dislocations in the Hand
Introduction
Pediatric Fractures of the Digits
Assessment, Classification, Management, and Complications
Adult Fractures
Metacarpal Fractures
Neck
Intraarticular
Shaft
Base
Thumb Metacarpal Fractures
Phalanges
Distal Phalanx
Proximal and Middle Phalanx
Intraarticular Proximal Interphalangeal (PIP) Joint Fractures
Management of Other Soft Tissue Injuries
Volar Plate Injuries
Ulnar and Radial Collateral Ligament Injuries to the MCP Joint
Ulnar and Radial Collateral Ligament Injuries to the PIP and DIP Joints
Management Principles and Operative Options and Tips
Closed vs. Open
Complications
Outcomes
Final Comments
57-Osteoarthritis and Prosthetic Joints in the Hand
57 - Osteoarthritis and Prosthetic Joints in the Hand
Introduction
Osteoarthritis of the Small Joints of the Hand
Preoperative Evaluation
Distal Interphalangeal Joint Arthrodesis
Surgical Technique
Proximal Interphalangeal Joint Arthrodesis
Surgical Technique
Proximal Interphalangeal Joint Arthroplasty
Surgical Technique
Rehabilitation
Metacarpophalangeal Joint Arthroplasty
Surgical Technique
Rehabilitation
Osteoarthritis of the Thumb
Preoperative Evaluation
Resection Arthroplasty
Surgical Technique
Trapeziectomy with Ligament Reconstruction and Tendon Interposition
Surgical Technique
Thumb CMC Arthrodesis
Surgical Technique
Rehabilitation
58-Wrist Pathology
58 - Wrist Pathology
Physical Examination of the Wrist
Radial-Sided Wrist Pain
Central Wrist Pain
Ulnar-Sided Wrist Pain
Kienböck’s Disease
Clinical Evaluation
Staging and Treatment
Stage I
Stage II
Stage IIIA
Stage II and IIIA with Ulnar Negative Variance
Stage II and IIIA with Ulnar Positive or Neutral Variance
Stage IIIB
Stage IV
De Quervain’s Tenosynovitis
Scaphoid Fractures
Scaphoid Nonunions
Scapholunate Dissociation
Treatment
Perilunate and Lunate Dislocations and Fracture Dislocations
Lunotriquetral (LT) Dissociation
Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC)
59-Rheumatoid Arthritis of the Hand and Wrist
59 - Rheumatoid Arthritis of the Hand and Wrist
Definition
Diagnostic Criteria
Pathophysiology
Management Principles and Operative Options
Assessment and Evaluation
General Assessment
Radiological Features
Identifying Patients with Aggressive Disease
Assessment of Disease Activity
Assessment of Disability Status and Health Status
Surgical Options
Synovectomy and Tenosynovectomy
Wrist
Pathogenesis of Rheumatoid Wrist Disease
X-ray Assessment of the Rheumatoid Wrist
Classifications of Rheumatoid Wrist Disease
Partial Wrist Arthrodesis
Total Wrist Arthrodesis
Total Wrist Arthroplasty
Distal Radioulnar Joint
Digital Extensor Deficiency
Flexor Tendon Rupture
Rheumatoid Digital Joint Replacements
Rheumatoid Digital Deformities
Rheumatoid Thumb Deformities
60-Lesions of the Hand
60 - Lesions of the Hand
Introduction
History, Examination, and Diagnosis
Imaging
Principles of Biopsy
Narrowing the Differential
Soft Tissue
Skin
Epidermal Inclusion Cysts
Warts
Primary Malignancies of the Skin
Fat
Lipoma
Lipoblastoma
Other
Connective Tissue
Ganglion Cyst
Giant Cell Tumor
Fibroma
Vascular
Pyogenic Granuloma
Glomus Tumor
Hemangioma
Vascular Malformations
Low-Flow Lesions
High-Flow Lesions
Nerve
Schwannoma
Neurofibroma
Granular Cell Tumor
Perineurioma
Other Benign Nerve Tumors
Malignant Peripheral Nerve Sheath Tumors
Soft Tissue Sarcomas
Cartilage
Enchondroma
Extraskeletal Chondroma
Periosteal Chondromas
Osteochondroma
Chondrosarcoma
Bone
Benign
Giant Cell Tumor
Aneurysmal Bone Cyst
Osteoid Osteoma
Malignant
Osteosarcoma
Ewing’s Sarcoma
Metastatic Disease
Conclusion
61-Nonoperative Facial Rejuvenation
61 - Nonoperative Facial Rejuvenation
Introduction
Botulinum Toxin
Formulations
Cosmetic Uses of BoNT-A
Adverse Effects and Complications
Soft Tissue Fillers
Historic Context
Rheological Properties
Nonbiodegradable Fillers
Biodegradable Fillers
Poly-L-lactic acid (PLLA)
Hyaluronic Acids (HA)
. Uses of HA include volume augmentation of the bony support of the face (e.g., malar area or mandible), replenishment of atroph...
Complications
Submental Fullness
ATX-101 (Deoxycholic Acid) (Kybella)
Cutaneous Remodeling
Microdermabrasion
Chemical Peels
Platelet-Rich Plasma (PRP)
Microneedling
Radiofrequency
Microfocused Ultrasound (MFU)
Lasers and Intense Pulsed Light (IPL) Technology
Conclusion
62-Facial Aging and Anatomy of the Facial Nerve
62 - Facial Aging and Anatomy of the Facial Nerve
Introduction
Five-Layered Anatomy, Facial Soft Tissue Spaces, and Retaining Ligaments of the Face
Layer 1 – Skin
Layer 2 – Subcutaneous Tissue
Layer 3 – Musculoaponeurotic Layer
Layer 4
Layer 5
Facial Spaces
1. Upper Temporal Space
2. Prezygomatic Space
3. Premaxillary Space
4. Lower Premasseter Space
5. Middle Premasseter Space
Retaining Ligaments of the Face
Facial Nerve Branches
Aging Changes of the Face
Skin
Subcutaneous Tissue
Muscle Aging
Aging of the Facial Spaces and Retaining Ligaments
Bone Changes
Regional Changes Observed with the Aging Face
Temple and Forehead
The Midcheek
Lower Face
Summary
63-Forehead Lift
63 - Forehead Lift
Introduction
Patient Options in Forehead Rejuvenation
Identifying the Patient in Need of a Forehead Lift
Upper Facial Aging and Inappropriate Expressions
Facial Asymmetry
Eyebrow Esthetics and Planning Eyebrow Elevation
Eyebrow Position and Shape, and Influence on Expression
What Is More Important – Eyebrow Height or Shape
Is There a Relationship Between Lower Orbital Volume and Eyebrow Position
Is There a Relationship Between Upper Orbital Volume and Eyebrow Position
The Attractive Eyebrow – Authors’ Personal Guidelines
Foreheadplasty Techniques
Bicoronal Incision Foreheadplasty
Hairline and Partial Hairline Incision Foreheadplasty
Partial Hairline Forehead Lift Plan
Planning Treatment of the Corrugator Supercilii Muscles in Open Foreheadplasty Procedures
Supraciliary and Forehead Crease Incision Techniques
Closed, Short-Scar Foreheadplasty Procedures
Anesthesia
Operative Technique for Closed, Nonendoscopic Forehead Lift
Marking Incisions
Making Incisions
Forehead Flap Elevation
Releasing and Mobilizing the Lateral Brow
Drain Placement
Flap Repositioning
Flap Anchoring
Incision Closure
Corrugator Myoplasty
Dressings
Postoperative Care
Case Example (Fig. 63.50)*
64-Upper Eyelid Rejuvenation
64 - Upper Eyelid Rejuvenation
Introduction
Periorbital Aging
Anatomy
Patient Evaluation
Surgical Techniques
Marking
Anesthesia
Skin Incision and Excision
Orbital Fat
Additional Procedures
Skin Closure
Postoperative Care
Complications
Retrobulbar Hematoma
Lagophthalmos
Blepharoptosis
Medial Canthal Webbing
Conjunctivitis/Chemosis
Oversculpting/Hallowed Appearance
Epiphora/Dry Eye
Conclusion
65-Lower Eyelid and Midcheek Rejuvenation
65 - Lower Eyelid and Midcheek Rejuvenation
Introduction
The Youthful Midcheek
Changes of the Midcheek with Aging
Surgical Anatomy and Dissection Planes
Patient Selection
Nonsurgical Techniques
Complications of Injectables in the Midcheek
Surgical Correction of Midcheek Aging
Extended Transconjunctival Lower Eyelid Blepharoplasty
Markings and Preparation
Surgical Technique
Complications
Long-Term Effects of the Release of the Tear Trough Ligament and Its Associated Orbicularis Oculi Origins
Subciliary/Transcutaneous Approach
Preoperative Preparation
Surgical Technique
Postoperative Care
Complication
Discussion
Summary
66-Facelift
66 - Facelift
Introduction
The Aging Face
Subcutaneous Facelift
SMAS Manipulation Techniques
SMAS Plication/Imbrication
The Deep Plane and Composite Rhytidectomy
Lateral SMASectomy
Extended SMAS
The High SMAS Facelift
Subperiosteal Facelift
Minimal Access Cranial Suspension (MACS) Lift
Complications
Hematoma
Nerve Injury
Skin Loss
Unsatisfactory Scars
Infection
Senior Author’s Limited Dissection Composite Facelift Technique
67-Neck Lift
67 - Neck Lift
Introduction
Why Perform a Neck Lift
How Should a Neck Lift be Performed
Strategies for Neck Lift
Submental Liposuction
“Short-Scar” Neck Lift (Neck Lift with Submental Incision Only)
Neck Lift with a Chin Implant
“Extended” Neck Lift
Neck Lift with Facelift
Surgical Planning in Neck Lift
Planning the Submental Incision
Planning Treatment of the Platysma
Assessing Platysma Deformity
Assessing the Anatomical Basis of Neck Problems
Planning the Modification of the Submental Region
Identifying the Neck with Excess Subplatysmal Volume
Understanding the Distribution of Fat in the Neck
Planning Treatment of the Prominent Submandibular Gland
Preoperative Preparations and Care
Smokers and Former Smokers
Ultrasonic and Radiofrequency “Skin Shrinking” Treatments
Allocating Operating Room Time
Anesthesia
Surgical Technique
Submandibular Gland Reduction
Partial Digastric Myectomy
Anterior Platysmaplasty
Management of the Lateral Platysmal Border
Transverse Platysma Myotomy
Incision Closure
Postoperative Care
Sleeping and Head Position
Drain Removal
Case Examples
Case 1
Case 2
Case 3
Case 4
Case 5
68-Rhinoplasty
68 - Rhinoplasty
Introduction
Anatomy
Skin
Cartilaginous and Bony Support
Nasal Bones
Upper Lateral Cartilages
Lower Lateral Cartilages
Septum
SMAS
Blood Supply
Nerve Supply
Patient Assessment
History
Physical Examination
Photography
Rhinoplasty Dynamics
Operative Approach
Endonasal Rhinoplasty
External Approach (Open) Rhinoplasty
Tip and Lower Lateral Cartilages
Grafts
Spreader Grafts
Supportive Grafts
Alar Base Adjustments
Final Steps
Postoperative Care
Complications
Secondary and Tertiary Rhinoplasty
Evaluation
Operative History
Patient Reported Issues
Objective Issues
Skin
Structural Support
Operative Principles and Approach
Complications
69-Blepharoptosis
69 - Blepharoptosis
Definition
Anatomy
Etiological Factors
Preoperative Assessment
Treatment Principles
Congenital Ptosis
Surgery for Congenital Ptosis
Techniques
Levator Resection
Tarsoconjunctival Resection (Fasanella–Servat Procedure)5
Brow Suspension
Surgery for Blepharophimosis Syndrome
Medial Canthoplasty
Brow Suspension
Surgery for Jaw-Winking Ptosis
Levator Ablation
Surgery for Myopathic Ptosis
Levator Muscle Surgery in Myopathic Ptosis
Brow Suspension Surgery for Myopathic Ptosis
Surgery for Involutional Ptosis
Complications
Undercorrection
Overcorrection
Poor Lid Contour
Poor Eyelid Closure with Corneal Exposure
70-Liposuction and Liposculpture
70 - Liposuction and Liposculpture
Introduction
Harvest Site
Donor Site Preparation
Harvest Technique
Depth of Liposuction
Cannula Size
Parcel Size
Aspiration Technique
Processing Technique
Centrifugation, Filtration, Decanting, and Rolling Techniques
Washing
Pharmacological Additives
Injection Technique
Recipient Site
Intrinsic Patient Variability in Adipose Tissue
Volume Retention Over Time
Impact of Serial Fat Grafting
Role of ASCs in Fat Graft Survival
Complications and Emerging Safety Concerns
Conclusion
71-Abdominoplasty and Body Contouring
71 - Abdominoplasty and Body Contouring
Anatomy
Skin
Fascia
Fat
The Umbilicus
Musculoaponeurotic System
Lymphatic Drainage
Blood Supply
Nerve Supply
Anatomical Landmarks
Esthetic Assessment
Abdominal Wall
Umbilicus
Back, Thighs, and Buttocks
Patient Assessment
History
Physical Examination
Documentation
Esthetics
General
Operative Principles and Approach
Liposuction
Standard Abdominoplasty
Markings
Technique
Mini-abdominoplasty
Markings
Technique
Free-Floating Umbilicus Abdominoplasty
Markings
Technique
High Lateral Tension (HLT) Abdominoplasty
Markings
Technique
Fleur-de-Lis Abdominoplasty
Markings
Technique
Postoperative Care
Complications
Body Contouring after Massive Weight Loss
Preoperative Management
Circumferential Lower Truncal Dermatolipectomy
Markings
Technique
Dorsal Surgery
Anterior Surgery
Therapy of “Love Handles” in Male Patients
Thigh Lift
Preoperative Assessment
Markings
Technique
Arm Lift (Brachioplasty)
Preoperative Assessment
Markings
Technique
Complications
Summary
72-Board and Fellowships Exams
72 - Board and Fellowships Exams
Introduction
FRACS(Plast)/EBOPRAS Exams
FRACS(Plast): The IMG (International Medical Graduate) Perspective
FRCS(Plast) Exams
FRCSC Exams
Plastic Surgery Fellowships in the United States