Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0071
Christopher L. Ellstrom, G. Evans
Management of pressure ulcers requires a multifaceted approach for both prevention and treatment. The posterior thigh flap is one option for definitive surgical management. Treatment is initiated optimizing factors for wound healing and minimizing risk factors for recurrence. Obtaining adequate pressure offloading, moisture control, decreased wound contamination, and correction of any malnutrition should be addressed before considering surgery. The arc of rotation allows for potential closure of defects of the upper gluteal region, lower sacrum, greater trochanter, pubis, or perineum. Ischial ulcers treated with the posterior thigh flap can have a high rate of wound healing complications, but total flap loss and other serious complications are relatively rare. Partial loss or recurrence can often be treated with flap readvancement. Patient selection and preparation are keys to success.
{"title":"Posterior Thigh Flap for Pressure Sores","authors":"Christopher L. Ellstrom, G. Evans","doi":"10.1093/MED/9780190499075.003.0071","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0071","url":null,"abstract":"Management of pressure ulcers requires a multifaceted approach for both prevention and treatment. The posterior thigh flap is one option for definitive surgical management. Treatment is initiated optimizing factors for wound healing and minimizing risk factors for recurrence. Obtaining adequate pressure offloading, moisture control, decreased wound contamination, and correction of any malnutrition should be addressed before considering surgery. The arc of rotation allows for potential closure of defects of the upper gluteal region, lower sacrum, greater trochanter, pubis, or perineum. Ischial ulcers treated with the posterior thigh flap can have a high rate of wound healing complications, but total flap loss and other serious complications are relatively rare. Partial loss or recurrence can often be treated with flap readvancement. Patient selection and preparation are keys to success.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74612597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190499075.003.0058
Ryan Moore, R. Vyas
Orthognathic surgery restores the facial function and aesthetics affected by skeletal and dental deformities. A comprehensive preoperative evaluation, including cephalometric analysis, is essential to correcting facial skeletal imbalance and asymmetry. Operative planning must account for maxillary-to-mandibular occlusal relationship and dental compensations, as well as facial proportions in all dimensions. Virtual surgical planning has recently emerged as a way to facilitate more precise and accurate surgical planning. Operative techniques used to correct facial skeletal and dental deformities, broadly categorized as maxillary or mandibular excess or deficiency, include the LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty.
{"title":"Orthognathic Surgery","authors":"Ryan Moore, R. Vyas","doi":"10.1093/med/9780190499075.003.0058","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0058","url":null,"abstract":"Orthognathic surgery restores the facial function and aesthetics affected by skeletal and dental deformities. A comprehensive preoperative evaluation, including cephalometric analysis, is essential to correcting facial skeletal imbalance and asymmetry. Operative planning must account for maxillary-to-mandibular occlusal relationship and dental compensations, as well as facial proportions in all dimensions. Virtual surgical planning has recently emerged as a way to facilitate more precise and accurate surgical planning. Operative techniques used to correct facial skeletal and dental deformities, broadly categorized as maxillary or mandibular excess or deficiency, include the LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81394632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0032
Christine J. Lee, R. Vyas
The nose has several vital functions, including respiration and olfaction. The nose, as the leading point of the face, is without protective covering and is the least resistant of the facial bones to the application of a directional mechanical force. The management of isolated nasal fractures, therefore, requires a systematic approach to diagnosis, treatment, and follow-up care to ensure optimal functional and aesthetic results while minimizing complications. Good results can usually be obtained from a closed reduction of most nasal fractures in appropriately selected patients. Open reduction and wire or plate fixation should be considered in very displaced and severely comminuted fractures or when accompanied by adjacent facial fractures. Proper early operative management minimizes the need for secondary surgical revision.
{"title":"Nasal Fractures","authors":"Christine J. Lee, R. Vyas","doi":"10.1093/MED/9780190499075.003.0032","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0032","url":null,"abstract":"The nose has several vital functions, including respiration and olfaction. The nose, as the leading point of the face, is without protective covering and is the least resistant of the facial bones to the application of a directional mechanical force. The management of isolated nasal fractures, therefore, requires a systematic approach to diagnosis, treatment, and follow-up care to ensure optimal functional and aesthetic results while minimizing complications. Good results can usually be obtained from a closed reduction of most nasal fractures in appropriately selected patients. Open reduction and wire or plate fixation should be considered in very displaced and severely comminuted fractures or when accompanied by adjacent facial fractures. Proper early operative management minimizes the need for secondary surgical revision.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"65 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78044983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190499075.003.0023
M. Paul
Current concepts in rejuvenating the aging face and neck have evolved from simple undermining of the skin resulting in skin tension-based closure to various techniques that utilize the superficial musculoaponeurotic system (SMAS) as a supporting layer with no tension on the skin. The evolution of techniques regarding the manipulation of the SMAS began with an understanding of the anatomy of the facial nerve and sub-SMAS anatomy. Both volume-based and vector-based corrections are required. The selection of the appropriate technique is based on the clinical examination and the surgical options that the surgeon possesses. A safely performed procedure that provides impressive rejuvenation of the aging face and neck is always the goal.
{"title":"Rhytidectomy","authors":"M. Paul","doi":"10.1093/med/9780190499075.003.0023","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0023","url":null,"abstract":"Current concepts in rejuvenating the aging face and neck have evolved from simple undermining of the skin resulting in skin tension-based closure to various techniques that utilize the superficial musculoaponeurotic system (SMAS) as a supporting layer with no tension on the skin. The evolution of techniques regarding the manipulation of the SMAS began with an understanding of the anatomy of the facial nerve and sub-SMAS anatomy. Both volume-based and vector-based corrections are required. The selection of the appropriate technique is based on the clinical examination and the surgical options that the surgeon possesses. A safely performed procedure that provides impressive rejuvenation of the aging face and neck is always the goal.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76210555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190499075.003.0095
R. Sood, Joshua M. Adkinson, B. Hartman
Stenosing flexor tenosynovitis of the digits, commonly known as trigger finger, is one of the most common conditions affecting the hand. It is characterized by a painful locking or clicking of the finger during flexion or extension. This can lead to significant pain or eventual flexion deformity. Treatment varies based on the duration, severity, and etiology and can be either conservative or operative. The complication rate of surgical intervention remains low, with the most common being pain at the operative site. Treatment of trigger finger in the patient with rheumatoid disease should be approached with caution. Overall management of trigger finger, whether conservative or operative, is routinely successful with the final result of a satisfied patient.
{"title":"Trigger Finger","authors":"R. Sood, Joshua M. Adkinson, B. Hartman","doi":"10.1093/med/9780190499075.003.0095","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0095","url":null,"abstract":"Stenosing flexor tenosynovitis of the digits, commonly known as trigger finger, is one of the most common conditions affecting the hand. It is characterized by a painful locking or clicking of the finger during flexion or extension. This can lead to significant pain or eventual flexion deformity. Treatment varies based on the duration, severity, and etiology and can be either conservative or operative. The complication rate of surgical intervention remains low, with the most common being pain at the operative site. Treatment of trigger finger in the patient with rheumatoid disease should be approached with caution. Overall management of trigger finger, whether conservative or operative, is routinely successful with the final result of a satisfied patient.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73340958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190499075.003.0015
M. Paul
The evolution of abdominal contouring began with excision of skin and subcutaneous tissue more than 100 years ago. This evolved into proper lower abdominal horizontal incision placement and fascial repair along with dermo-lipectomy. The introduction of liposuction was a sentinel event in body contouring, applicable as well to the entire abdomen. Taken further, abdominoplasty matured with targeted fat removal, fat grafting, and high-definition lipo-contouring. Limited undermining combined with targeted liposuction created an aesthetically pleasing abdominal contour while safely preserving the blood supply to the undermined flap. The introduction of barbed sutures for fascial repair and for wound closure, the use of basting sutures, and lateral to medial flap advancement moved modern abdominoplasty to a safer procedure with impressive aesthetic results. While producing an impressive aesthetic improvement was always the primary goal, increasing attention that focused on decreasing the risks of adverse events and sequelae was an important goal.
{"title":"Abdominoplasty","authors":"M. Paul","doi":"10.1093/med/9780190499075.003.0015","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0015","url":null,"abstract":"The evolution of abdominal contouring began with excision of skin and subcutaneous tissue more than 100 years ago. This evolved into proper lower abdominal horizontal incision placement and fascial repair along with dermo-lipectomy. The introduction of liposuction was a sentinel event in body contouring, applicable as well to the entire abdomen. Taken further, abdominoplasty matured with targeted fat removal, fat grafting, and high-definition lipo-contouring. Limited undermining combined with targeted liposuction created an aesthetically pleasing abdominal contour while safely preserving the blood supply to the undermined flap. The introduction of barbed sutures for fascial repair and for wound closure, the use of basting sutures, and lateral to medial flap advancement moved modern abdominoplasty to a safer procedure with impressive aesthetic results. While producing an impressive aesthetic improvement was always the primary goal, increasing attention that focused on decreasing the risks of adverse events and sequelae was an important goal.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80551203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0100
W. K. Ng
Compression neuropathies of the upper extremity are common, and these conditions can be symptomatically debilitating for patients. Although the author acknowledges that nerve compression can still occur at various sites from the neck proximally to the hand distally for all of the described nerves herein, the author aims with this chapter to describe a series of straightforward, reproducible, and reliable approaches to the evaluation and management of three upper extremity peripheral neuropathies to each of the three major nerves to the hand: carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome.
{"title":"Compression Neuropathies of the Upper Extremity","authors":"W. K. Ng","doi":"10.1093/MED/9780190499075.003.0100","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0100","url":null,"abstract":"Compression neuropathies of the upper extremity are common, and these conditions can be symptomatically debilitating for patients. Although the author acknowledges that nerve compression can still occur at various sites from the neck proximally to the hand distally for all of the described nerves herein, the author aims with this chapter to describe a series of straightforward, reproducible, and reliable approaches to the evaluation and management of three upper extremity peripheral neuropathies to each of the three major nerves to the hand: carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82643819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0103
J. Ko, N. Vedder, Rahul Kasukurthi
Nearly 1.5 million hand and wrist fractures are treated in the United States annually. Wrist fractures encompass fractures to the carpal bones, distal radius, and ulna. Most hand and forearm fractures occur in the home and are not work related. The scaphoid bone is most commonly involved, accounting for 60–85% of carpal fractures. The burden of wrist fractures is projected to increase as the population ages, and prompt and accurate diagnosis and treatment are necessary to avoid long-term disability. This chapter will focus on pathophysiology, diagnosis, imaging, and treatment of carpal injuries with emphasis on scaphoid fractures and perilunate dislocations.
{"title":"Carpal Fractures and Dislocations","authors":"J. Ko, N. Vedder, Rahul Kasukurthi","doi":"10.1093/MED/9780190499075.003.0103","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0103","url":null,"abstract":"Nearly 1.5 million hand and wrist fractures are treated in the United States annually. Wrist fractures encompass fractures to the carpal bones, distal radius, and ulna. Most hand and forearm fractures occur in the home and are not work related. The scaphoid bone is most commonly involved, accounting for 60–85% of carpal fractures. The burden of wrist fractures is projected to increase as the population ages, and prompt and accurate diagnosis and treatment are necessary to avoid long-term disability. This chapter will focus on pathophysiology, diagnosis, imaging, and treatment of carpal injuries with emphasis on scaphoid fractures and perilunate dislocations.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88012365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0059
R. Ettinger, S. Buchman
The zygomatic bone is a critical component of the midfacial complex. Its prominence within the face makes it susceptible to trauma and its intricate anatomy make posttraumatic repair of zygomaticomaxillary complex (ZMC) fractures challenging. The zygoma has a “tetrapod” structure with four key articulation points: the zygomaticomaxillary articulation and inferior orbital rim, zygomaticosphenoid articulation in the lateral orbital wall, zygomaticofrontal articulation and the lateral orbital rim, and the zygomatic arch. The zygoma is also a key contributor to several facial buttresses and a main determinant of malar projection and transverse facial width. Several approaches to the ZMC may be required to ensure appropriate reduction of each articulation site during operative repair. Concomitant injuries to other facial structures can be seen with ZMC fractures, given the zygomatic bones close association with the orbit, nasal bones, and the maxilla. Adequate ZMC fracture repair requires appropriate exposure of all involved fractures, robust mobilization of bone fragments, and application or rigid fixation while ensuring simultaneous reduction at all involved ZMC articulation points. Midface soft tissue resuspension should be performed following ZMC reduction and fixation to prevent unwanted soft tissue descent and lower lid malposition.
{"title":"Zygomaticomaxillary Complex Fractures","authors":"R. Ettinger, S. Buchman","doi":"10.1093/MED/9780190499075.003.0059","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0059","url":null,"abstract":"The zygomatic bone is a critical component of the midfacial complex. Its prominence within the face makes it susceptible to trauma and its intricate anatomy make posttraumatic repair of zygomaticomaxillary complex (ZMC) fractures challenging. The zygoma has a “tetrapod” structure with four key articulation points: the zygomaticomaxillary articulation and inferior orbital rim, zygomaticosphenoid articulation in the lateral orbital wall, zygomaticofrontal articulation and the lateral orbital rim, and the zygomatic arch. The zygoma is also a key contributor to several facial buttresses and a main determinant of malar projection and transverse facial width. Several approaches to the ZMC may be required to ensure appropriate reduction of each articulation site during operative repair. Concomitant injuries to other facial structures can be seen with ZMC fractures, given the zygomatic bones close association with the orbit, nasal bones, and the maxilla. Adequate ZMC fracture repair requires appropriate exposure of all involved fractures, robust mobilization of bone fragments, and application or rigid fixation while ensuring simultaneous reduction at all involved ZMC articulation points. Midface soft tissue resuspension should be performed following ZMC reduction and fixation to prevent unwanted soft tissue descent and lower lid malposition.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"152 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86655693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190499075.003.0029
S. Grob, D. Kikkawa, D. Park
Eyelid reconstruction is indicated in the setting of trauma, following cancer excision, for congenital deformities, and for age-related degeneration. As the eyelids have a large impact on the appearance of the eyes, the aesthetic result of reconstruction is as important as the restoration of eyelid function in ocular surface protection and lubrication. In this chapter, the authors discuss the operative care of patients with defects of varying extent involving the upper and lower eyelids, as well as common degenerative conditions such as eyelid margin malrotation and eyelid malposition, such as ptosis, retraction, entropion, and ectropion. Planning for repair should begin during the initial examination. The surgeon can evaluate the size of an eyelid lesion and attempt to predict the size of the possible defect after excision.
{"title":"Eyelid Reconstruction","authors":"S. Grob, D. Kikkawa, D. Park","doi":"10.1093/med/9780190499075.003.0029","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0029","url":null,"abstract":"Eyelid reconstruction is indicated in the setting of trauma, following cancer excision, for congenital deformities, and for age-related degeneration. As the eyelids have a large impact on the appearance of the eyes, the aesthetic result of reconstruction is as important as the restoration of eyelid function in ocular surface protection and lubrication. In this chapter, the authors discuss the operative care of patients with defects of varying extent involving the upper and lower eyelids, as well as common degenerative conditions such as eyelid margin malrotation and eyelid malposition, such as ptosis, retraction, entropion, and ectropion. Planning for repair should begin during the initial examination. The surgeon can evaluate the size of an eyelid lesion and attempt to predict the size of the possible defect after excision.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86225780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}