Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0046
A. Mericli, P. Garvey
The scapula flap is a workhorse flap for midface reconstruction. The flap is based on a robust and versatile vascular system which readily allows for the creation of chimeric flaps that include bone, muscle, skin, fat, and fascia. The soft tissue elements of a chimeric scapula flap can be more aggressively thinned, making it an ideal option for augmentation of facial atrophy or contour depressions. The scapula bone is thin and wide near the angle and thick and hearty along its lateral border near the glenohumeral joint, which allows the bone flap to be used for a myriad of bony defects.
{"title":"Scapular Osseous Free Flap","authors":"A. Mericli, P. Garvey","doi":"10.1093/MED/9780190499075.003.0046","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0046","url":null,"abstract":"The scapula flap is a workhorse flap for midface reconstruction. The flap is based on a robust and versatile vascular system which readily allows for the creation of chimeric flaps that include bone, muscle, skin, fat, and fascia. The soft tissue elements of a chimeric scapula flap can be more aggressively thinned, making it an ideal option for augmentation of facial atrophy or contour depressions. The scapula bone is thin and wide near the angle and thick and hearty along its lateral border near the glenohumeral joint, which allows the bone flap to be used for a myriad of bony defects.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"157 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77273364","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/9780190499075.003.0044
M. Houdek, S. Moran
The free vascularized fibula flap has become the most common microvascular flap option for long bone and mandibular reconstruction following trauma and tumor extirpation. The free fibula flap can provide up to 26 cm of straight, cortical bone and has acceptable donor site morbidity. Published series have noted high rates of reconstructive success, with primary bony union rates of up to 80% and overall union of 97% following supplemental nonvascularized bone grafting. It is a true workhorse flap and one that all reconstructive plastic surgeons need to be familiar.
{"title":"The Free Fibula Flap","authors":"M. Houdek, S. Moran","doi":"10.1093/MED/9780190499075.003.0044","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0044","url":null,"abstract":"The free vascularized fibula flap has become the most common microvascular flap option for long bone and mandibular reconstruction following trauma and tumor extirpation. The free fibula flap can provide up to 26 cm of straight, cortical bone and has acceptable donor site morbidity. Published series have noted high rates of reconstructive success, with primary bony union rates of up to 80% and overall union of 97% following supplemental nonvascularized bone grafting. It is a true workhorse flap and one that all reconstructive plastic surgeons need to be familiar.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"11 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91441111","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/9780190499075.003.0041
J. Zelken, M. Cheng
The anterolateral thigh (ALT) flap is one of the most versatile and reliable of the thigh-based free flaps. The ALT flap is indicated for reconstruction of a diverse range of defects of various surface area and depths; it can be used as a “ultra-thin” flap for resurfacing, rolled up for filling in dead space, or taken with muscle to obliterate spaces or provide bulk. The flap has been used in trauma salvage as a flow-through flap, as a tissue carrier to “piggy back” additional flaps. The flap can be raised as a pedicled (proximally or distally) or a free flap, either supra- or subfascia with or without muscle or additional tissue components.
{"title":"ALT Flaps","authors":"J. Zelken, M. Cheng","doi":"10.1093/med/9780190499075.003.0041","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0041","url":null,"abstract":"The anterolateral thigh (ALT) flap is one of the most versatile and reliable of the thigh-based free flaps. The ALT flap is indicated for reconstruction of a diverse range of defects of various surface area and depths; it can be used as a “ultra-thin” flap for resurfacing, rolled up for filling in dead space, or taken with muscle to obliterate spaces or provide bulk. The flap has been used in trauma salvage as a flow-through flap, as a tissue carrier to “piggy back” additional flaps. The flap can be raised as a pedicled (proximally or distally) or a free flap, either supra- or subfascia with or without muscle or additional tissue components.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82776491","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/9780190499075.003.0083
Ryan Moore, G. Evans
Preoperative evaluation and management of complex perineal wounds must account for any history of previous surgery, radiation, or trauma; the size and surface area following resection or debridement; and the loss of function or structural integrity. The gracilis muscle or myocutaneous flap is a local, well-vascularized option suitable for perineal soft tissue reconstruction, particularly for moderately sized defects of the groin. The use of functional gracilis muscle for anal sphincter reconstruction may also be considered for the treatment of fecal incontinence due to significant neurologic, traumatic, or iatrogenic injury, as well as for congenital abnormalities.
{"title":"Gracilis Flap for Perineal Reconstruction and Functional Restoration for the Treatment of Fecal Incontinence","authors":"Ryan Moore, G. Evans","doi":"10.1093/MED/9780190499075.003.0083","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0083","url":null,"abstract":"Preoperative evaluation and management of complex perineal wounds must account for any history of previous surgery, radiation, or trauma; the size and surface area following resection or debridement; and the loss of function or structural integrity. The gracilis muscle or myocutaneous flap is a local, well-vascularized option suitable for perineal soft tissue reconstruction, particularly for moderately sized defects of the groin. The use of functional gracilis muscle for anal sphincter reconstruction may also be considered for the treatment of fecal incontinence due to significant neurologic, traumatic, or iatrogenic injury, as well as for congenital abnormalities.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85991126","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/9780190499075.003.0084
G. Evans
Resection of the perineal area is challenging. Not only is there a component of loss of skin and muscle, but one must also consider reconstruction in an immediate or delayed fashion; whether a vaginal resection will result in partial or a total defect; and, if partial, whether the vaginal loss will be on the anterior, posterior, or distal vaginal wall. The pudendal flap may not be the best option for some of these defects. Loss of the vaginal introitus as well as part of the vault requires careful planning to provide a flap design with adequate length and width to prevent stenosis. Fraught with bacterial contamination, limitation of tissue advancement, and often tissues subjected to previous adjuvant therapy, perineal reconstruction is frequently accompanied by complications. Knowledge of the appropriate anatomy reduces morbidity. This chapter will focus on the pudendal (Singapore) artery flap for reconstruction. At the end of the chapter, readers should be able to understand the anatomy, design of the flap, and management of potential complications
{"title":"Pudendal Artery Flap (Singapore) for Perineal Reconstruction","authors":"G. Evans","doi":"10.1093/MED/9780190499075.003.0084","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0084","url":null,"abstract":"Resection of the perineal area is challenging. Not only is there a component of loss of skin and muscle, but one must also consider reconstruction in an immediate or delayed fashion; whether a vaginal resection will result in partial or a total defect; and, if partial, whether the vaginal loss will be on the anterior, posterior, or distal vaginal wall. The pudendal flap may not be the best option for some of these defects. Loss of the vaginal introitus as well as part of the vault requires careful planning to provide a flap design with adequate length and width to prevent stenosis. Fraught with bacterial contamination, limitation of tissue advancement, and often tissues subjected to previous adjuvant therapy, perineal reconstruction is frequently accompanied by complications. Knowledge of the appropriate anatomy reduces morbidity. This chapter will focus on the pudendal (Singapore) artery flap for reconstruction. At the end of the chapter, readers should be able to understand the anatomy, design of the flap, and management of potential complications","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88891274","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/9780190499075.003.0068
Jonathan T. Unkart, A. Suliman, A. Wallace
Gynecomastia is a common benign condition marked by male breast enlargement. It is usually caused by an increased estrogen-to-androgen ratio. Proper assessment requires a thorough history and physical examination to rule out physiologic and iatrogenic causes. It is critical to rule out male breast cancer. Surgical treatment for mild gynecomastia entails liposuction with glandular excision. More advanced gynecomastia may require staged surgical procedures and the use of techniques such as skin excision, breast reduction, subcutaneous mastectomy, and free nipple grafting. There are few contraindications, and patient satisfaction is typically high. To successfully treat gynecomastia, the clinician must have a full understanding of its pathogenesis.
{"title":"Gynecomastia","authors":"Jonathan T. Unkart, A. Suliman, A. Wallace","doi":"10.1093/med/9780190499075.003.0068","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0068","url":null,"abstract":"Gynecomastia is a common benign condition marked by male breast enlargement. It is usually caused by an increased estrogen-to-androgen ratio. Proper assessment requires a thorough history and physical examination to rule out physiologic and iatrogenic causes. It is critical to rule out male breast cancer. Surgical treatment for mild gynecomastia entails liposuction with glandular excision. More advanced gynecomastia may require staged surgical procedures and the use of techniques such as skin excision, breast reduction, subcutaneous mastectomy, and free nipple grafting. There are few contraindications, and patient satisfaction is typically high. To successfully treat gynecomastia, the clinician must have a full understanding of its pathogenesis.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86695905","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/9780190499075.003.0080
L. Gottlieb, Deana S Shenaq
The radial forearm free flap provides a relatively thin, potentially sensate, minimally hair-bearing septocutaneous flap with reliable anatomy and enough flexibility that it can be fashioned into a construct resembling a penis. The tube-within-a-tube design incorporates a centrally placed vascularized neourethra with a distal extension that gets folded over to create a semblance of a neoglans. Although this design eliminates any distal meatal stenosis, proximal urethral stenosis and fistulae continue to be the most frequent complication, especially in transgender men. An unsightly donor site scar is the primary disadvantage of the radial forearm free flap phalloplasty.
{"title":"Penile (Re)Construction with the Radial Forearm Free Flap","authors":"L. Gottlieb, Deana S Shenaq","doi":"10.1093/MED/9780190499075.003.0080","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0080","url":null,"abstract":"The radial forearm free flap provides a relatively thin, potentially sensate, minimally hair-bearing septocutaneous flap with reliable anatomy and enough flexibility that it can be fashioned into a construct resembling a penis. The tube-within-a-tube design incorporates a centrally placed vascularized neourethra with a distal extension that gets folded over to create a semblance of a neoglans. Although this design eliminates any distal meatal stenosis, proximal urethral stenosis and fistulae continue to be the most frequent complication, especially in transgender men. An unsightly donor site scar is the primary disadvantage of the radial forearm free flap phalloplasty.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81735174","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/9780190499075.003.0014
H. Seify
Liposuction of the hips and thighs is one of the most requested areas in any cosmetic practice. Proper patient selection, planning, and precise execution of the surgical plan will avoid complications and unhappy patients. The main caveats is to think in a three-dimensional manner when marking the patient and performing the procedure. Using the prone, lateral, and supine positions allows a circumferential contouring of this area. Adequate compression postoperatively gives the best chance for skin contraction. Like any liposuction procedure, the plastic surgeon must remember that what matters is what is left behind to give an aesthetic contour and not how much fat is removed.
{"title":"Liposuction of the Hips and Thighs","authors":"H. Seify","doi":"10.1093/MED/9780190499075.003.0014","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0014","url":null,"abstract":"Liposuction of the hips and thighs is one of the most requested areas in any cosmetic practice. Proper patient selection, planning, and precise execution of the surgical plan will avoid complications and unhappy patients. The main caveats is to think in a three-dimensional manner when marking the patient and performing the procedure. Using the prone, lateral, and supine positions allows a circumferential contouring of this area. Adequate compression postoperatively gives the best chance for skin contraction. Like any liposuction procedure, the plastic surgeon must remember that what matters is what is left behind to give an aesthetic contour and not how much fat is removed.","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":"81088959","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/9780190499075.003.0037
T. Tjoa, W. Armstrong
Parotidectomy is a surgical procedure performed for a variety of neoplastic, inflammatory, and infectious reasons. The key in parotid surgery is identifying and preserving the main trunk and branches of the facial nerve. While the pattern and course of the distal nerve branches can be quite variable, recognizing the landmarks used to identify the main trunk of the facial nerve allows the surgeon to complete the procedure in a safe and reproducible manner. Appropriate and complete diagnostic workup can direct preoperative counseling and inform patients of the expected course of treatment and outcomes.
{"title":"Parotidectomy","authors":"T. Tjoa, W. Armstrong","doi":"10.1093/med/9780190499075.003.0037","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0037","url":null,"abstract":"Parotidectomy is a surgical procedure performed for a variety of neoplastic, inflammatory, and infectious reasons. The key in parotid surgery is identifying and preserving the main trunk and branches of the facial nerve. While the pattern and course of the distal nerve branches can be quite variable, recognizing the landmarks used to identify the main trunk of the facial nerve allows the surgeon to complete the procedure in a safe and reproducible manner. Appropriate and complete diagnostic workup can direct preoperative counseling and inform patients of the expected course of treatment and outcomes.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"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":"76186119","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/9780190499075.003.0005
B. Christie, M. Bentz
This chapter outlines principles and techniques of local random pattern flap design. Local flaps may be utilized across the body for trauma following oncologic resection, trauma, or burn reconstruction. An approach to utilization of the local random pattern flap will be discussed, including assessment of the defect, indications/contraindications for use of a local flap, practicalities of design and technique, and postoperative care. Various specific local flaps and case examples of their use will be reviewed. The local random pattern flap is an essential tool in the plastic surgeon’s armamentarium, providing versatility when faced with daunting wounds that might otherwise require much more extensive reconstructive options. By adhering to basic principles of geometry and respecting flap vascularity, the local random pattern flap can offer uniquely advantageous reconstructive opportunities to both surgeon and patient.
{"title":"Local Random Pattern Flaps","authors":"B. Christie, M. Bentz","doi":"10.1093/MED/9780190499075.003.0005","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0005","url":null,"abstract":"This chapter outlines principles and techniques of local random pattern flap design. Local flaps may be utilized across the body for trauma following oncologic resection, trauma, or burn reconstruction. An approach to utilization of the local random pattern flap will be discussed, including assessment of the defect, indications/contraindications for use of a local flap, practicalities of design and technique, and postoperative care. Various specific local flaps and case examples of their use will be reviewed. The local random pattern flap is an essential tool in the plastic surgeon’s armamentarium, providing versatility when faced with daunting wounds that might otherwise require much more extensive reconstructive options. By adhering to basic principles of geometry and respecting flap vascularity, the local random pattern flap can offer uniquely advantageous reconstructive opportunities to both surgeon and patient.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76600764","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}
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