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/9780190499075.003.0091
S. Oates
Because of their location on the dorsum of the hand, the extensor tendons are particularly vulnerable to injury. This is even more likely over the joints since the dorsal skin is particularly thin there. Injuries can occur from both sharp and blunt trauma. Untreated extensor tendon injuries can result in significant functional impairment and potential long-term permanent deformities of the hand. There are significant differences in treatment for extensor tendon injuries involving the finger zones versus the hand. This chapter will describe the most common treatment modalities for extensor tendon injuries to the hand and forearm.
{"title":"Extensor Tendon Repair","authors":"S. Oates","doi":"10.1093/MED/9780190499075.003.0091","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0091","url":null,"abstract":"Because of their location on the dorsum of the hand, the extensor tendons are particularly vulnerable to injury. This is even more likely over the joints since the dorsal skin is particularly thin there. Injuries can occur from both sharp and blunt trauma. Untreated extensor tendon injuries can result in significant functional impairment and potential long-term permanent deformities of the hand. There are significant differences in treatment for extensor tendon injuries involving the finger zones versus the hand. This chapter will describe the most common treatment modalities for extensor tendon injuries to the hand and forearm.","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":"87872082","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/9780190499075.003.0051
Raj Yvas, L. Patty, Donald S. Mowlds
Closure of the velopharyngeal sphincter is necessary for the correct phonation of vowels and most consonants. Dysfunction of the velopharyngeal sphincter allows excess air passage into the nasal cavity, resulting in altered speech. Surgeons rely on a handful of diagnostic modalities as well as perceptual speech analysis by cleft-trained speech-language pathologists for proper evaluation of the underlying abnormality causing velopharyngeal dysfunction and for determination of subsequent treatment options. Pharyngeal flap surgery is considered in patients whose dysfunction occurs due to velopharyngeal insufficiency from a large anteroposterior central gap during closure of the velum and pharynx. The pharyngeal flap creates a static central obstruction while maintaining two patent lateral airway openings, ultimately aiding in improved phonation of oral consonants.
{"title":"Pharyngeal Flap","authors":"Raj Yvas, L. Patty, Donald S. Mowlds","doi":"10.1093/med/9780190499075.003.0051","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0051","url":null,"abstract":"Closure of the velopharyngeal sphincter is necessary for the correct phonation of vowels and most consonants. Dysfunction of the velopharyngeal sphincter allows excess air passage into the nasal cavity, resulting in altered speech. Surgeons rely on a handful of diagnostic modalities as well as perceptual speech analysis by cleft-trained speech-language pathologists for proper evaluation of the underlying abnormality causing velopharyngeal dysfunction and for determination of subsequent treatment options. Pharyngeal flap surgery is considered in patients whose dysfunction occurs due to velopharyngeal insufficiency from a large anteroposterior central gap during closure of the velum and pharynx. The pharyngeal flap creates a static central obstruction while maintaining two patent lateral airway openings, ultimately aiding in improved phonation of oral consonants.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90153542","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/9780190499075.003.0012
R. Vyas, Gennaya L. Mattison
Alveolar bone grafting plays a crucial role in cleft reconstruction. When neonatal presurgical orthodontia is successful in aligning the cleft segments, alveolar reconstruction can be initiated as a gingivoperiosteoplasty during primary cleft lip repair. In children with cleft palate, alveolar bone grafting is usually done after transverse maxillary expansion with a palatal expander. Exact timing of bone grafting is controversial; most centers initiate orthodontic evaluation/expansion between ages 7 and 8 years (beginning of mixed dentition) with an aim to bone graft before age 10 in order to allow osteogenic incorporation prior to eruption of the permanent canine teeth.
{"title":"Alveolar Bone Grafting","authors":"R. Vyas, Gennaya L. Mattison","doi":"10.1093/MED/9780190499075.003.0012","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0012","url":null,"abstract":"Alveolar bone grafting plays a crucial role in cleft reconstruction. When neonatal presurgical orthodontia is successful in aligning the cleft segments, alveolar reconstruction can be initiated as a gingivoperiosteoplasty during primary cleft lip repair. In children with cleft palate, alveolar bone grafting is usually done after transverse maxillary expansion with a palatal expander. Exact timing of bone grafting is controversial; most centers initiate orthodontic evaluation/expansion between ages 7 and 8 years (beginning of mixed dentition) with an aim to bone graft before age 10 in order to allow osteogenic incorporation prior to eruption of the permanent canine teeth.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87480746","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/9780190499075.003.0057
H. Alqattan, Ajani G. Nugent, S. Thaller
Comprehensive reconstruction of naso-orbito-ethmoidal fractures remains among the most challenging clinical problems for plastic surgeons. Successful repair centers on accurate diagnosis through a comprehensive history and physical examination and diagnostic imaging. Once this foundation is achieved, accurate anatomic reconstruction requires a stepwise approach and an intimate knowledge of the normal bony and soft tissue anatomy. The cornerstone remains the precise repositioning of the medial canthal tendon. Once this foundation is successfully reconstructed, the remaining bony framework can be anatomically, repositioned, reinforced, replaced with bone grafts &stabilized with rigid internal fixation.
{"title":"Naso-orbito-ethmoidal Complex Injuries","authors":"H. Alqattan, Ajani G. Nugent, S. Thaller","doi":"10.1093/MED/9780190499075.003.0057","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0057","url":null,"abstract":"Comprehensive reconstruction of naso-orbito-ethmoidal fractures remains among the most challenging clinical problems for plastic surgeons. Successful repair centers on accurate diagnosis through a comprehensive history and physical examination and diagnostic imaging. Once this foundation is achieved, accurate anatomic reconstruction requires a stepwise approach and an intimate knowledge of the normal bony and soft tissue anatomy. The cornerstone remains the precise repositioning of the medial canthal tendon. Once this foundation is successfully reconstructed, the remaining bony framework can be anatomically, repositioned, reinforced, replaced with bone grafts &stabilized with rigid internal fixation.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85340947","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/9780190499075.003.0026
A. Barrera
This chapter presents a brief review of the history of hair transplantation and the anatomy and physiology of hair follicular units. Also presented is a step-by-step description of the author’s preferred technique and pearls learned over the past 25 years to consistently accomplish natural and aesthetically pleasing results. This very labor-intensive procedure requires a team of skillful assistants to be able to do this well and comfortably. The author also describes the details of equipment and instrumentation needed, from surgical blades to the dissection microscopes, and more. The most frequent cases seen in practice include male pattern baldness, female pattern alopecia, and scarring alopecias secondary to previous surgeries (i.e., post rhytidectomy). The restoration of lost sideburns and a temporal hairline will demonstrate some of these examples.
{"title":"Advances in Hair Transplantation","authors":"A. Barrera","doi":"10.1093/MED/9780190499075.003.0026","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0026","url":null,"abstract":"This chapter presents a brief review of the history of hair transplantation and the anatomy and physiology of hair follicular units. Also presented is a step-by-step description of the author’s preferred technique and pearls learned over the past 25 years to consistently accomplish natural and aesthetically pleasing results. This very labor-intensive procedure requires a team of skillful assistants to be able to do this well and comfortably. The author also describes the details of equipment and instrumentation needed, from surgical blades to the dissection microscopes, and more. The most frequent cases seen in practice include male pattern baldness, female pattern alopecia, and scarring alopecias secondary to previous surgeries (i.e., post rhytidectomy). The restoration of lost sideburns and a temporal hairline will demonstrate some of these examples.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"125 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91453562","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/9780190499075.003.0002
W. Sivak, Erica Sivak, K. Shestak
Regional anesthesia, or rendering only a targeted part of the body anesthetized, has numerous benefits for both the surgeon and patient. Local anesthetic agents are essential to create and maintain regional blockades, and detailed knowledge of these agents is essential to providing safe and effective care. This chapter begins with review of the basic pharmacology, indications, and contraindications for the use of regional anesthesia. Numerous specific blockades used to anesthetize distinct regions of the body are reviewed with specific focus on anatomy and technique. When safely performed, regional anesthesia can provide an optimal experience for both surgeon and patient.
{"title":"Anesthesia","authors":"W. Sivak, Erica Sivak, K. Shestak","doi":"10.1093/med/9780190499075.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0002","url":null,"abstract":"Regional anesthesia, or rendering only a targeted part of the body anesthetized, has numerous benefits for both the surgeon and patient. Local anesthetic agents are essential to create and maintain regional blockades, and detailed knowledge of these agents is essential to providing safe and effective care. This chapter begins with review of the basic pharmacology, indications, and contraindications for the use of regional anesthesia. Numerous specific blockades used to anesthetize distinct regions of the body are reviewed with specific focus on anatomy and technique. When safely performed, regional anesthesia can provide an optimal experience for both surgeon and patient.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83817653","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/9780190499075.003.0079
P. Neligan
The rectus femoris muscle is an important but expendable knee extensor. It is a bipennate muscle with a dense and strong fascia on its undersurface. This feature makes it extremely attractive for the repair of defects of the lower abdominal wall and groin as a pedicled flap. It is centrally located between the vastus medialis and vastus lateralis muscles. It is generally used as a pedicled muscle and usually taken as a muscle flap without a skin paddle. The muscle is then grafted. Following harvest, the extensor tendons need to be centralized and repaired for a distance of 6–8 cm above the knee. In many situations this flap has been superseded by the ALT flap.
{"title":"The Rectus Femoris Flap for Groin Reconstruction","authors":"P. Neligan","doi":"10.1093/MED/9780190499075.003.0079","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0079","url":null,"abstract":"The rectus femoris muscle is an important but expendable knee extensor. It is a bipennate muscle with a dense and strong fascia on its undersurface. This feature makes it extremely attractive for the repair of defects of the lower abdominal wall and groin as a pedicled flap. It is centrally located between the vastus medialis and vastus lateralis muscles. It is generally used as a pedicled muscle and usually taken as a muscle flap without a skin paddle. The muscle is then grafted. Following harvest, the extensor tendons need to be centralized and repaired for a distance of 6–8 cm above the knee. In many situations this flap has been superseded by the ALT flap.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87150755","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/9780190499075.003.0039
Melissa A. Mueller, G. Evans
The rectus abdominis flap is a versatile, workhorse flap. It is ideal for head and neck reconstruction requiring large, soft tissue bulk without bony reconstruction, particularly for defects of the tongue, orbits, maxilla, cheek, posterior mandible, and cranial base. Its ability to be folded upon itself and harvested with multiple skin paddles makes it versatile for complex three-dimensional and multilaminar defects. Its pedicle size and length and consistent vascular anatomy make the flap a reliable choice for head and neck reconstruction. Its indications in head and neck reconstruction and technique in harvest are elaborated in this chapter.
{"title":"The Rectus Abdominis Flap","authors":"Melissa A. Mueller, G. Evans","doi":"10.1093/MED/9780190499075.003.0039","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0039","url":null,"abstract":"The rectus abdominis flap is a versatile, workhorse flap. It is ideal for head and neck reconstruction requiring large, soft tissue bulk without bony reconstruction, particularly for defects of the tongue, orbits, maxilla, cheek, posterior mandible, and cranial base. Its ability to be folded upon itself and harvested with multiple skin paddles makes it versatile for complex three-dimensional and multilaminar defects. Its pedicle size and length and consistent vascular anatomy make the flap a reliable choice for head and neck reconstruction. Its indications in head and neck reconstruction and technique in harvest are elaborated in this chapter.","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":"85574278","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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