Pub Date : 2019-07-01DOI: 10.1093/med/9780190499075.003.0027
Leo J. Urbinelli, I. Khansa, M. Urata
Osseous genioplasty is a powerful tool in the armamentarium of the craniofacial surgeon. Whether performed in isolation in patients with class I occlusion, or combined with a sagittal split osteotomy in patients with malocclusion, genioplasty can dramatically affect facial proportions and harmony. Genioplasty refers to the surgical or nonsurgical manipulation of the chin form or the mandibular symphysis. Genioplasty may alter the morphology of the anterior mandible through augmentation, reduction, or asymmetric recontouring, using either autologous techniques (bony reconstruction or autologous fat grafting) or alloplastic techniques (silicone implant or collagen/hyaluronic acid fillers). This chapter focuses on autologous manipulation of the mandibular symphysis through osseous genioplasty and presents an overview of patient assessment, indications, and technique for osseous genioplasty.
{"title":"Genioplasty","authors":"Leo J. Urbinelli, I. Khansa, M. Urata","doi":"10.1093/med/9780190499075.003.0027","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0027","url":null,"abstract":"Osseous genioplasty is a powerful tool in the armamentarium of the craniofacial surgeon. Whether performed in isolation in patients with class I occlusion, or combined with a sagittal split osteotomy in patients with malocclusion, genioplasty can dramatically affect facial proportions and harmony. Genioplasty refers to the surgical or nonsurgical manipulation of the chin form or the mandibular symphysis. Genioplasty may alter the morphology of the anterior mandible through augmentation, reduction, or asymmetric recontouring, using either autologous techniques (bony reconstruction or autologous fat grafting) or alloplastic techniques (silicone implant or collagen/hyaluronic acid fillers). This chapter focuses on autologous manipulation of the mandibular symphysis through osseous genioplasty and presents an overview of patient assessment, indications, and technique for osseous genioplasty.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76595898","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/9780190499075.003.0022
R. Karamanoukian, G. Evans
Skin aging is a multivariate phenomenon that is influenced by an interdependent and patient-specific footprint of biologic and chronologic aging processes. The most common patterns of aging include degenerative changes to the skin, muscle, muscle fascia, and adipocyte. The interplay of these four variables is a fundamental focus of a modern plastic surgery practice. Plastic surgeons must be proficient in skin aging pathophysiology and the mechanisms to optimize skin with topical dermatologic monotherapy alone, or as a prelude to surgery or laser. The focus of this chapter is to highlight the importance of skin aging in the global assessment of the cosmetic patient and to elucidate the role of skin optimization in the management of the patient requesting rejuvenative cosmetic surgery.
{"title":"Skin Optimization Strategies in Plastic Surgery","authors":"R. Karamanoukian, G. Evans","doi":"10.1093/MED/9780190499075.003.0022","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0022","url":null,"abstract":"Skin aging is a multivariate phenomenon that is influenced by an interdependent and patient-specific footprint of biologic and chronologic aging processes. The most common patterns of aging include degenerative changes to the skin, muscle, muscle fascia, and adipocyte. The interplay of these four variables is a fundamental focus of a modern plastic surgery practice. Plastic surgeons must be proficient in skin aging pathophysiology and the mechanisms to optimize skin with topical dermatologic monotherapy alone, or as a prelude to surgery or laser. The focus of this chapter is to highlight the importance of skin aging in the global assessment of the cosmetic patient and to elucidate the role of skin optimization in the management of the patient requesting rejuvenative cosmetic surgery.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78057191","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/9780190499075.003.0060
Ashkaun Shaterian, E. Lin
Axillary dissection represents an evaluation of the axillary lymph node basin to provide prognostic and therapeutic value for cancer patients. Axillary lymph node dissection (ALND) is most commonly utilized in breast cancer but has applications in the treatment of other malignant neoplasms that may drain to the axillary lymphatics. ALND offers pathologic staging of cancer, therapeutic removal of clinically apparent axillary disease, and the removal of lymph nodes with possible subclinical disease following sentinel lymph node biopsy. The anatomy of the axillary space and technique of axillary dissection are discussed in detail in the chapter text.
{"title":"Axillary Dissection","authors":"Ashkaun Shaterian, E. Lin","doi":"10.1093/med/9780190499075.003.0060","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0060","url":null,"abstract":"Axillary dissection represents an evaluation of the axillary lymph node basin to provide prognostic and therapeutic value for cancer patients. Axillary lymph node dissection (ALND) is most commonly utilized in breast cancer but has applications in the treatment of other malignant neoplasms that may drain to the axillary lymphatics. ALND offers pathologic staging of cancer, therapeutic removal of clinically apparent axillary disease, and the removal of lymph nodes with possible subclinical disease following sentinel lymph node biopsy. The anatomy of the axillary space and technique of axillary dissection are discussed in detail in the chapter text.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"258 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76363307","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/9780190499075.003.0011
A. Sajjadian
The ear is generally not a first choice as a cartilage graft donor site for several reasons, none of which is valid. When the graft is harvested anteriorly, the scar is well-concealed as long as the incision is placed within the rim of the conchal bowl. And, although no site can provide as much cartilage as the rib, the auricle can provide a surprisingly large amount of graft material. There is also characteristically minimal morbidity with the harvest of auricular cartilage. This distinguishes it from rib cartilage harvest, which may be accompanied by significant postoperative pain and occasionally pneumothorax. In addition, septal harvest may cause bleeding, saddling of the nose symptomatic of septal perforation, and other airflow disturbances. The most important and major problem with ear cartilage is the flaccidity inherent in its structure. This makes it a poor choice when significant structural support is mandatory.
{"title":"Auricular Cartilage","authors":"A. Sajjadian","doi":"10.1093/med/9780190499075.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0011","url":null,"abstract":"The ear is generally not a first choice as a cartilage graft donor site for several reasons, none of which is valid. When the graft is harvested anteriorly, the scar is well-concealed as long as the incision is placed within the rim of the conchal bowl. And, although no site can provide as much cartilage as the rib, the auricle can provide a surprisingly large amount of graft material. There is also characteristically minimal morbidity with the harvest of auricular cartilage. This distinguishes it from rib cartilage harvest, which may be accompanied by significant postoperative pain and occasionally pneumothorax. In addition, septal harvest may cause bleeding, saddling of the nose symptomatic of septal perforation, and other airflow disturbances. The most important and major problem with ear cartilage is the flaccidity inherent in its structure. This makes it a poor choice when significant structural support is mandatory.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74263593","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/9780190499075.003.0078
P. Neligan
Because the groin combines elements of myofascial strength, which influences the integrity of the abdominal cavity, with the role of being a conduit for neurovascular structures to the lower limb, reconstruction demands that the repair be strong as well as provide adequate soft tissue to protect these structures. The tensor fasciae lata (TFL) flap is supplied by the transverse or ascending branch of the lateral femoral circumflex artery. It is usually used as a pedicled flap and reaches the trochanteric area and the groin. It is one of the workhorse flaps for treatment of decubitus ulcers and is very durable. The flap consists of skin and fascia lata. The fascial component can be extended to include more fascia while still allowing closure of the skin donor defect
{"title":"Tensor Fasciae Lata for Groin Reconstruction","authors":"P. Neligan","doi":"10.1093/MED/9780190499075.003.0078","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0078","url":null,"abstract":"Because the groin combines elements of myofascial strength, which influences the integrity of the abdominal cavity, with the role of being a conduit for neurovascular structures to the lower limb, reconstruction demands that the repair be strong as well as provide adequate soft tissue to protect these structures. The tensor fasciae lata (TFL) flap is supplied by the transverse or ascending branch of the lateral femoral circumflex artery. It is usually used as a pedicled flap and reaches the trochanteric area and the groin. It is one of the workhorse flaps for treatment of decubitus ulcers and is very durable. The flap consists of skin and fascia lata. The fascial component can be extended to include more fascia while still allowing closure of the skin donor defect","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"05 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86300820","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/9780190499075.003.0072
C. Teven, D. Chang
Secondary lymphedema is a common complication of cancer treatment, particularly in breast cancer patients. Its prevalence has been reported at up to 28% of patients after lumpectomy and up to 49% of patients who have undergone mastectomy. Currently, the most widely used procedures for treatment of lymphedema consist of variations using microsurgical technique. This chapter will highlight surgical treatment options for postmastectomy lymphedema, with a focus on vascularized lymph node transfer and lymphovenous bypass. In most cases, microsurgical techniques do not cure lymphedema. However, they do improve severity, reduce the number of complications associated with lymphedema, and improve quality of life.
{"title":"Surgical Treatment of Postmastectomy Lymphedema","authors":"C. Teven, D. Chang","doi":"10.1093/MED/9780190499075.003.0072","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0072","url":null,"abstract":"Secondary lymphedema is a common complication of cancer treatment, particularly in breast cancer patients. Its prevalence has been reported at up to 28% of patients after lumpectomy and up to 49% of patients who have undergone mastectomy. Currently, the most widely used procedures for treatment of lymphedema consist of variations using microsurgical technique. This chapter will highlight surgical treatment options for postmastectomy lymphedema, with a focus on vascularized lymph node transfer and lymphovenous bypass. In most cases, microsurgical techniques do not cure lymphedema. However, they do improve severity, reduce the number of complications associated with lymphedema, and improve quality of life.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85253911","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/9780190499075.003.0034
J. M. Bourgeois, Keith A. Hurvitz
Total or partial ear loss injuries remain commonplace in society, and proper management is the key to a successful outcome. Acquired ear defects are becoming increasingly more common following trauma, which can include motor vehicle accidents, assaults, and workplace injuries. Reconstruction of the external ear following traumatic amputation remains an extremely challenging procedure for plastic surgeons. This chapter covers the intricacies of managing these deformities. It outlines the initial assessment of the injured patient followed by a review of the available operative techniques. After reading this chapter, the reader will have a better appreciation for managing patients presenting with traumatic total or partial ear loss.
{"title":"Traumatic Total or Partial Ear Loss","authors":"J. M. Bourgeois, Keith A. Hurvitz","doi":"10.1093/MED/9780190499075.003.0034","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0034","url":null,"abstract":"Total or partial ear loss injuries remain commonplace in society, and proper management is the key to a successful outcome. Acquired ear defects are becoming increasingly more common following trauma, which can include motor vehicle accidents, assaults, and workplace injuries. Reconstruction of the external ear following traumatic amputation remains an extremely challenging procedure for plastic surgeons. This chapter covers the intricacies of managing these deformities. It outlines the initial assessment of the injured patient followed by a review of the available operative techniques. After reading this chapter, the reader will have a better appreciation for managing patients presenting with traumatic total or partial ear loss.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89002813","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/9780190499075.003.0056
M. Ellis, M. Cohen
Traumatic injuries and oncologic defects of the orbit can present several challenges to the reconstructive surgeon. Fracture care has evolved over the past 20 years, and emphasis is placed on both rigid fixation and minimizing postoperative complications related to surgical exposure. Computed tomography data can now be reformatted to create three-dimensional representations that improve our diagnosis and interpretation of common fracture patterns. In cases of tumor invasion, a multidisciplinary approach will optimize outcomes for the patient. The primary objective after enucleation is to maintain soft tissue and bony orbital volume, which will facilitate use of a prosthesis. Exenteration requires circumferential orbit resurfacing, especially in cases of concomitant craniotomy and partial maxillectomy. The ultimate priority in orbit reconstruction, regardless of etiology, is to provide aesthetic and functional reconstruction.
{"title":"Reconstruction of Orbital Defects","authors":"M. Ellis, M. Cohen","doi":"10.1093/MED/9780190499075.003.0056","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0056","url":null,"abstract":"Traumatic injuries and oncologic defects of the orbit can present several challenges to the reconstructive surgeon. Fracture care has evolved over the past 20 years, and emphasis is placed on both rigid fixation and minimizing postoperative complications related to surgical exposure. Computed tomography data can now be reformatted to create three-dimensional representations that improve our diagnosis and interpretation of common fracture patterns. In cases of tumor invasion, a multidisciplinary approach will optimize outcomes for the patient. The primary objective after enucleation is to maintain soft tissue and bony orbital volume, which will facilitate use of a prosthesis. Exenteration requires circumferential orbit resurfacing, especially in cases of concomitant craniotomy and partial maxillectomy. The ultimate priority in orbit reconstruction, regardless of etiology, is to provide aesthetic and functional reconstruction.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88434359","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/9780190499075.003.0049
Samuel H. Lance, Catherine Tsai, A. Gosman
Understanding the anatomy and surgical technique for repair of the unilateral and bilateral cleft lip remain essential to the practice of plastic surgery. This chapter summarizes the relevant anatomy, clinical evaluation, surgical technique, and postoperative care of the cleft lip patient. Step-by-step surgical descriptions and illustrations are provided along with commentary regarding common pitfalls encountered with these techniques. The surgical techniques described are a modified Millard rotation advancement technique for repair of the unilateral cleft lip and a modified Byrd repair for correction of the bilateral cleft lip.
{"title":"Cleft Lip Repair","authors":"Samuel H. Lance, Catherine Tsai, A. Gosman","doi":"10.1093/MED/9780190499075.003.0049","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0049","url":null,"abstract":"Understanding the anatomy and surgical technique for repair of the unilateral and bilateral cleft lip remain essential to the practice of plastic surgery. This chapter summarizes the relevant anatomy, clinical evaluation, surgical technique, and postoperative care of the cleft lip patient. Step-by-step surgical descriptions and illustrations are provided along with commentary regarding common pitfalls encountered with these techniques. The surgical techniques described are a modified Millard rotation advancement technique for repair of the unilateral cleft lip and a modified Byrd repair for correction of the bilateral cleft lip.","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":"76964407","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/9780190499075.003.0055
Daniel Murariu, Heather A. McMahon, Kant Y K Lin
Upper maxillofacial fractures primarily involve the frontal sinus. The paired frontal sinuses consist of an anterior table, a posterior table, and a frontonasal duct also known as the nasofrontal outflow tract (NFOT). Diagnosis of frontal sinus fractures is best done with a computed tomographic (CT) scan. Indications for repair of fractures of the frontal sinus depend on the location of the fracture, the degree of displacement of the fractures, and the patency of the NFOT. The three mainstays in fracture treatment are open reduction and internal fixation of anterior table fractures when there is no NFOT obstruction, which can be combined with obliteration and/or cranialization of the sinus with posterior table fractures in the presence of NFOT obstruction. Indications and surgical techniques will be reviewed along with some illustrative case examples.
{"title":"Approach to Upper Maxillofacial Fractures","authors":"Daniel Murariu, Heather A. McMahon, Kant Y K Lin","doi":"10.1093/MED/9780190499075.003.0055","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0055","url":null,"abstract":"Upper maxillofacial fractures primarily involve the frontal sinus. The paired frontal sinuses consist of an anterior table, a posterior table, and a frontonasal duct also known as the nasofrontal outflow tract (NFOT). Diagnosis of frontal sinus fractures is best done with a computed tomographic (CT) scan. Indications for repair of fractures of the frontal sinus depend on the location of the fracture, the degree of displacement of the fractures, and the patency of the NFOT. The three mainstays in fracture treatment are open reduction and internal fixation of anterior table fractures when there is no NFOT obstruction, which can be combined with obliteration and/or cranialization of the sinus with posterior table fractures in the presence of NFOT obstruction. Indications and surgical techniques will be reviewed along with some illustrative case examples.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82545786","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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