Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0013
Aaron M. Kosins, R. Daniel, D. P. Nguyen
Indications for septorhinoplasty include both cosmetic and/or functional issues. Common cosmetic complaints include a hump, bulbous tip, wide dorsum and/or base, plunging tip, and asymmetry. Functional issues can be due to the nasal septum and turbinates as well as to the internal and external nasal valves. During initial assessment, it is very important for the plastic surgeon to discuss the patient’s individual wishes and concerns. Realistic expectations are paramount. This chapter will discuss the basic aspects of septorhinoplasty including preoperative analysis, surgical planning and operative technique.
{"title":"Basic Techniques in Septorhinoplasty","authors":"Aaron M. Kosins, R. Daniel, D. P. Nguyen","doi":"10.1093/MED/9780190499075.003.0013","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0013","url":null,"abstract":"Indications for septorhinoplasty include both cosmetic and/or functional issues. Common cosmetic complaints include a hump, bulbous tip, wide dorsum and/or base, plunging tip, and asymmetry. Functional issues can be due to the nasal septum and turbinates as well as to the internal and external nasal valves. During initial assessment, it is very important for the plastic surgeon to discuss the patient’s individual wishes and concerns. Realistic expectations are paramount. This chapter will discuss the basic aspects of septorhinoplasty including preoperative analysis, surgical planning and operative technique.","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":"74948816","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/9780190499075.003.0006
G. Evans, J. Kaplan
Free tissue transfer is a common reconstructive surgical technique used to treat a wide variety of defects and injuries. Distant donor tissue, which can include bone, muscle, skin, and fascia, is recruited in order to restore both form and function. Inherent to these procedures are the challenges involved in revascularizing donor tissue as well as monitoring flap viability during the operative and postoperative period. This chapter details the process that microsurgeons go through as they assess patients and their need for free tissue transfer in addition to describing operative techniques and equipment used in microsurgery for both vessel anastomosis and free flap monitoring.
{"title":"Principles of Microsurgery","authors":"G. Evans, J. Kaplan","doi":"10.1093/MED/9780190499075.003.0006","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0006","url":null,"abstract":"Free tissue transfer is a common reconstructive surgical technique used to treat a wide variety of defects and injuries. Distant donor tissue, which can include bone, muscle, skin, and fascia, is recruited in order to restore both form and function. Inherent to these procedures are the challenges involved in revascularizing donor tissue as well as monitoring flap viability during the operative and postoperative period. This chapter details the process that microsurgeons go through as they assess patients and their need for free tissue transfer in addition to describing operative techniques and equipment used in microsurgery for both vessel anastomosis and free flap monitoring.","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":"73675607","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/9780190499075.003.0050
Catharine B. Garland, Joseph E. Losee
Cleft palate repair is performed to allow for normal speech production, development, and social interactions. The goal of surgery is to restore the normal anatomic relationship of the tissues and muscles. The history of cleft palate repair has evolved from techniques that simply closed the mucosal layers to those that return the musculature of the palate to its normal anatomic position. A variety of techniques remain in common use today. This chapter reviews the relevant anatomy, preoperative and postoperative care, and the operative technique. The authors emphasize their preferred method of repair, the Furlow palatoplasty, and discuss in detail the steps for reconstruction of the hard and soft palate, with modifications as necessary to suit different cleft anatomy. Alternative techniques for cleft palate repair are reviewed in brief.
{"title":"Cleft Palate Repair","authors":"Catharine B. Garland, Joseph E. Losee","doi":"10.1093/med/9780190499075.003.0050","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0050","url":null,"abstract":"Cleft palate repair is performed to allow for normal speech production, development, and social interactions. The goal of surgery is to restore the normal anatomic relationship of the tissues and muscles. The history of cleft palate repair has evolved from techniques that simply closed the mucosal layers to those that return the musculature of the palate to its normal anatomic position. A variety of techniques remain in common use today. This chapter reviews the relevant anatomy, preoperative and postoperative care, and the operative technique. The authors emphasize their preferred method of repair, the Furlow palatoplasty, and discuss in detail the steps for reconstruction of the hard and soft palate, with modifications as necessary to suit different cleft anatomy. Alternative techniques for cleft palate repair are reviewed in brief.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"135 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76109475","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/9780190499075.003.0019
Donald S. Mowlds, V. Lambros
Currently, the term “fillers” refers to injectable off-the-shelf products used to treat skin irregularities and volume deficiencies. The use of fillers to correct wrinkles and creases as well as to restore volume to the aged face has grown rapidly. The clinician must fill lines and creases as well as undertake the more difficult task of creating three-dimensional shapes in the subcutaneous space with a two-dimensional instrument. Local anesthetic temporarily adds facial volume in order to demonstrate the intended result of the final injection. This technique is invaluable because “previewing” the intended result allows the clinician and client to make adjustments with impunity.
{"title":"Principles of Injectable Facial Filling","authors":"Donald S. Mowlds, V. Lambros","doi":"10.1093/MED/9780190499075.003.0019","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0019","url":null,"abstract":"Currently, the term “fillers” refers to injectable off-the-shelf products used to treat skin irregularities and volume deficiencies. The use of fillers to correct wrinkles and creases as well as to restore volume to the aged face has grown rapidly. The clinician must fill lines and creases as well as undertake the more difficult task of creating three-dimensional shapes in the subcutaneous space with a two-dimensional instrument. Local anesthetic temporarily adds facial volume in order to demonstrate the intended result of the final injection. This technique is invaluable because “previewing” the intended result allows the clinician and client to make adjustments with impunity.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"131 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79204529","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/9780190499075.003.0076
Erica L. Bartlett, A. Spiegel
Abdominal-based free tissue transfer accounts for the majority of autologous breast reconstruction. In situations where abdominal sources are unavailable, other donor sites should be considered. In this chapter, alternative donor sites for autologous breast reconstruction are discussed, specifically, gluteal- and thigh-based flaps. The superior gluteal artery perforator (SGAP) and inferior gluteal artery perforator (IGAP) flaps are discussed from the gluteal donor site, and the transverse upper gracilis (TUG), profunda artery perforator (PAP), and the lateral thigh perforator (LTP) flaps are discussed from the thigh donor site. Relevant anatomy and surgical technique are discussed for each flap in order to enhance awareness of secondary flap options in the plastic surgeon’s armamentarium for breast reconstruction.
{"title":"Breast Reconstruction with Non-Abdominal–Based Free Tissue Flaps","authors":"Erica L. Bartlett, A. Spiegel","doi":"10.1093/MED/9780190499075.003.0076","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0076","url":null,"abstract":"Abdominal-based free tissue transfer accounts for the majority of autologous breast reconstruction. In situations where abdominal sources are unavailable, other donor sites should be considered. In this chapter, alternative donor sites for autologous breast reconstruction are discussed, specifically, gluteal- and thigh-based flaps. The superior gluteal artery perforator (SGAP) and inferior gluteal artery perforator (IGAP) flaps are discussed from the gluteal donor site, and the transverse upper gracilis (TUG), profunda artery perforator (PAP), and the lateral thigh perforator (LTP) flaps are discussed from the thigh donor site. Relevant anatomy and surgical technique are discussed for each flap in order to enhance awareness of secondary flap options in the plastic surgeon’s armamentarium for breast reconstruction.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81059867","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/9780190499075.003.0075
M. Nahabedian
The deep inferior epigastric perforator (DIEP) and muscle-sparing (MS) free transverse rectus abdominis musculocutaneous (TRAM) flaps are arguably the most common flaps used for autologous breast reconstruction. The benefit of these flaps is that very little to no donor site muscle is harvested. The decision to use one or the other is occasionally made preoperatively based on body habitus but often intraoperatively based on the quality of the perforating vessels. The technical aspects of the operation are similar except for the actual dissection around the perforating vessels. Studies have demonstrated no significant differences in outcome when comparing the DIEP and MS free TRAM flaps.
{"title":"DIEP and Muscle Sparing Breast Free Flap","authors":"M. Nahabedian","doi":"10.1093/MED/9780190499075.003.0075","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0075","url":null,"abstract":"The deep inferior epigastric perforator (DIEP) and muscle-sparing (MS) free transverse rectus abdominis musculocutaneous (TRAM) flaps are arguably the most common flaps used for autologous breast reconstruction. The benefit of these flaps is that very little to no donor site muscle is harvested. The decision to use one or the other is occasionally made preoperatively based on body habitus but often intraoperatively based on the quality of the perforating vessels. The technical aspects of the operation are similar except for the actual dissection around the perforating vessels. Studies have demonstrated no significant differences in outcome when comparing the DIEP and MS free TRAM flaps.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90678886","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/9780190499075.003.0021
Thomas Griffin, N. Saedi, C. Zachary
Laser- and energy-based devices have offered significant advances in aesthetic surgery in the past several decades. They are now a mainstay of treatment for a host of medical and surgical conditions. Aesthetic laser therapy is a rapidly expanding field with new technological advances being made on a regular basis. Laser surgeons need to accurately identify the target, select the appropriate device, and then tailor the specific treatment parameters. Laser-, light-, and energy-based devices can be used for a host of applications including vascular lesions, treating pigmentation, laser hair removal, and skin resurfacing.
{"title":"Lasers and Energy-Based Devices","authors":"Thomas Griffin, N. Saedi, C. Zachary","doi":"10.1093/med/9780190499075.003.0021","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0021","url":null,"abstract":"Laser- and energy-based devices have offered significant advances in aesthetic surgery in the past several decades. They are now a mainstay of treatment for a host of medical and surgical conditions. Aesthetic laser therapy is a rapidly expanding field with new technological advances being made on a regular basis. Laser surgeons need to accurately identify the target, select the appropriate device, and then tailor the specific treatment parameters. Laser-, light-, and energy-based devices can be used for a host of applications including vascular lesions, treating pigmentation, laser hair removal, and skin resurfacing.","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":"90202016","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/9780190499075.003.0070
Sanam Zahedi, Jillian M. McLaughlin, L. Phillips
Pressure sores usually occur over bony prominences. Based on the distribution of pressure, sacral pressure sores are more common in supine patients, and ischial pressure sores are more common in sitting patients. Patients in acute care settings, in nursing homes, or with spinal cord injuries are among the most commonly affected populations. Pressure sores are a recurrent problem with multiple risk factors including direct pressure, friction, shearing forces, immobility, and moisture. Malnutrition, anemia, and chronic illness can also contribute to their formation by the impairment of blood supply and delayed wound healing. This chapter reviews the operative technique for using different types of gluteal flaps as coverage for sacral pressure sores. It highlights essential components of preoperative, operative, and postoperative decision-making and common postoperative complications encountered.
{"title":"Gluteal Flap for Pressure Sores","authors":"Sanam Zahedi, Jillian M. McLaughlin, L. Phillips","doi":"10.1093/MED/9780190499075.003.0070","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0070","url":null,"abstract":"Pressure sores usually occur over bony prominences. Based on the distribution of pressure, sacral pressure sores are more common in supine patients, and ischial pressure sores are more common in sitting patients. Patients in acute care settings, in nursing homes, or with spinal cord injuries are among the most commonly affected populations. Pressure sores are a recurrent problem with multiple risk factors including direct pressure, friction, shearing forces, immobility, and moisture. Malnutrition, anemia, and chronic illness can also contribute to their formation by the impairment of blood supply and delayed wound healing. This chapter reviews the operative technique for using different types of gluteal flaps as coverage for sacral pressure sores. It highlights essential components of preoperative, operative, and postoperative decision-making and common postoperative complications encountered.","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":"83392223","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/9780190499075.003.0045
P. Yu, M. Schaverien
The iliac crest free flap, although the gold standard for many years for mandibular reconstruction, remains an important option in the armamentarium for mandibular reconstruction. With the increasing popularity of the fibula osteocutaneous flap, which allows for more refined reconstruction and permits multiple osteotomies, the iliac crest flap is typically reserved for where the fibula flap is contraindicated, including in those with peripheral vascular disease, peroneal magnum, history of fibula fractures, and with previous bilateral fibular flaps. The many limitations of the traditional osteomusculocutaneous flap have been overcome by modified approaches to harvest, including the split iliac crest based on the inner cortex to preserve the thigh muscle attachments and reduce donor site morbidity, and the deep circumflex iliac artery perforator flap that does not include the bulky abdominal wall musculature and allows greater freedom of movement of the skin paddle. This chapter reviews the indications, anatomy, surgical techniques, and postoperative management for the free iliac crest flap.
{"title":"The Evolution of the Iliac Crest Flap","authors":"P. Yu, M. Schaverien","doi":"10.1093/MED/9780190499075.003.0045","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0045","url":null,"abstract":"The iliac crest free flap, although the gold standard for many years for mandibular reconstruction, remains an important option in the armamentarium for mandibular reconstruction. With the increasing popularity of the fibula osteocutaneous flap, which allows for more refined reconstruction and permits multiple osteotomies, the iliac crest flap is typically reserved for where the fibula flap is contraindicated, including in those with peripheral vascular disease, peroneal magnum, history of fibula fractures, and with previous bilateral fibular flaps. The many limitations of the traditional osteomusculocutaneous flap have been overcome by modified approaches to harvest, including the split iliac crest based on the inner cortex to preserve the thigh muscle attachments and reduce donor site morbidity, and the deep circumflex iliac artery perforator flap that does not include the bulky abdominal wall musculature and allows greater freedom of movement of the skin paddle. This chapter reviews the indications, anatomy, surgical techniques, and postoperative management for the free iliac crest flap.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87899814","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/9780190499075.003.0089
A. Cusano, L. L. Pu, M. Wong
Distal third wounds of the lower extremity are challenging to reconstruct because vital structures are frequently exposed and local options are often limited. Free tissue transfer is regarded as the reconstructive gold standard for defects of the distal leg, ankle, and foot. The gracilis and rectus abdominis muscle flaps have proved reliable for free flap reconstruction of the distal lower extremity. This chapter provides a general approach to lower extremity reconstruction and highlights the role of the gracilis and rectus abdominis muscles and musculocutaneous flaps in the reconstruction of the distal lower extremity. Each flap is reviewed with special attention given to its indications, contraindications, anatomy, preoperative preparation, room setup, flap design, and harvest, as well as to donor site management. Considerations for flap inset and anastomosis as well as postoperative care are also discussed. Four case examples are also provided.
{"title":"Gracilis and Rectus Abdominis Flaps for Leg and Foot Reconstruction","authors":"A. Cusano, L. L. Pu, M. Wong","doi":"10.1093/MED/9780190499075.003.0089","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0089","url":null,"abstract":"Distal third wounds of the lower extremity are challenging to reconstruct because vital structures are frequently exposed and local options are often limited. Free tissue transfer is regarded as the reconstructive gold standard for defects of the distal leg, ankle, and foot. The gracilis and rectus abdominis muscle flaps have proved reliable for free flap reconstruction of the distal lower extremity. This chapter provides a general approach to lower extremity reconstruction and highlights the role of the gracilis and rectus abdominis muscles and musculocutaneous flaps in the reconstruction of the distal lower extremity. Each flap is reviewed with special attention given to its indications, contraindications, anatomy, preoperative preparation, room setup, flap design, and harvest, as well as to donor site management. Considerations for flap inset and anastomosis as well as postoperative care are also discussed. Four case examples are also provided.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"43 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78632872","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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