Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0043
A. Salibian
The ulnar artery supplies approximately 80% of the forearm skin, making it ideal for use in large head and neck or intraoral defects. Unlike the radial forearm flap, the ulnar forearm flap has consistent proximal perforators that allow designing smaller, thicker flaps for isolated defects. The flap can be used as a reverse flow flap based on the distal ulnar artery to utilize the larger proximal surface area of the forearm. The venous drainage through the basilic vein or the extended vein from the arm allows large-caliber anastomosis to the ipsilateral or contralateral internal or external jugular vein.
{"title":"Ulnar Forearm Flap","authors":"A. Salibian","doi":"10.1093/MED/9780190499075.003.0043","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0043","url":null,"abstract":"The ulnar artery supplies approximately 80% of the forearm skin, making it ideal for use in large head and neck or intraoral defects. Unlike the radial forearm flap, the ulnar forearm flap has consistent proximal perforators that allow designing smaller, thicker flaps for isolated defects. The flap can be used as a reverse flow flap based on the distal ulnar artery to utilize the larger proximal surface area of the forearm. The venous drainage through the basilic vein or the extended vein from the arm allows large-caliber anastomosis to the ipsilateral or contralateral internal or external jugular vein.","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":"88451020","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/9780190499075.003.0054
Y. Thelekkat, W. Schubert
This chapter summarizes the treatment options for different fractures of the mandible with emphasis on early mobilization and restitution of form and function. Emphasis in the management of mandibular fractures includes the establishment of the premorbid occlusion, surgical anatomy, the course of the inferior alveolar nerve, and biomechanics of the mandible. The principles of plating and the concepts of load-sharing and load-bearing osteosynthesis have also been discussed so that the reader will better understand the application of each in different fracture situations. The chapter concludes by briefly describing the complications of mandible fractures and their management.
{"title":"Mandible Fractures","authors":"Y. Thelekkat, W. Schubert","doi":"10.1093/med/9780190499075.003.0054","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0054","url":null,"abstract":"This chapter summarizes the treatment options for different fractures of the mandible with emphasis on early mobilization and restitution of form and function. Emphasis in the management of mandibular fractures includes the establishment of the premorbid occlusion, surgical anatomy, the course of the inferior alveolar nerve, and biomechanics of the mandible. The principles of plating and the concepts of load-sharing and load-bearing osteosynthesis have also been discussed so that the reader will better understand the application of each in different fracture situations. The chapter concludes by briefly describing the complications of mandible fractures and their management.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"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":"87952598","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/9780190499075.003.0077
D. M. Sparkman, W. Kitzmiller
Groin dissection with regional lymphadenectomy is indicated as a diagnostic or therapeutic procedure in patients who have a primary malignant neoplasm that has known or suspected lymphatic drainage to the superficial or deep inguinal lymph nodes. These pathologic entities can include anal, vaginal, urethral, vulvar, uterine, penile, ovarian, rectal, and cutaneous cancers. The most common of these neoplasms plastic surgeons must manage is melanoma. The recommended method for lymph node analysis continues to evolve. All patients should undergo basic clinical evaluation for the presence of palpable nodes. This chapter gives an updated practical guide to patient selection, preparation, operative technique, and postoperative care for groin dissection and regional lymphadenectomy.
{"title":"Groin Dissection and Regional Lymphadenectomy","authors":"D. M. Sparkman, W. Kitzmiller","doi":"10.1093/MED/9780190499075.003.0077","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0077","url":null,"abstract":"Groin dissection with regional lymphadenectomy is indicated as a diagnostic or therapeutic procedure in patients who have a primary malignant neoplasm that has known or suspected lymphatic drainage to the superficial or deep inguinal lymph nodes. These pathologic entities can include anal, vaginal, urethral, vulvar, uterine, penile, ovarian, rectal, and cutaneous cancers. The most common of these neoplasms plastic surgeons must manage is melanoma. The recommended method for lymph node analysis continues to evolve. All patients should undergo basic clinical evaluation for the presence of palpable nodes. This chapter gives an updated practical guide to patient selection, preparation, operative technique, and postoperative care for groin dissection and regional lymphadenectomy.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"1992 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89001737","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/9780190499075.003.0096
S. P. Johnson, K. Chung
A ganglion cyst is a common reason for an outpatient hand surgery consultation. Clinically, a ganglion presents as a visible and palpable rubbery subcutaneous mass that is mobile and tethered to an underlying structure. Although commonly asymptomatic, patients may present with pain on activity and palpation, decreased range of motion and grip strength, paraesthesia from local nerve compression, or fears of malignancy. However, this benign soft-tissue mass is often asymptomatic, and it most frequently occurs on the dorsal wrist between the third and fourth extensor compartment. Excision is warranted for patients with recalcitrant pain, aesthetic concern, associated nerve entrapment, or to rule out an alternative etiology. Although recurrence is high, surgical excision is most effective when the synovial stalk communicating the ganglia with the underlying joint capsule is removed.
{"title":"Excision of Ganglion Cysts","authors":"S. P. Johnson, K. Chung","doi":"10.1093/MED/9780190499075.003.0096","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0096","url":null,"abstract":"A ganglion cyst is a common reason for an outpatient hand surgery consultation. Clinically, a ganglion presents as a visible and palpable rubbery subcutaneous mass that is mobile and tethered to an underlying structure. Although commonly asymptomatic, patients may present with pain on activity and palpation, decreased range of motion and grip strength, paraesthesia from local nerve compression, or fears of malignancy. However, this benign soft-tissue mass is often asymptomatic, and it most frequently occurs on the dorsal wrist between the third and fourth extensor compartment. Excision is warranted for patients with recalcitrant pain, aesthetic concern, associated nerve entrapment, or to rule out an alternative etiology. Although recurrence is high, surgical excision is most effective when the synovial stalk communicating the ganglia with the underlying joint capsule is removed.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82330477","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/9780190499075.003.0025
S. Grob, D. Park
Upper and lower blepharoplasties are some of the most common cosmetic surgical procedures. The eyelids function in ocular protection and lubrication and are capable of expressing a wide range of emotions in nonverbal communication. As such, the goals of surgery are to impart a natural rejuvenated appearance with adequate symmetry while preserving the normal function of the eyelids. Patients seeking blepharoplasty can present with any number of chief complaints that can be categorized as functional or aesthetic in nature. The two are, however, intimately intertwined and the surgeon must consider both the function and appearance of the eyelids. Herein, we discuss various approaches to the clinical management of patients for blepharoplasty, including preoperative evaluation, operative approaches, and postoperative care.
{"title":"Blepharoplasty","authors":"S. Grob, D. Park","doi":"10.1093/med/9780190499075.003.0025","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0025","url":null,"abstract":"Upper and lower blepharoplasties are some of the most common cosmetic surgical procedures. The eyelids function in ocular protection and lubrication and are capable of expressing a wide range of emotions in nonverbal communication. As such, the goals of surgery are to impart a natural rejuvenated appearance with adequate symmetry while preserving the normal function of the eyelids. Patients seeking blepharoplasty can present with any number of chief complaints that can be categorized as functional or aesthetic in nature. The two are, however, intimately intertwined and the surgeon must consider both the function and appearance of the eyelids. Herein, we discuss various approaches to the clinical management of patients for blepharoplasty, including preoperative evaluation, operative approaches, and postoperative care.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80235299","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/9780190499075.003.0018
A. Aly
Massive weight loss (MWL) patients often present with fairly extensive excess skin of the upper arms. The excess is located in the posterior axillary roll and the Aly posterior brachioplasty technique is designed to eliminate as much excess tissue as is required to create an arm contour that follows the normal underlying musculoskeletal anatomy. One of the major contributions that the author feels he has made to brachioplasty surgery is the delineation of the posterior axillary fold and its extension onto the upper arm as the deformity encountered in all MWL patients. Presurgical assessment and markings, as well as execution pearls are shared with the reader. Sample results and potential complications are discussed.
{"title":"Brachioplasty","authors":"A. Aly","doi":"10.1093/med/9780190499075.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0018","url":null,"abstract":"Massive weight loss (MWL) patients often present with fairly extensive excess skin of the upper arms. The excess is located in the posterior axillary roll and the Aly posterior brachioplasty technique is designed to eliminate as much excess tissue as is required to create an arm contour that follows the normal underlying musculoskeletal anatomy. One of the major contributions that the author feels he has made to brachioplasty surgery is the delineation of the posterior axillary fold and its extension onto the upper arm as the deformity encountered in all MWL patients. Presurgical assessment and markings, as well as execution pearls are shared with the reader. Sample results and potential complications are discussed.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"155 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88039572","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/9780190499075.003.0040
M. Klebuc
Microneurovascular muscle flaps can be effectively employed to reanimate the paralyzed mid-face. This chapter explores the indications and contraindications for free muscle flap smile restoration. Various sources of innervation are examined including the motor nerve to masseter and cross-face nerve grafts, as are different muscle flap donor sites. A detailed description of facial nerve exploration, sural nerve graft harvest, and the cross-face nerve graft procedure are provided. Single and two-staged facial reanimation procedures utilizing free gracilis muscle flaps are also described in detail, including technical nuances, postoperative care, and physical therapy. The technique is well suited for individuals whose native muscles of facial expression have failed to develop in utero, undergone irreversible atrophy, sustained significant trauma, or have been sacrificed during oncologic resection.
{"title":"Microneurovascular Reconstruction for Facial Reanimation","authors":"M. Klebuc","doi":"10.1093/MED/9780190499075.003.0040","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0040","url":null,"abstract":"Microneurovascular muscle flaps can be effectively employed to reanimate the paralyzed mid-face. This chapter explores the indications and contraindications for free muscle flap smile restoration. Various sources of innervation are examined including the motor nerve to masseter and cross-face nerve grafts, as are different muscle flap donor sites. A detailed description of facial nerve exploration, sural nerve graft harvest, and the cross-face nerve graft procedure are provided. Single and two-staged facial reanimation procedures utilizing free gracilis muscle flaps are also described in detail, including technical nuances, postoperative care, and physical therapy. The technique is well suited for individuals whose native muscles of facial expression have failed to develop in utero, undergone irreversible atrophy, sustained significant trauma, or have been sacrificed during oncologic resection.","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":"85435602","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/9780190499075.003.0065
M. Klebuc, Elizabeth A Killion, J. Selber, G. Evans
Latissimus dorsi muscle and myocutaneous flaps provide a versatile means of providing both implant-based and pure autologous breast reconstructions. The technique is well suited to lean patients and those with contraindications to the use of the lower abdomen as a donor site. The technique has been progressively refined over time to provide concealed scars and to reduce donor site morbidity. The use of endoscopic assistance, robotic flap harvest, muscle-sparing flap design, and perforator flaps based on the thoracodorsal vascular access (the thoracodorsal artery perforator flap or TAP-flap), continue to increase the utility of this donor site for breast reconstruction.
{"title":"Breast Reconstruction with the Latissimus Dorsi Flap","authors":"M. Klebuc, Elizabeth A Killion, J. Selber, G. Evans","doi":"10.1093/MED/9780190499075.003.0065","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0065","url":null,"abstract":"Latissimus dorsi muscle and myocutaneous flaps provide a versatile means of providing both implant-based and pure autologous breast reconstructions. The technique is well suited to lean patients and those with contraindications to the use of the lower abdomen as a donor site. The technique has been progressively refined over time to provide concealed scars and to reduce donor site morbidity. The use of endoscopic assistance, robotic flap harvest, muscle-sparing flap design, and perforator flaps based on the thoracodorsal vascular access (the thoracodorsal artery perforator flap or TAP-flap), continue to increase the utility of this donor site for breast reconstruction.","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":"79754287","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/9780190499075.003.0069
G. Reece, D. Goldberg
This chapter summarizes the various surgical treatment options that can be used to restore the integrity of the chest wall after trauma or tumor resection and to assist with wound healing problems associated with infection and radiation therapy. Emphasis is placed on several considerations for patients undergoing chest wall reconstruction. The authors discuss the indications, contraindications, limitations, surgical anatomy, and technique of each flap type and the effective postoperative care and rehabilitation needed in order to prevent postoperative pulmonary problems. This chapter reviews some of the commonly used flaps for chest wall reconstruction. These flaps include the latissimus dorsi, rectus abdominis, and pectoralis major myocutaneous flaps and the omental flap.
{"title":"Chest Wall Reconstruction","authors":"G. Reece, D. Goldberg","doi":"10.1093/MED/9780190499075.003.0069","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0069","url":null,"abstract":"This chapter summarizes the various surgical treatment options that can be used to restore the integrity of the chest wall after trauma or tumor resection and to assist with wound healing problems associated with infection and radiation therapy. Emphasis is placed on several considerations for patients undergoing chest wall reconstruction. The authors discuss the indications, contraindications, limitations, surgical anatomy, and technique of each flap type and the effective postoperative care and rehabilitation needed in order to prevent postoperative pulmonary problems. This chapter reviews some of the commonly used flaps for chest wall reconstruction. These flaps include the latissimus dorsi, rectus abdominis, and pectoralis major myocutaneous flaps and the omental flap.","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":"80090954","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/9780190499075.003.0007
S. Milner
Skin grafting is an indispensable technique used in a variety of clinical situations, including acute burns, traumatic wounds, scar contracture release, and oncological and congenital deficiencies. The author’s preferred techniques for harvesting and resurfacing various skin defects using split- and full-thickness skin grafts are described in this chapter, together with the assessment of donor and recipient sites, preoperative preparation and postoperative considerations.
{"title":"Skin Grafting","authors":"S. Milner","doi":"10.1093/med/9780190499075.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0007","url":null,"abstract":"Skin grafting is an indispensable technique used in a variety of clinical situations, including acute burns, traumatic wounds, scar contracture release, and oncological and congenital deficiencies. The author’s preferred techniques for harvesting and resurfacing various skin defects using split- and full-thickness skin grafts are described in this chapter, together with the assessment of donor and recipient sites, preoperative preparation and postoperative considerations.","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":"74510831","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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