Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0009
Paul A. Mittermiller, Joseph M Baylan, Dana N. Johns, D. Wan, H. Lorenz
The iliac crest and ribs are valuable sites for harvesting bone that can be used in a variety of plastic and reconstructive operations. Bone from the iliac crest is most commonly harvested through an open approach, but it can also be harvested through a percutaneous approach. The open approach offers cortical and cancellous bone, whereas the percutaneous approach yields only cancellous bone. Full-thickness bone from the ribs can also be harvested safely and efficiently. This chapter describes the techniques for these procedures, the tools routinely used, and common pitfalls and complications that the plastic surgeon must be aware of.
{"title":"Iliac Crest and Rib Bone Grafts","authors":"Paul A. Mittermiller, Joseph M Baylan, Dana N. Johns, D. Wan, H. Lorenz","doi":"10.1093/MED/9780190499075.003.0009","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0009","url":null,"abstract":"The iliac crest and ribs are valuable sites for harvesting bone that can be used in a variety of plastic and reconstructive operations. Bone from the iliac crest is most commonly harvested through an open approach, but it can also be harvested through a percutaneous approach. The open approach offers cortical and cancellous bone, whereas the percutaneous approach yields only cancellous bone. Full-thickness bone from the ribs can also be harvested safely and efficiently. This chapter describes the techniques for these procedures, the tools routinely used, and common pitfalls and complications that the plastic surgeon must be aware of.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77459735","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/9780190499075.003.0074
K. Lane, D. Daar
Nipple-sparing mastectomy (NSM) has gained increasing popularity as an option for treatment over the typical skin-sparing mastectomy (SSM). Proper patient selection is of utmost importance, and, in recent years, surgeons have expanded their eligibility criteria for NSM. While no standard operative technique exists, various incision locations have proven advantageous depending on patient and oncologic characteristics. Consideration of the appropriate reconstructive method must be included, and potential nipple necrosis and locoregional recurrence require diligent postoperative assessment. Enhanced coordination among all members of the breast cancer treatment team, including the patient, is essential to ensure successful treatment and recovery.
{"title":"Nipple-Sparing Surgery","authors":"K. Lane, D. Daar","doi":"10.1093/MED/9780190499075.003.0074","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0074","url":null,"abstract":"Nipple-sparing mastectomy (NSM) has gained increasing popularity as an option for treatment over the typical skin-sparing mastectomy (SSM). Proper patient selection is of utmost importance, and, in recent years, surgeons have expanded their eligibility criteria for NSM. While no standard operative technique exists, various incision locations have proven advantageous depending on patient and oncologic characteristics. Consideration of the appropriate reconstructive method must be included, and potential nipple necrosis and locoregional recurrence require diligent postoperative assessment. Enhanced coordination among all members of the breast cancer treatment team, including the patient, is essential to ensure successful treatment and recovery.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73197768","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/9780190499075.003.0030
E. Matros, J. Pribaz
The forehead flap is an essential part of any plastic surgeon’s reconstructive armamentarium because of its reliability and resemblance to native nasal soft tissues. It is considered the workhorse flap for any large or multi-subunit defect. While flap transfer can be completed in two stages, more refined outcomes can be achieved when performed in three stages, including the replacement of nasal lining. Secondary revisions and aesthetic corrections are useful adjunctive procedures that can be performed after the initial swelling has subsided to improve the final outcome.
{"title":"Forehead Flap for Nasal Reconstruction","authors":"E. Matros, J. Pribaz","doi":"10.1093/med/9780190499075.003.0030","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0030","url":null,"abstract":"The forehead flap is an essential part of any plastic surgeon’s reconstructive armamentarium because of its reliability and resemblance to native nasal soft tissues. It is considered the workhorse flap for any large or multi-subunit defect. While flap transfer can be completed in two stages, more refined outcomes can be achieved when performed in three stages, including the replacement of nasal lining. Secondary revisions and aesthetic corrections are useful adjunctive procedures that can be performed after the initial swelling has subsided to improve the final outcome.","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":"72715494","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/9780190499075.003.0031
M. Budd, Melissa D Kanack, M. Lee
The nasolabial flap is primarily used for nasal reconstruction and most frequently for full-thickness alar reconstruction due to the tissue’s location, texture, color, and bulk. The inferiorly based flap is most often used for alar reconstruction, while the superiorly based flap may also be used for nasal sidewall as well as alar reconstruction. Regardless of whether the flap will be superiorly or inferiorly based, the critical component of the patient marking is placement of the medial incision in the nasolabial or nasofacial crease. In the younger patient, consideration must be given to the donor site scar.
{"title":"Nasolabial Flap","authors":"M. Budd, Melissa D Kanack, M. Lee","doi":"10.1093/med/9780190499075.003.0031","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0031","url":null,"abstract":"The nasolabial flap is primarily used for nasal reconstruction and most frequently for full-thickness alar reconstruction due to the tissue’s location, texture, color, and bulk. The inferiorly based flap is most often used for alar reconstruction, while the superiorly based flap may also be used for nasal sidewall as well as alar reconstruction. Regardless of whether the flap will be superiorly or inferiorly based, the critical component of the patient marking is placement of the medial incision in the nasolabial or nasofacial crease. In the younger patient, consideration must be given to the donor site scar.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"129 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73764327","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/9780190499075.003.0085
H. Langstein, Elaina Y. Chen, Nicholas A. Wingate
The gastrocnemius muscle flap has long been known as a workhorse flap for leg reconstruction given its reliability and ease of harvest. Its utility is varied, but it is especially useful for deep wounds of the proximal third of the leg with exposed vital structures or hardware. This chapter describes the preoperative markings and operative technique for the standard harvest of the medial head of the gastrocnemius muscle, with variations such as island muscle flap, lateral head of gastrocnemius muscle flap, and gastrocnemius myocutaneous flap. Alternatives such as propeller flaps are discussed as well. The gastrocnemius flap is one of many reliable and versatile flaps that plastic surgeons have in their armamentarium of options to reconstruct any defect of the leg.
{"title":"Gastrocnemius Flap for Proximal Leg Reconstruction","authors":"H. Langstein, Elaina Y. Chen, Nicholas A. Wingate","doi":"10.1093/MED/9780190499075.003.0085","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0085","url":null,"abstract":"The gastrocnemius muscle flap has long been known as a workhorse flap for leg reconstruction given its reliability and ease of harvest. Its utility is varied, but it is especially useful for deep wounds of the proximal third of the leg with exposed vital structures or hardware. This chapter describes the preoperative markings and operative technique for the standard harvest of the medial head of the gastrocnemius muscle, with variations such as island muscle flap, lateral head of gastrocnemius muscle flap, and gastrocnemius myocutaneous flap. Alternatives such as propeller flaps are discussed as well. The gastrocnemius flap is one of many reliable and versatile flaps that plastic surgeons have in their armamentarium of options to reconstruct any defect of the leg.","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":"85455076","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/9780190499075.003.0053
J. McGrath, A. Gosain
While the lip deformity in unilateral and bilateral cleft lip and cleft palate patients may be the primary focus of parents, most surgeons agree that it is the stigmata of the cleft nasal deformity that is most conspicuous. The cleft lip nasal deformity has been a complex source of innovation for pediatric plastic surgeons for decades. Techniques have evolved as knowledge and experience have grown. Thoughtful surgeons continue to be critical of their outcomes and modify their technique throughout their careers. Here we discuss the fundamentals of the cleft lip nasal deformity and its primary and delayed repair.
{"title":"Cleft Nasal Deformity","authors":"J. McGrath, A. Gosain","doi":"10.1093/MED/9780190499075.003.0053","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0053","url":null,"abstract":"While the lip deformity in unilateral and bilateral cleft lip and cleft palate patients may be the primary focus of parents, most surgeons agree that it is the stigmata of the cleft nasal deformity that is most conspicuous. The cleft lip nasal deformity has been a complex source of innovation for pediatric plastic surgeons for decades. Techniques have evolved as knowledge and experience have grown. Thoughtful surgeons continue to be critical of their outcomes and modify their technique throughout their careers. Here we discuss the fundamentals of the cleft lip nasal deformity and its primary and delayed repair.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"23 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89757056","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/9780190499075.003.0048
D. Furnas
If the neonate with protruding ears, mildly constricted ears, a Stahl’s ear, or even cryptotia is seen by the plastic surgeon during the child’s first days of life, the timing is auspicious. By initiating immediate steps to mold the ear with tapes and splints, complete correction of the problem without surgery is a realistic expectation. The urgency and the effectiveness of early nonsurgical treatment of such ears is not yet widely appreciated by those responsible for primary medical care of neonates. It is the plastic surgeon’s task to heighten awareness of such treatment.
{"title":"Otoplasty for Protruding Ears, Cryptotia, or Stahl’s Ear","authors":"D. Furnas","doi":"10.1093/MED/9780190499075.003.0048","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0048","url":null,"abstract":"If the neonate with protruding ears, mildly constricted ears, a Stahl’s ear, or even cryptotia is seen by the plastic surgeon during the child’s first days of life, the timing is auspicious. By initiating immediate steps to mold the ear with tapes and splints, complete correction of the problem without surgery is a realistic expectation. The urgency and the effectiveness of early nonsurgical treatment of such ears is not yet widely appreciated by those responsible for primary medical care of neonates. It is the plastic surgeon’s task to heighten awareness of such treatment.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"67 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87760327","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/9780190499075.003.0081
Brogan G. A. Evans, G. Evans
Reconstruction of the vagina is usually performed in patients undergoing abdominal-perineal resection or pelvic exenteration for carcinoma of the cervix, vagina, or rectum. Vaginal reconstruction is indicated for both psychological rehabilitation and perineal wound healing. Immediate reconstruction after partial or total vaginal resection facilitates primary healing of the perineal defect, decreases fluid loss from the pelvis, reduces infection rate, prevents herniation of abdominal contents into the perineum, and decreases nutritional demands. Additionally, flap closure provides neovascularization of the remaining pelvic tissue, which is particularly important in successful wound healing for patients who have either had radiation to the area or who are having postoperative radiation therapy. Moreover, even in the sexually inactive patient, this surgery provides patients with faster healing and overall enhanced self-esteem
{"title":"Rectus Abdominis Flap for Perineal and Vaginal Reconstruction","authors":"Brogan G. A. Evans, G. Evans","doi":"10.1093/MED/9780190499075.003.0081","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0081","url":null,"abstract":"Reconstruction of the vagina is usually performed in patients undergoing abdominal-perineal resection or pelvic exenteration for carcinoma of the cervix, vagina, or rectum. Vaginal reconstruction is indicated for both psychological rehabilitation and perineal wound healing. Immediate reconstruction after partial or total vaginal resection facilitates primary healing of the perineal defect, decreases fluid loss from the pelvis, reduces infection rate, prevents herniation of abdominal contents into the perineum, and decreases nutritional demands. Additionally, flap closure provides neovascularization of the remaining pelvic tissue, which is particularly important in successful wound healing for patients who have either had radiation to the area or who are having postoperative radiation therapy. Moreover, even in the sexually inactive patient, this surgery provides patients with faster healing and overall enhanced self-esteem","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"167 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83349351","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/9780190499075.003.0010
G. Gheradini, R. Gruber
Cartilage grafts are used for many purposes. In assessing the defect to be filled with costal cartilage, some factors must be taken into account. The length of the defect can extend up to 6–7 cm; a larger defect would require multiple grafts or bone grafts (usually vascularized). Large costal cartilage grafts are also difficult to harvest and have increased morbidity at the donor and recipient sites. The rigidity and firmness of costal cartilage can be used for structural augmentation (i.e., correction of saddle-nose deformities or to provide structural rigidity to the trachea and eyelid). However, costal cartilage cannot be considered a substitute for bone grafts when significant structural support is needed. Costal cartilage grafts can be used as onlay-type grafts to correct traumatic, congenital, or surgically induced facial deformities and as spacers to maintain mobility of the temporomandibular joint.
{"title":"Costal Cartilage Grafts","authors":"G. Gheradini, R. Gruber","doi":"10.1093/MED/9780190499075.003.0010","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0010","url":null,"abstract":"Cartilage grafts are used for many purposes. In assessing the defect to be filled with costal cartilage, some factors must be taken into account. The length of the defect can extend up to 6–7 cm; a larger defect would require multiple grafts or bone grafts (usually vascularized). Large costal cartilage grafts are also difficult to harvest and have increased morbidity at the donor and recipient sites. The rigidity and firmness of costal cartilage can be used for structural augmentation (i.e., correction of saddle-nose deformities or to provide structural rigidity to the trachea and eyelid). However, costal cartilage cannot be considered a substitute for bone grafts when significant structural support is needed. Costal cartilage grafts can be used as onlay-type grafts to correct traumatic, congenital, or surgically induced facial deformities and as spacers to maintain mobility of the temporomandibular joint.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"188 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76027490","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/9780190499075.003.0101
Vincent G. Laurence, G. Rafijah
Tendon transfers, first performed more than 100 years ago, remain one of the most powerful tools in the hand surgeon’s repertoire for addressing chronic peripheral nerve palsies. Dozens of transfers have been described in the intervening years, but three sets of transfers to provide wrist, finger, and thumb extension after a high radial nerve injury remain among the most commonly performed. This chapter briefly discusses the history of tendon transfers; outlines the general principles, indications, and timing of transfers; and provides a detailed, step-by-step description of the authors’ preferred set of transfers (the FCR set) for a high radial nerve palsy.
{"title":"Tendon Transfers in Upper Extremity Reconstruction","authors":"Vincent G. Laurence, G. Rafijah","doi":"10.1093/MED/9780190499075.003.0101","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0101","url":null,"abstract":"Tendon transfers, first performed more than 100 years ago, remain one of the most powerful tools in the hand surgeon’s repertoire for addressing chronic peripheral nerve palsies. Dozens of transfers have been described in the intervening years, but three sets of transfers to provide wrist, finger, and thumb extension after a high radial nerve injury remain among the most commonly performed. This chapter briefly discusses the history of tendon transfers; outlines the general principles, indications, and timing of transfers; and provides a detailed, step-by-step description of the authors’ preferred set of transfers (the FCR set) for a high radial nerve palsy.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80485292","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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