Pub Date : 2019-07-01DOI: 10.1093/MED/9780190499075.003.0073
S. Lalezari, Vivian V. Le-Tran, K. Lane
Regional lymph node status is an important prognostic factor for patients with breast cancer and melanoma. Sentinel lymph node dissection (SLND) is used to determine lymph node status in the surgical staging of the clinically negative axilla in patients with clinical stage I, stage IIA, stage IIB, or stage IIIA T3, N1, M0 breast cancer. SLND is also indicated in patients with melanoma with Breslow depth > 1 mm. For breast cancer and melanoma patients in need of surgical staging of regional lymph nodes, SLND has significantly lowered the rates of surgical complications and morbidity compared to the more invasive complete lymph node dissection.
{"title":"Sentinel Lymph Node Dissection","authors":"S. Lalezari, Vivian V. Le-Tran, K. Lane","doi":"10.1093/MED/9780190499075.003.0073","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0073","url":null,"abstract":"Regional lymph node status is an important prognostic factor for patients with breast cancer and melanoma. Sentinel lymph node dissection (SLND) is used to determine lymph node status in the surgical staging of the clinically negative axilla in patients with clinical stage I, stage IIA, stage IIB, or stage IIIA T3, N1, M0 breast cancer. SLND is also indicated in patients with melanoma with Breslow depth > 1 mm. For breast cancer and melanoma patients in need of surgical staging of regional lymph nodes, SLND has significantly lowered the rates of surgical complications and morbidity compared to the more invasive complete lymph node dissection.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83032162","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/9780190499075.003.0047
Melissa D Kanack, Catherine Tsai, A. Gosman
Microtia may occur as an isolated finding or in conjunction with other associated anomalies or a genetic syndrome. Ear reconstruction for these patients is typically performed no earlier than 6 years of age. In this chapter, a staged autogenous method of ear reconstruction is described using costal cartilage. In the first stage, a costal cartilage graft is harvested and placed. The next stages involve lobule transposition, detachment of the auricle with placement of a posterior skin graft, and further refinement of the external ear landmarks with tragus creation and definition of the conchal bowl and ear canal.
{"title":"Microtia Repair","authors":"Melissa D Kanack, Catherine Tsai, A. Gosman","doi":"10.1093/med/9780190499075.003.0047","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0047","url":null,"abstract":"Microtia may occur as an isolated finding or in conjunction with other associated anomalies or a genetic syndrome. Ear reconstruction for these patients is typically performed no earlier than 6 years of age. In this chapter, a staged autogenous method of ear reconstruction is described using costal cartilage. In the first stage, a costal cartilage graft is harvested and placed. The next stages involve lobule transposition, detachment of the auricle with placement of a posterior skin graft, and further refinement of the external ear landmarks with tragus creation and definition of the conchal bowl and ear canal.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90578898","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/9780190499075.003.0020
B. Kinney
Botulinum toxins type A injections are likely exceeding 10 million yearly worldwide. While it is easy to “push the plunger” to achieve some result, precise, efficacious, and safe application for functional and aesthetic enhancement is deceptively more challenging. Accurate physical assessment is critical. Advanced techniques are surprisingly more difficult, and the pharmacology of toxins must be understood. Radio frequency nerve ablation is a newer approach that requires even more knowledge, precision, and preprocedure preparation while offering longer or permanent duration and the ability to achieve real-time results. In addition, it can be combined easily with surgical procedures.
{"title":"Botulinum Toxins and Radio Frequency for Facial Rejuvenation","authors":"B. Kinney","doi":"10.1093/MED/9780190499075.003.0020","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0020","url":null,"abstract":"Botulinum toxins type A injections are likely exceeding 10 million yearly worldwide. While it is easy to “push the plunger” to achieve some result, precise, efficacious, and safe application for functional and aesthetic enhancement is deceptively more challenging. Accurate physical assessment is critical. Advanced techniques are surprisingly more difficult, and the pharmacology of toxins must be understood. Radio frequency nerve ablation is a newer approach that requires even more knowledge, precision, and preprocedure preparation while offering longer or permanent duration and the ability to achieve real-time results. In addition, it can be combined easily with surgical procedures.","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":"75953543","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/9780190499075.003.0033
H. Langstein, S. Kroll
Repair of lip defects with Abbe and Estlander flaps requires a thorough knowledge of lip anatomy and physiology in order to achieve a successful outcome. Both the Abbe and Estlander flaps are unipedicled lip flaps that transfer tissue from one lip to the other. The Abbe flap is extremely useful for repairing moderately sized defects of either lip but requires a second stage to divide the vascular pedicle. The Estlander flap is a “terminal” Abbe flap at either commissure and does not require a second stage. This chapter will discuss the technical details for the performance of these lip flaps.
{"title":"Repair of Lip Defects with the Abbe and Estlander Flaps","authors":"H. Langstein, S. Kroll","doi":"10.1093/MED/9780190499075.003.0033","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0033","url":null,"abstract":"Repair of lip defects with Abbe and Estlander flaps requires a thorough knowledge of lip anatomy and physiology in order to achieve a successful outcome. Both the Abbe and Estlander flaps are unipedicled lip flaps that transfer tissue from one lip to the other. The Abbe flap is extremely useful for repairing moderately sized defects of either lip but requires a second stage to divide the vascular pedicle. The Estlander flap is a “terminal” Abbe flap at either commissure and does not require a second stage. This chapter will discuss the technical details for the performance of these lip flaps.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76497679","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/9780190499075.003.0088
Benjamin T. Lemelman, D. Chang
The medial plantar flap is an axial pattern flap from the non–weight-bearing area of the sole of the foot between the heel and the metatarsal heads. The flap can be raised as a pedicle or a free flap, based on either the medial or lateral plantar arteries, or both. Sensory function is provided by branches of the medial plantar nerve. The donor site defect in the foot has caused no difficulty except for occasional marginal hyperkeratosis.
{"title":"Plantar Flap for Foot Reconstruction","authors":"Benjamin T. Lemelman, D. Chang","doi":"10.1093/MED/9780190499075.003.0088","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0088","url":null,"abstract":"The medial plantar flap is an axial pattern flap from the non–weight-bearing area of the sole of the foot between the heel and the metatarsal heads. The flap can be raised as a pedicle or a free flap, based on either the medial or lateral plantar arteries, or both. Sensory function is provided by branches of the medial plantar nerve. The donor site defect in the foot has caused no difficulty except for occasional marginal hyperkeratosis.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73046432","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/9780190499075.003.0064
R. Barta, O. Adepoju, B. Cunningham
This chapter details breast reconstruction following breast surgery. Over the past decade the number of women choosing reconstruction with tissue expanders and implants has steadily increased, while the percentage of women having autologous reconstruction has plateaued or fallen off. The authors explain the use of tissue expanders and implants and detail the advancements made in the ability to evaluate tissue in real-time intervals. Additional advances in technique, implant design, acellular dermal matrix, and fat grafting have improved the aesthetic results of breast reconstruction even further, and these techniques are discussed in detail. The authors address patient-specific indications and contraindications, the use of acellular dermal matrix, the assessment of the defect and perfusion, patient markings, room setup, and operative technique.
{"title":"Breast Reconstruction with Implants and Tissue Expanders","authors":"R. Barta, O. Adepoju, B. Cunningham","doi":"10.1093/MED/9780190499075.003.0064","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0064","url":null,"abstract":"This chapter details breast reconstruction following breast surgery. Over the past decade the number of women choosing reconstruction with tissue expanders and implants has steadily increased, while the percentage of women having autologous reconstruction has plateaued or fallen off. The authors explain the use of tissue expanders and implants and detail the advancements made in the ability to evaluate tissue in real-time intervals. Additional advances in technique, implant design, acellular dermal matrix, and fat grafting have improved the aesthetic results of breast reconstruction even further, and these techniques are discussed in detail. The authors address patient-specific indications and contraindications, the use of acellular dermal matrix, the assessment of the defect and perfusion, patient markings, room setup, and operative technique.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78194013","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/9780190499075.003.0067
M. Clemens, B. Bengtson
The nipple and areola complex typically provides the final finishing touch of the breast reconstruction, and most surgeons and patients do not believe the breast has been completely reconstructed until this step is completed. There have been literally hundreds of different types of nipple-areolar reconstructions described, along with variations. This chapter reviews the anatomy, timing, options, and the most common techniques used in reconstruction today. In addition, the authors review tattooing options and caveats for success, including choosing a method to best match the contralateral side and bringing in some additional tissue that may be used in the future for the nipple reconstruction.
{"title":"Nipple-Areola Reconstruction","authors":"M. Clemens, B. Bengtson","doi":"10.1093/MED/9780190499075.003.0067","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0067","url":null,"abstract":"The nipple and areola complex typically provides the final finishing touch of the breast reconstruction, and most surgeons and patients do not believe the breast has been completely reconstructed until this step is completed. There have been literally hundreds of different types of nipple-areolar reconstructions described, along with variations. This chapter reviews the anatomy, timing, options, and the most common techniques used in reconstruction today. In addition, the authors review tattooing options and caveats for success, including choosing a method to best match the contralateral side and bringing in some additional tissue that may be used in the future for the nipple reconstruction.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78560129","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/9780190499075.003.0098
A. Hazel, N. Jones
Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.
{"title":"Endoscopic Carpal Tunnel Release","authors":"A. Hazel, N. Jones","doi":"10.1093/MED/9780190499075.003.0098","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0098","url":null,"abstract":"Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80313099","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/9780190499075.003.0063
B. Chang, Nishant Bhatt
Mastopexy is a skin tightening procedure to restore shape to the ptotic (sagging) breast. Patients must be willing to accept scars as a tradeoff for improved shape. Various patterns of skin tightening procedures are available with the Weiss pattern still being the most commonly used procedure. Patients must be assessed carefully preoperatively and have realistic expectations for scars and recurrent ptosis over time. Patient satisfaction is usually very good in the properly selected patient. The authors emphasize the importance of assessing the patient’s needs as carefully as possible so that both patient and physician are satisfied with the outcome of surgery.
{"title":"Mastopexy","authors":"B. Chang, Nishant Bhatt","doi":"10.1093/med/9780190499075.003.0063","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0063","url":null,"abstract":"Mastopexy is a skin tightening procedure to restore shape to the ptotic (sagging) breast. Patients must be willing to accept scars as a tradeoff for improved shape. Various patterns of skin tightening procedures are available with the Weiss pattern still being the most commonly used procedure. Patients must be assessed carefully preoperatively and have realistic expectations for scars and recurrent ptosis over time. Patient satisfaction is usually very good in the properly selected patient. The authors emphasize the importance of assessing the patient’s needs as carefully as possible so that both patient and physician are satisfied with the outcome of surgery.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77977213","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/9780190499075.003.0093
A. Moore, K. Brandt
Successful nerve repair requires an appropriate assessment of the injury combined with a functional examination that may need to be repeated over time. In this chapter, the authors review the key principles of nerve repair in order to maximize functional outcomes in patients with devastating nerve injuries. Managing nerve injuries requires careful patient evaluation; an understanding of the degree, timing, and extent of nerve injury; and consideration of the mechanism of injury. This chapter discusses the advantages and disadvantages of primary nerve repair, nerve autografts, synthetic nerve conduits, and processed nerve allografts. The indication for each of these techniques is discussed. Also discussed is the postoperative management of the reconstructed nerve patient.
{"title":"Nerve Repair","authors":"A. Moore, K. Brandt","doi":"10.1093/med/9780190499075.003.0093","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0093","url":null,"abstract":"Successful nerve repair requires an appropriate assessment of the injury combined with a functional examination that may need to be repeated over time. In this chapter, the authors review the key principles of nerve repair in order to maximize functional outcomes in patients with devastating nerve injuries. Managing nerve injuries requires careful patient evaluation; an understanding of the degree, timing, and extent of nerve injury; and consideration of the mechanism of injury. This chapter discusses the advantages and disadvantages of primary nerve repair, nerve autografts, synthetic nerve conduits, and processed nerve allografts. The indication for each of these techniques is discussed. Also discussed is the postoperative management of the reconstructed nerve patient.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91143900","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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