Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues. Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages. Simultaneous scalp and calvarial reconstruction is now routinely performed. Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures. This review contains 15 figures, 5 tables, and 41 references. Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)
{"title":"Calvarial and Scalp Reconstruction","authors":"M. Hanasono","doi":"10.2310/ps.10071","DOIUrl":"https://doi.org/10.2310/ps.10071","url":null,"abstract":"Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues. Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages. Simultaneous scalp and calvarial reconstruction is now routinely performed. Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.\u0000This review contains 15 figures, 5 tables, and 41 references.\u0000Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78773248","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}
C. Dy, David M. Brogan, M. Boyer, Carol B. Loeb, Jerome T. Loeb
The complexity of each brachial plexus injury (BPI) pattern and physiologic limitations of nerve regeneration create challenges for BPI patients and their surgeons. Detailed assessment via physical examination, electrodiagnostic studies, and advanced imaging can aid the surgeon in predicting the prognosis for each patient’s neurologic recovery and provide an outline for reconstructive priorities. Surgical exploration of the brachial plexus confirms the injury pattern and guides the overall treatment strategies. A multimodal reconstructive strategy including nerve grafting, extraplexal nerve transfers, distal intraplexal nerve transfers, and free-functioning muscle transfers is designed for each patient to accomplish the goals of providing a pain-free helper hand. Additional reconstructive procedures such as tendon transfers and selective joint arthrodeses are used after the results of the initial reconstructive efforts have been declared. Beyond the neurologic components of BPI, the surgeon must be attuned to the social and psychological sequelae of this devastating injury. This review contains 10 figures, 1 table, and 60 references. Key Words: brachial plexus injury, elbow flexion, free-functioning muscle transfer, nerve grafting, nerve transfer, reconstruction, shoulder abduction, , tendon transfer
{"title":"Nerve Reconstruction and Tendon Transfers for Treatment of Brachial Plexus Injuries","authors":"C. Dy, David M. Brogan, M. Boyer, Carol B. Loeb, Jerome T. Loeb","doi":"10.2310/ps.10067","DOIUrl":"https://doi.org/10.2310/ps.10067","url":null,"abstract":"The complexity of each brachial plexus injury (BPI) pattern and physiologic limitations of nerve regeneration create challenges for BPI patients and their surgeons. Detailed assessment via physical examination, electrodiagnostic studies, and advanced imaging can aid the surgeon in predicting the prognosis for each patient’s neurologic recovery and provide an outline for reconstructive priorities. Surgical exploration of the brachial plexus confirms the injury pattern and guides the overall treatment strategies. A multimodal reconstructive strategy including nerve grafting, extraplexal nerve transfers, distal intraplexal nerve transfers, and free-functioning muscle transfers is designed for each patient to accomplish the goals of providing a pain-free helper hand. Additional reconstructive procedures such as tendon transfers and selective joint arthrodeses are used after the results of the initial reconstructive efforts have been declared. Beyond the neurologic components of BPI, the surgeon must be attuned to the social and psychological sequelae of this devastating injury.\u0000 This review contains 10 figures, 1 table, and 60 references.\u0000Key Words: brachial plexus injury, elbow flexion, free-functioning muscle transfer, nerve grafting, nerve transfer, reconstruction, shoulder abduction, , tendon transfer","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83032308","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}
In the adult, the thyroid gland is located in the central compartment of the neck on the anterolateral aspect of the cervical trachea between the carotid sheaths. Patients with thyroid disorders require attentive care, and safe, successful surgery of the thyroid is dependent on an intimate knowledge of the anatomy and physiology of the gland. This review discusses nerve branches and function; arterial and venous blood supply; lymphatic drainage; histology; physiology; and thyroid hormone synthesis, secretion, and regulation. Nerve injuries and postoperative complications are summarized, as are functions of thyroid hormones. A thorough understanding of these relationships is imperative for proper medical recommendations, surgical procedure selection, and meticulous surgical technique to avoid complications. To provide safe care of patients with thyroid disorders, treating physicians must embrace the intricate details of the anatomy and physiology of this unique gland to avoid potentially devastating complications. This review contains 5 figures, 3 tables, and 29 references. Key Words: brachial cleft, lymphatic zones, recurrent laryngeal nerve, superior laryngeal nerve, nerve injury, thyroglossal duct cysts, thyroid, thyroidectomy
{"title":"The Endocrine System: Thyroid and Parathyroid","authors":"Samantha J. Baker, John R. Porterfield Jr","doi":"10.2310/surg.2240","DOIUrl":"https://doi.org/10.2310/surg.2240","url":null,"abstract":"In the adult, the thyroid gland is located in the central compartment of the neck on the anterolateral aspect of the cervical trachea between the carotid sheaths. Patients with thyroid disorders require attentive care, and safe, successful surgery of the thyroid is dependent on an intimate knowledge of the anatomy and physiology of the gland. This review discusses nerve branches and function; arterial and venous blood supply; lymphatic drainage; histology; physiology; and thyroid hormone synthesis, secretion, and regulation. Nerve injuries and postoperative complications are summarized, as are functions of thyroid hormones. A thorough understanding of these relationships is imperative for proper medical recommendations, surgical procedure selection, and meticulous surgical technique to avoid complications. To provide safe care of patients with thyroid disorders, treating physicians must embrace the intricate details of the anatomy and physiology of this unique gland to avoid potentially devastating complications.\u0000\u0000This review contains 5 figures, 3 tables, and 29 references.\u0000\u0000Key Words: brachial cleft, lymphatic zones, recurrent laryngeal nerve, superior laryngeal nerve, nerve injury, thyroglossal duct cysts, thyroid, thyroidectomy\u0000","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90609738","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}
{"title":"Injuries to the Liver and Biliary Tract","authors":"Ernest E. Moore, C. Burlew","doi":"10.2310/surg.2135","DOIUrl":"https://doi.org/10.2310/surg.2135","url":null,"abstract":"\u0000 ","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80124501","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}
Dominic Henn, Kellen Chen, Janos A. Barrera, Jagannath Padmanabhan, S. H. Kwon, G. Gurtner
Grafting of blood vessels and nerves are essential surgical techniques which are used to restore continuity in cases of acute or chronic vascular or nervous damage. Due to superior outcomes autologous grafts are generally preferred over allografts or alloplastic grafts. Bone, cartilage and tendons are physiologically subjected to various degrees of mechanical stress, which has been observed to play a critical role in graft survival and remodeling. Bone grafting is used to replace missing bone or to enhance new bone formation in the treatment of fractures, delayed or non-unions or in reconstructive surgery after trauma or tumor resection. Unlike bone, cartilage and tendons have a low capacity for self-renewal due their avascular nature and low cellularity which presents challenges to graft survival and healing rates. This review contains 2 figures, and 68 references. Keywords: autograft, allograft, vascular grafting, nerve grafting, bone grafting, cartilage grafting, tendon grafting, tissue engineering, regenerative medicine
{"title":"Grafting – Basic Principles and Surgical Applications, Part II","authors":"Dominic Henn, Kellen Chen, Janos A. Barrera, Jagannath Padmanabhan, S. H. Kwon, G. Gurtner","doi":"10.2310/ps.10121","DOIUrl":"https://doi.org/10.2310/ps.10121","url":null,"abstract":"Grafting of blood vessels and nerves are essential surgical techniques which are used to restore continuity in cases of acute or chronic vascular or nervous damage. Due to superior outcomes autologous grafts are generally preferred over allografts or alloplastic grafts. Bone, cartilage and tendons are physiologically subjected to various degrees of mechanical stress, which has been observed to play a critical role in graft survival and remodeling. Bone grafting is used to replace missing bone or to enhance new bone formation in the treatment of fractures, delayed or non-unions or in reconstructive surgery after trauma or tumor resection. Unlike bone, cartilage and tendons have a low capacity for self-renewal due their avascular nature and low cellularity which presents challenges to graft survival and healing rates.\u0000This review contains 2 figures, and 68 references. \u0000Keywords: autograft, allograft, vascular grafting, nerve grafting, bone grafting, cartilage grafting, tendon grafting, tissue engineering, regenerative medicine","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75324753","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}
Dominic Henn, Kellen Chen, Janos A. Barrera, Jagannath Padmanabhan, S. H. Kwon, G. Gurtner
Grafting is defined as a surgical procedure in which tissue is transplanted without its native blood supply from one anatomic region of the body to another. A graft can be transplanted within the same individual (autograft), or between individuals of the same (allograft) or a different species (xenograft). A graft fully relies on the blood supply of its recipient site, which is why healthy and well vascularized recipient sites are prerequisites for successful graft healing. Various types of tissues can be grafted with reliable healing rates and have become part of standard surgical treatment strategies. Pre-clinical research approaches within tissue engineering and regenerative medicine using stem cells, biological scaffolds, biomolecules, and gene therapy have demonstrated great advances in graft vascularization and healing and may yield translational treatment strategies improving patient outcomes in the future. This review contains 3 figures, and 48 references. Keywords: autograft, allograft, xenograft, vascularization, skin grafting, fat grafting, tissue engineering, regenerative medicine
{"title":"Grafting – Basic Principles and Surgical Applications, Part I","authors":"Dominic Henn, Kellen Chen, Janos A. Barrera, Jagannath Padmanabhan, S. H. Kwon, G. Gurtner","doi":"10.2310/ps.10005","DOIUrl":"https://doi.org/10.2310/ps.10005","url":null,"abstract":"Grafting is defined as a surgical procedure in which tissue is transplanted without its native blood supply from one anatomic region of the body to another. A graft can be transplanted within the same individual (autograft), or between individuals of the same (allograft) or a different species (xenograft). A graft fully relies on the blood supply of its recipient site, which is why healthy and well vascularized recipient sites are prerequisites for successful graft healing. Various types of tissues can be grafted with reliable healing rates and have become part of standard surgical treatment strategies. Pre-clinical research approaches within tissue engineering and regenerative medicine using stem cells, biological scaffolds, biomolecules, and gene therapy have demonstrated great advances in graft vascularization and healing and may yield translational treatment strategies improving patient outcomes in the future.\u0000This review contains 3 figures, and 48 references.\u0000Keywords: autograft, allograft, xenograft, vascularization, skin grafting, fat grafting, tissue engineering, regenerative medicine","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72936270","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}
J. Bekeny, Vikas S Kotha, E. Zolper, C. Kennedy, J. Day, Kenneth L. Fan, C. Attinger, K. Evans
Historically, patients with chronic diabetic foot ulcers were managed with major lower extremity amputations such as below-knee amputations and above-knee amputations. With the advancement of microsurgical techniques, patients have been able to achieve limb salvage and reap the associated morbidity and mortality benefits. In order to ensure successful limb salvage, a patient’s biomechanic, diabetic, vascular, and infectious profiles need to be optimized. Serial debridement supplemented with antibiotics until negative deep tissue cultures is the gold standard for infection eradication. A surgeon needs to have a good understanding of patient and wound-specific anatomic considerations. Simpler techniques, such as primary closure, skin grafting, and Integra placement, may be used. In complex wounds, more involved reconstructive modalities, such as local flap or free tissue transfer, may be required. Coverage selection depends on an intimate understanding of the patient’s comorbidities, wound characteristics, and vascular status. This review contains 7 figures, 2 tables, and 32 references. Keywords: diabetic foot ulcer, chronic wound, nonhealing vasculopathic wound, local flap, free flap, free tissue transfer, abductor digiti minimi flap, abductor hallicus flap, flexor digitorum brevis flap
{"title":"Surgical Coverage of Diabetic Feet","authors":"J. Bekeny, Vikas S Kotha, E. Zolper, C. Kennedy, J. Day, Kenneth L. Fan, C. Attinger, K. Evans","doi":"10.2310/ps.10104","DOIUrl":"https://doi.org/10.2310/ps.10104","url":null,"abstract":"Historically, patients with chronic diabetic foot ulcers were managed with major lower extremity amputations such as below-knee amputations and above-knee amputations. With the advancement of microsurgical techniques, patients have been able to achieve limb salvage and reap the associated morbidity and mortality benefits. In order to ensure successful limb salvage, a patient’s biomechanic, diabetic, vascular, and infectious profiles need to be optimized. Serial debridement supplemented with antibiotics until negative deep tissue cultures is the gold standard for infection eradication. A surgeon needs to have a good understanding of patient and wound-specific anatomic considerations. Simpler techniques, such as primary closure, skin grafting, and Integra placement, may be used. In complex wounds, more involved reconstructive modalities, such as local flap or free tissue transfer, may be required. Coverage selection depends on an intimate understanding of the patient’s comorbidities, wound characteristics, and vascular status.\u0000This review contains 7 figures, 2 tables, and 32 references.\u0000Keywords: diabetic foot ulcer, chronic wound, nonhealing vasculopathic wound, local flap, free flap, free tissue transfer, abductor digiti minimi flap, abductor hallicus flap, flexor digitorum brevis flap","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76889308","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}
This chapter presents a systematic approach to the diagnosis and management of the most common oral cavity lesions. Oral cavity lesions are broadly categorized based on etiology and are further characterized according to clinical features such as location, shape, size, associated symptoms, and duration. Some of these conditions present with pathognomonic signs and symptoms, whereas others may present nonspecific features, making clinical diagnosis challenging. Formulating a differential diagnosis requires taking a thorough history and performing a detailed physical examination, often along with investigative studies and tests. Management protocols differ according to the specific condition, ranging from observation alone to medication-based and/or surgical therapy. This review 32 figures, 6 tables, and 53 references. Key Words: hematologic malignancy, immune-mediated disease, mucosal melanoma, oral anatomy, oral cancer, oral examination, oral infections, oral manifestations, oral mucosal disease, oral precancerous lesions, salivary gland disease
{"title":"Oral Cavity Lesions","authors":"M. Kuten-Shorrer, J. Bruch, N. Treister","doi":"10.2310/surg.2025","DOIUrl":"https://doi.org/10.2310/surg.2025","url":null,"abstract":"This chapter presents a systematic approach to the diagnosis and management of the most common oral cavity lesions. Oral cavity lesions are broadly categorized based on etiology and are further characterized according to clinical features such as location, shape, size, associated symptoms, and duration. Some of these conditions present with pathognomonic signs and symptoms, whereas others may present nonspecific features, making clinical diagnosis challenging. Formulating a differential diagnosis requires taking a thorough history and performing a detailed physical examination, often along with investigative studies and tests. Management protocols differ according to the specific condition, ranging from observation alone to medication-based and/or surgical therapy.\u0000This review 32 figures, 6 tables, and 53 references.\u0000Key Words: hematologic malignancy, immune-mediated disease, mucosal melanoma, oral anatomy, oral cancer, oral examination, oral infections, oral manifestations, oral mucosal disease, oral precancerous lesions, salivary gland disease","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80740612","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}
The perception of beauty impacts our daily lives, such that the pursuit of beauty is often the pursuit of an improved quality of life. Although there are guidelines for facial proportions, there is no set beauty ideal in the modern day. Aesthetic surgeons should be familiar with facial proportions and should be able to modify these with respect to cultural and ethnic variations. To achieve imperceptible scarring, aesthetic surgeons should be able to control tissue tension, properly orient incisions, appreciate anatomical subunits, and avoid distortion of surrounding structures. Aesthetic surgery, when performed with craftsmanship, can achieve a long-lasting and harmonious result. This review contains 10 figures, and 26 references. Keywords: defining beauty, facial aesthetic proportions, facial subunits, scarring, resting skin tension lines, evolution of facelift, SMAS, facial aging
{"title":"Aesthetic Principles","authors":"D. Sarhaddi, F. Nahai","doi":"10.2310/ps.10010","DOIUrl":"https://doi.org/10.2310/ps.10010","url":null,"abstract":"The perception of beauty impacts our daily lives, such that the pursuit of beauty is often the pursuit of an improved quality of life. Although there are guidelines for facial proportions, there is no set beauty ideal in the modern day. Aesthetic surgeons should be familiar with facial proportions and should be able to modify these with respect to cultural and ethnic variations. To achieve imperceptible scarring, aesthetic surgeons should be able to control tissue tension, properly orient incisions, appreciate anatomical subunits, and avoid distortion of surrounding structures. Aesthetic surgery, when performed with craftsmanship, can achieve a long-lasting and harmonious result. \u0000This review contains 10 figures, and 26 references.\u0000Keywords: defining beauty, facial aesthetic proportions, facial subunits, scarring, resting skin tension lines, evolution of facelift, SMAS, facial aging","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75231141","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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