Key Notes on Plastic Surgery

Adrian Richards, Hywel Dafydd

• Publisher: Wiley-Blackwell
• Year: 2014
• ISBN:
  9781118756997
• Edition: 2
• Topic: Médecine
• Subtopic: Médecine plastique et cosmétique

This is the new edition of the concise but comprehensive handbook that should be owned by all surgical trainees specialising in plastic surgery. Taking a pithy systematic approach, Key Notes on Plastic Surgery offers the latest developments within the field in bullet point form and includes key papers for viva voces. It is informed by the current FRCS (Plast) curriculum, making it ideal preparation for the UK exit examination or equivalent international board exam.

Key features

• Fully covers the entire scope of plastic surgery
• Clearly divided into 10 sections with logical subheadings for easy fact-finding
• Acts as an adjunct to the established longer texts
• Brand new chapter on ethics and the law – a compulsory component of the oral examination
• Illustrations outlining key surgical procedures and relevant anatomy

Fully revised to include all the latest clinical guidelines, Key Notes on Plastic Surgery is the perfect rapid reference tool for trainees in plastic surgery and dermatologic surgery who require quick, accurate answers.

Chapter 1
General Principles

1. Embryology, structure and function of the skin
2. Blood supply to the skin
3. Classification of flaps
4. Geometry of local flaps
5. Wound healing and skin grafts
6. Bone healing and bone grafts
7. Cartilage healing and cartilage grafts
8. Nerve healing and nerve grafts
9. Tendon healing
10. Transplantation
11. Tissue engineering
12. Alloplastic implantation
13. Wound dressings
14. Sutures and suturing
15. Tissue expansion
16. Lasers
17. Local anaesthesia
18. Microsurgery
19. Haemostasis and thrombosis
20. Further reading

Embryology, structure and function of the skin

• Skin differentiates from ectoderm and mesoderm during the 4th week.
• Skin gives rise to:
  • Teeth and hair follicles, derived from epidermis and dermis
  • Fingernails and toenails, derived from epidermis only.
• Hair follicles, sebaceous glands, sweat glands, apocrine glands and mammary glands are ‘epidermal appendages’ because they develop as ingrowths of epidermis into dermis.
• Functions of skin:
  1. Physical protection
  2. Protection against UV light
  3. Protection against microbiological invasion
  4. Prevention of fluid loss
  5. Regulation of body temperature
  6. Sensation
  7. Immunological surveillance.

The epidermis

• Composed of stratified squamous epithelium.
• Derived from ectoderm.
• Epidermal cells undergo keratinisation—their cytoplasm is replaced with keratin as the cell dies and becomes more superficial.
• Rete ridges are epidermal thickenings that extend downward between dermal papillae.
• Epidermis is composed of these five layers, from deep to superficial:

1. Stratum germinativum
   • Also known as the basal layer.
   • Cells within this layer have cytoplasmic projections (hemidesmosomes), which firmly link them to the underlying basal lamina.
   • The only actively proliferating layer of skin.
   • Stratum germinativum also contains melanocytes.
2. Stratum spinosum
   • Also known as the prickle cell layer.
   • Contains large keratinocytes, which synthesise cytokeratin.
   • Cytokeratin accumulates in aggregates called tonofibrils.
   • Bundles of tonofibrils converge into numerous desmosomes (prickles), forming strong intercellular contacts.
3. Stratum granulosum
   • Contains mature keratinocytes, with cytoplasmic granules of keratohyalin.
   • The predominant site of protein synthesis.
   • Combination of cytokeratin tonofibrils with keratohyalin produces keratin.
4. Stratum lucidum
   • A clear layer, only present in the thick glabrous skin of palms and feet.
5. Stratum corneum
   • Contains non-viable keratinised cells, having lost their nuclei and cytoplasm.
   • Protects against trauma.
   • Insulates against fluid loss.
   • Protects against bacterial invasion and mechanical stress.

Cellular composition of the epidermis

• Keratinocytes—the predominant cell type in the epidermis.
• Langerhans cells—antigen-presenting cells (APCs) of the immune system.
• Merkel cells—mechanoreceptors of neural crest origin.
• Melanocytes—neural crest derivatives:
  • Usually located in the stratum germinativum.
  • Produce melanin packaged in melanosomes, which is delivered along dendrites to surrounding keratinocytes.
  • Melanosomes form a cap over the nucleus of keratinocytes, protecting DNA from UV light.

The dermis

• Accounts for 95% of the skin's thickness.
• Derived from mesoderm.
• Papillary dermis is superficial; contains more cells and finer collagen fibres.
• Reticular dermis is deeper; ...