Plastic Reconstructive And Aesthetic Surgery: The Essentials

The Essentials (With DVD-ROM)

Deniz Dayicioglu, John C Oeltjen, Kenneth L Fan, Seth R Thaller

• Publisher: WSPC
• Year: 2012
• Print ISBN: 9789814307109
• eBook ISBN: 9789814440561
• Topic: Biological Sciences
• Subtopic: Science General
• Index: Biological Sciences

This is a concise but comprehensive textbook for plastic surgery residents reviewing for in-service and certifying examinations as well as practicing plastic surgeons preparing for Maintenance of Certification. The book is divided into chapters based on the 24 so-called common plastic surgical procedures. This will allow a discussion of the procedure prior to embarking on surgery and serve as a basis for the development of a basic fund of knowledge in the specialty of Plastic, Reconstructive, and Aesthetic Surgery. Contributors have been selected based on their clinical expertise and academic excellence.

Contents:

• Core Knowledge and General Principles:
  • Wound Repair (Jason P Ulm and Kevin O Delaney)
  • Grafts and Flaps (Jason P Ulm and Dennis K Schimpf)
  • Anesthetic Implications in Cosmetic Surgery (Gian Paparcuri and Miguel Cobas)
  • Lasers and Aesthetic Devices (Mark S Nestor and Matthew B Zarraga)
• Plastic Surgery Involving the Integument:
  • Benign and Malignant Skin Lesions (Wrood M Kassira)
  • Infantile Hemangioma (Karim W Sadik and Haaris S Mir)
  • Burn Injury and Treatment (Jessica A Ching and C Wayne Cruse)
  • Cleft Lip and Palate: Anatomy, Embryology, and Repair (Kenneth L Fan, Raja Mohan and Seth R Thaller)
  • Essentials in Plastic Surgery Microtia Chapter (Kenneth L Fan, Raja Mohan and Seth R Thaller)
  • Head and Neck Malignancy (David Nesky and Donald Weed)
  • Principles in Facial Injury Management (Patrick Cole and Larry Hollier, Jr)
  • Aesthetic Surgery of the Face: Face Lift (Erick Martell and Alan Matarasso)
  • Eyelid, Cheek, Lip, Nasal, Scalp, Ear Reconstruction (Anuja K Antony, Victor J Hassid and Mimis N Cohen)
• Plastic Surgery of the Upper Extremity:
  • Infectious and Inflammatory Disorders of the Upper Extremity (Joshua M Adkinson and Robert X Murphy, Jr)
  • Compression Neuropathies in the Upper Extremity (Askari Morad)
  • Benign and Malignant Tumors of the Upper Extremity (Sara Yegiyants, Yash Avasha and Zubin J Panthaki)
  • Rheumatoid Arthritis of the Hand (Haaris S Mir and Stacy R Henderson)
  • Congenital Hand Anomalies (Sara Yegiyants and Zubin J Panthaki)
  • Upper Extremity Trauma (Deniz Dayicioglu and Derek Ulvila)
  • Dupuytren's Disease (Sara Yegiyants and Zubin J Panthaki)
  • Microsurgery: General Principles (Harvey W-M Chim and Christopher J Salgado)
• Plastic Surgery of the Lower Extremity:
  • Lower Extremity Reconstruction (John R Barbour and Milton B Armstrong)
  • Reduction Mammaplasty, Augmentation Mammaplasty, and Mastopexy (John C Oeltjen)
  • Breast Reconstruction (John C Oeltjen)
  • Aesthetic Body Contouring: Abdominoplasty (Steven Rueda and Seth R Thaller)
  • Aesthetic Body Contouring: Abdominoplasty Body Contouring after Bariatric Surgery (Benjamin Lemelman, Paul G Cofnas and Seth R Thaller)
  • Body Contouring via Suction Lipectomy (Michelle De Souza and Garry Martin II)
  • Abdominal and Thoracic Reconstruction (Umbareen Mahmood and Deniz Dayicioglu)
  • Pressure Ulcers (Jessica S Suber, Rajiv P Parikh and Deniz Dayicioglu)
  • Vascular Anomalies (Harvey Chim and Arun K Gosain)

Readership: Practicing plastic surgeons preparing for Maintenance of Certification examinations, plastic surgery residents, general surgery and other specialty residents rotating through plastic surgery rotations; medical school students rotating through a plastic surgery rotation.

PLASTIC SURGERY OF THE LOWER EXTREMITY

CHAPTER 22

LOWER EXTREMITY RECONSTRUCTION

John R. Barbour and Milton B. Armstrong

Illustrative Case

A 25 year-old female school teacher was involved in a single vehicle collision. She sustained an open tibia fracture [Gustilo IIIb] but maintained intact distal sensation and pulses (Fig. 1A). She was treated initially at an outside facility and transferred to a tertiary care center with plastic surgery and reconstructive expertise following medical stabilization, serial operative débridements, and external fixation of the bony fragments (Fig. 1B). Four days following transfer, seven days following the injury, an anterior-lateral thigh fasciocutaneous flap was performed (Fig. 1C), plugged into the anterior tibial artery and vein proximally (Fig. 1D). The bulky excessive tissue was later debulked in the operating room (Figs. 1E and 1F). The patient has now achieved full weight-bearing status on this extremity and is fully ambulatory, having returned to work and full activity.

Fig. 1. Operative sequence from initial presentation through final operative debulking.

Principles of Lower Extremity Reconstruction

• The modern dilemma that reconstructive surgeons face is no longer how to salvage an extremity but knowing whether or not attempting salvage is the best treatment for the patient.

• The goal in the reconstruction of lower extremity trauma is to restore the anatomy of the altered segment and to achieve functional recovery.

• Primary factors influencing outcomes of lower extremity injuries include degree of soft tissue damage, absence of plantar sensation, and severity of vascular injury.

• Indications for primary amputation include complete anatomic division of the posterior tibial nerve in adult patients, crush injuries with > 8 hours of warm ischemia, and an unstable patient.

• Preservation of mobility of the knee and ankle joints and restoration of the sensation and proprioception of the plantar surface of the foot allow for a functional extremity.

• Bone stabilization should be achieved expediently, and can be achieved internally with screws, rods, or plates or externally with percutaneous pins.

• Early flap coverage of wounds has demonstrated improved results if accomplished within the first 72 hours following injury.

• Limb reconstruction should be reserved for patients with reasonable expectation of ambulation within one year of the injury.

• Amputation may result in a more functional limb, as it can result in a quicker return to ambulation, activity, and work.

Evaluation

• Evaluation of a patient with a significant extremity injury should focus on the patient as a whole, with assessment and treatment following standard guidelines of the Advanced Trauma Life Support system.

• Severe open fractures treated at dedicated trauma units with both orthopedic and plastic surgery services have lower complication rates and lower need for revision surgery compared with those treated initially at local hospitals without such services.¹

History

• The exact mechanisms of injury including any for...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Editors
• Contributors
• Foreword
• Preface
• Core Knowledge and General Principles
• Plastic Surgery Involving the Integument
• Plastic Surgery of the Upper Extremity
• Plastic Surgery of the Lower Extremity
• Index