LANDES B I O S C I E N C E Practical Plastic Surgery Kryger Sisco a d e m e c u m V V ma d e m e c u Practical Plastic Surgery Zol B. Kryger Mark Sisco LANDES B I O S C I E N C E m V a d e m e c u Table of contents I. General Principles II. The Problematic Wound III. Integument IV. Head and Neck V. Trunk and Lower Extremity VI. Craniofacial Surgery VII. Aesthetic Surgery VIII. The Hand and Upper Extremity The Vademecum series includes subjects generally not covered in other handbook series, especially many technology-driven topics that reflect the increasing influence of technology in clinical medicine. The name chosen for this comprehensive medical handbook series is Vademecum, a Latin word that roughly means “to carry along”. In the Middle Ages, traveling clerics carried pocket-sized books, excerpts of the carefully transcribed canons, known as Vademecum. In the 19th century a medical publisher in Germany, Samuel Karger, called a series of portable medical books Vademecum. The Landes Bioscience Vademecum books are intended to be used both in the training of physicians and the care of patients, by medical students, medical house staff and practicing physicians. We hope you will find them a valuable resource. All titles available at www.landesbioscience.com LANDES B I O S C I E N C E Appendix I A. Important Flaps and Their Harvest B. Radial Forearm Free Flap Appendix II Surgical Instruments ISBN 978-1-57059-696-4 9 7 8 1 5 7 0 5 9 6 9 6 4 Kryger Zol B. Kryger, M.D. Division of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois, U.S.A. Mark Sisco, M.D. Division of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois, U.S.A. Practical Plastic Surgery A USTIN , T EXAS U.S.A. vademecum L A N D E S B I O S C I E N C E VADEMECUM Practical Plastic Surgery LANDES BIOSCIENCE Austin, Texas U.S.A. Copyright ©2007 Landes Bioscience All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any informa- tion storage and retrieval system, without permission in writing from the publisher. Printed in the U.S.A. Please address all inquiries to the Publisher: Landes Bioscience, 1002 West Avenue, 2nd Floor, Austin, Texas 78701, U.S.A. Phone: 512/ 637 6050; FAX: 512/ 637 6079 ISBN: 978-1-57059-696-4 Library of Congress Cataloging-in-Publication Data Practical plastic surgery / [edited by] Zol B. Kryger, Mark Sisco. p. ; cm. (Vademecum) Includes bibliographical references and index. ISBN 978-1-57059-696-4 1. Surgery, Plastic. I. Kryger, Zol B. II. Sisco, Mark. III. Series. [DNLM: 1. Reconstructive Surgical Procedures methods. WO 600 P895 2007] RD118.P73 2007 617.9'5 dc22 2007030517 While the authors, editors, sponsor and publisher believe that drug selection and dosage and the specifications and usage of equipment and devices, as set forth in this book, are in accord with current recommendations and practice at the time of publication, they make no warranty, expressed or implied, with respect to material described in this book. In view of the ongoing research, equipment development, changes in governmental regulations and the rapid accumulation of information relating to the biomedical sciences, the reader is urged to carefully review and evaluate the information provided herein. Dedication This book is dedicated to the students and house-staff whose interest and commitment to learning plastic surgery inspired us to create a practical guide to help them along the way. Z.B.K. and M.S. Contents Foreword xix Preface xxi Section I: General Principles 1. Wound Healing and Principles of Wound Care 1 Leonard Lu and Robert D. Galiano 2. Basic Concepts in Wound Repair 4 Zol B. Kryger and Michael A. Howard 3. Dressings 12 Anandev Gurjala and Michael A. Howard 4. Pharmacologic Wound Care 20 Peter Kim and Thomas A. Mustoe 5. Negative Pressure Wound Therapy 24 Peter Kim and Gregory A. Dumanian 6. Leeches 27 Mark Sisco 7. Local Anesthetics 29 Zol B. Kryger and Ted Yagmour 8. Basic Anesthetic Blocks 33 Zol B. Kryger 9. Surgery under Conscious Sedation 38 Zol B. Kryger and Neil A. Fine 10. Principles of Reconstructive Surgery 43 Constance M. Chen and Robert J. Allen 11. Principles of Surgical Flaps 49 Constance M. Chen and Babak J. Mehrara 12. Microvascular Surgical Technique and Methods of Flap Monitoring 56 Sean Boutros and Robert D. Galiano 13. Tissue Expansion 61 Zol B. Kryger and Bruce S. Bauer 14. Alloplastic Materials 65 Jason H. Ko and Julius Few Section II: The Problematic Wound 15. The Chronic Infected Wound and Surgical Site Infections 71 Kevin J. Cross and Philip S. Barie 16. Diabetic Wounds 80 Roberto L. Flores and Michael S. Margiotta 17. Wounds Due to Vascular Causes 87 Kevin J. Cross and Robert T. Grant 18. Radiated Wound and Radiation-Induced Enteric Fistulae 95 Russell R. Reid and Gregory A. Dumanian 19. Pressure Ulcers 100 Zol B. Kryger and Victor L. Lewis 20. Infected and Exposed Vascular Grafts 111 Mark Sisco and Gregory A. Dumanian 21. Management of Exposed and Infected Orthopedic Prostheses 114 Mark Sisco and Michael A. Howard Section III: Integument 22. Hypertrophic Scars and Keloids 117 Zol B. Kryger 23. Benign Skin Lesions 121 Zol B. Kryger 24. Basal Cell and Squamous Cell Carcinoma 126 Darrin M. Hubert and Benjamin Chang 25. Melanoma 131 Gil S. Kryger and David Bentrem 26. Vascular Anomalies 138 Robert D. Galiano and Geoffrey C. Gurtner 27. Skin Grafting and Skin Substitutes 145 Constance M. Chen and Jana Cole 28. Burns: Initial Management and Resuscitation 154 Baubak Safa Section IV: Head and Neck 29. Head and Neck Cancer 163 Zol B. Kryger 30. Ear Reconstruction 168 Amir H. Taghinia, Theodore C. Marentis, Ankit I. Mehta, Paul Gigante and Bernard T. Lee 31. Eyelid Reconstruction 178 Amir H. Taghinia and Bernard T. Lee 32. Nasal Reconstruction 188 Clark F. Schierle and Victor L. Lewis 33. Lip Reconstruction 193 Amir H. Taghinia, Edgar S. Macias, Dzifa S. Kpodzo and Bohdan Pomahac 34. Mandible Reconstruction 211 Patrick Cole, Jeffrey A. Hammoudeh and Arnulf Baumann 35. The Facial Nerve and Facial Reanimation 216 Zol B. Kryger 36. Frontal Sinus Fractures 225 Joseph Raviv and Daniel Danahey 37. Orbital Fractures 231 John Nigriny 38. Fractures of the Zygoma and Maxilla 237 Zol B. Kryger 39. Nasal and NOE Fractures 243 Clark F. Schierle and Victor L Lewis 40. Mandible Fractures 248 Jeffrey A. Hammoudeh, Nirm Nathan and Seth Thaller Section V: Trunk and Lower Extremity 41. Breast Disease and Its Implications for Reconstruction 258 Kristina D. Kotseos and Neil A. Fine 42. TRAM Flap Breast Reconstruction 263 Amir H. Taghinia, Margaret L. McNairy and Bohdan Pomahac 43. Latissimus Flap Breast Reconstruction 274 Roberto L. Flores and Jamie P. Levine 44. Tissue Expander Breast Reconstruction 278 Timothy W. King and Jamie P. Levine 45. Nipple Reconstruction and Tattooing 283 Kristina D. Kotseos and Neil A. Fine 46. Reduction Mammaplasty 288 Timothy W. King and Jamie P. Levine 47. Sternal Wounds 294 Jonathan L. Le and William Y. Hoffman 48. Chest Wall Defects 299 Jason Pomerantz and William Hoffman 49. Coverage of Spinal Wounds 304 Jason Pomerantz and William Hoffman 50. Abdominal Wall Defects 309 Mark Sisco and Gregory A. Dumanian 51. Pelvic, Genital and Perineal Reconstruction 314 Mark Sisco and Gregory A. Dumanian 52. Lower Extremity Reconstruction 318 Mark Sisco and Michael A. Howard Section VI: Craniofacial Surgery 53. Basic Dental Concepts 324 Mark Sisco and Jeffrey A. Hammoudeh 54. Cephalometrics 327 Matthew Jacobsen and Jeffrey A. Hammoudeh 55. Craniofacial Syndromes and Craniosynostosis 334 Zol B. Kryger and Pravin K. Patel 56. Craniofacial Microsomia 340 Zol B. Kryger 57. Microtia Repair 343 Zol B. Kryger 58. Cleft Lip 348 Alex Margulis 59. Cleft Palate 356 Alex Margulis Section VII: Aesthetic Surgery 60. Rhytidectomy 368 Stephen M. Warren and James W. May, Jr. 61. Browlift 377 Clark F. Schierle and John Y.S. Kim 62. Otoplasty 382 Clark F. Schierle and Victor L. Lewis 63. Blepharoplasty 386 Robert T. Lancaster, Stephen M. Warren and Elof Eriksson 64. Rhinoplasty 394 Ziv M. Peled, Stephen M. Warren and Michael J. Yaremchu 65. Genioplasty, Chin and Malar Augmentation 400 Jeffrey A. Hammoudeh, Christopher Low and Arnulf Baumann 66. Augmentation Mammaplasty 406 Richard J. Brown and John Y.S. Kim 67. Gynecomastia Reduction 413 Richard J. Brown and John Y.S. Kim 68. Mastopexy 417 Richard J. Brown and John Y.S. Kim 69. Abdominoplasty 423 Amir H. Taghinia and Bohdan Pomahac 70. Liposuction 430 Zol B. Kryger 71. Laser Resurfacing 433 Keren Horn and Jerome Garden 72. Chemical Rejuvenation of the Face 440 Keren Horn and David Wrone 73. Fat Injection and Injectable Fillers 446 Darrin M. Hubert and Louis P. Bucky 74. Cosmetic Uses of Botulinum Toxin 451 Leonard Lu and Julius Few 75. Dermabrasion 454 Zol B. Kryger 76. Hair Restoration 458 Anandev Gurjala Section VIII: The Hand and Upper Extremity 77. Anatomy of the Hand 462 Zol B. Kryger 78. Radiographic Findings 468 Zol B. Kryger and Avanti Ambekar 79. Examination of the Hand and Wrist 476 Zol B. Kryger 80. Soft Tissue Infections 481 Zol B. Kryger and Hongshik Han 81. Compartment Syndrome of the Upper Extremity 486 Zol B. Kryger 82. Replantation 492 Zol B. Kryger 83. Fractures of the Distal Radius and Ulna 497 Craig Birgfeld and Benjamin Chang 84. Wrist Fractures 502 Gil Kryger 85. Finger and Metacarpal Fratures 512 Oliver Kloeters and John Y.S. Kim 86. Brachial Plexus Injuries 518 Mark Sisco and John Y.S. Kim 87. Nerve Injuries 523 Zol B. Kryger 88. Vascular Trauma 529 Zol B. Kryger 89. Extensor Tendon Injuries 533 Zol B. Kryger 90. Flexor Tendon Injuries 539 Zol B. Kryger 91. Injuries of the Finger 547 Millicent Odunze and Gregory A. Dumanian 92. Soft Tissue Coverage 561 Hongshik Han 93. Carpal Tunnel Syndrome 566 David S. Rosenberg and Gregory A. Dumanian [...]... EtOH) - Venous insufficiency - Extremity edema (e.g., CHF) - Arterial insufficiency/PVD Extrinsic - Smoking - Radiation - Chemotherapy - Drugs (e.g steroids) - Temperature (cold) - Mechanical - Pressure - Sheer - Trauma Local - Desiccation - Inflammation Infection Bacterial burden Hematoma Foreign Body Ischemia - Necrotic burden Dead cells, exudate - Cellular burden Senescent and nonviable cells - Edema... secondary importance, sutures can be left in place for weeks or even months The following is a guideline for the timing of suture removal: Eyelids → 3-5 days → 5-7 days Face Breast → 7 -1 0 days Trunk → 7 -1 0 days Hands → 1 0 -1 4 days → 1 0 -1 4 days Feet 8 Practical Plastic Surgery Considerations in Wound Healing and Scar Formation Important factors that contribute to a worsened scar outcome include: Tension on the... M.D., Resident Division of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois, U.S.A Chapters 2, 7-9 , 13 , 19 , 22, 23, 29, 35, 38, 5 5-5 7, 70, 75, 7 7-8 2, 8 7-9 0, 92, 9 7-9 9, 10 1, Appendix IA, Appendix II Leonard Lu, M.D., Resident Division of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois, U.S.A Chapters 1, 74 Edgar S Macias, B.S.,... properties: 1 Maintain a moist wound healing environment 2 Absorb exudate 3 Provide a barrier against bacteria 4 Debride—both macroscopic and microscopic material Practical Plastic Surgery, edited by Zol B Kryger and Mark Sisco ©2007 Landes Bioscience 13 Dressings Table 3 .1 Factors that impair wound healing Intrinsic Wound: - Hypoperfusion - Hypoxia Systemic: - Age - Obesity - Malnutrition - Hormones - Disease... Professor Division of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois, U.S.A Chapters 5, 18 , 20, 50, 51, 91, 9 3-9 5, 98, 10 1 Elof Eriksson, M.D Ph.D., Professor and Chief Division of Plastic Surgery Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts, U.S.A Chapter 63 Julius Few, M.D., Assistant Professor Division of Plastic Surgery Northwestern... Kryger 10 0 Dupuytren’s Disease 597 Oliver Kloeters and John Y.S Kim 10 1 Reflex Sympathetic Dystrophy 6 01 Zol B Kryger and Gregory A Dumanian Appendix I— Part A: Important Flaps and Their Harvest 607 Zol B Kryger and Mark Sisco Groin Flap 607 Rectus Abdominis Flap 611 Fibula Composite Flap 612 Pectoralis Major Flap 614 Latissimus Dorsi Flap 615 ... Chang, M.D., Associate Professor Division of Plastic Surgery University of Pennsylvania Medical School Philadelphia, Pennsylvania, U.S.A Chapters 24, 83 Constance M Chen, M.D., M.P.H., Resident Division of Plastic Surgery New York-Presbyterian Hospital New York, New York, U.S.A Chapters 10 , 11 , 27 Jana Cole, M.D., Assistant Professor Division of Plastic Surgery University of Washington Seattle, Washington,... Although there are several excellent atlases and texts, we have come across few references that are compact, affordable, timely, and focus on the practical, day-to-day practice of plastic surgery The purpose of Practical Plastic Surgery is to provide a guide to plastic surgery as it is practiced in academic medical centers As such, it is written with the resident and fellow in mind It is also our intention... Resident Division of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois, U.S.A Chapters 32, 39, 61, 62 Mark Sisco, M.D., Resident Division of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois, U.S.A Chapters 6, 20, 21, 28, 5 0-5 3, 86, Appendix IA, Appendix II Thomas Wiedrich, M.D., Associate Professor Division of Plastic Surgery Northwestern... of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois, U.S.A Chapters 61, 6 6-6 8, 81, 82, 85, 86, 88, 97, 99, 10 0, Appendix IB Peter Kim, M.D., Resident Division of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois, U.S.A Chapters 4, 5, Appendix IB Timothy W King, M.D Ph.D., Resident NYU Medical Center Institute of Reconstructive Plastic . Floor, Austin, Texas 787 01, U.S.A. Phone: 512 / 637 6050; FAX: 512 / 637 6079 ISBN: 97 8 -1 -5 705 9-6 9 6-4 Library of Congress Cataloging-in-Publication Data Practical plastic surgery / [edited by] Zol. ISBN 97 8 -1 -5 705 9-6 9 6-4 1. Surgery, Plastic. I. Kryger, Zol B. II. Sisco, Mark. III. Series. [DNLM: 1. Reconstructive Surgical Procedures methods. WO 600 P895 2007] RD 118 .P73 2007 617 .9'5. U.S.A. Chapters 2, 7-9 , 13 , 19 , 22, 23, 29, 35, 38, 5 5-5 7, 70, 75, 7 7-8 2, 8 7-9 0, 92, 9 7-9 9, 10 1, Appendix IA, Appendix II Robert T. Lancaster, M.D., Resident Department of Surgery Massachusetts