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Burn, chemical, and electrical injuries

Synopsis ■ Review diagnostic criteria for the different types of burn injuries. ■ Review the pathogenesis of the different types of burn injuries. ■ Review first aid management of burn patients. ■ Relate extent of burn injury and magnitude of the physiologic stress response. ■ Review acute management of burn patients, including fluid, nutritional, and wound care. ■ Review burn wound management. ■ Learn indications for…

Perineal reconstruction

Synopsis ■ Surgical site is typically hostile after resection and/or radiation for an underlying condition. ■ Healthy tissue transfer is usually necessary to mitigate wound-healing challenges. ■ A proactive surgical approach can help lessen impact of complications. Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Perineal reconstruction poses the challenge of healing a problematic area with multiple site-specific obstacles. Although…

Pressure sores

Synopsis ■ Pressure sores are a common problem associated with great morbidity and cost. ■ The etiology of pressure sores is multifactorial, and includes pressure, friction, shear, moisture, malnutrition, and infection. ■ Successful treatment of pressure sores requires a multidisciplinary evaluation in order to accurately stage wounds, identify/eradicate wound/bone infection, minimize risk factors for recurrence, and optimize wound healing potential. ■ Prevention and treatment of pressure…

Reconstruction of acquired vaginal defects

Access video lecture content for this chapter online at Elsevier eBooks+ Introduction Acquired vaginal defects most commonly result from the resection of pelvic malignant neoplasms. Advanced colorectal carcinomas frequently involve the posterior vaginal wall. Carcinoma of the bladder may extend into the anterior vaginal wall. Primary tumors of the vaginal wall may result in any number of vaginal defects. Local extension or recurrence of uterine or…

Breast, chest wall, and facial considerations in gender affirmation

Access video content for this chapter online at Elsevier eBooks+ Introduction Gender dysphoria refers to the significant distress that results from an incongruence between the sex assigned at birth and the individual’s gender identity. Social transition, hormones, and gender-affirming surgery (GAS) can be effective in the medical treatment of gender dysphoria. Transgender and gender non-binary individuals may choose to undergo one or more surgical procedures depending…

Gender affirmation surgery, female to male: phalloplasty; and correction of male genital defects

Access video content for this chapter online at Elsevier eBooks+ Patient selection Gender-affirming genital surgery involves a complex series of staged procedures requiring a multidisciplinary approach with numerous other healthcare providers. Due to the irreversible nature of surgery, the World Professional Association for Transgender Health (WPATH) has published guidelines within the Standards of Care (SOC) to assist healthcare teams in identifying appropriate surgical candidates. The recommended…

Gender confirmation surgery, male to female: vaginoplasty

Recent studies estimate that approximately 25 million individuals worldwide, including 1 million people in the United States, identify as transgender. Over the last several years, an increasing number of transgender women have pursued surgical interventions. Some 28% of transgender women report having undergone gender confirming surgical procedures, with 5%–13% of these surgeries involving genital procedures. Of the transgender women who have not undergone these surgeries, 45%–54%…

Gender confirmation surgery: diagnosis and management

Access video lecture content for this chapter online at Elsevier eBooks+ Epidemiology It is estimated that approximately 0.5%–1.3% of the population in the United States has gender dysphoria. In 2014, the prevalence of transgender individuals was estimated at 1.4 million, which was double the predicted estimate in 2011. This is consistent with other reports citing an increase in the number of patients (from 2000 to 2014)…

Abdominal wall reconstruction

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction The abdominal wall is an important “organ”. It serves to protect the viscera and provides an important functional role with maintaining a pressurized core under which the lower extremities achieve locomotion and over which the thorax, upper extremities, and head are supported. Loss of continuity of the abdominal wall is an important…

Reconstruction of the posterior trunk

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Wounds of the posterior trunk can arise as a result of trauma, tumor ablation, chronic pressure, or congenital defects. Management of these wounds can be quite challenging for the reconstructive surgeon given the relative lack of soft-tissue laxity, dearth of microsurgical recipient vessels, and dependent anatomical location. Of note, there are the…

Reconstruction of the chest

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Plastic surgeons are frequently called upon to reconstruct soft-tissue and bony defects of the chest wall. Chest wall defects are exciting and challenging as thewy have multiple etiologies, can have a significant impact on cardiopulmonary dynamics, often occur in patients with multiple medical comorbidities, and require multidisciplinary care. While algorithms for sternal…

Trunk anatomy

Surface anatomy and skin considerations ( Fig. 10.1 ) The surface anatomy of the trunk is of vital importance for operative planning. In the anterior thorax, the sternocleidomastoid (SCM) is the most superior of the critical landmarks. The SCM is the largest of the cervical muscles, traveling obliquely across the neck. It originates on both the manubrium and the clavicle and inserts on the mastoid process…

Diabetic foot: management of vascularity and considerations in soft-tissue reconstruction

Introduction Advances in microsurgery have broadened the scope of reconstructive solutions available for the closure of chronic lower extremity wounds. Pedicled muscle flaps and free tissue transfer offer high rates of limb salvage for patients who might otherwise be subject to minor or major limb amputation. Diabetes is not an absolute contraindication for skin grafting, local muscle flaps, or free flap reconstruction, but patients with diabetes…

Diabetic foot: management of wounds and considerations in biomechanics and amputations

Access video content for this chapter online at Elsevier eBooks+ Principles of wound healing General Contemporary understanding and management of lower extremity wounds has experienced a renaissance in the last several years with a combination of advances in technology and an evolution of evidence-based knowledge leading to significant progressions in the assessment, treatment, and suppression of chronic non-healing lower extremity wounds. The application of these practices…

Diabetic foot: introduction

Introduction The diabetic foot is a detrimental condition experienced by diabetic patients secondary to a complex combination of pathophysiological mechanisms. Once established, the diabetic foot is difficult to treat, with the most definitive treatment being major amputation of the affected lower extremity. Recent advances in management have focused on limb salvage modalities. These have come to include local debridement, advanced wound care, revascularization, bony reconstruction, and…

Foot reconstruction

SYNOPSIS Functional limb salvage mandates a multidisciplinary team approach that comprises vascular surgery, plastic surgery, foot and ankle surgery, infectious disease, general medicine, endocrinologist, rheumatology, physical therapy, pedorthotist, and prosthetist. A successful functional limb salvage is one that restores function whether it be via soft-tissue reconstruction or minor or major amputation. Successful healing of a foot and ankle wound is dependent upon accurate determination of wound…

Skeletal reconstruction

Access video content for this chapter online at Elsevier eBooks+ Introduction Skeletal reconstruction in the lower limb can be challenging for both orthopedic and plastic surgeons. Bony defects may be encountered in isolation, for instance after oncologic resection, while more commonly complex cases with coexisting soft-tissue defects can result after trauma or chronic infections. Moreover, traumatic injuries already treated with internal fixation can become complicated resulting…

Lower extremity pain: regenerative peripheral nerve interfaces

Access video content for this chapter online at Elsevier eBooks+ Introduction Lower extremity pain can have a variety of sources including bone, joint, tendon, ligament, muscle, and nerve. Neuropathic pain can be particularly severe and adversely impacts a patient’s quality of life, ability to work, and even the ability to perform simple activities of daily living. Adequate treatment of neuropathic pain may require a series of…

Targeted muscle reinnervation in the lower extremity

Access video content for this chapter online at Elsevier eBooks+ Introduction Targeted muscle reinnervation (TMR) is a nerve transfer of a proximal nerve, either mixed or sensory, into a distal motor nerve. Initially described by Dumanian and Kuiken, TMR was first used to help gain more dynamic and intuitive control over upper extremity myoelectric prosthetics. These first cohorts of patients were incidentally found to have decreased…

Diagnosis, treatment, and prevention of lower extremity pain

Introduction Symptomatic neuromas of the lower extremity can be debilitating to patients because of chronic pain and decreased physical independence from painful ambulation. They are also one of the few peripheral nerve–mediated pain processes, along with compressive neuropathies, that a plastic surgeon can effectively treat with operative intervention. The problem with symptomatic neuromas is heightened in patients with stump neuromas following an amputation, as these neuromas…