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Introduction Advances in digital technology have impacted and will continue to impact plastic surgery. The chapter will explore the effects of current and future technology on patients’ and physicians’ experiences prior to the plastic surgery consultation, during the patient encounter(s), in the operating room and the perioperative period, and during long-term follow-up. The chapter will also discuss the impact of digital advances on education, research, medical…
Access video content for this chapter online at Elsevier eBooks+ Introduction “Robot” is a term derived from the Czech word robota , meaning “forced labor”. It was Karel Čapek (a Czech writer, playwright, and critic) who introduced the term to the English language and to science fiction in his play Rossom's Universal Robots in 1921. Before entering the field of surgery, robots were heavily used in…
Synopsis ■ Plastic surgeons have historically been distinguished by their ability to innovate and should continue to maintain this competitive advantage. ■ This chapter will familiarize the surgeon innovator with a systematic approach to innovation. This process includes idea formation, valuation, funding, intellectual property, institutional technology transfer, the FDA regulatory process, and conflicts of interest. ■ Negative pressure wound therapy, acellular dermal matrix, and noninvasive body…
Introduction The loss of tissue or organs is a devastating event for a patient leading to potential risk of death or tremendous functional impairments. Affected patients suffer from stigmatizing deformities, life-threatening illness or great psychological burden. Thus, the aim to replace solid organs or tissues with autologous, allogeneic or xenogeneic transplants is deeply anchored in the medical history. Autologous transplantation describes the reconstruction of defects using…
Synopsis ■ What is a biomaterial? ■ There are many definitions of biomaterials but a widely used one from the National Institutes of Health defines a biomaterial as “any substance (other than a drug) or combination of substances synthetic or natural in origin, which can be used for any period of time, as a whole or part of a system which treats, augments, or replaces tissue,…
Synopsis ■ Melanocytes usually exist as single cells in the basal layer of the epidermis, of which they represent approximately 1 in 8 cells. They function to export melanin via dendrites to the squamous cells which form a shield over the nucleus to absorb ultraviolet radiation. ■ Melanoma occurs predominantly in fairer-skinned people as a result of ultraviolet radiation. The incidence has risen dramatically in recent…
Synopsis All typical skin and skin-associated soft-tissue tumors apart from malignant melanocytic tumors are described from the point of view of the plastic surgeon. Topics covered include: ■ Diagnosis: inspection and palpation, dermoscopy, imaging ■ Pathologic diagnosis: TNM classification and clinical staging ■ Treatment modalities, including wide excision, lymph node dissection, reconstructive surgery, radiation therapy, chemotherapy, laser therapy ■ Benign cutaneous and soft-tissue tumors ■ Malignant…
Synopsis ■ Lymphedema is a progressive disease that can occur as a result of congenital defects, iatrogenic injury, or infection of the lymphatic system. ■ The lymphatic system is comprised of capillary lymphatics that drain into progressively larger collecting vessels. ■ Lymphedema can develop due to genetic/developmental abnormalities of the lymphatic system (i.e., primary lymphedema) or more commonly, after trauma or infection of the lymphatic system…
Synopsis ■ Radiation therapy (RT) can be used as a primary or adjuvant treatment for many cancers. ■ The unit of dose measurement is the gray (Gy). ■ Side-effects are characterized as acute and late toxicities. ■ Acute toxicities are temporary and reversible. ■ Late toxicities are permanent. ■ The primary mechanism of action of radiation is through breakage of DNA strands. ■ Treatment planning is…
Access video lecture content for this chapter online at Elsevier eBooks+ Introduction Breast augmentation is one of the most commonly performed aesthetic surgery procedures worldwide, with breast implants being a staple of reconstructive and aesthetic surgery. The ability of the human body’s tissue to expand when applying constant pressure to it has been used by plastic surgeons to treat and reconstruct a multitude of defects and…
Synopsis ■ Microsurgery and supermicrosurgery refers to the surgical coaptation of small vessels, usually around 1 mm in diameter or smaller, under microscope magnification. Microsurgery is a broad term not only limited to blood vessels but also refers to coaptation of tiny nerves and lymphatics. ■ This technique has evolved significantly over the last four decades, starting from revascularization and replantation in 1960 to free flap…
Synopsis ■ Flap is tissue(s) with its own vascular supply, allowing transfer from one site to another. ■ Flaps come in various forms, shapes, and function. They may be composed of a simple skin tissue or multiple composite tissues. ■ The purpose of classification is to understand the anatomy and the features that each flap provides. It also allows communication not only with peers but with…
Synopsis ■ This chapter provides an overview of the angiosome concept and reviews the vascular anatomy of the body. The historical perspective summarizes the major progress in understanding the vascular basis and clinical applications of flaps in reconstructive surgery. ■ The anatomical basis of angiosomes, choke anastomotic vessels, arterial territories, and venous drainage of the human body are summarized. The neurovascular territories of skin and muscle…
Synopsis ■ Fat grafting is an important technique for tissue repair and/or augmentation in both reconstructive and aesthetic plastic surgery. ■ Fat grafting can be used as a minimally invasive adjunct to restore volume and rejuvenate tissues lost secondary to aging, trauma, or disease. ■ The biology and principal components of adipose tissue are reviewed with specific focus on adipose-derived stem cells. ■ The safety of…
Synopsis ■ Primary neurorrhaphy remains the gold standard in nerve repair; all other methods of repair are judged in comparison to primary neurorrhaphy. ■ Excessive tension will inhibit nerve regeneration, however a small amount of tension to achieve primary coaptation is acceptable. ■ In the event of a nerve gap, several options for repair exist including: ■ Mobilization and primary coaptation ■ Interpositional nerve autografting ■…
Synopsis ■ This chapter will concentrate on the principles and concepts of bone repair, grafting, and reconstruction. ■ The embryology, physiology, microanatomy, and histochemistry of bone will be reviewed. ■ Principles of mechanotransduction and cellular mechanisms of bone turnover will also be discussed. ■ Pathophysiology of traumatic injury to bone (fractures, segmental loss, defects) will be categorized and reviewed. ■ Bone-remodeling mechanisms (osteoconduction, osteoinduction, osseointegration) will…
Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Cartilage is one kind of connective tissue, which is mainly composed of chondrocytes and their produced extracellular matrices (ECM) of type II collagen fibers, proteoglycans, and elastic fibers. According to the composition, cartilage can be classified into three types. (1) Hyaline cartilage, which is the most common type of cartilage and can…
Introduction The field of tissue engineering embodies, like few other areas of scientific endeavor, the principles, aspirations, and the techniques of plastic surgery. However, the “boom time” promise of the early “frontier” tissue engineers and their pioneering endeavors have not been matched, to date, by real-world solutions that translated into useful outcomes for plastic surgery patients. Unfortunately, the fortunes of the tissue engineering sector closely matched…
Synopsis ■ Human skin is a highly complex trilaminar structure with a plethora of emergent properties critical to health and survival. ■ Skin grafts are key to restoring cutaneous integrity after complex burn and polytrauma. ■ The history of skin grafting is one of need and innovation, resulting in advances in reconstructive surgery. ■ Clinical needs have resulted in myriad classes of skin grafts, each with…