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Extensor Tendon Injuries

Extensor Tendon Injuries Unlike flexor tendons, the extensor tendons are not constrained in a sheath, but nevertheless have a complex and intricate anatomy. The dorsal skin being thinner and pliable is more susceptible to trauma. As extensor tendon repairs are perceived to be a lot easier, they end up being delegated to junior surgical trainees. Although the surgical repair itself may be simple, thorough understanding of…

Flexor Tendon Injuries

Introduction Flexor tendon injuries are among commonly seen hand trauma, and outcomes of the treatment in the fingers and thumbs are traditionally unsatisfactory. In the hand and the forearm, flexor tendons are divided into five anatomical zones. Zone 2 is the most complex area, which has attracted most attention from surgeons and investigators alike. Over the past decades, zone 2 flexor tendon repairs have evolved greatly,…

Fingertip Injuries

Introduction The hand is in harm’s way. It is at the frontier of all work and contact with the environment. The fingertips, as a collective functional unit, bear the statistical brunt of such injuries. Hand injuries constitute the single most frequent surgical presentation in an average Emergency Department. The hand is unique in its dual role as a considerable gatherer of information about the environment and…

Congenital Hand Differences

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Embryology The upper limb bud develops from the flank of the developing embryo from day 26. Somatic lateral plate mesoderm forms the skeleton and mesoderm from somites migrates in to form the musculature and contributes to the vascular system. Fibroblast growth factors initiate development along three axes with the interaction of signaling…

Lymphedema: Anatomy, Pathophysiology, Evaluation, and Treatment

Introduction Lymphedema is a chronic, debilitating disease resulting from infections, obesity, congenital abnormalities, or traumatic injuries. Congenital abnormalities of the lymphatic system resulting in lymphedema are referred to as primary lymphedema. In contrast, lymphedema resulting from trauma, injury, infections, or other external factors is known as secondary lymphedema. Regardless of the type, patients who have lymphedema experience swelling, pain, recurrent infections, and have impaired quality of…

Lower Limb Reconstruction

Introduction Worldwide, lower extremity trauma is associated with significant cost, as well as considerable morbidity and even mortality. In the United States, open tibial shaft fractures are most common in young adult males and typically result from motor vehicle collisions (MVCs). Quantifying the cost of such injuries is challenging. To improve understanding of the financial and medical implications of limb-threatening lower extremity trauma and its management,…

Pressure Injuries

Introduction Pressure sores, also known as pressure injuries, pressure ulcers, decubitus ulcers, and bedsores, are a common problem. A pressure sore comprises a “localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.” The development of a pressure sore has significant implications for patients and healthcare providers, increasing length of…

Genitourinary and Perineal Reconstruction

Perineal Reconstruction Niri S. Niranjan and Charles Y.Y. Loh Perineal reconstruction is a challenging feat and there are multiple considerations for the surgeon. Discussed here are the relevant anatomy, common workhorse flaps for perineal reconstructions, our tips and tricks from experience, especially – from its conception – with the lotus petal flap, and the importance of reconstructing the perineal body. Introduction The management of advanced pelvic…

Abdominal Wall Reconstruction

Anatomy The abdominal wall is a multilayered structure that wraps around and protects the abdominal viscera. In addition, it is involved in numerous other functions including trunk movement, respiratory effort (active expiration), and an adjunctive force in micturition and defecation. Anatomically, it is bound by the xiphoid process and costal margin superiorly and the iliac crests and pubis inferiorly. The abdominal wall consists of skin, superficial…

Chest Wall Reconstruction

Overview of the Thoracic Cage The thoracic cage serves two principal functions: to protect the thorax and upper abdomen and their associated viscera, and to allow movement for ventilation. It consists of 12 pairs of ribs and their respective costal cartilages; the manubrium and sternum anteriorly, and the thoracic vertebrae posteriorly. The costal cartilages of the true ribs (1–7) articulate directly to the manubrium The costal…

Mastopexy and Breast Reduction

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction The best way to approach esthetic breast surgery is to work with gravity – not against it. Remove tissue where it is in excess and add tissue where it is deficient. Although this sounds simplistic, it forms the basis of the principles of esthetic breast surgery. Although in some cases the…

Congenital Breast Anomalies

Embryology Breast development begins at approximately the 5th to 6th embryonic week. It proceeds from a single ectodermal bud and begins developing along the ventral side of the embryo as paired longitudinal bands of thickened ectoderm called milk lines (mammary ridges). The latter extend from axilla to groin. The majority of the mammary ridge involutes by the 9th week of gestation except for a focus of…

Breast Reconstruction

Introduction The female breast is a defining characteristic of femininity, and its distortion or absence may result in significant quality of life impairment and psychological distress. As a result, a variety of surgical techniques have been developed for reconstruction of congenital, traumatic, or oncological defects of the breast. These procedures have naturally and iteratively evolved over time, resulting in better cosmetic results and decreased surgical morbidity.…

Breast Augmentation

For video accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction Breast augmentation is the most popular esthetic surgery procedure. In the United States 450,000 implants are placed for reconstructive surgery purposes and 5,083,717 for breast augmentation annually. Given its history, there is a vast amount of literature devoted to differing opinions, philosophies, and controversy regarding its safety. Many injectable and implantable…

Facial Trauma

Introduction The modern management of facial trauma had its origins in the trenches of World War I, when disciplines united to deal with the devastating results of missiles. Plastic surgeons, neurosurgeons, dentists, and anesthetists worked together in a structured environment to deal with this complex situation. A great boost to the management of facial trauma occurred when Paul Tessier successfully advocated the extended multidisciplinary care of…

Scalp and Calvarial Reconstruction

Introduction Scalp comprises the forehead and the hair-bearing regions. It extends from the supraorbital ridge anteriorly to the highest nuchal line posteriorly, while ears and zygomatic arches define its lateral borders. In surgical practice, the scalp refers to the hair-bearing region exclusively, separating forehead from the frontal hairline. Hair-bearing scalp represents an irreplaceable tissue unit with esthetic importance. Its reconstructive approach should adhere to the basic…

Ear Reconstruction

Introduction A variety of traumatic ear defects are observed after amputation, be they partial, subtotal or total, all of which require complex contour reconstruction. There are multiple causes of ear amputations and this summary chapter aims to define some principles and guidelines that permit a precise surgical management plan. Initial Assessment Concerning a Posttraumatic Amputation Mechanism of Ear Amputation Clean Amputations These are usually secondary to…

Eyelid Reconstruction

Introduction Reconstructive surgery of the face and eyelids has undergone significant changes in the past half century. The increased specialization and advanced understanding of anatomy and physiology of the periocular region has coincided with an increased number of reconstructive options available to the surgeon. With this widened armamentarium and a changing expectation of patients, aesthetic awareness is now a significant part of reconstructive surgery even if…

Nasal Reconstruction

Introduction The nose maintains the central position on the face and often can be a challenging structure to successfully reconstruct, both its form and the function. The fundamental techniques of reconstruction emerged early in history as a response to the use of nasal rhinokopia (nasal amputation) as a punishment. , Sushruta Samitha (600 BC) described both the use of pedicled cheek flaps and the paramedian forehead…

Lip Reconstruction

Introduction The lips constitute the main feature of the lower third of the face, and have been a focus of interest by reconstructive, cleft, and esthetic surgeons. Functionally, the lips play many important roles – articulation and enunciation in speech; maintenance of oral competence during eating, drinking, and forceful blowing; and expression of emotion and kissing. These roles are possible because, unlike the other elements of…