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Endoscopic breast-conserving surgery with immediate omental flap reconstruction

Description of technique Pre-operative marking and positioning Pre-operative marking was done with the patient in standing and supine position. After induction of general anaesthesia, the patient was then placed in the supine position and ipsilateral arm abducted to 90 degrees to avoid affecting the operative procedure. Endoscopic video monitors (Olympus Optical Co., Tokyo, Japan) were set up on both sides of the patient's head to allow…

Endoscopic mastectomy

Description of technique Pre-operative marking and positioning Pre-operative marking was done with the patient in standing and supine position. After induction of general anaesthesia, the patient was then placed in supine position and ipsilateral arm abducted to 90 degrees to avoid affecting the operative procedure. Endoscopic video monitors (Olympus Optical Co., Tokyo, Japan) were set up on both sides of the patient's head to allow both…

Endoscopic breast-conserving surgery

Description of technique Pre-operative marking and positioning Pre-operative marking was done with the patient in standing and supine position. After induction of general anaesthesia, the patient was then placed in supine position and ipsilateral arm abducted to 90 degrees to avoid affecting the operative procedure. Endoscopic video monitors (Olympus Optical Co., Tokyo, Japan) were set up on both sides of the patient's head to allow both…

Vaginal rejuvenation: Nonsurgical options

Introduction In the aesthetic world, nonsurgical aesthetic procedures have been increasing. Today, 50% of aesthetic procedures are surgical and 50% nonsurgical. Vaginal rejuvenation: today’s trend in aesthetic procedures. Nonsurgical genital/vaginal aesthetic options are an essential part of our armamentarium. Innovation is key, not only in new technologies but also by bringing something we already do elsewhere to the genital/vaginal area. Background International Society of Aesthetic Plastic…

Hair transplantation

Introduction Androgenetic alopecia (AGA) is the most common cause of hair loss in both men and women, and is significantly mediated by dihydrotestosterone (DHT). The two primary methods of hair transplantation are follicular unit transplantation (FUT) and follicular unit extraction (FUE). FUT is a highly reliable procedure involving removal of occipital scalp tissue, microscopic dissection of follicular units, and subsequent reimplantation into desired areas. FUE is…

Noninvasive liposculpting

Introduction Noninvasive advanced technology liposculpting treatments are increasingly supplanting, complimenting, and preliminary to excisional body contouring surgery. For optimal patient care and to maintain dominance in the body contouring market, a plastic surgeon needs to embrace reliable and safe technology, particularly for success in the office setting. Formidable barriers are a vast array of options, high capital purchase, costly disposables, maintenance fees, lack of experience, conflicting…

Suture lifts

Introduction The pattern of facial aging is hallmarked by several facets, including the loss of volume in facial fat pads and diminished skin elasticity. In the midface, these processes lead to deepening of the nasolabial fold and diminished anterior cheek projection, while in the lower third of the face, the result of the maturation process can result in jowling, blunting of the cervicomental angle, and an…

Laser hair removal and vein ablation

Introduction (pearls) Laser treatments are some of the most effective and minimally invasive options for removing unwanted hair and ablating veins. Lasers function based on the principle of selective photothermolysis, in which the pigment in the hair (melanin) or in oxyhemoglobin in the blood vessel is heated to destroy the chromophore without overheating the surrounding tissues to avoid epidermal damage. Lasers are selected based on wavelength, pulse…

Laser resurfacing

Brief introduction A logical approach to rejuvenation follows an understanding of skin anatomy and physiology, as they relate to skin aging. Any assessment of the face should include the surface, where sun and aging result in pigment inhomogeneities, wrinkles, and telangiectasia. Epidermal changes include basilar hyperpigmentation, hyperkeratosis, and thinning of the “living” portion of the epidermis. Another component of skin aging derives from changes in the…

Soft tissue fillers

Brief introduction Anatomic neurovascular, muscular, and anatomy of each region is imperative. Soft tissue fillers can refer to a multitude of substances that are injected into the skin or subdermal area for cosmetic or therapeutic use. Cosmetically, soft tissue fillers are best used to volumize areas of hollowness, camouflage areas of gravitational changes of aging, or improve anatomic harmony by changing the relationships and proportions of…

Chemodenervation

Introduction Botulinum toxin type A injections represent the single most frequently performed minimally invasive aesthetic procedure in the United States, totaling an estimated 7.7 million procedures in 2019 alone, according to the American Society of Plastic Surgery. Neuromodulators represent a cornerstone of minimally invasive surgery with 150% more procedures performed annually than the next three leading procedures (soft tissue fillers, chemical peels, and laser hair removal)…

Chemical peels

Brief introduction Skin resurfacing procedures have continued to increase in popularity as the worldwide trend in noninvasive to minimally invasive procedures increases. Chemical peels are a low-cost yet highly effective means by which skin resurfacing can be achieved. Peels are a great alternative to laser resurfacing for certain indications and a great adjunct to laser resurfacing in other instances. With the proper patient evaluation, skin preparation,…

Basics of skin care

The importance of the skin The skin is the body’s largest organ, which maintains not only our homeostasis but also a physiologic environment for us to inhabit. Moreover, the skin has an important aesthetic function, as it reveals information about health, age, and environmental exposures. The skin has captivated people since the beginning of time: skin has been described in the canon of western literature as…

Lower-Extremity Trauma Reconstruction

Synopsis Management of lower-extremity trauma involves a multidisciplinary approach that usually requires full trauma evaluation. The decisions for amputation vs. salvage as well as reconstruction require close collaboration by orthopedic and plastic surgeons, and must be individualized to patient, injury, and situation. Timely and adequate debridement, bony fixation, and wound closure are essential to limit the zone of injury and to reduce the risks of infectious…

Compartment Syndrome Treatment

Synopsis Acute compartment syndrome is a surgical emergency with diverse etiologies. Acute compartment syndrome is classically described clinically with “the 6 P's”: pain, pallor, paresthesia, paresis, poikilothermia, and pulselessness. Clinical examination along with judgment is the gold standard for diagnosis; however, suspicion of compartment syndrome can be confirmed by measurement of intracompartmental pressures. The definitive treatment of acute compartment syndrome is early fasciotomy. Delayed or inadequate…

Splinting and Hand Therapy Principles

Synopsis This chapter presents information to guide hand therapists in providing care on international short-term medical missions. It reviews principles of hand therapy evaluation and treatment in this setting with recommendations to guide instruction to local therapists in host countries. The goal is to impart hand therapy knowledge and skills to local therapists, in particular splint/orthosis fabrication, promotion of independence, and facilitation of ongoing patient care.…

Cerebral Palsy Surgery

Synopsis Cerebral palsy is a disorder of the central nervous system affecting body movement and muscle coordination. It is the most common of all childhood disabilities, affecting roughly 2 to 3 children out of every 1000. Cerebral palsy is found all over the world, including in developing countries. A spectrum of spastic upper-extremity disorders is associated with pediatric cerebral palsy. One such condition is a thumb-in-palm…

Replantation

Synopsis The term replantation is used when there is surgical reattachment of a completely amputated body part. In contrast, when there is some tissue still attached, and reattachment of this incompletely amputated part requires microsurgical repair of the vessels, this is called revascularization. Malt and McKhann performed the first successful upper arm replantation in 1962, and Komatsu and Tamai reported the first successful replantation of a…

Hand Fracture Treatment: Acute and Delayed

Synopsis Hand fractures are common injuries and have been reported to account for 10% of upper-extremity fractures. Timely diagnosis and treatment are essential to provide a good outcome. Although many hand fractures can be managed without surgery, recognition of those requiring surgery is essential. Operative treatment is aimed to provide functional stabilization of the fracture followed by appropriately timed rehabilitation. Occasionally, secondary procedures such as capsulotomy…

Common Tendon Transfers

Synopsis Tendon transfers can be used to restore hand and wrist function after a nerve injury, both in the acute setting and in delayed presentations. Injuries of the brachial plexus and peripheral motor nerves are common indications for tendon transfers. Alternatively, patients may have loss of a muscle-tendon unit (MTU) from trauma or after an oncologic resection; reconstruction with a tendon transfer can replace the function…