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Cleft Hand

Synopsis Cleft hand, or central longitudinal deficiency, is characterized by a V-shaped defect, absence of 1 or more central digits, syndactyly or other abnormalities of bordering digits, and a deficient first web space. Cleft hand is an autosomal-dominant condition with variable penetrance that manifests from a defect in the apical ectodermal ridge of the limb bud with some cases involving new mutations. Cleft hand can be…

Transverse Deficiency

Synopsis Congenital transverse deficiency of the upper extremity is a rare but disabling condition in which all elements beyond a given level in the extremity are absent. The most common level is the proximal forearm, but it can occur at any level from the humerus to the metacarpals. This chapter describes the disorder, presentation, and an approach to management of patients with this condition. Surgery is…

Thumb Hypoplasia Reconstruction

Synopsis Almost any deficiency of the thumb compromises the function of the hand. Differences range from minor shortening of an otherwise normal thumb to complete absence of the thumb. Blauth has classified the hypoplastic thumb into five categories depending on the degree of hypoplasia. The thumb may simply be short but otherwise well formed, Blauth types 1 and 2. Such thumbs are rarely benefited by surgery.…

Polydactyly Reconstruction

Synopsis Polydactyly of the hand refers to the presence of an extra digit or part of a digit. It can be defined as radial, central, or ulnar, referring to the region of the extra digit. The condition can occur in isolation or as part of a syndrome. Radial polydactyly, or thumb duplication, is classified by the Wassel classification. Ulnar polydactyly is classified into two or three…

Syndactyly Reconstruction

Synopsis Syndactyly is the most common congenital hand deformity, presenting with varying levels of severity. Left untreated, syndactyly can result in hand deformity and/or failure of the hand to reach its full functional potential. Surgical treatment typically occurs within the first 2 years of life or earlier (3–6 months) in the setting of border or multiple-digit involvement. Conditions associated with syndactyly, including Apert syndrome or Poland…

Post-Operative Burn Therapy

Synopsis Surgery most commonly performed for post-burn injuries includes initial excision of non-viable tissue and, later, release of scars, correction of joint contractures, and use of grafts and flaps to resurface areas of skin loss. Common areas include the neck, axilla, elbow, wrist, hands, hips, and knees. Surgical procedures will vary depending on the skills of the surgeon, and outcomes are most critically affected by the…

Foot Burn Reconstruction

Synopsis Foot burns consist of a small percentage of the total body surface area calculated for burns, but injury to this region of anatomical importance can often result in debilitating consequences. The complexity of these burns requires specialized treatment by a multidisciplinary group, consisting of foot and ankle professionals, burn reconstructive surgeons, and rehabilitative experts. The goal of reconstruction should be to achieve smooth and painless…

Leg Burn Reconstruction

Synopsis Over 200,000 patients are treated yearly in the United States for burns, and yearly millions suffer from burns overseas. Due to the large surface area and dependent position of the lower extremities, burns are very common and can range from small, superficial burns to extensive, deep burns resulting in amputation. Burn scar contracture release is the most commonly performed lower-extremity burn reconstructive procedure in our…

Hand Burn Reconstruction

Synopsis Deep burns to the hands are significant injuries that result in scarring, contractures, and functional limitations. These post-burn contractures are common in pediatric and adult patients despite appropriate initial management. The most common contractures include the first and interdigital web spaces, and flexion or extension contractures. Pre-operative management includes a complete hand examination focusing on skin quality, previous skin grafts, web spaces, and joint range…

Elbow and Wrist Burn Reconstruction

Synopsis Burns continue to be a significant source of morbidity and mortality in low- and middle-income countries. Patients that survive the original injury often develop burn scar contracture because burns across the neck, axilla, elbow, and wrist are forced to heal by secondary intention. The physical examination is the most important part of evaluating a patient with wrist or elbow contracture. The surgeon must identify scar…

Shoulder and Axilla Burn Reconstruction

Synopsis Burn injury to the axilla is caused by flame or direct contact. Ignition of clothing is the most common cause. Burns that will not heal within 2 weeks should be excised and skin grafted to prevent progressive scar contraction that will directly affect shoulder motion. Pain during acute burn management will limit abduction of the arm. The supple, concave quality of the axilla offers reduced…

Neck Burn Reconstruction

Synopsis Contractures of the neck are common sequelae of neck burns, even in centers with ideal facilities, let alone in circumstances with limited resources. Among the classifications put forward, Achauer and VanderKam's classification of neck contractures are the one most commonly followed. The goal of surgery for neck burn contractures is to create a mobile and supple neck. Early excision and grafting, where required, with splinting…

Face Burn Reconstruction (Cheek, Nose, and Lip)

Synopsis The burned face presents a challenging problem that must be addressed in a comprehensive and thoughtful manner. This is further complicated by the demand for not only a functional result but also one that is esthetically acceptable. Of the many facial structures that are affected in burn injury, this chapter will focus in particular on the cheeks, the nose, and the lips. Clinical Problem The…

Eyelid Burn Reconstruction

Synopsis The sequelae of facial burn injury can be devastating. Involvement of the eyelid area is of particular importance, both functionally and esthetically. It is essential to recognize eyelid injuries early and to institute aggressive management to prevent immediate and long-term consequences. Although injuries to the globe and loss of vision are very uncommon, inappropriate management of these injuries may lead to corneal and ocular problems…

Burn Wound Management

Synopsis The assessment and treatment of burn wounds requires a knowledgeable interprofessional health care team. Burn injuries can range in depth from a minor superficial injury to a deep full-thickness wound that may include the underlying structures and organs. All depths of injuries require a multifaceted plan of care to prevent infection, scarring, contractures, and death. The plan begins with an in-depth assessment of the injury…

Acute Burn Management

Synopsis Burn care starts at the time of injury with appropriate wound care, fluid resuscitation, and nutrition. Appropriate early management of many burns can prevent infection, allow for healing without surgery, and prevent contracture formation. Knowledge of the burn wound is key to correctly classifying burn injuries and thereby determining which wounds require surgery. Although the fundamentals of surgical burn wound management have not changed significantly…

Jaw Surgery

Synopsis Jaw surgery is a broad topic that encompasses a wide array of pathologies of the maxillofacial skeleton. With regard to global reconstructive surgery and the issues seen most commonly in developing nations, this chapter has been organized into the following three sections: 1. Lower facial fractures 2. Mandibular distraction for severe retrognathia 3. Jaw tumors Methods of treatment for these three problems vary in both…

Microtia

Synopsis Microtia literally means “small ear” but is used in reference to a spectrum of auricular deformities that almost always occur in association with aural atresia (absence of an external auditory canal). From a practical point of view, any congenital deformity of the auricle that requires insertion of a complete or near-complete framework is an example of microtia. Microtia has been classified in various ways, but…

Nasal Reconstruction

Synopsis Nasal defects pose a unique set of challenges for the reconstructive surgeon given the significance, both functionally and esthetically, and nuanced anatomy of the nasal framework. The character of the defect, including the size, location, depth (layers of tissue lost), subunits involved, and comorbid patient factors, will dictate the most appropriate method of reconstruction. All components of the nasal defect must be restored, including lining,…

Ptosis Repair

Synopsis Blepharoptosis or ptosis describes the descent of the upper eyelid below the normal anatomical position, which can result in reduced visual function or, in children, amblyopia. The upper eyelid margin normally lies 0.5 to 2 mm below the superior corneal limbus. Descent of the upper eyelid margin inferiorly can be attributed to myogenic, aponeurotic, neurogenic, or mechanical etiologies that are present at birth (congenital) or acquired.…