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Book Details
Abstract
Fully updated to meet the demands of the 21st-century surgeon, Principles, Volume 1 of Plastic Surgery, 3rd Edition, provides you with the most current knowledge and techniques in the principles of plastic surgery, allowing you to offer every patient the best possible outcome. Access all the state-of-the-art know-how you need to overcome any challenge you may face and exceed your patients’ expectations.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
- Apply the very latest advances in plastic surgery and ensure optimal outcomes with evidence-based advice from a diverse collection of world-leading authorities.
- Stay abreast of the latest information on business practices, stem cell therapy, and tissue engineering, and walk through the history, psychology, and core principles of reconstructive and aesthetic plastic surgery.
- Know what to look for and what results you can expect with over 1,000 color photographs and illustrations.
- Easily find the answers you need with a more templated, user-friendly, high-yield presentation.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Plastic Surgery | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Video Contents | xi | ||
| Foreword | xvi | ||
| Preface | xvii | ||
| List of Contributors | xviii | ||
| Acknowledgments | xl | ||
| Dedication | xli | ||
| 1 Plastic surgery and innovation in medicine | 1 | ||
| Introduction | 1 | ||
| Innovation and research | 2 | ||
| Innovation and plastic surgery | 2 | ||
| Composite tissue allotransplantation | 2 | ||
| Collaboration | 3 | ||
| Drivers of innovation | 4 | ||
| Principles of innovation | 5 | ||
| External influences and innovation | 8 | ||
| Documentation, data gathering, and regulation | 8 | ||
| References | 10.e1 | ||
| 2 History of reconstructive and aesthetic surgery | 11 | ||
| Origin of plastic surgery | 11 | ||
| The distant past | 11 | ||
| In Ancient Egypt | 11 | ||
| In Mesopotamia | 12 | ||
| In India | 12 | ||
| In Greece | 13 | ||
| In Rome | 13 | ||
| Plastic surgery after the decline of the Roman Empire | 14 | ||
| Byzantine surgery | 14 | ||
| The Middle Ages | 14 | ||
| Arabian surgery | 14 | ||
| The rise of the universities | 15 | ||
| The discovery of printing | 15 | ||
| The Renaissance | 15 | ||
| Renaissance surgery | 15 | ||
| Nasal reconstruction in the western world | 16 | ||
| The decline of plastic surgery | 18 | ||
| The rebirth of plastic surgery | 18 | ||
| The 19th century | 19 | ||
| The golden age of plastic surgery | 19 | ||
| The 20th century | 20 | ||
| The origin of modern plastic surgery | 20 | ||
| The training programs | 23 | ||
| The birth of the scientific societies | 24 | ||
| The scientific journals | 24 | ||
| Postwar plastic surgery | 25 | ||
| Aesthetic surgery | 25 | ||
| The origin | 25 | ||
| Development | 26 | ||
| The problem of the beauty doctors | 26 | ||
| Postwar aesthetic surgery | 28 | ||
| References | 29.e1 | ||
| Further reading | 29.e3 | ||
| 3 Psychological aspects of plastic surgery | 30 | ||
| Body image and plastic surgery | 30 | ||
| Defining body image | 30 | ||
| Body image determines emotional response and behavior | 31 | ||
| Four stages of body image development | 31 | ||
| Early childhood | 31 | ||
| Starting school | 31 | ||
| Adolescence | 31 | ||
| Aging | 31 | ||
| How plastic surgery changes body image | 31 | ||
| Personality and character formation | 32 | ||
| Defense mechanisms | 32 | ||
| Perioperative psychological reactions | 33 | ||
| The physician–patient relationship | 33 | ||
| Personality styles and personality disorders | 34 | ||
| Obsessive-compulsive personality and personality disorder | 34 | ||
| Patient example | 34 | ||
| Narcissistic personality and personality disorder | 35 | ||
| Dependent personality and personality disorder | 35 | ||
| Paranoid personality disorder | 35 | ||
| Histrionic personality and personality disorder | 36 | ||
| Borderline personality disorder | 36 | ||
| Strategies for management of the difficult patient | 36 | ||
| The hateful patient | 36 | ||
| The dependent clinger | 37 | ||
| 4 The role of ethics in plastic surgery | 55 | ||
| Ethics as seen by professional associations | 57 | ||
| Ethical relationships with patients | 58 | ||
| The ethics of advertising | 59 | ||
| The role of ethics in the outpatient office | 60 | ||
| Ethics in the operating room | 61 | ||
| Ethical relations with other providers and third-party payers | 61 | ||
| The ethics of expert witness testimony | 62 | ||
| Summary | 62 | ||
| References | 63 | ||
| 5 Business principles for plastic surgeons | 64 | ||
| Introduction | 64 | ||
| Strategy | 65 | ||
| Accounting | 67 | ||
| Income statement | 67 | ||
| Balance sheet | 67 | ||
| Summary of cash flows | 68 | ||
| Financial ratios | 68 | ||
| Profitability ratios | 69 | ||
| Leverage ratios | 69 | ||
| Liquidity ratios | 69 | ||
| Efficiency ratios | 69 | ||
| Finance | 69 | ||
| Time value of money | 70 | ||
| Opportunity cost | 71 | ||
| Net present value and discounted cash flows | 72 | ||
| Return on investment | 73 | ||
| Economics | 73 | ||
| Marketing | 75 | ||
| Operations | 76 | ||
| Innovation | 78 | ||
| Entrepreneurship | 80 | ||
| Sustainable enterprise | 82 | ||
| Human resource management | 83 | ||
| Legal and regulatory considerations | 84 | ||
| Sarbanes–Oxley Act, 2002 | 85 | ||
| American Recovery and Reinvestment Act, 2009 | 85 | ||
| Patient Protection and Affordable Care Act, 2010 | 86 | ||
| Dodd–Frank Wall Street Reform and Consumer Protection Act, 2010 | 86 | ||
| Negotiation | 86 | ||
| Ethics | 87 | ||
| Leadership | 88 | ||
| Acknowledgments | 90 | ||
| References | 91.e1 | ||
| 6 Medico-legal issues in plastic surgery | 92 | ||
| Introduction | 92 | ||
| Interactions with attorneys and the legal system | 92 | ||
| Legal interactions: depositions and narratives | 93 | ||
| Areas of the law | 93 | ||
| Tort law: negligence, malpractice | 93 | ||
| Informed consent | 93 | ||
| Privacy law | 94 | ||
| Warranty law | 94 | ||
| Product liability | 95 | ||
| Fraud and abuse | 95 | ||
| Contract law | 97 | ||
| Regulatory issues within the law | 97 | ||
| Agency law | 98 | ||
| Internet and “blog” defamation law | 98 | ||
| Basic actions of a malpractice lawsuit (a guide) | 99 | ||
| Aesthetic practice liabilities | 100 | ||
| Managed care liabilities | 101 | ||
| Liability carrier’s issues | 101 | ||
| Legal issues in physician partnerships | 101 | ||
| Patient selection | 102 | ||
| Summary | 103 | ||
| References | 103 | ||
| Further reading | 103 | ||
| 7 Photography in plastic surgery | 104 | ||
| Purpose | 104 | ||
| Standards in capturing images | 106 | ||
| Digital image characteristics | 106 | ||
| Background | 107 | ||
| White balance | 107 | ||
| Composition and positioning | 107 | ||
| Full face | 107 | ||
| Eyes | 107 | ||
| Glabella | 108 | ||
| Nose | 108 | ||
| Lips, nasolabial folds, and mentum | 110 | ||
| Dental occlusal views | 110 | ||
| Ears | 110 | ||
| Chest and breast | 110 | ||
| Lower trunk, abdomen, and buttocks | 110 | ||
| Lower extremity | 112 | ||
| Hands and feet | 114 | ||
| Specialty views | 114 | ||
| In the hospital and operating room | 114 | ||
| Archiving and image management | 117 | ||
| Cameras | 117 | ||
| Format | 119 | ||
| Storage | 119 | ||
| File formats | 120 | ||
| Image attributes, metadata, and retrieval | 120 | ||
| Digital image processing | 121 | ||
| Measurement and analysis | 121 | ||
| Planning and simulation | 121 | ||
| The future | 121 | ||
| Three-dimensional imaging | 121 | ||
| Video | 122 | ||
| References | 123.e1 | ||
| 8 Patient safety in plastic surgery | 124 | ||
| The risk of having surgery | 124 | ||
| Obese patients/sleep apnea patients having plastic surgery | 126 | ||
| Intraoperative management of the plastic surgery patient | 128 | ||
| Deep venous thrombosis/pulmonary emboli in the liposuction patient | 130 | ||
| Care of the liposuction patient during surgery | 131 | ||
| Facial aesthetic surgery | 131 | ||
| Complications from breast surgery | 132 | ||
| Fire in the operating room | 132 | ||
| Protocol-based systems for reducing wrong patient and wrong-sided surgery | 133 | ||
| The sociology of the plastic surgery operating room | 134 | ||
| Best of intentions, not the best of results | 135 | ||
| References | 136.e1 | ||
| 9 Local anesthetics in plastic surgery | 137 | ||
| Introduction | 137 | ||
| Patient selection | 137 | ||
| Choice of sedation | 138 | ||
| Premedication | 138 | ||
| Sedation | 138 | ||
| Historical perspective | 137.e1 | ||
| Selection of local anesthetics | 139 | ||
| Anesthetic drugs | 139 | ||
| Vasoconstricting agents | 139 | ||
| Carbonated anesthesia | 140 | ||
| Selection of technique | 140 | ||
| For facelift | 140 | ||
| For breast reduction | 141 | ||
| For breast augmentation | 142 | ||
| For abdominoplasties | 143 | ||
| For liposuctions | 143 | ||
| Problems or complications | 144 | ||
| Respiration | 144 | ||
| Hypertension | 145 | ||
| Hypotension | 145 | ||
| Bradycardia | 145 | ||
| Tachycardia | 145 | ||
| Reversal effect of oversedation | 145 | ||
| Adverse drug interactions | 145 | ||
| Nausea and vomiting | 145 | ||
| Allergic reaction to local anesthetics | 146 | ||
| Central nervous system toxicity | 146 | ||
| Cardiovascular toxicity | 146 | ||
| Treatment of toxicity | 146 | ||
| Discussion | 146 | ||
| Different actions of local anesthesia | 146 | ||
| Absorption of local anesthetics | 147 | ||
| Vasoconstrictive effect of epinephrine | 147 | ||
| Toxicity of anesthetics | 147 | ||
| Epinephrine | 148 | ||
| Carbonated anesthesia | 148 | ||
| The pre-emptive effect of local anesthetics | 148 | ||
| Conclusions | 149 | ||
| References | 149.e1 | ||
| 10 Evidence-based medicine and health services research in plastic surgery | 150 | ||
| The best evidence – where do we find it? | 150 | ||
| Evaluating existing literature | 150 | ||
| Literature search strategies | 151 | ||
| PubMed | 151 | ||
| Clinical Queries | 151 | ||
| PICO | 151 | ||
| Meta-analysis | 151 | ||
| Systematic reviews | 152 | ||
| Study design and levels of evidence | 153 | ||
| Experimental studies | 153 | ||
| Randomized controlled clinical trials | 153 | ||
| Alternatives to randomized controlled clinical trials | 154 | ||
| Patient preference trials | 154 | ||
| Large multicenter trials | 154 | ||
| Observational studies | 155 | ||
| Cohort studies | 155 | ||
| Case-control studies | 155 | ||
| Case series and case reports | 156 | ||
| Large-database analysis | 156 | ||
| Population-based research | 156 | ||
| Effectiveness versus efficacy | 156 | ||
| The importance of power | 157 | ||
| Data sources | 158 | ||
| Clinical registries | 158 | ||
| Administrative claims data | 159 | ||
| How to use large databases for research | 159 | ||
| Small-area variation | 159 | ||
| Volume–outcome analysis | 159 | ||
| Large cohort studies | 160 | ||
| Epidemiology | 160 | ||
| Examples of large-database analyses in plastic surgery | 160 | ||
| Patient-reported outcomes research | 161 | ||
| Definition of terms | 161 | ||
| Essential elements for PRO measures | 162 | ||
| Overview of PRO measure development | 162 | ||
| Modern psychometric methods | 164 | ||
| Utilities and preference-based measures | 164 | ||
| Key concepts | 164 | ||
| Comparative effectiveness analysis | 166 | ||
| Definition | 166 | ||
| National research priority | 166 | ||
| Complexities | 166 | ||
| Whose perspective to take? | 166 | ||
| Types of economic studies | 167 | ||
| Study design | 167 | ||
| Limitations | 167 | ||
| Summary | 168 | ||
| Future trends | 168 | ||
| Multicenter clinical trials network | 168 | ||
| Knowledge translation | 168 | ||
| A model for understanding KT | 169 | ||
| Barriers to uptake | 169 | ||
| Learning collaboratives | 170 | ||
| Role of electronic medical records/ integrating data collection into flow of usual care versus research | 170 | ||
| Possible solutions: generic | 171 | ||
| Possible solutions: plastic surgery and PRO measures | 171 | ||
| What do we do with the outcomes? | 172 | ||
| Performance measures | 172 | ||
| Public reporting and P4P | 173 | ||
| Decision aids for patients | 174 | ||
| Conclusions | 174 | ||
| References | 175.e1 | ||
| 11 Genetics and prenatal diagnosis | 176 | ||
| Introduction | 176 | ||
| Human genome | 177 | ||
| Historical perspective | 177.e1 | ||
| Basic molecular biology | 177 | ||
| DNA | 177 | ||
| Organization of genomic DNA | 178 | ||
| Gene expression | 179 | ||
| Gene regulation | 180 | ||
| Epigenetic mechanisms | 181 | ||
| Inheritance | 182 | ||
| Mendelian patterns of inheritance | 182 | ||
| Autosomal inheritance | 182 | ||
| Sex-linked inheritance | 183 | ||
| Nonmendelian patterns of inheritance | 183 | ||
| Uniparental disomy | 183 | ||
| Mitochondrial inheritance | 183 | ||
| Genetic causes for disease | 184 | ||
| Mutations | 184 | ||
| Inherited chromosomal abnormalities | 185 | ||
| The gene as a focus for therapy | 185 | ||
| Gene delivery | 186 | ||
| Gene therapy in tissue repair, reconstruction, and regeneration | 187 | ||
| Tissue repair | 189 | ||
| Tissue reconstruction and regeneration | 190 | ||
| Ethical issues of genetic discovery and gene therapy | 191 | ||
| Genetic disease and diagnosis | 192 | ||
| Congenital anomalies | 192 | ||
| Nomenclature | 192 | ||
| Selected congenital anomalies | 193 | ||
| Orofacial clefts | 193 | ||
| Nonsyndromic cleft lip and palate | 193 | ||
| Syndromic cleft lip and palate | 194 | ||
| Craniosynostosis | 195 | ||
| Syndromic craniosynostosis | 196 | ||
| Prenatal diagnosis | 198 | ||
| Ultrasound | 198 | ||
| Invasive testing | 199 | ||
| Future development | 199 | ||
| References | 200.e1 | ||
| 12 Principles of cancer management | 201 | ||
| Background | 201 | ||
| History of cancer treatment | 201 | ||
| Surgery | 202 | ||
| Radiation | 202 | ||
| Chemotherapy | 204 | ||
| Immunotherapy and biologics | 204 | ||
| Photodynamic therapy | 206 | ||
| Pathobiology | 207 | ||
| Critical mass | 207 | ||
| Tumor margins | 207 | ||
| Classification | 208 | ||
| Management | 208 | ||
| Conclusion | 210 | ||
| References | 211.e1 | ||
| 13 Stem cells and regenerative medicine | 212 | ||
| Introduction | 212 | ||
| Discussion of biomedical burden (Fig. 13.1) | 212 | ||
| Why stem cells and regenerative medicine should be of interest to plastic surgeons | 213 | ||
| Historical perspective | 214.e1 | ||
| Human embryonic stem cells | 214 | ||
| Definitions | 214 | ||
| Current concepts and research | 215 | ||
| Clinical correlates | 216 | ||
| Postnatal and somatic stem cells | 217 | ||
| Adipose-derived stromal cells | 217 | ||
| Definitions and harvest | 217 | ||
| ASC harvest | 218 | ||
| Current concepts and research | 219 | ||
| Difference between mouse and human ASCs | 219 | ||
| Enrichment based on cell surface receptors | 219 | ||
| Methods of ASC delivery | 220 | ||
| In vitro: protocols on differentiation | 220 | ||
| Osteogenic differentiation (Fig. 13.10) | 220 | ||
| Adipogenic differentiation (Fig. 13.12) | 221 | ||
| Chondrogenic differentiation | 221 | ||
| In vivo model | 221 | ||
| Nude athymic mouse 4-mm calvarial defect | 221 | ||
| Clinical correlates | 223 | ||
| Future direction of tissue engineering using ASCs | 223 | ||
| Bone marrow mesenchymal stem cells | 223 | ||
| Definitions | 223 | ||
| Current concepts and research | 224 | ||
| In vitro: protocols on tissue harvest and differentiation | 226 | ||
| In vivo models | 226 | ||
| Clinical correlates | 228 | ||
| Tissue-specific stem cells | 228 | ||
| Definitions | 228 | ||
| Current concepts and research | 229 | ||
| Skin | 229 | ||
| Bone | 230 | ||
| Blood vessels | 230 | ||
| Muscle | 230 | ||
| Peripheral nerve | 231 | ||
| Clinical correlates | 232 | ||
| Skin | 232 | ||
| Bone | 232 | ||
| Blood vessels | 232 | ||
| Muscle | 232 | ||
| Nervous system | 233 | ||
| Prospective clinical applications of stem cell therapy | 233 | ||
| Scaffolds for stem cell delivery | 233 | ||
| Genetic induction therapies | 234 | ||
| iPS Cells | 235 | ||
| Definitions | 235 | ||
| In vitro | 237 | ||
| Culture and Maintenance of iPS cells | 237 | ||
| Lentivirus production and transduction | 237 | ||
| In vitro differentiation | 237 | ||
| In vivo models and potential clinical correlates | 238 | ||
| References | 239.e1 | ||
| 14 Wound healing | 240 | ||
| Introduction | 241 | ||
| Acute wounds | 241 | ||
| The wound-healing process | 242 | ||
| Hemostasis | 242 | ||
| Inflammation | 245 | ||
| Platelets | 245 | ||
| Neutrophils | 246 | ||
| Mast cells | 247 | ||
| Macrophages | 248 | ||
| Resolution of inflammation | 248 | ||
| Infection | 249 | ||
| Biofilm | 250 | ||
| Vascularization | 250 | ||
| Wound closure | 252 | ||
| Proliferative phase | 253 | ||
| Granulation tissue | 253 | ||
| Chronic wounds | 253 | ||
| Venous ulcers | 253 | ||
| Arterial ulcers | 253 | ||
| Diabetic ulcers | 254 | ||
| Pressure ulcers | 255 | ||
| Ischemia and tissue oxygenation | 256 | ||
| Limited supply and high demand: the oxygen imbalance | 257 | ||
| Redox signaling | 258 | ||
| Nitric oxide | 259 | ||
| MicroRNAs | 259 | ||
| Inflammation | 259 | ||
| Angiogenesis | 260 | ||
| Hypoxia response | 260 | ||
| Stem cells | 260 | ||
| Stem cells | 261 | ||
| Induced pluripotent stem cells | 264 | ||
| Scar | 264 | ||
| Keloid | 265 | ||
| Hypertrophic scar | 265 | ||
| Regenerative fetal healing | 265 | ||
| Acknowledgment | 266 | ||
| References | 266.e1 | ||
| 15 Skin wound healing: | 267 | ||
| Wound repair biology | 267 | ||
| Adult wound repair | 268 | ||
| Inflammatory phase | 268 | ||
| Proliferation phase | 269 | ||
| Extracellular matrix formation | 269 | ||
| Granulation tissue formation and angiogenesis | 271 | ||
| Wound contraction | 271 | ||
| Epithelial resurfacing | 272 | ||
| Remodeling phase | 273 | ||
| Regulation | 273 | ||
| Growth factors in skin wound healing | 273 | ||
| Platelet-derived growth factor | 274 | ||
| Transforming growth factor-β | 274 | ||
| Fibroblast growth factors | 274 | ||
| Vascular endothelial growth factor | 275 | ||
| Other growth factors and cytokines | 275 | ||
| Growth factor interactions with the extracellular matrix | 275 | ||
| Fetal wound repair biology | 276 | ||
| Transition from scar-free healing to scar formation | 277 | ||
| Differences between fetal and adult repair | 277 | ||
| Cellular differences | 277 | ||
| Differences in wound repair | 277 | ||
| Growth factor expression in fetal wound repair | 278 | ||
| Differences in gene expression | 278 | ||
| Differences in matrix composition | 278 | ||
| Adult wound pathology | 279 | ||
| Nonhealing wounds | 279 | ||
| Pressure sores | 279 | ||
| Lower extremity wounds | 279 | ||
| Venous | 279 | ||
| Arterial | 279 | ||
| Diabetic | 281 | ||
| Radiation injury | 281 | ||
| Infection | 281 | ||
| Malnutrition and obesity | 282 | ||
| Medical treatment | 282 | ||
| Excessive healing | 283 | ||
| Hypertrophic scar | 283 | ||
| Keloid | 284 | ||
| Clinical wound management | 285 | ||
| Incisional wounds | 285 | ||
| Excisional wounds | 286 | ||
| Wound treatment | 287 | ||
| Chronic open wounds | 287 | ||
| Wound dressings | 287 | ||
| Subatmospheric pressure | 288 | ||
| Compression therapy | 288 | ||
| Pharmacologic treatment | 290 | ||
| Engineered skin replacements | 290 | ||
| Excessive scar treatment | 290 | ||
| Scar classification | 290 | ||
| Therapies | 290 | ||
| Prevention | 291 | ||
| Treatment algorithm | 291 | ||
| Immature hypertrophic scars (red) | 291 | ||
| Linear hypertrophic scars (red, slightly raised) | 292 | ||
| Widespread burn hypertrophic scars (red, raised) | 293 | ||
| Minor keloids (red, raised) | 294 | ||
| Major keloids (dark, raised) | 294 | ||
| Impact of scar on plastic surgery | 294 | ||
| Emerging scar therapies | 294 | ||
| Future perspectives | 295 | ||
| Growth factor and protease-scavenging therapy | 295 | ||
| Gene therapy | 295 | ||
| Stem cell therapy | 296 | ||
| References | 296.e1 | ||
| 16 Scar prevention, treatment, and revision | 297 | ||
| Personal and social significance of scars | 297 | ||
| History and physical examination | 298 | ||
| Assessing scars | 298 | ||
| Scar biology | 300 | ||
| Conditions of excessive scarring | 301 | ||
| Hypertrophic scar | 302 | ||
| Keloid | 302 | ||
| Prevention | 304 | ||
| Surgical technique | 304 | ||
| Patient-specific factors | 306 | ||
| Wound infections and foreign-body reactions | 306 | ||
| Adjunct therapy | 306 | ||
| Treatment | 307 | ||
| Treatment of hypertrophic scar | 307 | ||
| Treatment of keloid scar | 308 | ||
| Emerging treatments | 309 | ||
| Scar revision | 310 | ||
| Introduction | 310 | ||
| Indications | 310 | ||
| Timing | 310 | ||
| Planning | 311 | ||
| Scar release | 311 | ||
| Principles of tissue rearrangement | 312 | ||
| Scar revision techniques | 312 | ||
| Postoperative care and follow-up | 316 | ||
| References | 318.e1 | ||
| 17 Skin graft | 319 | ||
| Historical perspective | 319.e1 | ||
| Anatomy and physiology | 319 | ||
| Epidermis | 319 | ||
| Dermis | 320 | ||
| Blood vessel supply of the skin | 321 | ||
| Stem cells and regeneration of skin | 321 | ||
| Hair follicles | 321 | ||
| Glandular structures | 322 | ||
| Science | 323 | ||
| Mechanisms of skin graft take | 323 | ||
| Serum imbibition | 323 | ||
| Revascularization | 323 | ||
| Maturation | 324 | ||
| Skin appendages and functional structures | 325 | ||
| Clinical application | 325 | ||
| Split-thickness skin graft | 326 | ||
| Technique | 326 | ||
| Meshed skin graft | 327 | ||
| Full-thickness skin graft | 329 | ||
| Composite graft | 329 | ||
| Skin fixation and dressing | 329 | ||
| Sealants | 330 | ||
| First dressing change | 330 | ||
| Recipient site considerations | 331 | ||
| Wound bed preparation | 331 | ||
| Functional consideration | 332 | ||
| Aesthetic considerations | 332 | ||
| Donor site considerations | 333 | ||
| Donor site dressing | 333 | ||
| Skin graft storage | 334 | ||
| Complications | 334 | ||
| Hematoma | 334 | ||
| Seroma | 334 | ||
| Infection | 334 | ||
| Nontake | 334 | ||
| Wound contraction | 334 | ||
| Instability | 334 | ||
| Cosmetic issues | 334 | ||
| Donor site | 335 | ||
| Future | 335 | ||
| Dermal substitutes | 335 | ||
| Cell cultures | 336 | ||
| Bioengineered cultured allogenic bilayered constructs | 337 | ||
| References | 338.e1 | ||
| 18 Tissue graft, tissue repair, and regeneration | 339 | ||
| Introduction | 339 | ||
| Dermal graft and repair | 339 | ||
| Surgical technique | 340 | ||
| The fate of implanted dermal graft | 340 | ||
| Clinical application for tissue repair and recent development | 340 | ||
| Future | 342 | ||
| Surgical technique and tissue repair application | 348 | ||
| Future | 348 | ||
| History | 339.e1 | ||
| Fat graft and repair | 342 | ||
| Clinical application for tissue repair and recent developments | 342 | ||
| Future | 346 | ||
| History | 342.e1 | ||
| Fascial graft and repair | 348 | ||
| History | 348.e1 | ||
| Tendon graft and repair | 350 | ||
| Surgical technique and tissue repair application | 350 | ||
| Tendon substitute and engineered tendon | 351 | ||
| 19 Tissue engineering | 367 | ||
| Introduction | 367 | ||
| Definition of tissue engineering | 367 | ||
| Regenerative medicine | 367 | ||
| Embryology | 368 | ||
| Examples from nature | 369 | ||
| Historical perspective | 369.e1 | ||
| Components of tissue engineering | 369 | ||
| Cells | 369 | ||
| Cell sources | 369 | ||
| Biochemical signaling | 371 | ||
| Biomechanical signaling and 2D and 3D culture | 371 | ||
| Co-culture | 372 | ||
| Bioreactors | 372 | ||
| Applications for stem cells and tissue engineering | 373 | ||
| Matrix | 374 | ||
| Biomaterials | 374 | ||
| Natural biomaterials | 375 | ||
| Synthetic biomaterials | 375 | ||
| Ceramic biomaterials | 375 | ||
| Hydrogels | 375 | ||
| Tissue-engineering construct fabrication | 377 | ||
| Tailored delivery systems | 380 | ||
| Blood vessels: vascularization – nutrition | 381 | ||
| Extrinsic vascularization model of tissue engineering | 381 | ||
| Intrinsic vascularization models and in vivo bioreactors | 382 | ||
| Testing and characterization of tissue-engineering approaches | 386 | ||
| Risk management, regulation, and ethics | 388 | ||
| Case studies and status of tissue engineering for specific tissues | 388 | ||
| Skin tissue engineering | 388 | ||
| Adipose tissue engineering | 389 | ||
| Muscle tissue engineering | 390 | ||
| Tissue engineering of nerves | 391 | ||
| Tissue engineering of blood vessels | 392 | ||
| Bone tissue engineering | 392 | ||
| Cartilage tissue engineering | 393 | ||
| Tissue engineering of other organs | 394 | ||
| References | 396.e1 | ||
| 20 Repair, grafting, and engineering of cartilage | 397 | ||
| Introduction | 397 | ||
| Autologous cartilage grafts and applications | 398 | ||
| Auricular cartilage graft | 398 | ||
| Nasal cartilage graft | 404 | ||
| Rib cartilage graft | 407 | ||
| Autologous perichondrial graft | 408 | ||
| Cartilage engineering | 413 | ||
| Introduction and basic principle | 413 | ||
| Engineering of auricular cartilage | 413 | ||
| Engineered cartilage for rhinoplasty and facial contouring | 419 | ||
| Engineered cartilage for joint cartilage repair and reconstruction | 421 | ||
| Future directions | 423 | ||
| Stem cell-based cartilage engineering | 423 | ||
| In vitro engineering of cartilage with enhanced mechanical strength | 423 | ||
| Design and precise control of engineered cartilage 3D structure | 424 | ||
| References | 424.e1 | ||
| 21 Repair and grafting of bone | 425 | ||
| Microanatomy and histochemistry | 425 | ||
| Cortical versus cancellous bone | 425 | ||
| The chemical composition of bone | 427 | ||
| Inorganic phase | 427 | ||
| Organic phase | 427 | ||
| The cellular composition of bone | 427 | ||
| Osteoblasts | 428 | ||
| Histology and function | 428 | ||
| Regulation of osteoblast differentiation | 428 | ||
| Major signaling pathways | 428 | ||
| Transcriptional regulation | 429 | ||
| Osteocytes | 429 | ||
| Histology and function | 429 | ||
| Osteocyte functions | 429 | ||
| Osteoclasts | 430 | ||
| Histology and function | 430 | ||
| Osteoclast differentiation | 431 | ||
| Extracellular matrix | 431 | ||
| Principles of bone homeostasis and turnover | 432 | ||
| Wolff’s law and mechanotransduction | 433 | ||
| Bone regeneration: the role of the stem cell | 433 | ||
| Molecular mechanisms of bone regeneration | 434 | ||
| Bone morphogenetic protein | 434 | ||
| Bone morphogenetic protein function | 435 | ||
| Transforming growth factor-β | 436 | ||
| Fibroblast growth factor | 437 | ||
| Platelet-derived growth factor | 438 | ||
| Healing of fractures | 438 | ||
| Primary bone repair | 439 | ||
| Secondary (callus) bone repair | 439 | ||
| Variables influencing bone repair | 441 | ||
| Blood supply | 441 | ||
| Fracture fixation | 442 | ||
| Age | 444 | ||
| Bone remodeling | 444 | ||
| Osteoinduction | 444 | ||
| Osteoconduction | 445 | ||
| Osseointegration | 445 | ||
| Distraction osteogenesis | 446 | ||
| Histology | 446 | ||
| Variables affecting osteogenesis | 447 | ||
| Patient factors | 448 | ||
| Age | 448 | ||
| Blood supply | 448 | ||
| Radiation | 448 | ||
| Clinical application of bone transfers | 448 | ||
| Indication for bone transfers | 448 | ||
| Bone graft healing and graft survival | 448 | ||
| Cancellous versus cortical grafts | 449 | ||
| Clinical considerations | 449 | ||
| Techniques of harvest: autologous bone grafts | 449 | ||
| Ilium | 449 | ||
| Tibia and fibula | 452 | ||
| Greater trochanter and olecranon | 452 | ||
| Rib | 452 | ||
| Calvarium | 454 | ||
| Vascularized bone flaps | 455 | ||
| Vascularized iliac transfer | 455 | ||
| Vacularized fibula | 455 | ||
| Vascularized scapula | 455 | ||
| Vascularized rib | 456 | ||
| Vacularized calvarium | 457 | ||
| Principles of bone transfer | 459 | ||
| Allogeneic bone grafts | 459 | ||
| Processing and preservation | 459 | ||
| Risk of disease transmission | 459 | ||
| Immunogenicity | 460 | ||
| Incorporation of allograft bone | 460 | ||
| Formulations of allogeneic bone grafts | 460 | ||
| Xenogeneic bone grafts | 460 | ||
| Bone substitutes | 460 | ||
| Cement pastes | 460 | ||
| Calcium phosphates | 460 | ||
| BoneSource | 461 | ||
| Norian SRS/CRS | 461 | ||
| Osteoactive materials | 461 | ||
| Prefabricated polymers | 462 | ||
| Methylmethacrylate | 462 | ||
| Medpor | 462 | ||
| References | 463.e1 | ||
| 22 Repair and grafting of peripheral nerve | 464 | ||
| Introduction | 464 | ||
| Types of nerve injury | 464 | ||
| Nerve injury | 464 | ||
| Penetrating injuries | 465 | ||
| Crush injuries | 466 | ||
| Stretch and nerve avulsion injuries | 467 | ||
| Evaluation of nerve injuries | 468 | ||
| Nerve repair | 469 | ||
| Timing of repair | 469 | ||
| Tension and nerve repair | 469 | ||
| Type of repair: epineural versus fascicular | 469 | ||
| Type of repair: end-to-end versus end-to-side | 470 | ||
| Intraoperative nerve stimulation | 471 | ||
| Factors affecting outcome | 471 | ||
| Bridging the gap: current techniques | 472 | ||
| Nerve transfer: alternative to conduits | 474 | ||
| Bioengineering: the future? | 476 | ||
| Postoperative management | 476 | ||
| Summary | 477 | ||
| References | 478.e1 | ||
| 23 Vascular territories | 479 | ||
| Introduction | 479 | ||
| Historical perspective | 480.e1 | ||
| Vascular anatomical research | 480 | ||
| Angiosome | 480 | ||
| Arterial territories | 482 | ||
| Venous drainage | 484 | ||
| Neurovascular territories | 487 | ||
| Neurovascular anatomy of muscles of the body | 488 | ||
| The angiosome concept | 491 | ||
| Comparative anatomy | 491.e1 | ||
| Vascular territories of the body | 491.e4 | ||
| Vascular territories of the forearm | 491.e4 | ||
| Forearm skin | 491.e4 | ||
| Muscles | 491.e4 | ||
| Forearm bones | 491.e5 | ||
| Clinical implications | 491.e7 | ||
| Donor site morbidity | 491.e7 | ||
| Free-flap donor sites | 491.e7 | ||
| Vascular territories of the lower leg | 491.e7 | ||
| Lower leg skin | 491.e7 | ||
| Lower leg muscles | 491.e8 | ||
| Anterior-leg muscles | 491.e8 | ||
| Lateral-leg muscles | 491.e8 | ||
| Posterior leg muscles | 491.e9 | ||
| Leg skin vascular supply | 491.e10 | ||
| Connective tissue framework | 491.e10 | ||
| Compartment syndromes | 491.e10 | ||
| Flap donor sites | 491.e10 | ||
| Vascular anastomoses around the knee | 491.e11 | ||
| Vascular territories of the head and neck | 491.e13 | ||
| Head and neck skin and superficial musculoaponeurotic system | 491.e13 | ||
| Head and neck muscles | 491.e14 | ||
| Muscles of facial expression | 491.e15 | ||
| Ocular muscles | 491.e16 | ||
| Muscles of mastication | 491.e16 | ||
| Posterior neck muscles | 491.e16 | ||
| Lateral neck muscles | 491.e16 | ||
| Anterior neck muscles | 491.e16 | ||
| Aerodigestive system | 491.e16 | ||
| Internal nose | 491.e16 | ||
| Tongue and floor of mouth | 491.e16 | ||
| Palate, pharynx, larynx, esophagus, and trachea | 491.e17 | ||
| Glands | 491.e17 | ||
| Anatomic concepts related to flap design | 492 | ||
| Vessels follow the connective tissue framework of the body | 493 | ||
| Arteries radiate from fixed to mobile areas and veins converge from mobile to fixed areas | 494 | ||
| Vessels “hitchhike” with nerves | 495 | ||
| Vessel growth and orientation are products of tissue growth and differentiation | 496 | ||
| Vessels interconnect to form a continuous three-dimensional network of vascular arcades | 497 | ||
| Arteries | 497 | ||
| Veins | 497 | ||
| Vessels obey the law of equilibrium | 498 | ||
| Vessels have a relatively constant destination but may have a variable origin | 499 | ||
| Venous networks consist of linked valvular and avalvular channels that allow equilibrium of flow and pressure | 499 | ||
| Directional veins | 499 | ||
| Oscillating avalvular veins | 499 | ||
| Muscles are prime movers of venous return | 499 | ||
| Superficial veins follow nerves and deep veins follow arteries | 499 | ||
| Applications of angiosome concept | 500 | ||
| Preoperative assessment of the cutaneous vascular supply | 500 | ||
| Flap design | 500 | ||
| Dopplers | 500 | ||
| Color duplex Doppler | 501 | ||
| CT angiography | 501 | ||
| Axes of skin flaps | 501 | ||
| Distally based skin flaps | 501 | ||
| Skin flap dimensions | 502 | ||
| Fasciocutaneous flaps | 504 | ||
| Musculocutaneous flaps | 504 | ||
| Perforator flaps | 505 | ||
| The delay phenomenon | 507 | ||
| Composite flaps | 508 | ||
| Angiosome concept and flap design | 508 | ||
| References | 511.e1 | ||
| 24 Flap classification and applications | 512 | ||
| History | 512.e1 | ||
| Flap classification | 512 | ||
| Muscle and musculocutaneous flaps | 516 | ||
| Type I: one vascular pedicle | 516 | ||
| Type II: dominant vascular pedicle and minor pedicle | 516 | ||
| Type III: two dominant pedicles | 516 | ||
| Type IV: segmental vascular pedicles | 517 | ||
| Type V: one dominant vascular pedicle and secondary segmental vascular pedicles | 517 | ||
| Fascia and fasciocutaneous flaps | 517 | ||
| Perforator flaps | 519 | ||
| Abdominal viscera classification | 521 | ||
| Flap modifications | 521 | ||
| Tissue expansion | 522 | ||
| Segmental transposition flaps | 522 | ||
| Vascularized bone | 524 | ||
| Functional muscle flaps | 528 | ||
| Sensory flap | 528 | ||
| Combination flaps | 528 | ||
| Prelaminated and prefabricated flaps | 530 | ||
| Distally based flaps and reverse-flow flaps | 531 | ||
| Reverse transposition flap | 531 | ||
| Venous flaps | 533 | ||
| Microvascular composite tissue transplantation | 533 | ||
| Flap application | 534 | ||
| Advantages and disadvantages of muscle and musculocutaneous flaps | 538 | ||
| Advantages and disadvantages of fascia, fasciocutaneous, and perforator flaps | 539 | ||
| Flap transposition and arc of rotation | 539 | ||
| Prediction of skin territory | 540 | ||
| Selection of specific muscle and musculocutaneous flaps | 541 | ||
| Selection of specific fascia and fasciocutaneous flaps | 542 | ||
| Regional application of muscle and musculocutaneous flaps | 542 | ||
| Head and neck reconstruction | 542 | ||
| Breast reconstruction | 546 | ||
| Mediastinum | 549 | ||
| Chest wall and pulmonary cavity | 552 | ||
| Abdominal wall | 553 | ||
| Groin and perineum | 554 | ||
| Lower extremity | 557 | ||
| Foot | 560 | ||
| Pressure wounds | 562 | ||
| Preoperative and postoperative management | 565 | ||
| Positioning of the patient | 569 | ||
| Flap monitoring techniques | 570 | ||
| Complications | 571 | ||
| References | 572.e1 | ||
| 25 Flap pathophysiology and pharmacology | 573 | ||
| Introduction | 573 | ||
| Pathophysiology of flap failure | 573 | ||
| Vasospasm and thrombosis in pathogenesis of pedicle and free flap failure | 573 | ||
| Xanthine dehydrogenase/xanthine oxidase enzyme system in pathogenesis of ischemia–reperfusion injury in free flap surgery | 575 | ||
| Neutrophilic nicotinamide adenine diphosphate (NADPH) and myeloperoxidase (MPO) enzyme system in pathogenesis of ischemia/reperfusion injury in free flap surgery | 575 | ||
| Intracellular Ca2+ overload in pathogenesis of ischemia–reperfusion injury in free flap failure | 576 | ||
| Pathogenesis of no-reflow phenomenon in free flap surgery | 577 | ||
| Surgical manipulation for augmentation of pedicle flap viability | 577 | ||
| Flap design in augmentation of pedicle flap viability | 577 | ||
| Surgical delay in augmentation of pedicle flap viability | 577 | ||
| Vascular delay in augmentation of pedicle flap viability | 578 | ||
| Mechanism of surgical delay in augmentation of pedicle flap viability | 578 | ||
| Surgical delay procedure reduces arteriovenous (AV) shunt flow | 578 | ||
| Surgical delay procedure depletes vasoconstriction and prothrombotic substances in the skin flap | 579 | ||
| Surgical delay procedure induces vascular territory expansion by opening existing choke arteries | 579 | ||
| Surgical delay procedure induces angiogenesis | 580 | ||
| Pharmacological therapy for augmentation of pedicle flap viability | 580 | ||
| Drug therapy against vasoconstriction and thrombosis in pedicle and free flap surgery | 580 | ||
| Angiogenic cytokine protein or gene therapy for augmentation of pedicle flap viability | 581 | ||
| Pharmacological therapy for augmentation of free flap viability | 582 | ||
| Drug therapy for prevention of vasospasm and thrombosis in free flap surgery | 582 | ||
| Anticoagulant agents | 582 | ||
| Thrombolytic agents | 582 | ||
| Antispasmodic agents | 583 | ||
| Preischemic and postischemic pharmacological conditioning against ischemia–reperfusion injury in free flap surgery | 583 | ||
| Local preischemic conditioning against ischemia–reperfusion injury in skeletal muscle | 583 | ||
| Remote preischemic conditioning against ischemia–reperfusion injury in skeletal muscle | 583 | ||
| Postischemic conditioning for augmentation of free flap viability | 584 | ||
| Conclusion and future directions | 585 | ||
| Acknowledgments | 585 | ||
| References | 586.e1 | ||
| 26 Principles and techniques of microvascular surgery | 587 | ||
| Introduction | 587 | ||
| Historical perspective | 588.e1 | ||
| Tools | 588 | ||
| Surgical microscopes | 588 | ||
| Loupes | 588 | ||
| Types | 589 | ||
| Choosing loupes | 589 | ||
| Microsurgical instruments | 589 | ||
| Types | 590 | ||
| Scissors | 590 | ||
| Needle holders | 590 | ||
| Forceps | 590 | ||
| Vascular clamps | 590 | ||
| Bipolar coagulator | 591 | ||
| Irrigation and suction | 591 | ||
| Anastomotic devices | 591 | ||
| Microsutures | 591 | ||
| Anastomotic devices | 592 | ||
| Other nonsuture methods | 593 | ||
| General principles of microvascular surgery | 593 | ||
| Basics | 593 | ||
| Planning and positioning | 594 | ||
| Securing the flap or flap inset | 594 | ||
| Choice and dissection of recipient vessels | 594 | ||
| Preparation of vessels | 596 | ||
| Anastomotic sequence | 598 | ||
| Microvascular anastomosis techniques | 598 | ||
| Suturing techniques | 598 | ||
| End-to-end anastomosis | 598 | ||
| End-to-side | 601 | ||
| Use of the coupler | 604 | ||
| Difficult, less commonly encountered microvascular anastomosis | 604 | ||
| Anastomosis between size-discrepant vessels | 604 | ||
| Vertically oriented anastomosis | 605 | ||
| Atherosclerosis and loose intima | 605 | ||
| Microvascular grafts | 605 | ||
| Testing patency | 607 | ||
| General aspects of free-flap surgery | 607 | ||
| Advantages and disadvantages | 608 | ||
| Preoperative evaluation | 608 | ||
| Patient factors | 608 | ||
| Evaluation of recipient and donor sites | 609 | ||
| Choice of flap | 609 | ||
| Timing | 610 | ||
| Microvascular anesthesia | 611 | ||
| Special techniques and flap modifications | 611 | ||
| Endoscopic harvest | 611 | ||
| Perforator flaps, freestyle flaps, and supramicrosurgery | 611 | ||
| Chimeric flaps | 612 | ||
| Thinned flaps | 612 | ||
| Prefabricated/prelaminated flaps | 612 | ||
| Postoperative management, complications, and outcomes | 613 | ||
| Monitoring | 613 | ||
| Buried flaps | 614 | ||
| Flap outcomes | 614 | ||
| Causes of a failing flap | 614 | ||
| Anastomotic failure | 614 | ||
| Vasospasm | 615 | ||
| Thrombogenesis | 615 | ||
| Ischemic tolerance, ischaemia–reperfusion injury, and no-reflow phenomenon | 617 | ||
| Donor site complications – dependent again on flap choice | 618 | ||
| Management of failed flaps | 618 | ||
| Future of microsurgery | 620 | ||
| References | 621.e1 | ||
| 27 Principles and applications of tissue expansion | 622 | ||
| Introduction | 622 | ||
| Historical perspective | 622.e1 | ||
| Biology of tissue expansion | 623 | ||
| Skin | 623 | ||
| Capsule | 623 | ||
| Muscle | 623 | ||
| Bone | 623 | ||
| Vascularity of expanded tissue | 624 | ||
| Cellular and molecular basis for tissue expansion | 624 | ||
| Implant types | 626 | ||
| Expanders with distal ports | 627 | ||
| Expanders with integrated ports | 627 | ||
| Self-inflating expanders | 627 | ||
| Prosthesis shape, texture, and surface treatment | 627 | ||
| Basic principles | 627 | ||
| Incision planning and implant selection | 628 | ||
| Implant and distal port positioning | 628 | ||
| Implant inflation strategy and technique | 629 | ||
| Tissue expansion in special cases | 629 | ||
| Burns | 629 | ||
| Tissue expansion in children | 629 | ||
| Expansion of myocutaneous, fascial, and free flaps | 630 | ||
| Expanded full-thickness skin grafts | 630 | ||
| Reconstruction in the head and neck | 631 | ||
| Scalp | 631 | ||
| Male-pattern baldness | 633 | ||
| Forehead | 635 | ||
| Lateral face and neck | 635 | ||
| Nose | 637 | ||
| Ear | 637 | ||
| Periorbital area with expanded full-thickness grafts | 638 | ||
| Reconstruction in the breast, chest, trunk, and extremities | 640 | ||
| Postmastectomy breast reconstruction | 640 | ||
| The expander device | 642 | ||
| Immediate postmastectomy breast reconstruction | 643 | ||
| Submuscular position | 643 | ||
| Subpectoral (dual-plane) position | 644 | ||
| Subpectoral position with an acellular allogenic dermal matrix | 644 | ||
| Secondary breast reconstruction with tissue expansion | 645 | ||
| Tissue expansion in cases of chest wall irradiation | 645 | ||
| The hypoplastic breast | 647 | ||
| The tuberous breast | 647 | ||
| The immature breast | 648 | ||
| Correction of Poland syndrome | 648 | ||
| Expansion of the trunk | 648 | ||
| Expansion in the extremities | 650 | ||
| Complications and their management | 651 | ||
| Implant failure | 652 | ||
| Infection | 652 | ||
| Implant exposure | 652 | ||
| Compromise and loss of flap tissue | 652 | ||
| References | 653.e1 | ||
| 28 Therapeutic radiation: | 654 | ||
| Introduction | 654 | ||
| Radiation technology | 655 | ||
| Particle therapy | 655 | ||
| Brachytherapy | 656 | ||
| Physics | 657 | ||
| Radiobiology | 659 | ||
| Historical perspective | 654.e1 | ||
| Applications | 662 | ||
| Radiation treatment-planning and process | 662 | ||
| Clinical applications | 664 | ||
| Units of radiation | 664 | ||
| Treatment intent | 664 | ||
| Patient selection | 664 | ||
| Breast cancer | 664 | ||
| Breast conservation | 665 | ||
| Indications for postmastectomy radiation (PMRT) | 665 | ||
| Radiation of the nodal draining areas | 665 | ||
| RT techniques | 666 | ||
| Sequencing with systemic treatment | 668 | ||
| Head and neck cancer | 668 | ||
| Soft-tissue sarcoma | 669 | ||
| Doses and techniques in adults | 669 | ||
| Skin cancers | 670 | ||
| Nonmelanoma skin cancers | 670 | ||
| Benign disorders | 671 | ||
| Specific toxicities and complications | 671 | ||
| Bony injury | 671 | ||
| Bone growth in children | 672 | ||
| Lymphedema | 672 | ||
| Brachial plexopathy | 673 | ||
| Radiation-induced malignancies | 673 | ||
| Exposure to radiation | 673 | ||
| Conclusion and future trends | 674 | ||
| References | 675.e1 | ||
| 29 Vascular anomalies | 676 | ||
| Introduction | 676 | ||
| Vascular tumors | 678 | ||
| Infantile hemangioma | 678 | ||
| Pathogenesis | 678 | ||
| Clinical features | 680 | ||
| Head and neck hemangiomas | 680 | ||
| Multiple hemangiomas | 680 | ||
| Hepatic hemangiomas | 680 | ||
| Hemangiomas and structural anomalies | 681 | ||
| Diagnosis | 681 | ||
| Nonoperative management | 681 | ||
| Observation | 681 | ||
| Wound care | 682 | ||
| Topical corticosteroid | 682 | ||
| Intralesional corticosteroid | 682 | ||
| Systemic pharmacotherapy | 682 | ||
| Embolic therapy | 684 | ||
| Laser therapy | 684 | ||
| Operative management | 684 | ||
| Proliferative phase (infancy) | 684 | ||
| Involuting phase (early childhood) | 684 | ||
| Involuted phase (late childhood) | 685 | ||
| Congenital hemangiomas | 687 | ||
| 30 Benign and malignant nonmelanocytic tumors of the skin and soft tissue | 707 | ||
| Introduction | 707 | ||
| Diagnosis | 707 | ||
| Inspection and palpation | 707 | ||
| Dermoscopy | 709 | ||
| Ultrasound and Doppler imaging | 709 | ||
| X-ray, CT, MRI, angiography, scintigraphy, and positron emission tomography (PET) | 710 | ||
| Pathologic diagnosis | 710 | ||
| The TNM clinical classification system and the pTNM pathologic classification system | 711 | ||
| Clinical staging | 711 | ||
| Treatment | 711 | ||
| Wide excision | 711 | ||
| Lymph node dissection | 714 | ||
| Axillary lymph node dissection | 714 | ||
| Inguinal lymph node dissection | 715 | ||
| Reconstructive surgery | 717 | ||
| Radiation therapy | 717 | ||
| Chemotherapy | 717 | ||
| Laser therapy | 718 | ||
| Others (including immunotherapy, cryotherapy, electrocoagulation therapy, and sclerotherapy) | 718 | ||
| Benign cutaneous and soft-tissue tumors | 718 | ||
| Benign epithelial-origin tumors | 718 | ||
| Epidermal nevus (e.g., verrucous epidermal nevus and linear epidermal nevus) | 718 | ||
| Seborrheic keratosis (also known as senile wart) | 719 | ||
| Keratoacanthoma | 719 | ||
| Epidermoid cyst (also known as epidermal cyst and atheroma) | 719 | ||
| Milia | 719 | ||
| Dermoid cyst | 720 | ||
| Others | 720 | ||
| Benign appendage-origin tumors | 721 | ||
| Nevus sebaceous | 721 | ||
| Pilomatricoma (also known as calcifying epithelioma and pilomatrixoma) | 721 | ||
| Trichilemmal cyst | 722 | ||
| Syringoma | 722 | ||
| Apocrine cystadenoma (also known as apocrine cysthidroma) | 722 | ||
| Chondroid syringoma (also known as cutaneous mixed tumor) | 723 | ||
| Others | 723 | ||
| Benign neural crest-origin tumors | 723 | ||
| Pigment cell nevus (also known as pigmented nevus and nevus cell nevus) | 723 | ||
| Lentigo simplex | 723 | ||
| Acquired pigment cell nevus | 724 | ||
| Congenital pigment cell nevus | 724 | ||
| Dysplastic nevus (also known as Clark’s nevus and atypical mole) | 724 | ||
| Juvenile melanoma (also known as Spitz nevus) | 724 | ||
| Nevus spilus (also known as café-au-lait spot) | 725 | ||
| Becker’s melanosis (also known as Becker’s pigmented hairy nevus) | 725 | ||
| Nevus of Ota (also known as nevus fuscoceruleus ophthalmomaxillaris and oculodermal melanocytosis) | 725 | ||
| Nevus of Ito | 726 | ||
| Mongolian spot (also known as congenital dermal melanocytosis) | 726 | ||
| Blue nevus | 727 | ||
| Neuroma | 727 | ||
| Schwannoma (also known as neurilemmoma) | 727 | ||
| Neurofibroma | 728 | ||
| Others | 728 | ||
| Benign mesenchymal-origin tumors | 729 | ||
| Dermatofibroma (also known as fibrous histiocytoma) | 729 | ||
| Xanthoma | 729 | ||
| Juvenile xanthogranuloma | 729 | ||
| Soft fibroma | 730 | ||
| Keloid and hypertrophic scars | 730 | ||
| Lipoma | 731 | ||
| Leiomyoma | 731 | ||
| Rhabdomyoma | 732 | ||
| Osteochondrogenic tumors | 732 | ||
| Accessory auricle (also known as nevus cartilagines) | 732 | ||
| Granuloma | 733 | ||
| Glomus tumor | 734 | ||
| Capillary malformation | 734 | ||
| Hemangioma simplex | 734 | ||
| Strawberry hemangioma | 734 | ||
| Venous malformation | 735 | ||
| Arteriovenous fistula and arteriovenous malformation (AVM) | 735 | ||
| Lymphatic malformation | 736 | ||
| Others | 736 | ||
| Malignant cutaneous and soft-tissue tumors | 736 | ||
| Malignant epithelial-origin tumors | 736 | ||
| Actinic keratosis | 736 | ||
| Bowen’s disease | 736 | ||
| Squamous cell carcinoma | 737 | ||
| Basal cell carcinoma | 737 | ||
| Malignant appendage-origin tumors | 738 | ||
| Sebaceous carcinoma | 738 | ||
| Trichilemmal carcinoma | 738 | ||
| Sweat gland carcinoma | 738 | ||
| Extramammary Paget’s disease | 739 | ||
| Merkel cell carcinoma | 739 | ||
| Malignant mesenchymal-origin tumors | 739 | ||
| Dermatofibrosarcoma protuberans (DFSP) | 739 | ||
| Malignant fibrous histiocytoma (MFH) | 739 | ||
| Liposarcoma | 740 | ||
| Leiomyosarcoma | 740 | ||
| Rhabdomyosarcoma | 741 | ||
| Osteosarcoma | 741 | ||
| Chondrosarcoma | 741 | ||
| Angiosarcoma | 741 | ||
| Kaposi’s sarcoma | 742 | ||
| Others | 742 | ||
| References | 742.e1 | ||
| 31 Melanoma | 743 | ||
| Introduction | 743 | ||
| Historical perspective | 744.e1 | ||
| Clinical evaluation | 744 | ||
| Clinical diagnosis | 744 | ||
| Junctional nevus | 744 | ||
| Compound nevus | 744 | ||
| Intradermal nevus | 744 | ||
| Blue nevus | 745 | ||
| Congenital nevus | 745 | ||
| Atypical (dysplastic) nevus | 745 | ||
| Atypical (dysplastic) nevus syndrome | 746 | ||
| B-K mole syndrome | 747 | ||
| Differential diagnosis | 747 | ||
| Hutchinson freckle | 747 | ||
| Melanoma | 748 | ||
| Multiple primary melanomas | 749 | ||
| Classification/staging of disease | 750 | ||
| Histologic subtypes of melanoma | 752 | ||
| Histopathologic factors of prognostic significance | 753 | ||
| T category of TNM staging system | 755 | ||
| In-transit and regional lymph node disease | 756 | ||
| Lymphoscintigraphy (lymphatic mapping) and sentinel lymph node biopsy | 757 | ||
| Sentinel lymph node biopsy | 758 | ||
| N category of TNM system | 760 | ||
| Evaluation of systemic disease | 761 | ||
| Computerized scans | 762 | ||
| M category of TNM system | 763 | ||
| Surgical considerations and treatment | 764 | ||
| Initial biopsy | 764 | ||
| Wide local excision | 764 | ||
| Head and neck | 766 | ||
| Extremities | 766 | ||
| Trunk | 768 | ||
| Lymphadenectomy | 768 | ||
| Cervical lymphadenectomy | 771 | ||
| Axillary lymphadenectomy | 771 | ||
| Pelvic and inguinofemoral lymphadenectomy | 772 | ||
| Adjuvant treatment for melanoma | 777 | ||
| Interferon-α | 777 | ||
| Radiation therapy | 778 | ||
| Isolated limb perfusion | 778 | ||
| Treatment of metastatic melanoma | 779 | ||
| Chemotherapeutic agents | 779 | ||
| Tumor vaccines | 781 | ||
| Interleukin-2 | 782 | ||
| Biochemotherapy | 782 | ||
| Ipilimumab | 782 | ||
| Molecularly targeted treatment of melanoma | 783 | ||
| Surveillance | 783 | ||
| Summary | 784 | ||
| References | 785.e1 | ||
| 32 Implants and biomaterials | 786 | ||
| Historical perspective | 786.e1 | ||
| Metals | 786 | ||
| Stainless steel | 786 | ||
| Cobalt-chromium | 787 | ||
| Titanium | 787 | ||
| Gold | 787 | ||
| Platinum | 788 | ||
| Polymers | 788 | ||
| Silicone | 789 | ||
| Polytetrafluoroethylene | 790 | ||
| Polyester | 791 | ||
| Polyprolene | 791 | ||
| Polyethylene | 791 | ||
| Biodegradable polymers | 791 | ||
| Ceramics | 792 | ||
| Adhesives and glues | 792 | ||
| Platelet gels | 793 | ||
| Fibrin tissue adhesives | 793 | ||
| Cyanoacrylate | 793 | ||
| Skin substitutes | 793 | ||
| Integra | 794 | ||
| Epicel (cultured epidermal autografts) | 795 | ||
| Dermagraft | 795 | ||
| Apligraf | 795 | ||
| Bioprosthetic mesh | 795 | ||
| Small intestinal submucosa | 796 | ||
| Human acellular dermal matrix | 796 | ||
| Porcine acellular dermal matrix | 796 | ||
| Other bioprosthetic mesh products | 796 | ||
| Future materials | 796 | ||
| References | 797.e1 | ||
| 33 Facial prosthetics in plastic surgery | 798 | ||
| Advantages of craniofacial osseointegration | 799 | ||
| Historical perspective | 799.e1 | ||
| Indications for craniofacial osseointegration | 799 | ||
| Ear reconstruction | 800 | ||
| Osseointegrated nasal reconstruction | 802 | ||
| Osseointegrated orbital reconstruction | 802 | ||
| Midfacial reconstruction | 803 | ||
| Factors important to obtain osseointegration | 804 | ||
| Choice of implant material | 804 | ||
| Implant–tissue interface | 804 | ||
| Bone bed | 805 | ||
| Bone preparation | 805 | ||
| Implant load | 805 | ||
| Treatment planning | 805 | ||
| Surgical technique | 806 | ||
| Prosthetic construction | 808 | ||
| Maintenance program | 809 | ||
| Ancillary autogenous procedures | 810 | ||
| Craniofacial osseointegration outcomes | 810 | ||
| Individual implant success rates | 810 | ||
| Skin response | 812 | ||
| Prosthetic success | 812 | ||
| Conclusion | 812 | ||
| References | 813.e1 | ||
| 34 Transplantation in plastic surgery | 814 | ||
| Nomenclature | 815 | ||
| Transplantation immunology | 815 | ||
| Major histocompatibility complex | 815 | ||
| Other transplant antigens | 816 | ||
| Immunologic rejection cascade | 816 | ||
| Cells of immune response | 816 | ||
| Macrophages | 816 | ||
| Natural killer cells | 816 | ||
| Granulocyte | 817 | ||
| B lymphocyte | 817 | ||
| Immunoglobulin | 817 | ||
| Complement | 817 | ||
| Dendritic cells | 818 | ||
| T lymphocytes | 818 | ||
| T-cell binding and activation | 818 | ||
| Antigen recognition and graft rejection | 819 | ||
| Inflammatory mediators in transplantation | 819 | ||
| Immunologic screening | 820 | ||
| Current immunosuppression | 820 | ||
| Corticosteroids | 821 | ||
| Antiproliferative agents | 821 | ||
| Azathioprine | 821 | ||
| Mycophenolate mofetil | 822 | ||
| Calcineurin inhibitors | 823 | ||
| Cyclosporine | 823 | ||
| Tacrolimus | 823 | ||
| Rapamycin | 824 | ||
| Antilymphocyte preparations | 824 | ||
| Antilymphocyte/antithymocyte globulin | 824 | ||
| OKT3 | 825 | ||
| Anti-IL-2 | 825 | ||
| Alemtuzumab | 825 | ||
| Immunologic tolerance | 826 | ||
| Clonal deletion | 826 | ||
| Anergy | 827 | ||
| Immune regulation by regulatory cells | 827 | ||
| Transplantation in plastic surgery | 828 | ||
| Skin | 828 | ||
| Skin autograft | 828 | ||
| Skin allograft | 829 | ||
| Skin xenograft | 829 | ||
| Bone | 829 | ||
| Bone autograft | 829 | ||
| Bone allograft | 830 | ||
| Cartilage | 830 | ||
| Autologous cartilage | 830 | ||
| Cartilage allograft | 831 | ||
| Cartilage xenograft | 831 | ||
| Nerve | 831 | ||
| Nerve autograft | 831 | ||
| Nerve allograft | 831 | ||
| Limb and composite tissues | 831 | ||
| Technical considerations | 832 | ||
| Functional considerations | 832 | ||
| Immunologic considerations | 832 | ||
| Experimental limb transplantation | 832 | ||
| Hand transplantation | 834 | ||
| Immunosuppression and transplant survival | 834 | ||
| Measuring outcomes in hand transplantation | 835 | ||
| Future of transplantation in plastic surgery | 837 | ||
| References | 840.e1 | ||
| 35 Technology innovation in plastic surgery: A practical guide for the surgeon innovator | 841 | ||
| Introduction | 841 | ||
| The idea | 842 | ||
| Determining the value | 843 | ||
| Funding | 845 | ||
| Intellectual property | 846 | ||
| Institutional technology transfer | 847 | ||
| FDA regulatory approval process | 847 | ||
| Conflict of interest | 849 | ||
| Innovations in plastic surgery | 850 | ||
| Negative pressure wound therapy | 850 | ||
| Acellular dermal matrix | 851 | ||
| Noninvasive body contouring | 852 | ||
| References | 853.e1 | ||
| 36 Robotics, simulation, and telemedicine in plastic surgery | 854 | ||
| Introduction | 854 | ||
| Robotics | 855 | ||
| Historical perspective | 855.e1 | ||
| Introduction | 855 | ||
| Definition of a robot | 855 | ||
| The role of robotics in plastic surgery: planning and performance | 855 | ||
| The use of robotics in plastic surgery: surgical tools and prosthetics | 855 | ||
| Surgical robots in the operating room | 855 | ||
| Design features and usage of robotic surgery | 855 | ||
| Advantages and disadvantages of robotic surgery versus endoscopic surgery | 856 | ||
| Future use of surgical robots in plastic surgery | 857 | ||
| Robotics in limb and hand surgery | 857 | ||
| Robotics as a rung on the reconstructive ladder: upper limb example | 857 | ||
| Current upper extremity prosthetic options | 857 | ||
| Robotic hand prostheses and neural arm–hand prostheses | 858 | ||
| Choosing a robotic arm: benefits and limitations | 861 | ||
| Lower limb prostheses | 862 | ||
| Robotics in craniofacial surgery and ear, nose, and throat surgery | 862 | ||
| Robotics in chest and abdominal (trunk) surgery | 863 | ||
| Robots in urologic (prostate) surgery | 863 | ||
| Robotic surgery: the evidence base for improved outcomes | 864 | ||
| Next-generation robotic devices and the future of robotics in surgery | 864 | ||
| Simulation | 865 | ||
| Introduction and definition of simulation | 865 | ||
| Rationale for using simulation for plastic surgery and evidence of its utility in surgical training paradigms | 865 | ||
| Introduction | 870 | ||
| Definition and methods | 870 | ||
| Social networking | 871 | ||
| Plastic surgery and telemedicine | 871 | ||
| Ubiquitous mobile telemedicine | 872 | ||
| Technological convergence | 873 | ||
| Historical perspective | 865.e1 | ||
| The role of simulation in plastic surgery | 865 | ||
| Training simulators | 865 | ||
| Surgical planning simulators | 868 | ||
| Future applications of simulation | 869 | ||
| Telemedicine | 870 | ||
| Historical perspective | 870.e1 | ||
| Conclusion | 873 | ||
| Acknowledgments | 873 | ||
| References | 874.e1 | ||
| Index | i1 | ||
| A | i1 | ||
| B | i11 | ||
| C | i30 | ||
| D | i51 | ||
| E | i53 | ||
| F | i59 | ||
| G | i79 | ||
| H | i82 | ||
| I | i95 | ||
| J | i99 | ||
| K | i99 | ||
| L | i100 | ||
| M | i108 | ||
| N | i120 | ||
| O | i131 | ||
| P | i136 | ||
| Q | i149 | ||
| R | i149 | ||
| S | i158 | ||
| T | i172 | ||
| U | i187 | ||
| V | i195 | ||
| W | i199 | ||
| X | i202 | ||
| Y | i203 | ||
| Z | i203 | ||
| Online Index | e1 | ||
| A | e1 | ||
| B | e2 | ||
| C | e5 | ||
| D | e7 | ||
| E | e7 | ||
| F | e9 | ||
| G | e11 | ||
| H | e12 | ||
| I | e13 | ||
| J | e14 | ||
| K | e14 | ||
| L | e15 | ||
| M | e15 | ||
| N | e18 | ||
| O | e19 | ||
| P | e20 | ||
| Q | e22 | ||
| R | e22 | ||
| S | e23 | ||
| T | e27 | ||
| U | e30 | ||
| V | e31 | ||
| W | e33 | ||
| X | e34 | ||
| Z | e34 |