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Book Details
Abstract
Fully updated to meet the demands of the 21st-century surgeon, Lower Extremity, Trunk and Burns Surgery, Volume 4 of Plastic Surgery, 3rd Edition, provides you with the most current knowledge and techniques across your field, 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. Compatible with Kindle®, nook®, and other popular devices.
- Apply the very latest advances in extremity, trunk, and burn plastic surgery and ensure optimal outcomes with evidence-based advice from a diverse collection of world-leading authorities.
- Purchase this volume individually or own the entire set, with the ability to search across all six volumes online!
- Apply the latest techniques in lower extremity, trunk, and burn reconstruction, including microsurgical lymphatic reconstruction, super microsurgery, sternal fixation, and more.
- Know what to look for and what results you can expect with over 950 photographs and illustrations.
- See how to perform key techniques with 12 surgical videos online.
- Access the complete, fully searchable contents online, download all the tables and figures, and take advantage of additional content and images at www.expertconsult.com!
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 | ||
I Lower Extremity Surgery | 1 | ||
1 Comprehensive lower extremity anatomy | 1 | ||
Embryology | 1 | ||
The gluteal region | 2 | ||
Gluteal skeletal structure | 2 | ||
Gluteal fascial anatomy | 5 | ||
Muscles of the buttocks | 5 | ||
Gluteal vasculature | 5 | ||
Gluteal innervation | 5 | ||
The thigh | 8 | ||
Thigh skeletal structure | 8 | ||
Thigh fascial composition | 8 | ||
Thigh musculature | 11 | ||
Thigh vasculature | 19 | ||
Profunda femoris | 22 | ||
Lateral circumflex femoral arterial system | 23 | ||
Medial circumflex femoral arterial system | 23 | ||
Profunda femoris perforating branches | 25 | ||
Innervation of the thigh | 26 | ||
Motor innervation | 26 | ||
Cutaneous innervation | 26 | ||
The leg | 30 | ||
Knee and leg skeletal structure | 30 | ||
Knee skeletal structure | 30 | ||
Leg skeletal structure | 30 | ||
Leg fascial composition | 34 | ||
Deep fascia of the leg | 34 | ||
Interosseous membrane | 34 | ||
Lower leg compartments | 34 | ||
Compartment syndrome | 37 | ||
Leg musculature | 37 | ||
Anterior compartment | 37 | ||
Lateral compartment | 37 | ||
Posterior compartment – superficial layer | 43 | ||
Posterior compartment – deep layer | 45 | ||
Leg vasculature | 45 | ||
Leg nerve anatomy | 48 | ||
Lower leg nerve topography | 48 | ||
Lower leg motor innervation | 48 | ||
Lower leg cutaneous innervation | 48 | ||
The ankle and foot | 50 | ||
Ankle and foot skeletal structure | 50 | ||
Ankle | 50 | ||
Foot | 50 | ||
Ankle and foot fascial composition | 52 | ||
Extensor retinacula | 52 | ||
Flexor retinaculum | 52 | ||
Peroneal retinaculum | 54 | ||
Plantar fascia | 54 | ||
Fascial compartment of foot | 54 | ||
Foot musculature | 56 | ||
Foot and ankle vasculature | 59 | ||
Dorsalis pedis | 59 | ||
Posterior tibial artery – medial and lateral plantar arteries | 59 | ||
Peroneal arterial branches | 59 | ||
Ankle and foot nerve anatomy | 61 | ||
Foot cutaneous innervation | 61 | ||
Foot motor innervation | 61 | ||
Conclusion | 61 | ||
2 Management of lower extremity trauma | 63 | ||
Introduction | 63 | ||
Basic science and disease process | 63 | ||
Diagnosis and patient presentation | 64 | ||
Historical perspective | 63.e1 | ||
Patient selection | 65 | ||
Amputation versus salvage | 65 | ||
Treatment and surgical techniques | 66 | ||
Timing of treatment | 66 | ||
Fracture management | 67 | ||
Vascular injury | 67 | ||
Reconstructive options | 68 | ||
Local flaps | 68 | ||
Perforator flaps | 68 | ||
Muscle-based flaps | 72 | ||
Fascial-based flaps | 75 | ||
Free tissue transfer – muscle | 77 | ||
Free tissue transfer – fasciocutaneous | 81 | ||
Skeletal reconstruction | 83 | ||
Negative-pressure wound therapy in lower extremity defects | 83 | ||
Amputation | 83 | ||
Treatment of associated complications | 83 | ||
Rhabdomyolysis | 83 | ||
Fat embolization | 84 | ||
Compartment syndrome | 84 | ||
Postoperative care | 85 | ||
Antibiotics | 85 | ||
Anticoagulation | 85 | ||
Blood loss | 85 | ||
Outcomes, prognosis, and complications | 85 | ||
Outcomes and prognosis | 85 | ||
Functional outcomes | 85 | ||
Amputation versus salvage | 86 | ||
Patient satisfaction | 86 | ||
Cost-utility | 86 | ||
Complications | 86 | ||
Wound complications | 86 | ||
Osteomyelitis | 86 | ||
Nonunion | 87 | ||
Chronic pain | 87 | ||
Secondary procedures | 87 | ||
Secondary cosmetic procedures | 87 | ||
Secondary functional procedures | 91 | ||
References | 91.e1 | ||
3 Lymphatic reconstruction of the extremities | 92 | ||
Introduction | 92 | ||
Historical perspective | 92.e1 | ||
Ablative operations | 92.e1 | ||
Liposuction | 92.e1 | ||
Physiological operations | 92.e1 | ||
Greater omentum flaps | 92.e2 | ||
Vein grafts | 92.e2 | ||
Reconstruction methods | 92.e3 | ||
Lymphovenous bypass | 92.e4 | ||
Basic science/disease process | 92 | ||
Classification and etiology of lymphedema | 93 | ||
Diagnosis/patient presentation | 93 | ||
Patient selection | 93 | ||
Nonsurgical therapy | 93 | ||
Patient selection for reconstruction | 94 | ||
Treatment/surgical technique | 94 | ||
Ablative operations | 94 | ||
Physiological operations | 95 | ||
Lymphaticolymphatic bypass | 95 | ||
Lymphatic vessel reconstruction: Baumeister technique | 95 | ||
Microvascular lymph node transfer | 96 | ||
Lymphovenous bypass | 96 | ||
Lymphovenous shunts | 96 | ||
Postoperative care | 97 | ||
Outcomes, prognosis, and complications | 98 | ||
Secondary procedures following the reconstruction | 99 | ||
Summary | 99 | ||
References | 100.e1 | ||
4 Lower extremity sarcoma reconstruction | 101 | ||
Introduction | 101 | ||
Soft-tissue and bone sarcomas | 101 | ||
Sarcomas in the lower extremity | 102 | ||
Basic science/disease process | 102 | ||
Epidemiology soft-tissue sarcomas | 102 | ||
Bone sarcomas | 103 | ||
Tumor growth and metastasizing | 103 | ||
Diagnosis/patient presentation/imaging | 103 | ||
Historical perspective | 103.e1 | ||
Patient profile/general considerations/treatment planning | 104 | ||
Patient profile | 104 | ||
General considerations | 104 | ||
Treatment planning | 105 | ||
Surgery | 105 | ||
Radiotherapy | 106 | ||
Chemotherapy | 106 | ||
Treatment/surgical resection techniques | 106 | ||
Biopsy techniques | 106 | ||
Fine-needle or core needle aspirations | 106 | ||
Excisional biopsy | 106 | ||
Incisional biopsy | 107 | ||
Reoperative biopsies and surgical revisions | 107 | ||
Surgical technique for definitive resection | 108 | ||
Soft-tissue sarcomas | 108 | ||
Vascular involvement | 108 | ||
Nerve involvement | 109 | ||
Osseous involvement | 109 | ||
Primary osseous sarcomas | 109 | ||
Specimen handling | 109 | ||
Wound closure | 109 | ||
Lymph node dissection | 110 | ||
Indications for amputation | 110 | ||
Reconstructive options for lower extremity preservation | 110 | ||
Soft tissue | 110 | ||
Neuromuscular unit | 111 | ||
Skeletal reconstruction | 111 | ||
Vascular surgery | 112 | ||
Complex approaches | 112 | ||
Postoperative care | 112 | ||
Immediate postoperative care | 112 | ||
Oncologic postoperative care and follow-up | 113 | ||
Secondary procedures | 113 | ||
Early secondary procedures – soft tissue | 113 | ||
Early secondary procedures – skeleton | 113 | ||
Late secondary procedures | 114 | ||
Outcomes, prognosis, and complications | 114 | ||
Outcomes and prognosis | 114 | ||
Soft-tissue sarcomas | 114 | ||
Bone sarcomas | 115 | ||
Complications – management of recurrent disease | 116 | ||
References | 125.e1 | ||
5 Reconstructive surgery: | 127 | ||
Introduction | 127 | ||
History | 127.e1 | ||
Principles | 127 | ||
The value of autologous tissue | 128 | ||
The reconstructive elevator | 128 | ||
Skin grafts and substitutes | 128 | ||
Approach by location (local flaps) | 130 | ||
Thigh | 130 | ||
Lower leg | 130 | ||
Microvascular free tissue transfer | 131 | ||
Treatment approach | 131 | ||
Preoperative evaluation | 131 | ||
Primary limb amputation | 132 | ||
Debridement | 133 | ||
Timing of reconstruction | 133 | ||
Selection of recipient vessel | 133 | ||
Special considerations | 133 | ||
Osteomyelitis | 133 | ||
Diabetes | 134 | ||
Coverage after tumor ablation | 136 | ||
Exposed prosthesis | 137 | ||
Soft tissue expansion | 137 | ||
Postoperative care | 137 | ||
Monitoring | 137 | ||
Management of flap complications | 138 | ||
Secondary operations | 138 | ||
Muscle/musculocutaneous flaps | 138 | ||
Tensor fascia lata | 138 | ||
Rectus femoris | 139 | ||
Biceps femoris | 139 | ||
Gracilis | 140 | ||
Soleus | 141 | ||
Gastrocnemius | 142 | ||
Fasciocutaneous/perforator flap | 143 | ||
Groin/SCIP (superficial circumflex iliac perforator) | 143 | ||
Medial thigh/anteromedial perforator and gracilis perforator | 143 | ||
Lateral thigh/profunda femoris perforator | 144 | ||
Anterolateral thigh perforator | 145 | ||
Sural | 146 | ||
Tap (thoracodorsal artery perforator) | 147 | ||
Compound flaps | 148 | ||
Supermicrosurgery | 149 | ||
References | 150.e1 | ||
6 Diagnosis and treatment of painful neuroma and of nerve compression in the lower extremity | 151 | ||
Introduction | 151 | ||
Historical perspective | 152.e1 | ||
Basic science/disease process | 152 | ||
The painful neuroma | 152 | ||
Chronic nerve compression | 153 | ||
Diagnosis/patient presentation | 156 | ||
The painful neuroma | 156 | ||
Chronic nerve compression | 157 | ||
Patient selection | 157 | ||
The painful neuroma | 157 | ||
Chronic nerve compression | 158 | ||
Surgical technique | 159 | ||
The painful neuroma (Box 6.1) | 159 | ||
Chronic nerve compression (Box 6.3) | 164 | ||
Postoperative care/rehabilitation | 170 | ||
The painful neuroma | 170 | ||
Chronic nerve compression | 170 | ||
Outcomes, prognosis, and recurrence | 172 | ||
The painful neuroma | 172 | ||
Chronic nerve compression | 172 | ||
References | 173.e1 | ||
7 Skeletal reconstruction | 174 | ||
Introduction | 174 | ||
Basic science | 174 | ||
Diagnosis/patient presentation | 175 | ||
Historical perspective | 174.e1 | ||
Treatment and surgical technique | 176 | ||
Methods of skeletal reconstruction | 176 | ||
Bone grafting | 176 | ||
Vascularized bone transfer | 177 | ||
Periosteal and other bone flaps | 178 | ||
Distraction osteogenesis and the Ilizarov technique | 179 | ||
Allograft reconstruction | 180 | ||
Reconstruction by anatomic area | 181 | ||
Upper extremity | 181 | ||
Humerus | 181 | ||
Forearm | 181 | ||
Femur | 183 | ||
Tibia | 183 | ||
Pelvis and spine | 184 | ||
Clavicle | 185 | ||
Vascularized epiphyseal reconstruction | 185 | ||
Postoperative care | 186 | ||
Postoperative monitoring | 186 | ||
Adjuncts to skeletal reconstruction | 186 | ||
Postoperative aesthetic considerations | 187 | ||
Conclusion | 188 | ||
References | 188.e1 | ||
8 Foot reconstruction | 189 | ||
Introduction | 189 | ||
Historical perspective | 189.e1 | ||
Basic science | 189 | ||
Angiosomes of the foot | 189 | ||
Compartment pressure measurement | 190 | ||
Gait analysis | 190 | ||
Patient presentation | 191 | ||
Clinical evaluation | 191 | ||
Connective tissue disorders | 192 | ||
Venous ulcer | 192 | ||
Ischemia | 193 | ||
Diabetic foot ulcer | 194 | ||
Neuropathic changes | 195 | ||
Hemorheologic abnormalities | 195 | ||
Chronic wound evaluation | 196 | ||
Bone assessment | 196 | ||
Infection identification and directed antibiotic therapy | 196 | ||
Patient selection | 197 | ||
Identify function of the limb | 197 | ||
Management | 198 | ||
Trauma and crush injuries | 198 | ||
Debridement of the chronic wound | 198 | ||
Wound management | 199 | ||
External fixation | 199 | ||
Treatment/surgical technique | 201 | ||
Soft tissue reconstruction | 201 | ||
Angiosomes and clinical implications | 201 | ||
Closure techniques | 201 | ||
Reconstruction by anatomic location | 205 | ||
Ankle and foot dorsum | 205 | ||
Extensor digitorum brevis muscle flap | 205 | ||
Lateral supramalleolar flap | 206 | ||
Plantar forefoot | 207 | ||
Toe fillet flap | 207 | ||
Neurovascular island flap | 207 | ||
V-Y plantar flap | 207 | ||
Forefoot amputations and associated flaps | 207 | ||
Plantar midfoot | 208 | ||
Neurovascular island flaps | 208 | ||
Suprafascial flaps | 208 | ||
Midfoot amputations | 208 | ||
Plantar hindfoot | 208 | ||
Intrinsic muscle flaps | 209 | ||
Medial plantar artery flap | 209 | ||
Heel pad flaps | 209 | ||
Sural artery flap | 209 | ||
Microvascular composite tissue transplantation (free flaps) | 211 | ||
Hindfoot amputations | 216 | ||
Postoperative care | 217 | ||
Outcomes | 217 | ||
Summary | 218 | ||
References | 218.e1 | ||
II Trunk Surgery | 220 | ||
9 Comprehensive trunk anatomy | 220 | ||
Basic science and disease process: embryology of the trunk | 220 | ||
History | 220.e1 | ||
Back | 220 | ||
Muscles | 221 | ||
Vascular anatomy | 223 | ||
Chest | 223 | ||
Muscles | 224 | ||
Vascular anatomy | 225 | ||
Abdomen | 227 | ||
Muscles | 228 | ||
Vascular anatomy | 229 | ||
Nerves | 230 | ||
Pelvis | 230 | ||
Female perineum | 230 | ||
Vascular anatomy | 232 | ||
Male perineum | 235 | ||
Vascular anatomy | 235 | ||
References | 238.e1 | ||
10 Reconstruction of the chest | 239 | ||
Introduction | 239 | ||
Common flaps for reconstruction | 241 | ||
Pectoralis major | 241 | ||
Latissimus dorsi | 241 | ||
Serratus anterior | 244 | ||
Rectus abdominus | 244 | ||
Omentum | 245 | ||
Patient selection/approach to patient | 247 | ||
History | 245.e1 | ||
Chest wall tumors | 247 | ||
Basic science/disease process | 247 | ||
Diagnosis/presentation/patient selection | 247 | ||
III Burns Surgery | 393 | ||
18 Acute management of burn/electrical injuries | 393 | ||
Aims of burn care | 393 | ||
Acute management of burn injuries | 393 | ||
History | 393.e1 | ||
Epidemiology | 393 | ||
Risk factors | 394 | ||
Mechanisms of thermal injury | 394 | ||
Types of burns | 394 | ||
Thermal burns | 394 | ||
Flash and flame burns | 394 | ||
Scalds | 394 | ||
Contact burns | 394 | ||
Tar | 395 | ||
Chemical burns | 396 | ||
Electrical burns | 396 | ||
Nonaccidental burns | 397 | ||
Pathophysiology | 397 | ||
Local response | 398 | ||
Systemic response | 398 | ||
Hypovolemia and fluid extravasation | 399 | ||
Mediators of burn injury | 399 | ||
Initial evaluation and treatment | 399 | ||
Burn assessment | 402 | ||
Diagnosis/patient presentation | 402 | ||
Epidermal burns | 404 | ||
Superficial partial thickness burns | 404 | ||
Deep partial thickness | 405 | ||
Full thickness injuries | 406 | ||
Inhalation injury | 407 | ||
Management of moderate to severe burns | 408 | ||
Resuscitation formulae | 409 | ||
Monitoring | 410 | ||
Management of the burn wound | 410 | ||
Topical ointments | 410 | ||
Wound dressings | 410 | ||
Biological wound dressings | 410 | ||
Physiological wound dressings | 415 | ||
Conservative versus surgical therapy | 416 | ||
Surgery | 416 | ||
Summary of burn wound treatment (Box 18.10) | 420 | ||
Metabolism/nutrition | 421 | ||
Nutrition | 423 | ||
Nutrition formulae | 423 | ||
Endocrine and glucose monitoring | 423 | ||
Hepatic protein monitoring | 423 | ||
Anabolic steroids | 423 | ||
β-blockade | 425 | ||
Amino acids | 425 | ||
Rehabilitation | 425 | ||
Pain control | 426 | ||
Complications (Box 18.16) | 427 | ||
Skin graft loss | 427 | ||
Infected burn | 427 | ||
Adrenal insufficiency | 428 | ||
Compartment syndrome | 428 | ||
Deep venous thrombosis | 431 | ||
Gastrointestinal complications | 431 | ||
Heterotopic ossification | 431 | ||
Heparin-induced thrombocytopenia | 432 | ||
Inflammation | 432 | ||
Neutropenia | 432 | ||
Infection | 432 | ||
Hypertrophic scar | 434 | ||
Hypothermia | 434 | ||
Secondary sclerosing cholangitis | 434 | ||
References | 434.e1 | ||
19 Extremity burn reconstruction | 435 | ||
Introduction | 435 | ||
History | 435.e1 | ||
Basic science/disease process | 435 | ||
Electrical burns | 435 | ||
Diagnosis/patient presentation | 436 | ||
Fluid infusion and edema | 436 | ||
Compartment syndrome | 437 | ||
Related trauma | 439 | ||
Patient selection | 440 | ||
Treatment/surgical technique | 440 | ||
Acute-phase surgery: skin grafting | 441 | ||
Skin substitutes | 441 | ||
Joint reconstruction with dermis in acute phase (Figs 19.7 and 19.8) | 441 | ||
Postoperative care | 442 | ||
Positioning the patient | 443 | ||
Upper extremity | 443 | ||
Shoulder | 443 | ||
Elbow | 443 | ||
Wrist | 443 | ||
Lower extremity | 443 | ||
Hip | 443 | ||
Knee | 444 | ||
Ankle | 444 | ||
Passive mobilization | 444 | ||
Active mobilization | 444 | ||
Outcomes, prognosis, complications | 444 | ||
Unstable healing: Marjolin’s ulcer | 444 | ||
Scar retraction | 444 | ||
Axillary contractures (Fig. 19.11) | 445 | ||
Elbow contractures | 445 | ||
Heterotopic ossification | 446 | ||
Skeletal-muscle complications: bone exposure | 446 | ||
Secondary procedures | 446 | ||
Z-plasty | 447 | ||
Skin grafts | 447 | ||
Dermal substitutes (INTEGRA®) in the surgical treatment of sequelae | 448 | ||
Flaps | 448 | ||
Fasciocutaneous and myocutaneous flaps | 449 | ||
Skin expansion | 450 | ||
Free flap | 450 | ||
Nerve repair | 450 | ||
Surgery of tendon retraction | 451 | ||
Amputation | 451 | ||
Lipofilling | 453 | ||
Laser | 454 | ||
References | 455.e1 | ||
20 Cold and chemical injury to the upper extremity | 456 | ||
Cold injury | 456 | ||
History | 456.e1 | ||
Basic science/disease process | 456 | ||
Pathophysiology | 456 | ||
Freezing phase | 457 | ||
Rewarming phase | 457 | ||
Diagnosis/patient presentation | 457 | ||
Physical exam | 457 | ||
Staging | 457 | ||
Radiographic studies | 457 | ||
Patient selection | 458 | ||
Treatment/surgical technique | 458 | ||
Nonoperative management | 458 | ||
Field management | 458 | ||
Rapid rewarming | 458 | ||
Adjunctive therapy | 458 | ||
Splinting | 458 | ||
Operative management | 458 | ||
Amputation | 458 | ||
Length salvage | 459 | ||
Postoperative care | 459 | ||
Outcomes/prognosis/complications | 459 | ||
Secondary procedures | 460 | ||
Sympathectomy | 460 | ||
Hyperbaric oxygen | 460 | ||
Thrombolytics | 460 | ||
Chemical injury | 460 | ||
History | 460.e1 | ||
Basic science/disease process | 460 | ||
Pathophysiology | 460 | ||
Classification | 460 | ||
Oxidizing agents | 460 | ||
Chromic acid | 460 | ||
Sodium hypochlorite | 461 | ||
Reducing agents | 461 | ||
Hydrochloric acid | 461 | ||
Corrosive agents | 461 | ||
Phenol | 461 | ||
White phosphorus | 461 | ||
Desiccants | 461 | ||
Sulfuric acid | 461 | ||
Vesicants | 461 | ||
Mustard gas | 461 | ||
Protoplasmic poisons | 461 | ||
Formic acid | 461 | ||
Hydrofluoric acid | 461 | ||
Diagnosis/patient presentation | 461 | ||
Oxidizing agents | 461 | ||
Chromic acid | 461 | ||
Sodium hypochlorite | 462 | ||
Reducing agents | 462 | ||
Hydrochloric acid | 462 | ||
Corrosive agents | 462 | ||
Phenol | 462 | ||
White phosphorus | 462 | ||
Desiccants | 462 | ||
Sulfuric acid | 462 | ||
Vesicants | 462 | ||
Mustard gas | 462 | ||
Protoplasmic poisons | 462 | ||
Formic acid | 462 | ||
Hydrofluoric acid (HF) | 462 | ||
Patient selection | 462 | ||
Treatment/surgical technique | 462 | ||
Primary treatment | 462 | ||
Secondary treatment | 463 | ||
Oxidizing agents | 463 | ||
Chromic acid | 463 | ||
Sodium hypochlorite | 463 | ||
Reducing agents | 463 | ||
Hydrochloric acid | 463 | ||
Corrosive agents | 463 | ||
Phenol | 463 | ||
White phosphorus | 463 | ||
Desiccants | 463 | ||
Sulfuric acid | 463 | ||
Vesicants | 463 | ||
Mustard gas | 463 | ||
Protoplasmic poisons | 463 | ||
Formic acid | 463 | ||
Hydrofluoric acid | 464 | ||
Postoperative care | 464 | ||
Outcomes/prognosis/complications | 464 | ||
Secondary procedures | 464 | ||
Extravasation injury | 464 | ||
History | 464.e1 | ||
Basic science/disease process | 464 | ||
Osmotically active agents | 464 | ||
Vasoconstrictive agents | 464 | ||
Cytotoxic agents | 464 | ||
Diagnosis/patient presentation | 465 | ||
Patient selection | 465 | ||
Treatment/surgical technique | 465 | ||
Osmotically active agents | 466 | ||
Vasoconstrictive agents | 466 | ||
Cytotoxic agents | 466 | ||
Postoperative care | 466 | ||
Outcomes/prognosis/complications | 466 | ||
Secondary procedures | 467 | ||
References | 467.e1 | ||
21 Management of facial burns | 468 | ||
Introduction | 468 | ||
History | 468.e1 | ||
Basic science | 468 | ||
Diagnosis: determination of depth of burn | 470 | ||
Treatment of acute facial burns | 470 | ||
Eyes/eyelid | 470 | ||
Ears | 473 | ||
Nose | 473 | ||
Mouth | 473 | ||
Wound nonoperative management of facial burn scars | 473 | ||
Surgical management of the late effects of face, head and neck burns | 473 | ||
Introduction | 473 | ||
General principles | 474 | ||
Importance of allowing total wound healing and scar maturation | 474 | ||
Reconstruction must be preceded by analysis of the problem and diagnosis of the factors causing it | 474 | ||
An overall plan for reconstruction should be developed | 474 | ||
Restoration of function usually precedes aesthetic reconstruction | 474 | ||
Local flaps should be used whenever possible | 474 | ||
Skin grafts are used because of their thinness when a thicker flap would hide underlying anatomic contours or interfere with function | 474 | ||
Skin replacement should generally be performed in “aesthetic units” when subtotal or total unit defects are present | 474 | ||
Skin replacement should be performed with as well-matched skin as possible to the recipient site | 475 | ||
As many goals as possible should be accomplished during each operative procedure | 475 | ||
Ancillary techniques should be employed to maximum advantage | 475 | ||
Follow-up must be diligent | 475 | ||
An algorithmic approach to facial burn in reconstruction | 475 | ||
Specific techniques | 478 | ||
Scar replacement with local skin | 478 | ||
Serial excision | 478 | ||
W-plasty | 478 | ||
Skin grafts | 479 | ||
Introduction | 479 | ||
Split-thickness skin grafts in facial burn reconstruction | 479 | ||
The application of full-thickness skin grafts in facial burn reconstruction | 479 | ||
Composite and nonskin grafts | 480 | ||
Flaps | 480 | ||
Introduction | 480 | ||
Z-plasty | 481 | ||
Trapeze-plasty | 481 | ||
Reconstructive options when normal skin for donor site is inadequate | 482 | ||
Tissue expansion | 482 | ||
Technical points in tissue expansion | 482 | ||
Dermal substitutes | 482 | ||
Nonoperative facial reconstructive adjunct techniques | 484 | ||
Laser therapy | 484 | ||
Steroid injections | 485 | ||
Corrective cosmetics | 485 | ||
Hair transplantation | 485 | ||
Fat transplantation | 485 | ||
Prosthetics | 485 | ||
Reconstruction of specific anatomic areas | 485 | ||
Forehead | 485 | ||
Eyebrows | 485 | ||
Eyelids | 485 | ||
Upper eyelids | 486 | ||
Lower eyelids | 486 | ||
Medial canthus scars | 488 | ||
Nose | 488 | ||
Upper lip | 489 | ||
Lower lip and chin | 489 | ||
Oral commissure | 489 | ||
Cheeks | 490 | ||
Ears | 491 | ||
Scalp | 492 | ||
Neck | 493 | ||
Severe cervical burn scars and contractures | 494 | ||
Postoperative care | 497 | ||
Complications | 497 | ||
Outcomes and prognosis | 497 | ||
Secondary procedures | 498 | ||
Besides these general techniques, there are specific examples of common secondary procedures in facial reconstruction | 498 | ||
References | 499.e1 | ||
22 Reconstructive burn surgery | 500 | ||
Introduction | 500 | ||
Timing of reconstructive procedures | 500 | ||
Hypertrophic scars and contractures | 501 | ||
History | 500.e1 | ||
Overview of techniques for reconstructive surgery | 501 | ||
Scar release | 501 | ||
Wound closure | 502 | ||
Skin grafts | 502 | ||
Skin substitutes | 502 | ||
Local flaps | 502 | ||
Other flaps | 503 | ||
Tissue expansion | 503 | ||
Specific reconstructive problems and procedures | 503 | ||
Head and neck | 504 | ||
Scalp | 504 | ||
Facial defects | 504 | ||
Eyelids and eyebrows | 504 | ||
Nose and lips | 505 | ||
Ears | 505 | ||
Other facial areas | 506 | ||
Neck | 506 | ||
Breast reconstruction | 506 | ||
Perineum | 506 | ||
Upper extremity | 507 | ||
Axilla | 507 | ||
Elbow | 507 | ||
Wrist and hand | 507 | ||
Wrist | 508 | ||
Digit contractures | 508 | ||
Web space contractures | 508 | ||
Nail deformities | 509 | ||
Lower extremity | 509 | ||
Postoperative management: splints, pressure garments and rehabilitation | 509 | ||
Outcomes | 509 | ||
Conclusion | 509 | ||
References | 510 | ||
23 Management of patients with exfoliative disorders, epidermolysis bullosa, and TEN | 511 | ||
Toxic epidermal necrolysis | 511 | ||
Basic science/disease process | 511 | ||
Patient presentation/diagnosis | 512 | ||
Historical perspective | 511.e1 | ||
Patient selection | 514 | ||
General | 514 | ||
Treatment/surgical technique | 515 | ||
ABCs | 515 | ||
Wound care | 515 | ||
Drug withdrawal and the issue of corticosteroids | 515 | ||
Postoperative care | 516 | ||
General care issues | 516 | ||
Ocular care | 516 | ||
Novel pharmacologic therapy | 517 | ||
Outcomes, prognosis, and complications | 517 | ||
Secondary procedures | 517 | ||
Epidermolysis bullosa | 517 | ||
Basic science/disease process | 517 | ||
Patient presentation/diagnosis | 518 | ||
Subtypes and clinical characteristics | 519 | ||
Investigations | 520 | ||
Patient selection | 521 | ||
Treatment/surgical technique | 521 | ||
Surgical care | 521 | ||
Use of skin equivalents | 522 | ||
Postoperative care | 522 | ||
Outcomes, prognosis, and complications | 522 | ||
References | 525.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 \rIndex | e1 | ||
A | e1 | ||
B | e2 | ||
C | e5 | ||
D | e6 | ||
E | e6 | ||
F | e7 | ||
G | e10 | ||
H | e11 | ||
I | e11 | ||
J | e12 | ||
K | e12 | ||
L | e12 | ||
M | e15 | ||
N | e16 | ||
O | e16 | ||
P | e16 | ||
Q | e18 | ||
R | e18 | ||
S | e19 | ||
T | e22 | ||
U | e24 | ||
V | e25 | ||
W | e25 | ||
X | e26 | ||
Z | e26 |