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Cirurgia Plástica Volume Quatro

Cirurgia Plástica Volume Quatro

David H Song | Peter C. Neligan

(2012)

Additional Information

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