BOOK
Lower Extremity Soft Tissue & Cutaneous Plastic Surgery E-Book
G Dock Dockery | Mary Elizabeth Crawford | Michael J. Coughlin | Sigvard T. Hansen
(2012)
Additional Information
Book Details
Abstract
Since publication of the first edition, Lower Extremity Soft Tissue & Cutaneous Plastic Surgery has attracted wide acclaim for its superb illustrations, clear step-by-step approach, thoroughness and practicality. Progressing from basic information on instruments and principles of tissue handling through to complex techniques, no surgeon of the foot and ankle will want to be without this authoritative text which will aid in their recognition of conditions and provide a suitable method of treatment with the latest surgical techniques.
This second edition provides additional information regarding the current techniques of suturing, aseptic and sterile techniques, vascular anatomy, incisional and excisional procedures, cutaneous flaps and grafts as well as reconstructive and plastic surgical techniques. Four new chapters have been added along with numerous new photographs and illustrations. Emphasis is placed on plastic surgery techniques that are applicable on the foot, ankle and lower leg whenever possible.
- Over 1,300 superb full color illustrations
- Practical step-by-step instructions of all the major techniques
- Suitable for all surgeons performing reconstructive or plastic surgery on the lower limb
- Four new chapters:
- Cutaneous anatomy and its surgical implications
- Aseptic techniques
- Leg ulcer management
- Dressings and postoperative care
- Text fully updated throughout with extra illustrations for maximum clarity
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Lower Extremity Soft Tissue & Cutaneous Plastic Surgery | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Contributors | vii | ||
| Foreword | ix | ||
| Foreword | xi | ||
| Preface | xiii | ||
| Abbreviations | xv | ||
| Introduction | xvii | ||
| Who is this book for? | xvii | ||
| Where are these surgeries performed? | xvii | ||
| Principles of cutaneous surgery | xvii | ||
| Chapter 1 Preoperative patient evaluation | 1 | ||
| Chapter Contents | 1 | ||
| Introduction | 1 | ||
| Second opinion | 1 | ||
| Informed consent | 2 | ||
| Patient examination | 2 | ||
| History | 2 | ||
| Physical examination | 3 | ||
| Patient preparation | 4 | ||
| Patient expectations | 5 | ||
| Further reading | 5 | ||
| Chapter 2 Cutaneous anatomy and its surgical implications | 7 | ||
| Chapter Contents | 7 | ||
| Introduction | 7 | ||
| Epidermis | 7 | ||
| Specialized cells and appendages of the epidermis | 8 | ||
| Dermis | 9 | ||
| Subcutaneous layer | 9 | ||
| Surgical implications | 10 | ||
| Conclusion | 10 | ||
| Further reading | 10 | ||
| Chapter 3 Vascular anatomy and its surgical implications | 13 | ||
| Chapter Contents | 13 | ||
| Introduction | 13 | ||
| Angiosomal circulation to the foot and ankle | 13 | ||
| Posterior tibial artery angiosomes | 14 | ||
| Medial calcaneal angiosome | 14 | ||
| Medial plantar angiosome | 14 | ||
| Lateral plantar angiosome | 15 | ||
| Anterior tibial artery angiosomes | 15 | ||
| Dorsalis pedis angiosome | 15 | ||
| Peroneal artery angiosomes | 16 | ||
| Lateral calcaneal angiosome | 16 | ||
| Anterior perforating peroneal angiosome | 16 | ||
| Cutaneous circulation of the skin and superficial fascia | 16 | ||
| Mechanisms of anastomosis | 17 | ||
| Compromised vascular states | 17 | ||
| Incision planning | 18 | ||
| Venous and lymphatic drainage | 18 | ||
| Conclusion | 19 | ||
| References | 20 | ||
| Further Reading | 21 | ||
| Chapter 4 Surgical principles | 23 | ||
| Chapter Contents | 23 | ||
| Introduction | 23 | ||
| Skin properties | 23 | ||
| Contour lines | 23 | ||
| Lines of minimal movement and relaxed skin tension lines | 24 | ||
| Incision planning | 24 | ||
| Incision making | 25 | ||
| References | 27 | ||
| Further reading | 27 | ||
| Chapter 5 Basic instruments and tissue handling | 29 | ||
| Chapter Contents | 29 | ||
| Tissue handling | 29 | ||
| The operating room | 29 | ||
| Surgical instruments | 30 | ||
| Instrument stand | 30 | ||
| Scalpel handles and blades | 30 | ||
| Tissue-handling forceps | 32 | ||
| Scissors | 32 | ||
| Tissue retractors | 34 | ||
| Artery forceps or mosquito hemostats | 36 | ||
| Needle holders/drivers | 37 | ||
| Punches | 38 | ||
| Miscellaneous instruments | 38 | ||
| Hand signals in surgery | 39 | ||
| Further reading | 43 | ||
| Chapter 6 Anesthesia | 45 | ||
| Chapter Contents | 45 | ||
| Introduction | 45 | ||
| Local anesthetics | 45 | ||
| Anesthetic techniques | 46 | ||
| Topical anesthesia | 46 | ||
| Nerve blocks and infiltration | 46 | ||
| Intravenous sedation | 48 | ||
| Regional nerve block | 49 | ||
| Conclusion | 50 | ||
| Further reading | 50 | ||
| Chapter 7 Aseptic techniques | 53 | ||
| Chapter Contents | 53 | ||
| Introduction | 53 | ||
| Definition of asepsis | 53 | ||
| Definition of antisepsis | 54 | ||
| Definition of sterility | 54 | ||
| Surgical infections | 54 | ||
| Types of surgical incision infections and their classification | 54 | ||
| Prevention of contamination | 54 | ||
| Preoperative | 54 | ||
| Intraoperative | 55 | ||
| Postoperative | 55 | ||
| Contamination risk factors | 55 | ||
| Systemic factors | 55 | ||
| Surgical incision factors | 56 | ||
| The operative procedure factors | 56 | ||
| Type of operation factors | 56 | ||
| Postoperative incision management | 56 | ||
| Surgical instrument and equipment sterilization | 57 | ||
| Autoclaves (steam under pressure) | 57 | ||
| Instrument disinfection | 57 | ||
| Low-temperature steam | 57 | ||
| Dry heat | 57 | ||
| Chemical disinfectants | 57 | ||
| Operating room attire | 57 | ||
| Scrub suits | 57 | ||
| Head cover | 57 | ||
| Facemask | 57 | ||
| Eye cover or protection | 58 | ||
| Foot covers | 58 | ||
| Asepsis | 58 | ||
| Preoperative preparation | 59 | ||
| Hand scrubbing | 59 | ||
| Surgical gowning | 60 | ||
| Sterile gloving | 60 | ||
| Removing sterile gloves | 61 | ||
| Patient’s skin scrub | 61 | ||
| Preparation of the surgical site | 62 | ||
| Skin disinfection and scrubbing | 62 | ||
| Draping of the operation site | 63 | ||
| Intraoperative preparation | 65 | ||
| Postoperative preparation | 65 | ||
| Summary | 65 | ||
| Further reading | 68 | ||
| Chapter 8 Hemostatic techniques | 69 | ||
| Chapter Contents | 69 | ||
| Introduction | 69 | ||
| Laboratory testing | 69 | ||
| Hemostatic agents | 70 | ||
| Mechanical methods | 70 | ||
| Thermal methods | 71 | ||
| Chemical methods | 72 | ||
| Medicinal leeches | 74 | ||
| Conclusion | 74 | ||
| Further reading | 74 | ||
| Chapter 9 Suture materials and techniques | 77 | ||
| Chapter Contents | 77 | ||
| Introduction | 77 | ||
| Physiological factors | 77 | ||
| Incision placement and planning | 78 | ||
| Wound closure materials | 78 | ||
| Sutures | 78 | ||
| Characteristics of suture material | 78 | ||
| Absorbable sutures | 78 | ||
| Non-absorbable sutures | 79 | ||
| Suture classification | 80 | ||
| Needles | 80 | ||
| Characteristics of surgical needles | 80 | ||
| Needle coding system | 81 | ||
| Alternatives to suturing | 81 | ||
| Adhesive tape strips | 81 | ||
| Skin staples | 82 | ||
| Surgimate® staplers | 82 | ||
| Staple configuration | 82 | ||
| 3M™ staplers | 83 | ||
| Indications/techniques | 83 | ||
| Staple removal | 83 | ||
| Tissue adhesives | 83 | ||
| Tension assisted wound closure | 85 | ||
| Tension assisted wound closure devices for the lower extremity | 85 | ||
| Rapid intraoperative tissue expansion | 85 | ||
| Continuous external tissue expansion | 85 | ||
| Skin incisions | 86 | ||
| Mobilization and retention suture techniques | 86 | ||
| Basic suture technique | 86 | ||
| Retention sutures | 86 | ||
| Special suturing techniques | 88 | ||
| Tendon sutures | 88 | ||
| Internal suture techniques | 89 | ||
| Buried sutures | 89 | ||
| Deep suture retention techniques | 89 | ||
| One-half buried horizontal mattress sutures | 91 | ||
| Apical sutures | 91 | ||
| Cosmetic closure | 91 | ||
| Intradermal suture (continuous subcuticular) | 91 | ||
| Dog-ear repair | 92 | ||
| Conclusion | 93 | ||
| References | 99 | ||
| Further reading | 100 | ||
| Chapter 10 Wound-healing properties | 101 | ||
| Chapter Contents | 101 | ||
| Phases of wound (incision or injury) healing | 101 | ||
| Compromises to wound healing | 102 | ||
| Intrinsic factors affecting wound healing | 103 | ||
| Extrinsic factors affecting wound healing | 103 | ||
| Conclusion | 104 | ||
| Further reading | 104 | ||
| Chapter 11 Digital medical photography | 105 | ||
| Chapter Contents | 105 | ||
| Introduction | 105 | ||
| Uses of photography in practice | 106 | ||
| Equipment | 106 | ||
| Macro format | 106 | ||
| Focal length | 106 | ||
| Optical and digital zoom | 107 | ||
| Resolution | 107 | ||
| Image collection | 107 | ||
| Storage formats | 107 | ||
| Accessories | 108 | ||
| Lighting sources | 108 | ||
| Guidelines for digital medical photography | 108 | ||
| General considerations | 109 | ||
| Operating room images | 109 | ||
| Photographing X-rays and other imaging studies | 109 | ||
| Copying slides | 109 | ||
| Medical presentations | 110 | ||
| Publishing digital images | 110 | ||
| The digital darkroom and photo editing software | 110 | ||
| Conclusion | 110 | ||
| Further reading | 110 | ||
| Chapter 12 Excisional techniques and procedures | 113 | ||
| Chapter Contents | 113 | ||
| Introduction | 113 | ||
| Fusiform ellipse | 113 | ||
| M-plasty | 116 | ||
| Modified M-plasty | 117 | ||
| S-incision (Alvarado double-S) | 118 | ||
| Crescentic ellipse (double elliptical excision) | 118 | ||
| Reciprocal approaches and other variations | 119 | ||
| Mercedes Benz closure | 119 | ||
| O–Z closure | 119 | ||
| O–T and A–T closure | 119 | ||
| Bowtie closure (Alvarado) | 121 | ||
| Combined-V closure (Alvarado) | 123 | ||
| Further reading | 126 | ||
| Chapter 13 Biopsy techniques | 127 | ||
| Chapter Contents | 127 | ||
| Introduction | 127 | ||
| General considerations | 127 | ||
| Biopsy indications | 128 | ||
| Patient preparation | 128 | ||
| Biopsy guidelines | 129 | ||
| Shave and saucerization biopsy | 130 | ||
| Scissor biopsy | 133 | ||
| Punch biopsy | 133 | ||
| Elliptical excision as a biopsy technique | 136 | ||
| Incisional biopsy | 136 | ||
| Pathology | 138 | ||
| Further reading | 140 | ||
| Chapter 14 Flap classification and survival factors | 143 | ||
| Chapter Contents | 143 | ||
| Introduction | 143 | ||
| Flap classification | 143 | ||
| Vascular anatomy of the flap | 144 | ||
| Angiosomes | 144 | ||
| Flap design | 147 | ||
| Flap failure and survival factors | 148 | ||
| Conclusion | 149 | ||
| Further reading | 149 | ||
| Chapter 15 V–Y- and Y–V-plasty | 151 | ||
| Chapter Contents | 151 | ||
| V–Y-plasty | 151 | ||
| Y–V-plasty | 152 | ||
| V–Y–S-plasty | 152 | ||
| Single V–Y fasciocutaneous island flap | 157 | ||
| Extended V–Y island flap | 160 | ||
| Double V–Y island flap | 161 | ||
| Oblique sigmoid island flap | 161 | ||
| Conclusion | 161 | ||
| Further reading | 161 | ||
| Chapter 16 Z and W skin plasty | 163 | ||
| Chapter Contents | 163 | ||
| Single Z skin plasty | 163 | ||
| Planning the Z-plasty | 165 | ||
| Variations of the Z skin plasty | 167 | ||
| Extension of limbs or central arm | 167 | ||
| Asymmetrical Z-plasty flaps | 167 | ||
| Long central-arm Z-plasty flap | 167 | ||
| Curved-arm Z-plasty | 167 | ||
| Lazy-S Z-plasty | 167 | ||
| Planimetric Z-plasty | 170 | ||
| Extended planimetric Z-plasty | 170 | ||
| Oblique continuous planimetric Z-plasty | 170 | ||
| Multiple Z-plasty | 171 | ||
| Double opposing Z-plasty | 171 | ||
| Double opposing semicircular flap | 172 | ||
| Four-flap Z-plasty | 173 | ||
| Double-Z rhomboid flap | 173 | ||
| W skin plasty | 174 | ||
| Geometric broken-line closure (GBLC) | 174 | ||
| Postoperative care | 174 | ||
| Conclusion | 175 | ||
| Further reading | 176 | ||
| Chapter 17 Advancement and rotational flaps | 177 | ||
| Chapter Contents | 177 | ||
| Advancement flaps | 177 | ||
| Types of advancement flaps | 177 | ||
| Single advancement flap | 177 | ||
| Pantographic expansion flap | 179 | ||
| Double advancement flap | 179 | ||
| Rotational flaps | 180 | ||
| Classic rotation flap | 181 | ||
| Satterfield–Jolly rotation flap | 181 | ||
| Catanzariti–Wehman rotation flap | 181 | ||
| Single-lobed rotation flap | 183 | ||
| Double-lobed rotation flap | 183 | ||
| Conclusion | 189 | ||
| Further reading | 193 | ||
| Chapter 18 Transpositional flaps | 195 | ||
| Chapter Contents | 195 | ||
| General concepts | 195 | ||
| Transposition flaps | 195 | ||
| Simple or classic transposition flap | 196 | ||
| Complex transpositional flaps | 196 | ||
| Rhombic flap | 196 | ||
| Limberg rhomboid flap | 196 | ||
| Dufourmentel flap | 199 | ||
| Webster flap | 199 | ||
| Double rhomboid flap | 200 | ||
| Triple rhomboid flap | 200 | ||
| Iida double transposition flap | 201 | ||
| Rhomboid flap with multiple Z-plasty | 202 | ||
| The ‘Reading Man’ transposition flap | 203 | ||
| Comparative procedures | 204 | ||
| Interpolation flaps | 204 | ||
| Conclusion | 205 | ||
| Further reading | 205 | ||
| Chapter 19 Skin grafts | 207 | ||
| Chapter Contents | 207 | ||
| Introduction | 207 | ||
| Historical background | 207 | ||
| Skin anatomy | 208 | ||
| Skin graft physiology | 209 | ||
| Skin contraction in skin grafts | 210 | ||
| Indications for skin grafting | 211 | ||
| Decision ladder for wound closure | 211 | ||
| Split-thickness skin grafts vs full-thickness skin grafts | 211 | ||
| Donor site locations | 211 | ||
| Instrumentations for split-thickness skin graft harvesting | 212 | ||
| Preoperative preparation of the recipient bed | 212 | ||
| Intraoperative preparation of the recipient bed | 213 | ||
| Technique of split-thickness skin graft donor site harvesting with power instrumentation | 213 | ||
| Meshing and pie-crusting | 215 | ||
| Application of the split-thickness skin graft | 216 | ||
| Dressing the skin graft | 216 | ||
| Postoperative care | 217 | ||
| Full-thickness skin grafts | 217 | ||
| Donor site locations: full-thickness skin grafts | 218 | ||
| Full-thickness skin graft harvesting | 218 | ||
| Full-thickness skin graft dressing | 218 | ||
| Postoperative care | 218 | ||
| Donor site healing | 218 | ||
| Graft storage | 220 | ||
| Skin graft complications | 220 | ||
| Summary | 220 | ||
| References | 222 | ||
| Further reading | 224 | ||
| Chapter 20 Autografts, allografts and xenografts in cutaneous surgery | 225 | ||
| Chapter Contents | 225 | ||
| Introduction | 225 | ||
| Skin autograft | 225 | ||
| Skin allograft and xenograft | 226 | ||
| Cultured cells and composite grafts | 227 | ||
| Conclusion | 229 | ||
| Further reading | 229 | ||
| Chapter 21 Soft tissue considerations in partial-foot amputations | 231 | ||
| Chapter Contents | 231 | ||
| Background | 231 | ||
| Basic principles of soft tissue reconstruction | 232 | ||
| Soft tissue of the sole | 232 | ||
| Principles of closure of partial-foot amputations | 232 | ||
| Debridement | 232 | ||
| Vascular assessment | 233 | ||
| Treatment of infection | 233 | ||
| Management of comorbidities | 233 | ||
| Vascular disease | 233 | ||
| Anemia | 233 | ||
| Wound closure | 234 | ||
| Closure of specific types of partial-foot amputations | 234 | ||
| Ungual tuft | 234 | ||
| Amputation of the toe | 234 | ||
| Toe fillet flaps | 234 | ||
| Resections of the first ray | 235 | ||
| Central ray resections | 236 | ||
| Fifth ray resections | 236 | ||
| Transmetatarsal amputations | 238 | ||
| Lisfranc disarticulation | 239 | ||
| Chopart’s disarticulation | 240 | ||
| Amputation of the heel | 240 | ||
| Conclusion | 242 | ||
| References | 246 | ||
| Chapter 22 The role of microsurgical-free flaps in foot and ankle surgery | 249 | ||
| Chapter Contents | 249 | ||
| Introduction | 249 | ||
| Microscope and microinstrumentation | 249 | ||
| History of microsurgery | 252 | ||
| Basic science concepts | 252 | ||
| Technical factors | 253 | ||
| Patient factors | 255 | ||
| Free flaps and free flap failure | 256 | ||
| Choices of flaps | 256 | ||
| Working with the vascular, orthopedic and podiatric surgeons | 263 | ||
| Postoperative regimen | 265 | ||
| Revising free flaps | 265 | ||
| Future directions | 265 | ||
| Conclusion | 266 | ||
| References | 266 | ||
| Chapter 23 The use of local muscle flaps in foot and ankle reconstruction | 269 | ||
| Chapter Contents | 269 | ||
| Introduction | 269 | ||
| Vascular anatomy of the leg | 270 | ||
| Arterial–arterial connections | 271 | ||
| Local muscle flaps of the distal one-third of the leg | 271 | ||
| The soleus muscle flap | 272 | ||
| The peroneus brevis muscle flap | 272 | ||
| The extensor digitorum longus and peroneus tertius muscle flaps | 274 | ||
| The extensor hallucis longus muscle flap | 275 | ||
| Tibialis anterior muscle flap | 275 | ||
| Abductor digiti minimi muscle flap | 275 | ||
| Abductor hallucis BREVIS muscle flap | 276 | ||
| Flexor digitorum brevis muscle flap | 277 | ||
| Flexor digiti minimi and opponens digiti minimi muscle flaps | 277 | ||
| Extensor digitorum brevis muscle flap | 279 | ||
| Doppler techniques in muscle dissection | 280 | ||
| Conclusion | 285 | ||
| References | 288 | ||
| Chapter 24 Nail and periungual reconstruction | 289 | ||
| Chapter Contents | 289 | ||
| Introduction | 289 | ||
| Anatomy of the nail | 289 | ||
| Pathologic anatomy | 290 | ||
| Nail trauma | 290 | ||
| Diagnosis of nail and periungual conditions | 291 | ||
| Techniques of nail and periungual biopsy | 292 | ||
| Shave biopsy of soft tissues | 292 | ||
| Nail bed and plate biopsy | 292 | ||
| Longitudinal nail biopsy | 292 | ||
| Nail punch biopsy | 293 | ||
| Lateral and horizontal nail biopsy | 293 | ||
| Longitudinal wedge biopsy | 294 | ||
| Nail matrix biopsy | 294 | ||
| Matrix punch biopsy | 294 | ||
| Transverse fusiform matrix biopsy | 295 | ||
| Longitudinal wedge matrix biopsy | 295 | ||
| Surgical nail procedures | 296 | ||
| Local anesthesia toe block | 296 | ||
| Soft tissue procedures | 297 | ||
| Soft tissue lateral wedge resection | 297 | ||
| Soft tissue correction of malaligned toenail | 297 | ||
| Distal skin plasty for clubbing deformity | 297 | ||
| Partial and total nail avulsions | 297 | ||
| Partial matrixectomy | 298 | ||
| Total matrixectomy | 298 | ||
| Zadik procedure | 298 | ||
| Terminal Syme operation | 298 | ||
| Postoperative care | 300 | ||
| Conclusion | 302 | ||
| Further reading | 304 | ||
| Chapter 25 Digital procedures | 307 | ||
| Chapter Contents | 307 | ||
| Introduction | 307 | ||
| Etiology of digital conditions | 308 | ||
| Digital skin incisions | 308 | ||
| Digital lesions | 309 | ||
| Acquired digital fibrokeratoma | 309 | ||
| Angioleioma | 310 | ||
| Cutaneous horn | 311 | ||
| Dermal neuroma | 311 | ||
| Dermatofibroma | 311 | ||
| Glomus tumor | 312 | ||
| Helomata | 312 | ||
| Hemangioma | 313 | ||
| Lipoma | 314 | ||
| Mucoid cysts | 314 | ||
| Nevi | 317 | ||
| Osteochondroma | 317 | ||
| Osteophyte (subungual exostosis) | 318 | ||
| Pyogenic granuloma | 318 | ||
| Verruca | 322 | ||
| Soft tissue digital angular correction | 322 | ||
| Planes of deformity | 322 | ||
| Tenotomy | 323 | ||
| Toe tendon lengthening | 324 | ||
| Toe tendon transfers | 325 | ||
| Skin procedures for flexible toe correction | 329 | ||
| Skin wedges for toe alignment | 329 | ||
| Skin Z-plasty for toe alignment | 329 | ||
| Osseous digital correction | 329 | ||
| Arthroplasty | 330 | ||
| Arthroplasty or arthrodesis with flexor tendon transfer | 330 | ||
| Treatment of elongated toes | 331 | ||
| Staged-combined procedures | 333 | ||
| Digital syndactylization | 334 | ||
| Mini webbing procedure | 337 | ||
| Partial webbing procedure | 337 | ||
| Fusiform webbing procedure | 337 | ||
| Full-length webbing procedure | 338 | ||
| Modified syndactylization | 338 | ||
| Digital desyndactylization | 339 | ||
| Rectangular flap desyndactylization procedure | 340 | ||
| Z-flap desyndactylization procedure | 344 | ||
| Fusiform graft desyndactylization procedure | 344 | ||
| Other unique methods | 344 | ||
| Digital amputations | 344 | ||
| Distal digital amputation | 349 | ||
| Partial digital amputation | 350 | ||
| Total digital amputation | 352 | ||
| Conclusion | 352 | ||
| Further reading | 355 | ||
| Chapter 26 Foot and ankle benign soft tissue masses | 357 | ||
| Chapter Contents | 357 | ||
| General considerations | 357 | ||
| History and physical examination | 357 | ||
| Diagnosis options | 357 | ||
| Treatment options | 358 | ||
| Bursa | 359 | ||
| Epidermal inclusion cyst | 359 | ||
| Direct incisional technique | 359 | ||
| Fusiform excision | 361 | ||
| Fibromas | 362 | ||
| Ganglion cyst | 364 | ||
| Lipoma | 370 | ||
| Pigmented villonodular synovitis | 374 | ||
| General postoperative considerations | 378 | ||
| Conclusion | 380 | ||
| Further reading | 380 | ||
| Chapter 27 Surgical dressings | 381 | ||
| Chapter Contents | 381 | ||
| Introduction | 381 | ||
| Occlusive dressings | 381 | ||
| Traditional dressings | 382 | ||
| Negative pressure dressing | 384 | ||
| Conclusion | 386 | ||
| Further reading | 386 | ||
| Chapter 28 Scars | 389 | ||
| Chapter Contents | 389 | ||
| Introduction | 389 | ||
| Definitions | 389 | ||
| Normal scar tissue | 389 | ||
| Widespread scar | 389 | ||
| Suture tracks | 390 | ||
| Hypertrophic scar | 391 | ||
| Keloid scars | 392 | ||
| Other types of scars | 393 | ||
| Treatment | 394 | ||
| Pressure therapy | 394 | ||
| Intralesional steroid injections | 394 | ||
| Dilute alcohol injection | 394 | ||
| Other injections | 395 | ||
| Recombinant interferon-gamma | 395 | ||
| 5-Fluorouracil | 396 | ||
| Verapamil hydrochloride | 396 | ||
| Combined treatment | 397 | ||
| Silicone gel sheeting | 397 | ||
| Laser therapy | 398 | ||
| Surgical therapy | 398 | ||
| Scar prevention | 400 | ||
| Conclusion | 407 | ||
| Further reading | 408 | ||
| Chapter 29 Negative pressure wound therapy in lower extremity reconstructiona | 411 | ||
| Chapter Contents | 411 | ||
| Introduction | 411 | ||
| Historical aspects | 411 | ||
| Mechanism of action | 412 | ||
| Vacuum therapy system anatomy | 412 | ||
| Animal studies and foundation of NPWT | 413 | ||
| Clinical studies | 414 | ||
| General considerations | 415 | ||
| Acute vs chronic wounds | 415 | ||
| Infected wounds | 416 | ||
| Exposed tendon, fascia and joint capsule | 416 | ||
| Exposed bone or orthopedic hardware | 416 | ||
| Diabetic wounds | 421 | ||
| Venous stasis ulcerations | 422 | ||
| Compartment syndrome | 422 | ||
| Split-thickness skin grafts | 422 | ||
| Degloving injuries | 423 | ||
| Completion of therapy | 423 | ||
| Vacuum holiday or therapeutic pause | 425 | ||
| Advanced techniques | 425 | ||
| Contraindications | 428 | ||
| Complications of negative pressure wound therapy | 429 | ||
| Conclusion | 431 | ||
| References | 432 | ||
| Further reading | 433 | ||
| Chapter 30 Surgical complications and their treatments | 435 | ||
| Chapter Contents | 435 | ||
| Introduction | 435 | ||
| Bleeding complications | 436 | ||
| Wound dehiscence and necrosis | 438 | ||
| Postoperative edema | 440 | ||
| Postoperative infection | 440 | ||
| Cutaneous myiasis | 443 | ||
| Life-threatening complications | 443 | ||
| Conclusion | 444 | ||
| Further reading | 444 | ||
| Chapter 31 Leg ulcer managementa | 447 | ||
| Chapter Contents | 447 | ||
| Introduction | 447 | ||
| Etiology | 449 | ||
| Venous ulcers | 449 | ||
| Arterial ulcers | 449 | ||
| Diabetic ulcers | 450 | ||
| Pressure ulcers | 450 | ||
| Inflammatory ulcers | 450 | ||
| Wound repair physiology | 451 | ||
| Phase 1: inflammation | 451 | ||
| Phase 2: proliferation and tissue formation | 452 | ||
| Phase 3: tissue remodeling | 452 | ||
| For Recognition of Adult Immobilized Life (FRAIL) | 452 | ||
| Preoperative preparation | 452 | ||
| Medical history | 452 | ||
| Physical examination | 453 | ||
| Diagnostic assessment | 453 | ||
| Prevention | 455 | ||
| Techniques | 456 | ||
| Compression therapy | 456 | ||
| Pharmacologic therapy for venous ulcers | 456 | ||
| Antimicrobials and the bacterial balance of leg ulcers | 457 | ||
| Background | 457 | ||
| Diagnosis | 457 | ||
| Antibiotics and antiseptics | 457 | ||
| Dressings for leg ulcers – moist wound healing | 457 | ||
| Surgical techniques | 458 | ||
| Wound bed preparation and debridement | 458 | ||
| Removal of bacteria | 459 | ||
| Removal of senescent cells | 459 | ||
| Effects of stimulation of growth factors | 459 | ||
| Removal of non-migratory tissue | 459 | ||
| Types of debridement | 459 | ||
| Surgical/sharp debridement | 459 | ||
| Mechanical debridement | 460 | ||
| Autolytic debridement | 460 | ||
| Biosurgical debridement | 460 | ||
| Enzymatic and chemical debridement | 460 | ||
| Skin grafting | 461 | ||
| Split- and full-thickness skin grafts | 461 | ||
| Preoperative preparation | 461 | ||
| Techniques | 461 | ||
| Optimizing outcomes | 463 | ||
| Pitfalls and their management | 463 | ||
| Bioengineered skin equivalents | 464 | ||
| Graftskin as a bioengineered skin equivalent | 464 | ||
| Subfascial endoscopic perforator surgery (SEPS) | 465 | ||
| Shave therapy for venous ulcers | 466 | ||
| Summary | 466 | ||
| References | 466 | ||
| Chapter 32 Dressings and postoperative carea | 471 | ||
| Chapter Contents | 471 | ||
| Dressings | 471 | ||
| Introduction | 471 | ||
| Historical perspective | 472 | ||
| Functions of dressings | 472 | ||
| Acute wounds vs chronic wounds | 472 | ||
| Acute wounds | 472 | ||
| Enhancement of epithelial migration | 472 | ||
| Stimulation of angiogenesis | 472 | ||
| Retention of growth factors | 472 | ||
| Facilitation of autolytic debridement | 472 | ||
| Protection against exogenous organisms | 472 | ||
| Maintenance of voltage gradients | 472 | ||
| Chronic wounds | 472 | ||
| Types of dressings | 473 | ||
| Non-adherent fabrics | 473 | ||
| Absorptive dressings | 473 | ||
| Occlusive/moisture-retentive | 473 | ||
| Non-biologic occlusive dressings | 473 | ||
| Foams | 473 | ||
| Technique | 474 | ||
| Films | 474 | ||
| Technique | 475 | ||
| Hydrocolloids | 475 | ||
| Index | 489 | ||
| A | 489 | ||
| B | 490 | ||
| C | 490 | ||
| D | 491 | ||
| E | 491 | ||
| F | 492 | ||
| G | 492 | ||
| H | 493 | ||
| I | 493 | ||
| J | 493 | ||
| K | 493 | ||
| L | 494 | ||
| M | 494 | ||
| N | 494 | ||
| O | 495 | ||
| P | 495 | ||
| R | 496 | ||
| S | 496 | ||
| T | 498 | ||
| U | 498 | ||
| V | 498 | ||
| W | 499 | ||
| X | 499 | ||
| Y | 499 | ||
| Z | 499 |