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Flaps and Reconstructive Surgery E-Book

Flaps and Reconstructive Surgery E-Book

Fu-Chan Wei | Samir Mardini


Additional Information

Book Details


With coverage of nearly twice the number of flaps as the previous edition, Flaps and Reconstructive Surgery, 2nd Edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. It includes chapters and expert commentaries from more than 100 authors and world-renowned leaders in the field, while brand-new cases and high-quality illustrations focused on flap harvest, markings, and reconstruction keep you abreast of today's latest developments.

  • Includes high-quality illustrations of regional anatomy, flap anatomy, and step-by-step flap dissections, as well as clear photographs demonstrating successful reconstructions.
  • Detailed case studies illustrate how to optimize every aspect of care for the reconstructive surgery patient, including the postoperative period and long-term follow-up.
  • Brand-new section on reconstruction takes an algorithmic approach to the reconstruction of defects around the body.
  • Features chapters covering the entire spectrum of reconstructive surgery, including head and neck reconstruction, chest wall reconstruction, abdominal wall, upper and lower extremity, and facial reanimation.
  • Content focuses on both local and free flaps.
  • New section on reconstructive transplant surgery highlights major topics such as face and hand transplantations, abdominal wall transplantation, uterus transplantation, and nerve allotransplantation.

Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Flaps and Reconstructive Surgery i
Copyright Page iv
Table Of Contents v
Video Table of Contents ix
List of Chapter Contributors xv
List of Expert Commentary Contributors xxiv
Video Contributor List xxx
Preface xxxix
Dedication xli
Acknowledgments xlii
1 Principles 1
1 Problem Analysis in Reconstructive Surgery 1
History of Reconstructive Surgery 1
The Reconstructive Ladder 1
The Reconstructive Elevator 2
Surgical Judgment 2
The Present State of Reconstructive Surgery 2
A Modified Reconstructive Ladder/Elevator 3
Reconstructive Microsurgery 3
The Future of Microsurgery 4
References 5
2 Classification of Flaps e1
Introduction e1
A Brief History of Flaps e1
Skin Flaps and Their Classification e2
Cormack and Lamberty Classification e2
Mathes and Nahai Classification e2
Nakajima Classification e2
Taylor’s “Angiosome” Concept-Based Classification e3
Muscle Flaps e4
Mathes and Nahai Muscle Flap Classification e4
Taylor Classification e4
Other Flaps e4
Serafin Classification e4
Combined Flaps e4
Conjoined Flaps e5
Chimeric Flaps e6
Secondary Characteristics e7
Perforator Flaps e7
Vascularized Composite Allotransplantation Classification e7
Conclusion e8
References e9
3 Considerations in Flap Selection 6
Introduction 6
The Recipient Site 6
The Donor Site 11
Role of Combined Flaps 12
Future Considerations 13
References 14
4 Emerging Technology in Reconstructive Surgery e11
Introduction e11
Virtual Surgical Planning and Rapid Prototype Modeling e11
Mandibular and Maxillary Reconstruction e11
Orbital Reconstruction e14
Intraoperative Stereotactic Navigation e14
Assessment of Tissue Perfusion with Indocyanine Green Angiography e15
Free Flap Perfusion e16
Free Flap Design e17
Mastectomy Skin Flap Necrosis e18
Lymphatic Surgery e18
Preoperative Planning with Computed Tomography Angiography e19
Breast Reconstruction e19
Use in Designing Other Free Flaps e20
Three-Dimensional Imaging Systems e21
Conclusions e22
References e23
5 Prefabrication and Prelamination 16
Introduction 16
Flap Prefabrication 18
Concept 18
Technique 18
Flap Maturation 19
Flap Transfer 19
Clinical Examples 19
Flap Prelamination 20
Concept 20
Technique 20
Flap Maturation 23
Flap Transfer 23
Clinical Examples 23
Conclusion 23
References 27
6 Tissue Engineering e25
Introduction e25
Mechanisms of Action e26
Current Strategies in Tissue Engineering e26
Complex Scaffolds and Matrices e26
Fundamental Role of Vascularization e26
Proangiogenic Strategies e26
Decellularization of Tissues to Obtain the Ideal Scaffold e27
Cells and Stem Cells: the Substrate e27
Pluripotent Stem Cells for Use in Autologous Conditions e27
Induced Pluripotent Stem Cells e27
Multipotent Stem Cells for Use in Autologous Conditions e27
Unipotent Progenitor Cells e27
Blood Outgrowth Endothelial Cells e27
Tissue Engineering-Based Clinical Applications e27
Skin e28
Epidermal Substitutes e28
Dermal Substitutes e28
Compound Substitutes with Epidermal and Dermal Elements e28
De-Novo Assembly of Matrices e29
Urethra and Bladder e30
Bone e30
Trachea e30
The Cardiovascular System e32
Vascular Grafts e32
Cell Therapy for Myocardium e32
Heart Valves e32
Conclusion e32
References e33
7 Percutaneous Aponeurotomy and Lipofilling (PALF): 28
Introduction 28
2-D Application of PALF 29
3-D Application of PALF 31
Cicatrix to Matrix 31
Keys to Fat Grafting 32
Surface Area-to-Volume Ratio. 32
Interstitial Fluid Pressure. 32
Recipient Site Vascularity. 33
Ability to Differentiate Necrotic Cysts from Cancer. 33
General Fat Grafting Techniques 33
Fat Harvest 33
Fat Processing 33
Fat Delivery 34
Postoperative Support 35
Reverse Abdominoplasty and Fat Transfer 35
References 35
8 Lymphedema: 40
Introduction 40
Lymphatic Anatomy and Physiology 40
Pathophysiology 42
Indications for Lymphatic Surgery 42
Contraindications to Physiologic Procedures 45
The Initial Patient Visit 45
Anatomic Imaging 46
Functional Imaging 47
Lymphoscintigraphy 47
Indocyanine Green Lymphangiography 47
Lymphaticovenular Anastomosis Versus Vascularized Lymph Node Transfer 48
Lymphaticovenular Anastomosis 48
Operative Technique 48
Postoperative Management 49
Treatment of Upper Extremity Lymphedema with Lymph Node Transfer 49
Flap Options 49
Recipient Site 50
Preparation of the Axillary Recipient Site 50
Vascularized Groin Lymph Node Transfer with Reverse Lymphatic Mapping 50
Anatomy and Flap Design 50
Treatment of Lower Extremity Lymphedema with Vascularized Lymph Node Transfer 53
Vascularized Axillary Lymph Node Transfer with Reverse Lymphatic Mapping 53
Donor Site 53
Recipient Site Preparation 54
Medial Sural Vessels 54
Vascularized Supraclavicular Lymph Node Transfer with Reverse Lymphatic Mapping 55
Flap Markings and Elevation 56
Postoperative Management 56
Outcomes 56
Conclusion 57
References 59
9 Robotic Applications in Plastic and Reconstructive Surgery e36
Introduction e36
Operating Interface e36
Robotic Operating Team e37
Transoral Robotic Surgery (TORS) e37
Indications e37
Robotic Muscle Harvest e37
Indications e38
Robotic Microvascular Anastomosis e39
Indications e39
Future Directions e39
Summary e39
References e41
2 Clinical Anatomy and Recipient Vessel Anatomy, Selection, and Exposure 61
10 Clinical Anatomy of the Head and Neck, and Recipient Vessel Selection 61
Introduction 61
Anatomy of the Head and Neck 61
Anatomy of the Facial Skeleton 61
The Fascia of the Head and Neck 62
Anatomy of the Facial Musculature 63
Arterial Anatomy of the Head and Neck 64
Facial Artery 64
Advantages and Disadvantages 68
Exposure of the Facial Artery 68
Submental Artery 69
3 Reconstruction 138
14 Head and Neck Reconstruction 138
Introduction 138
Preoperative Considerations 138
Critical Concepts of Craniofacial Microvascular Reconstruction 138
Aesthetic Subunit Appearance 138
Defect Boundaries 139
Tissue Requirements 140
Bone and Soft Tissue Support 140
Soft Tissue Volume 140
Timing 141
Secondary Revisions 141
Indications 142
Regions of the Head and Neck 142
Scalp and Forehead 142
Periorbit 142
Midface 143
Nose 143
Mandible 143
Tongue 144
Esophagus 144
Voice 145
Free Flap Choices for Craniofacial Reconstruction 145
Ulnar Forearm Flap 145
Anatomy 147
Surgical Technique 147
Application, Advantages, and Disadvantages 147
Anterolateral Thigh (ALT) Flap 148
Application, Advantages, and Disadvantages 148
Groin Flap 149
Application, Advantages, and Disadvantages 150
Deep Circumflex Iliac Artery Flap 151
4 Conventional Workhorse Flaps 367
A Local and Free Flaps in the Head and Neck 367
31 Local Flaps in the Head and Neck 367
5 Perforator-Based Workhorse Flaps 648
56 Perforator Flaps in the Lateral Thoracic Region 648
Introduction 648
Flap Anatomy (Figs 56.1, 56.2 and 11.1, 11.2, 11.3, 11.5, 11.8, and 11.9) 649
Arterial Supply of the Flap (see Figs 56.1, 56.2 and 11.1, 11.2, 11.3, 11.5) 649
Latissimus Dorsi Perforator Flap 649
6 Reconstructive Transplant Surgery e204
63 Starting a Reconstructive Transplantation Program e204
Introduction e204
Should an Institution Develop a Reconstructive Transplant Program? e205
Forming the Team e205
Research or Clinical Practice e207
Committee Approvals e207
Funding the Program e207
The Organ Procurement Organization e207
Going Live e208
Maintaining an Active Program e208
Conclusions e208
References e209
64 Face Transplantation 739
Introduction 739
Immune Suppression 740
Acute Rejection 740
Chronic Rejection 740
GVHD 740
Immune Tolerance 741
Side Effects of Immune Suppression 741
Indications 741
Trauma and Burns 741
The Military 742
Congenital Defects 742
Infectious Disease 742
Malignant Disease 742
Future Indications 742
Preoperative Considerations 743
Patient Selection 743
Donor Considerations 744
Surgical Planning 744
Surgical Technique 744
Postoperative Considerations 745
Complications 746
Outcomes 746
Medical Outcomes 746
Functional Outcomes 747
Aesthetic Outcomes 747
Social Outcomes 748
Discussion 748
Future Directions 748
References 752
65 Hand and Upper Extremity Transplantation 754
Introduction 754
Immunotherapy 754
Indications 755
Preoperative Considerations 755
Patient Screening 755
Preoperative Planning 755
Cadaver Rehearsal 756
Team Assignments 756
Rotating Surgeons 757
Use or Replace Existing Motors 757
Ischemia Time 757
Surgical Technique 757
Donor Operation 757
Anesthesia Considerations 759
Operating Room Set-Up 759
Dissections 759
Osteosynthesis 760
Muscle/Tendon Reconstruction 760
Nerve Reconstruction 760
Revascularization 761
Skin Closure 761
Dressings 762
Transplant Level, Specific Techniques 762
Distal Forearm (see Case 65.1, left hand) 762
Middle Forearm 762
Proximal Forearm (see Case 65.2, left forearm) 762
Transhumeral (see Cases 65.1 and 65.2, right upper limbs) 762
Postoperative Considerations 764
Complications 764
Outcomes 765
Future Directions 766
References 768
66 Laryngeal, Abdominal Wall, and Uterus Transplantation 770
Introduction 770
Laryngeal Allotransplantation 770
Arterial Anatomy (Fig. 66.1 and Figs 10.4 and 10.5) 770
Venous Anatomy 771
Neural Anatomy 771
Indications 771
Laryngeal Composite Tissue Component (Fig. 66.1) 771
Flap Design 771
Donor Procedure 771
Recipient Procedure 771
Flap Modifications 772
Postoperative Care 772
Immunosuppressive Protocol 772
Future Landmarks 772
Abdominal Wall Allotransplantation 772
Arterial Anatomy (see Fig. 66.2 and Figs 11.3 and 11.6) 772
Venous Anatomy (see Fig. 11.8) 772
Neural Anatomy (see Figs 11.9 and 11.10) 772
Indications 772
Abdominal Wall Composite Tissue Component (Fig. 66.2) 772
Flap Design 772
Donor Procedure 772
Recipient Procedure 773
Flap Modifications 773
Postoperative Care 773
Immunosuppressive Protocol 773
Future Landmarks 773
Uterus Transplantation 773
Arterial Anatomy 774
Venous Anatomy 774
Neural Anatomy 774
Indications 774
Uterine Transplanted Tissue Component (Fig. 66.3A) 774
Flap Design 774
Donor Procedure 774
Surgical Procedure in the Donor 774
Recipient Procedure 775
Surgical Procedure in Recipient 775
Flap Modifications 776
Postoperative Care 776
Immunosuppressive Protocol 776
Future Landmarks 776
Case Report 776
The Donor 777
Surgical Procedure 777
Immunosuppressive Protocol 777
Prophylaxis 777
Results 777
Other CTAs in Case Reports 778
References 778
67 Immunology and Research in Reconstructive Transplantation e210
Introduction e210
Basics of Transplantation Immunology e210
The Role of the MHC/HLA Antigens e210
Non-HLA Antigens e211
ABO Blood Group Antigens e211
Minor Histocompatibility Antigens e211
Allorecognition Pathways e211
T-Cell Activation e211
B-Cell Activation e212
Rejection e212
Hyperacute Rejection e213
Accelerated Rejection e213
Acute Rejection e213
Chronic Allograft Vasculopathy (Chronic Rejection) e213
Immunologic Factors of Chronic Rejection e213
Non-Immunologic Factors of Chronic Rejection e213
Tolerance e214
Chimerism and Donor Bone Marrow Transplantation e215
Cell-Based Therapies in VCA e216
T-Regulatory Cells e216
Dendritic Cells e216
Mesenchymal Stem Cells e217
References e218
68 Peripheral Nerve Allotransplantation 779
Introduction 779
Peripheral Nerve Regeneration 779
Nerve Allotransplantation 781
Schwann Cells and Immunology of Nerve Allotransplantation 781
Current Strategies for Nerve Allotransplantation 782
Clinical Experience with Nerve Allotransplantation 783
Nerve Regeneration in Vascularized Composite Allotransplantation 785
Summary 788
Nerve Autograft Substitutes 788
Conduits and Processed Nerve Allografts 788
Nerve Conduits 788
Processed Nerve Allografts 792
Conclusion 794
References 795
Index 799
A 799
B 801
C 802
D 803
E 804
F 805
G 809
H 810
I 811
J 812
K 812
L 812
M 814
N 816
O 816
P 817
R 820
S 822
T 825
U 827
V 827
W 828
Y 828
Z 828
Inside Back Cover ibc1