Plastic Surgery Secrets Plus, 2e

Front Cover......Page 1
Plastic Surgery\\nSecrets......Page 4
Copyright Page......Page 5
Dedication......Page 6
Contents......Page 8
Contributors......Page 14
Acknowledgments......Page 26
Foreword......Page 28
Afterword......Page 30
Preface to the first edition......Page 32
Preface to the Second Edition......Page 33
Section I: Fundamental Principles of Plastic Surgery......Page 34
6. When does collagen production peak in a healing wound?......Page 36
15. Why do partial-thickness wounds reepithelialize faster than full-thickness  wounds?......Page 37
24. What is the wound vacuum-assisted closure, and how does it accelerate wound healing?......Page 38
33. What causes hypertrophic/keloid scars? What features distinguish them?......Page 39
Bibliography......Page 40
5. What are the different methods of suturing skin wounds?......Page 41
10. What influences the permanent appearance of suture marks?......Page 42
19. What is a “dog ear”? How can it be eliminated?......Page 43
22. How is a Z-plasty designed?......Page 44
30. What is the V-Y advancement technique?......Page 45
34. What is the Dufourmental flap?......Page 46
Bibliography......Page 47
6. How can the masseter muscle be relaxed in cases of trismus?......Page 48
12. Twenty-four hours after suction-assisted lipectomy of the abdomen and upper thighs, a patient has become confused and somewhat disoriented. She has a petechial rash over the shoulders and anterior chest. Is she possibly allergic to the pain medication?......Page 49
16. What preoperative instructions should be given to a 10-month-old child before cleft lip repair?......Page 50
19. Why is sodium bicarbonate sometimes added to local anesthesia?......Page 51
24. When is it usually considered safe to discharge a patient after outpatient surgery under general anesthesia?......Page 52
Bibliography......Page 53
6. What is the effect of expansion on blood flow in the tissues over the expander?......Page 54
14. What are the advantages of the various designs?......Page 55
21. What factors should be considered when selecting a patient for tissue expansion?......Page 56
28. How do you make the advancement?......Page 57
37. Where and when do preexpanded transposition flaps play a role?......Page 58
43. What are the complications of tissue expansion?......Page 59
Bibliography......Page 60
5. What is the Oppenheimer effect?......Page 61
9. How is HA used in plastic surgery?......Page 62
13. What are the disadvantages of using silicone?......Page 63
16. What is cyanoacrylate? How is it used?......Page 64
Bibliography......Page 65
6. What are the guidelines for handling pressure wounds?......Page 66
8. What about traumatic wounds?......Page 67
13. Should quantitative microbiology be used before closing all wounds?......Page 68
14. What is the value of antibacterial agents in problematic wounds?......Page 69
Bibliography......Page 70
4. What have laboratory studies shown?......Page 71
6. What are contraindications to VAC?......Page 72
11.How is the VAC used to treat acute wounds with exposure of bone, tendon, and vital structures?......Page 73
15.What is the role of the VAC in extravasation injuries and toxic bites?......Page 74
20.Can the VAC be placed over a fresh wound closure or fresh flap?......Page 75
21.Does the VAC require prolonged hospitalization and how is it used in outpatient management?......Page 76
Bibliography......Page 77
7. Is there a time limit to the process of fetal cutaneous wound healing?......Page 78
16. Do fetal wounds heal differently in congenital models versus surgically created models?......Page 79
25. Can scarless healing after in utero repair of cleft lip and palate completely eliminate the facial growth abnormality associated with postnatal, surgically induced scar formation?......Page 80
Bibliography......Page 81
5. Can you explain the rules of the game in “patient selection”?......Page 83
7. One hears so much about the importance of “informed consent.” What does that mean, and how different is that from plain vanilla consent?......Page 84
10. What can be done to prevent things going from bad to worse?......Page 85
Bibliography......Page 88
5. Is “division and inset” of the flap included in the cross finger flap code?......Page 89
11. When more than one muscle flap is used to close a single defect, should each muscle flap be reported separately?......Page 90
16. A Dupuytren’s contracture requires a fasciectomy of the palm, middle, ring, and small fingers. Y-V flaps are performed to provide extra skin length. How is this coded?......Page 91
22. In a carpal tunnel release, can incision of the fascia proximally be reported separately with 25020?......Page 92
Bibliography......Page 93
3. What specifically is meant by a “practice”?......Page 94
5. What are the “external goods”?......Page 95
8. What is meant by “autonomy”?......Page 96
10. How is it determined what is ethical? Who says?......Page 97
15. How do the “three steps of ethical process” apply to providing expert testimony?......Page 98
18. What is the most important ethical challenge to plastic surgeons?......Page 99
20. Does the use of implant materials present a special ethical situation for plastic surgeons?......Page 100
24. How does one categorize the “impaired surgeon”?......Page 101
26. Are there ethical concerns for plastic surgery education?......Page 102
Bibliography......Page 103
6. How can the period of consolidation be shortened?......Page 105
13. What is BMP-3, and how may this protein affect suture fate?......Page 106
20. Neovascularization is the process of new blood vessel formation. How does angiogenesis contribute to new blood vessel growth, and how does it differ from vasculogenesis?......Page 107
29. What is therapeutic neovascularization?......Page 108
Bibliography......Page 109
Section II: Integument......Page 112
3. What are the major forms of cutaneous melanoma?......Page 114
5. What are the general histopathologic features of cutaneous melanoma?......Page 115
Histopathologic Features......Page 119
8. What are the clinical and histopathologic features of lentigo maligna melanomas?......Page 120
Histopathologic Features (Figs. 13-11 and 13-12)......Page 121
Clinical Features......Page 122
Histopathologic Features (Figs. 13-13 to 13-15)......Page 123
Histopathologic Features (Fig. 13-16)......Page 124
15. What are the clinical and histopathologic features of desmoplastic neurotropic melanoma?......Page 125
Clinical Features......Page 126
20. What are the clinical and histopathologic features of small cell melanoma?......Page 127
Histopathologic Features......Page 128
23. What is the differential diagnosis of spitzoid melanoma?......Page 129
27. What is the differential diagnosis of melanoma originating in or resembling blue nevi (malignant blue nevus)?......Page 130
30. What are the principal diagnostic problems associated with metastatic melanoma?......Page 131
33. What are the principal prognostic factors for melanoma?......Page 132
Other Prognostic Information Reported to Be Significant in Some Databases......Page 133
38. What are current recommendations for the surgical management of patients with melanoma?......Page 134
Bibliography......Page 135
7. Is there a direct correlation between amount of sun exposure in a particular area of skin and incidence of basal cell skin cancer?......Page 136
14. List the different types of BCC......Page 137
17. How is BCC treated?......Page 138
25. What is the best way to treat recurrent lesions?......Page 139
Bibliography......Page 140
6. Describe the steps involved in a Mohs procedure......Page 141
13. Which tumor types are treated by Mohs surgery?......Page 143
20. What is the role of Mohs surgery in treating Merkel cell carcinoma?......Page 144
26. What are the economic implications of Mohs surgery?......Page 145
Bibliography......Page 146
5. What is Kasabach-Merritt phenomenon?......Page 147
11. An ultrasonographer asks for your advice regarding a vascular lesion on the scalp that has been discovered in a 30-week fetus. What is your opinion?......Page 148
18. Which of the following are the features of Sturge-Weber syndrome?: (A) Port-wine stain in V2 distribution; (B) choroidal “angiomatosis”; (C) leptomeningeal vascular anomalies; (D) skeletal and fibrovascular hypertrophy......Page 149
25. Which of the following eponymous vascular disorders are characterized by fast-flow? (A) Bonnet-Dechaume-Blanc (Wyburn-Mason) syndrome; (B) Sturge-Weber syndrome; (C) Klippel-Trenaunay syndrome; (D) Parkes Weber syndrome; (E) Rendu-Osler-Weber syndrome (......Page 150
30. A teenage girl requests a rhinoplasty, but your thorough evaluation reveals a history of epistaxis. What is the differential diagnosis?......Page 151
Bibliography......Page 152
7. What is collagen?......Page 153
14. What about electron beam radiation therapy?......Page 154
Bibliography......Page 155
5. Describe the anatomy of a hair follicle and the anatomic importance......Page 156
6. What defines a follicular unit?......Page 157
11. What criteria are used for assessing a patient’s donor supply?......Page 158
17. What medical treatments are available for androgenic alopecia?......Page 159
Bibliography......Page 160
6. Have weird reactions been reported in tattoos?......Page 161
10. What happened to the CO2 laser?......Page 162
18. Do all Q-switched lasers work for every tattoo?......Page 163
24. What about traumatic tattoos?......Page 164
Bibliography......Page 165
Section III: Craniofacial Surgery I-Congenital......Page 166
6. How is craniosynostosis classified?......Page 168
12. Which imaging studies are necessary before surgery?......Page 169
22. What is the current safe strategy for treatment of faciocraniosynostosis?......Page 170
Bibliography......Page 171
6. By what type of ossification does the lower jaw form?......Page 172
8. What four structures contribute to the formation of the palate?......Page 174
9. Are the terms hard and soft palate synonymous with primary and secondary palate?......Page 175
17. Which craniofacial cleft results from failed fusion of the mandibular and maxillary prominences at the lateral commissure?......Page 176
24. What is the clinical significance of cranial sutures during fetal and adult life?......Page 177
Bibliography......Page 178
10. What are the most common mistakes made in the rotation-advancement method?......Page 179
18. Summarize the evolution of bilateral cleft surgery......Page 181
28. What is important to the future treatment of clefts?......Page 182
Bibliography......Page 183
6. What is the etiology of cleft palate?......Page 184
11. Do any other muscles contribute to velopharyngeal closure?......Page 185
16. How should a mother feed a child with a cleft palate if the child cannot suck?......Page 186
23. What is the Furlow double-opposing Z-plasty technique?......Page 187
29. What can be done about residual speech problems after cleft palate repair?......Page 188
Bibliography......Page 189
2.  are the etiologies of residual lip deformities following primary cleft lip repair?......Page 190
6. What are the etiologies of palatal dysfunction following primary cleft palate repair?......Page 191
8. What patterns of velopharyngeal closure are commonly seen in cleft palate patients with velopharyngeal insufficiency? What is the treatment of each?......Page 192
Bibliography......Page 196
2. How are the surfaces of the teeth described?......Page 198
7. What are natal and neonatal teeth?......Page 199
11. What is a posterior dental crossbite?......Page 200
15. Describe the most common injuries involving the teeth......Page 201
20. What is the process of dental decay?......Page 202
Bibliography......Page 203
5. How long does it take before a prosthesis is outgrown?......Page 204
13. How effective are passive techniques?......Page 205
17. How does the UCLP device produce orthopedic correction?......Page 206
24. Does pinned POC treatment adversely affect maxillary growth?......Page 207
32. How much expansion is necessary?......Page 208
41. Why is this period critical for the alveolar bone graft?......Page 209
49. How is the craniofacial status of adult patients with isolated BCLP surgically treated in childhood different from that of normal samples?......Page 210
Bibliography......Page 211
6. What are the requirements for a landmark?......Page 212
7. What are the most commonly used landmarks?......Page 214
9. What are the components of cephalometric analysis?......Page 215
12. What does the profile analysis assess?......Page 216
21. What is computerized cephalometrics?......Page 217
Bibliography......Page 219
2. What do the terms centric occlusion and centric relation mean?......Page 220
6. What is the value of a surgical splint in an orthognathic procedure? How are splints made?......Page 221
9. Classify chin deformities......Page 222
13. What are the risks of nerve injury during orthognathic surgery?......Page 223
Bibliography......Page 224
7. How does one prepare a cleft patient for orthognathic surgery?......Page 225
13. How do you select the optimal technique for mandibular osteotomies?......Page 226
15. What is the indication for a maxillary segmental osteotomy?......Page 227
Bibliography......Page 228
4. How are cranial bones formed?......Page 229
13. What is the incidence of increased intracranial pressure with single-suture and multiple-suture involvement?......Page 230
18. When does the metopic suture normally fuse?......Page 231
22. To which multiple-suture synostoses do the terms “tower skull,” “pointed head,” and “cloverleaf skull” refer?......Page 232
26. What is “slit ventricle syndrome”?......Page 234
27. What is “postshunt craniosynostosis”? What causes it?......Page 235
29. How does one differentiate between deformational and synostotic plagiocephaly? Which is more common?......Page 236
36. When can defects of the skull be expected to spontaneously heal? How does this affect reconstructive plans?......Page 237
42. How does treatment of unilateral coronal synostosis (plagiocephaly) differ from treatment of bilateral coronal synostosis (brachycephaly)?......Page 238
43. What is a Le Fort III advancement osteotomy?......Page 240
47. Is there a role for the endoscopic approach to craniosynostosis reconstruction?......Page 241
Bibliography......Page 244
6. What are the three types of distraction?......Page 245
8. What is distraction histogenesis?......Page 246
14. What are the molecular signals that play a role in distraction osteogenesis?......Page 247
20. Can craniofacial distraction treat obstructive sleep apnea?......Page 248
26. What are the critical factors for successful distraction?......Page 249
31. How does distraction fail?......Page 250
Bibliography......Page 251
6. What are the indications for mandibular distraction?......Page 252
9. What is the preoperative workup for a patient undergoing mandibular distraction?......Page 253
15. What is the utility of a multiplanar device?......Page 254
16. When is transport distraction helpful for mandibular deformities?......Page 255
24. What are the most common complications following mandibular distraction? How are they treated?......Page 257
Bibliography......Page 258
8. What is the activation period?......Page 259
9. What is the period of rigid retention?......Page 260
21. Are all surgeons currently using distraction osteogenesis to advance the maxilla in cleft patients?......Page 261
Bibliography......Page 262
4. What are the DOG periods?......Page 263
7. What craniofacial disorders have been successfully treated with DOG techniques?......Page 264
14. What is combined distraction–compression cranial vault remodeling?......Page 265
18. What is the future direction for cranial DOG?......Page 266
Bibliography......Page 267
8. What is an encephalocele?......Page 268
17. After correction of OHT, what is done with the excess interorbital skin?......Page 269
Bibliography......Page 270
4. How does cranial growth occur, and what are the theories regarding the etiology of sutural synostosis?......Page 271
Form......Page 272
Function......Page 274
18. Can craniofacial anomalies be treated anywhere? What is the importance of a multidisciplinary team?......Page 275
Bibliography......Page 276
6. What is the incidence of craniofacial clefts?......Page 277
10. What is internasal dysplasia? To which Tessier cleft does this term apply?......Page 278
13. What is an oronasoocular cleft?......Page 279
15. Why is the no. 4 cleft also called meloschisis?......Page 280
19. When was hemifacial microsomia first described?......Page 281
26. Why is orbital hypertelorism usually associated with the no. 12 cleft?......Page 282
31. What is a no. 30 cleft?......Page 283
Bibliography......Page 284
9. Are clinical ear findings of craniofacial microsomia associated with hearing loss?......Page 286
11. What classification systems have been used in an attempt to encompass the range of abnormalities found in craniofacial microsomia?......Page 287
22. What are the methods of soft tissue deficiency treatment?......Page 288
Bibliography......Page 289
3. What tumors (malignant and benign) are commonly found in the cranial base?......Page 290
5. How has the development of transfacial approaches to the cranial base enabled more successful skull base surgery?......Page 291
13. What are the variations of the transfrontal approach, and what are indications for their use?......Page 292
17. What are the variations of the transfrontal nasal-orbital approach and indications for their use?......Page 293
20. What transfacial surgical approach is used for small clival lesions with superior, posterior, and inferior extensions, and small to moderate nasopharyngeal lesions?......Page 294
23. What are the variations of the transpalatal approach and indications for their use?......Page 295
25. What are the options for flap reconstruction?......Page 296
28. What complications may occur after skull base surgery?......Page 298
Bibliography......Page 300
6. How did conjoined twins become known as “Siamese twins”?......Page 301
8. What were some of the historical separations?......Page 303
Bibliography......Page 304
Section IV: Craniofacial Surgery II-Traumatic......Page 306
5. Numbness in the infraorbital division of the trigeminal nerve is consistent with what fracture?......Page 308
11. Which nasoethmoidal fractures do not display telecanthus?......Page 309
18. How are injuries of the parotid duct detected?......Page 310
26. Numbness of the lower lip usually accompanies what type of mandibular fracture?......Page 311
34. Supraorbital fractures usually displace the eye in which direction?......Page 312
41. How should split palate fractures be treated?......Page 313
Bibliography......Page 314
4. What is the best way to diagnose single sutural craniosynostosis?......Page 315
6. What is the best way to determine ideal cranial bone graft harvest sites?......Page 316
11. What studies need to be obtained prior to orthognathic surgery?......Page 317
Bibliography......Page 318
7. What are the advantages and disadvantages of open versus closed treatment of pediatric facial fractures?......Page 319
14. How do you treat pediatric nasal fractures?......Page 320
15. How do you treat pediatric mandible fractures?......Page 321
17. What pediatric facial fracture is considered a true surgical emergency?......Page 322
Bibliography......Page 323
7. What radiographic modality best detects and delineates the presence and extent of frontal sinus fractures?......Page 324
13. How can frontal sinus fractures be classified?......Page 325
Bibliography......Page 327
4. Numbness of the nasal tip after trauma results from injury to which nerve?......Page 328
13. What is the management of nasal fractures?......Page 329
20. What are late complications of nasal fractures?......Page 330
Bibliography......Page 331
4. Which is the only bone that exists entirely within the orbital confines?......Page 332
14. What is the annulus of Zinn?......Page 333
19. What is the most common site of an isolated intraorbital fracture?......Page 334
23. What physical findings suggest an orbital fracture?......Page 335
31. What are the principles of orbital fracture management?......Page 336
39. What incisions are used to approach the orbit?......Page 337
40. Which incision has the greatest propensity for complications such as scleral show or ectropion?......Page 338
45. What is the surgical approach to treatment of an NOE fracture?......Page 339
Bibliography......Page 340
4. Why is the commonly used term tripod fracture a misnomer for zygomatic complex fractures?......Page 341
8. Which diagnostic images provide the most information in evaluating and formulating a treatment plan for zygomatic fractures?......Page 342
10. What are the surgical principles for reconstruction of zygomatic fractures?......Page 343
13. Which anatomic structure is most useful when assessing whether the zygomatic complex is appropriately reduced?......Page 344
20. Describe the approach to the zygomatic arch from a coronal incision......Page 345
28. During reconstruction of a comminuted ZMC fracture, three-point fixation was established and the soft tissues were resuspended. However, the patient continues to have facial asymmetry. What fracture could have been missed?......Page 347
Bibliography......Page 348
4. What is the difference between a Le Fort fracture and a Le Fort osteotomy?......Page 349
11. What incisions are necessary for adequate fracture exposure?......Page 350
19. When miniplates and screws are used to obtain rigid internal fixation for maxillary and orbital fractures, should they be removed later?......Page 351
Bibliography......Page 352
3. List the clinical signs that may be associated with mandibular fractures......Page 353
8. What is the concept of favorable and unfavorable fractures?......Page 354
17. What are the concepts of “zone of compression” and “zone of tension” in the treatment of mandible fractures with internal fixation?......Page 355
24. What muscle is primarily responsible for condylar displacement in patients with a subcondylar fracture?......Page 356
Bibliography......Page 357
4. Discuss the types of imaging studies available for the diagnosis and treatment of panfacial fractures......Page 359
8. What sequence is used in the surgical approach to panfacial fractures?......Page 360
13. What functional problems may persist even after satisfactory treatment of panfacial fractures?......Page 361
Bibliography......Page 362
3. What is the treatment of posttraumatic enophthalmos?......Page 363
5. What is telecanthus?......Page 364
9. What is a growing skull fracture?......Page 366
11. What are the possible long-term complications following a frontal sinus fracture?......Page 367
15. What is the pathophysiology of cheek ptosis following open reduction internal fixation of orbital and midfacial fractures?......Page 368
19. What are the long-term risks of titanium fixation used in facial fracture management?......Page 369
22. What are the clinical findings of CCF?......Page 370
24. What is the treatment of mandibular nonunion?......Page 371
Bibliography......Page 372
8. Discuss the management of an established posttraumatic deformity of the orbitozygomatic complex with enophthalmos......Page 373
13. What foreign materials are useful in head and neck reconstruction and why?......Page 374
Foreign Materials......Page 375
22. A large full-thickness scalp defect results after tumor resection or trauma, with a skull defect that requires reconstruction. How can this best be managed?......Page 376
Bibliography......Page 377
Section V: Head and Neck Reconstruction......Page 378
4. How would you treat this patient?......Page 380
8. From which embryologic structure does the external auditory meatus develop?......Page 381
11. A patient presents with a deep facial laceration in the emergency department. Clear fluid is draining from the wound. What structure was most likely damaged?......Page 382
14. A 50-year-old man has gustatory sweating and flushing of the right cheek after undergoing superficial parotidectomy for removal of a parotid tumor. What is the most likely cause of his current symptoms?......Page 383
18. List the layers of the eyelid......Page 384
24. What major congenital syndromes are associated with first and second branchial arch abnormalities?......Page 385
28. Describe the action of the muscles of mastication on the mandible.......Page 386
Bibliography......Page 387
5. What is the classification of lymph node regions in the neck?......Page 388
8. What are the most common benign and malignant tumors of the nose and paranasal sinuses?......Page 389
12. What is the role of elective radiation therapy in oral tongue cancer?......Page 391
19. What is the role of a larynx preservation strategy using radiotherapy with or without chemotherapy in advanced laryngeal cancers?......Page 392
24. What are the major indications for facial nerve sacrifice during surgery for parotid gland neoplasms?......Page 393
29. What are the indications for a selective neck dissection versus modified radical neck dissection in patients with squamous cell carcinoma? What if the tumor is papillary thyroid cancer or melanoma?......Page 394
Bibliography......Page 395
7. In a rotation flap, where is the line of greatest tension?......Page 396
12. How many rhomboid flaps are most commonly used for closure of a hexagonaldefect?......Page 397
18. Describe the fallacy of the length-to-width ratio in designing skin flaps in the headand neck.......Page 398
31. What are the major functional muscles of the lips and cheeks?......Page 399
36. What are the indications for an Abbe flap?......Page 400
40. What are the options for restoration of the hair-bearing skin for lip reconstruction?......Page 401
44. What is the motor nerve supply to the muscles of the cheek?......Page 402
51. How are defects of the head and neck classified?......Page 403
Bibliography......Page 404
3. What is the innervation of the scalp?......Page 406
7. What types of forehead wounds are optimal for direct closure?......Page 407
11. What are the advantages and disadvantages of using local flaps in the forehead?......Page 409
14. What are the advantages of skin expansion during forehead reconstruction?......Page 410
18. What flaps serve as appropriate sources for microvascular composite tissue transplants to the forehead?......Page 411
24. When are hair strip grafts useful for eyebrow reconstruction?......Page 412
Bibliography......Page 413
3. Is the quality of nasal skin uniform over its surface?......Page 414
7. How are local flaps used in nasal reconstruction?......Page 415
11. How can forehead tissue be transferred?......Page 416
14. How and why are primary bone and cartilage grafts used in nasal reconstruction?......Page 417
17. Is tissue expansion helpful?......Page 418
20. Is there a role for microsurgery in nasal lining reconstruction?......Page 419
Bibliography......Page 420
4. How is levator palpebrae superioris function measured?......Page 421
12. What are the most common malignant tumors of the eyelids? What is the most common location for a malignant tumor of the eyelids?......Page 422
17. How much vertical height of upper tarsus is used in the design of a tarsoconjunctival flap for lower lid reconstruction?......Page 423
19. Is the contralateral eyelid a preferred site for skin graft harvest?......Page 424
25. What factors contribute to entropion?......Page 425
Bibliography......Page 426
4.Can an amputated ear be replanted?......Page 428
10.What are the basic steps in microtia reconstruction?......Page 429
13 Discuss some of the complications of ear reconstruction. How would you remedy them?......Page 430
19.Describe the appearance of a mature post chondritis deformity. What are the considerations in timing of reconstruction?......Page 432
Bibliography......Page 433
4.What is the primary function of the lips?......Page 434
16.Should sutures be placed directly on the mucocutaneous junction to align the vermilion border?......Page 435
28.What options are available for repair of localized mucosal and vermilion defects?......Page 436
30.How do you reconstruct the oral commissure?......Page 437
31.Describe the flaps commonly used for lip reconstruction......Page 440
Bibliography......Page 441
2.What are the borders and contents of the floor of the mouth?......Page 442
4.What are the benign and premalignant lesions of the oral cavity?......Page 443
11.How are palatal defects reconstructed?......Page 444
17.What are the reconstructive options for a composite defect that includes a missing bony segment?......Page 445
24.Classify the lingual flaps.......Page 446
33.What are the advantages and disadvantages of the jejunum free flap for intraoral reconstruction?......Page 447
Bibliography......Page 448
7.What are conventional techniques for mandibular reconstruction?......Page 449
15.How can donor radius fracture be prevented?......Page 450
2.What is the role of dental rehabilitation by osseointegration?......Page 451
Bibliography......Page 453
6.Describe the course of the deep temporal fascia.......Page 455
9.What are Hatchet, Worthen, and Orticochea flaps?......Page 456
19.What are the most commonly used free flaps for scalp reconstruction?......Page 457
Bibliography......Page 458
8.What is the relationship of the facial nerve to the superficial musculoaponeurotic system?......Page 460
12.What is the relationship of the frontal branch of the facial nerve to the SMAS and temporoparietal fascia?......Page 461
13.What are the “facial danger zones”?......Page 462
Bibliography......Page 463
6.What is the neural pathway of spontaneous facial expressions?......Page 464
13.How long after injury to the facial nerve can some function be restored with microsurgery?......Page 465
19.What are the advantages and disadvantages of CFNG?......Page 466
24.What are the indications for free muscle transfer in facial paralysis?......Page 467
26.What are the advantages and disadvantages of the gracilis free muscle transfer (Fig. 65-3)?......Page 468
30.What are the reconstructive goals in a child with Möbius syndrome?......Page 469
Bibliography......Page 470
Section VI: Breast Surgery......Page 472
7.What type of anesthesia is required?......Page 474
13.What types of breast implants are available?......Page 475
19.What is the classification of capsular contracture?......Page 476
26.Is there an increased risk for breast cancer in patients undergoing breast augmentation?......Page 477
Bibliography......Page 478
3.Why do pedicles other than the inferior ones seem to have as much sensation postoperatively?......Page 479
5.What are the advantages and disadvantages of the vertical reduction technique?......Page 480
7.What are some other methods of breast reduction, and what are the advantages and disadvantages of each?......Page 481
12.Do studies support the efficacy of breast reduction for symptomatic patients?......Page 482
21.What are the most common complications of reduction mammaplasty?......Page 483
Bibliography......Page 484
4.What are the supporting structures of the breast?......Page 486
10.What are the major drawbacks to mastopexy?......Page 487
15.What are the various surgical options available for treatment of breast ptosis?......Page 488
18.What is meant by a constricted breast or inferior-pole hyperplasia?......Page 489
Bibliography......Page 490
6.What features make a mammographic lesion suspicious for malignancy? Do all lesions require biopsy?......Page 491
13.What is the STAR trial?......Page 492
24.What is atypical hyperplasia? Does it increase the risk of breast cancer?......Page 493
Bibliography......Page 494
6.What is a TRAM flap?......Page 495
13.What are the indications for a latissimus dorsi flap?......Page 496
20.Is there evidence that quality of life is improved following breast reconstruction?......Page 497
Bibliography......Page 498
6.Is the best way to determine nipple-areola position by measurement from the other side?......Page 499
10.Is the skate flap the best design to use for matching an opposite large nipple?......Page 500
20.When is the ideal time for nipple–areola tattoo?......Page 501
Bibliography......Page 502
10.What questions are pertinent in taking the history?......Page 503
21.What is the role of medical therapy?......Page 504
25.Discuss the surgical techniques used for gynecomastia......Page 505
27.Which techniques may prevent unwanted results?......Page 506
Bibliography......Page 507
Section VII: Aesthetic Surgery......Page 508
5.Outline the chronologic appearance of signs of aging in the face and neck......Page 510
8.Which retaining ligaments provide support to the soft tissues and skin of the face over the bony skeleton?......Page 511
11.What is the normal or ideal position for the female eyebrow?......Page 512
17.What signs of aging in the neck can be corrected by aesthetic rejuvenation?......Page 513
26.Is there an age at which the patient is “too old” to undergo facial rejuvenative surgery?......Page 514
Bibliography......Page 515
8.Describe Ellenbogen’s criteria for the ideal eyebrow position and contour......Page 517
18.What are the potential complications of a forehead and brow lift?......Page 518
Bibliography......Page 519
3.Is blepharoplasty the procedure of choice for brightening and refreshing the eye region?......Page 520
7.Is the preaponeurotic fat continuous with the deeper orbital fat?......Page 521
10.Does removal of the palpebral lobe of the lacrimal gland have any deleterious consequences? What about the orbital lobe?......Page 522
15.Does lower lid skin or skin-muscle resection change the shape of the eye? If so, how?......Page 523
19.What forms the supratarsal fold?......Page 524
20.What is the double eyelid operation often requested by Asians or people of Asian ancestry?......Page 525
25.How do you plan a medial epicanthoplasty?......Page 526
28.What are the pros and cons of the endoscopic forehead lift?......Page 527
30.When is a direct excision of lower eyelid skin indicated?......Page 528
35.In patients with eyeliner and eyebrow tattoos, where should the blepharoplasty incisions be placed?......Page 529
Bibliography......Page 530
7.What are the retaining ligaments of the face?......Page 531
12.What is the role of midface muscle in a prominent NLF?......Page 532
23.With the extended SMAS dissection, what step should be performed at the level of the zygomaticus major muscle to maximize resuspension of the malar fat pad?......Page 533
32.Which muscles of the face are most responsible for the smiling mechanism? Which is most responsible for forming the medial NLC?......Page 534
33.Which of the following approaches to rhytidectomy best addresses the NLF: Lateral SMAS-ectomy, conventional SMAS, extended SMAS, or composite rhytidectomy?......Page 535
Bibliography......Page 536
2.Describe the various face lift techniques used and give an example of a good candidate for each......Page 537
5.How can the malar fat pad be repositioned?......Page 538
6.What are some of the common tell-tale signs of face lift surgery?......Page 539
9.What is a “witch’s chin” deformity?......Page 540
12.What is the treatment of an expanding hematoma?......Page 541
17.Which nerve is the most commonly injured during a rhytidectomy?......Page 542
23.Four weeks after undergoing an extended SMAS rhytidectomy, a 57-year-old woman has persistence of dense hemiparesis over the distribution of the right marginal mandibular nerve.........Page 543
27.A 60-year-old woman requests rhytidectomy. She has smoked two packs of cigarettes daily for 20 years. What postoperative complication would most likely occur?......Page 545
34.What technical maneuvers are often necessary when performing a short scar rhytidectomy?......Page 546
38.A 65-year-old woman desires facial rejuvenation and has an obtuse cervicomental angle, noticeable fat pads in the anterior neck, and vertical, diverging subcutaneous.........Page 547
Bibliography......Page 548
10.What are the surgical approaches for rhinoplasty?......Page 549
18.What are the three main sources for grafting in rhinoplasty?......Page 550
19.What grafting technique(s) can the surgeon use to open/widen the internal nasal valve?......Page 551
22.What techniques are available surgically to stabilize the base of the nose?......Page 552
24.What action should be taken in a patient with an infected nasal allograft?......Page 553
29.What is cephalic positioning of the lateral crura?......Page 555
Bibliography......Page 558
5.By what age has the ear attained 85% of adult size? When should otoplasty be performed?......Page 559
15.What important concept did Luckett contribute to the principles of otoplasty?......Page 560
22.Correction of which third of the ear is most important?......Page 561
25.What is the most common late deformity after otoplasty?......Page 562
Bibliography......Page 563
2.What are the layers of the anterior abdominal wall?......Page 565
6.What is a fleur-de-lis abdominoplasty?......Page 567
13.Where and how should umbilicus be placed?......Page 568
Bibliography......Page 570
9.What is wetting solution? Why do we use it?......Page 571
17.What are the most common complications of liposuction?......Page 572
Controversies......Page 573
Bibliography......Page 574
4.What is the impact of this on the field of plastic surgery?......Page 575
5.Why is body contouring in massive weight loss patients a greater challenge?......Page 576
8.What are some of the considerations of breast surgery in massive weight loss patients?......Page 577
11. Explain the different terminologies used for contouring procedures of the abdomen and the lower body......Page 578
13.What are some considerations in markings for a lower body lift?......Page 579
16.What are some common risks of body contouring surgery after massive weight loss?......Page 580
Bibliography......Page 581
3.What agents are most commonly used for chemical peeling? What are the typical concentrations?......Page 582
8.Can peeling be done simultaneously with surgery?......Page 583
15.What are alpha-hydroxy acids?......Page 584
22.Compare the effects of dermabrasion in the perioral area with the effects of phenol......Page 585
Bibliography......Page 586
9.What is selective photothermolysis and thermal relaxation time? Why are these concepts important in aesthetic laser surger......Page 587
16.How is the carbon dioxide laser used in aesthetic surgery?......Page 588
22.Why is laser hair removal most successful in the winter?......Page 589
29.What are the side effects and complications following laser resurfacing?......Page 590
35.Summarize the types of lasers commonly used in plastic surgery......Page 591
Bibliography......Page 593
5.Which procedures in plastic surgery are commonly performed endoscopically?......Page 594
10.Who is the ideal candidate for endoscopic facial rejuvenation?......Page 595
Bibliography......Page 596
3.What alloplastic implant materials are most commonly used to augment the facial skeleton?......Page 597
7.What are the advantages of wide subperiosteal exposure of the skeletal area to be augmented?......Page 598
14.Can fat grafts substitute for alloplastic implants to augment the facial skeleton?......Page 599
Bibliography......Page 600
7.What is skeletal expansion and why is it important?......Page 601
9.What is the difference between an absolute and relative crossbite?......Page 602
14.How is lip length affected by closure of the circumvestibular incision?......Page 603
19.What are the soft tissue changes in the upper lip that occur after Le Fort I osteotomy?......Page 604
Bibliography......Page 605
6.What factors determine the transverse position of the chin?......Page 606
14.How much subperiosteal dissection is recommended to perform an osseous genioplasty?......Page 607
17.What are the potential complications of an osseous genioplasty?......Page 608
19.What is a witch’s chin deformity?......Page 610
Bibliography......Page 611
7.What is Botox?......Page 612
16.What is the glabellar complex, and what are the recommended Botox dosages to treat this area?......Page 613
24.Can Restylane be used in conjunction with other cosmetic procedures?......Page 614
25.Shortly after Restylane is injected into the nasolabial fold of a 36-year-old healthy woman, her right ala turns blue. Twenty-four hours later a small, painful ulcer develops.........Page 615
34.What is the frequency of microdermabrasion treatments, and what do you tell your patients to expect?......Page 616
Bibliography......Page 617
Section VIII: Trunk and Lower Extremity......Page 618
2.What are the muscular layers of the chest wall?......Page 620
12.Is there a correlation between use of the internal mammary artery for bypass grafting and the incidence of sternal wound infections?......Page 621
15.How can the pectoralis major muscle be used as a “turnover” flap?......Page 622
20.Which congenital anomalies are associated with developmental abnormalities of the ribs?......Page 623
24.What is pectus excavatum?......Page 624
Bibliography......Page 626
5.What fascial layer lines the entire abdominal wall?......Page 627
9.What is the motor and sensory innervation to the abdominal wall?......Page 628
14.How are acquired abdominal wall defects managed?......Page 629
17.Describe the concept of staged abdominal reconstruction.......Page 630
23.How has the application of mesh affected the surgical approach and outcomes in abdominal hernia repair?......Page 632
28.What is gas gangrene of the abdominal wall? How do you differentiate it from anaerobic clostridial cellulitis?......Page 633
32.Besides the physical findings of the abdominal wall, what characteristics do patients with gastroschisis have in common?......Page 634
39.What is the role of the rectus femoris in abdominal wall reconstruction?......Page 635
Bibliography......Page 636
Anatomyof Posterior Trunk Flaps......Page 638
Regional Approachto Posterior Trunk Defects......Page 641
Bibliography......Page 642
8.What factors increase the complication rate for sural flaps?......Page 643
17.How can abnormal weight-bearing in the neuropathic foot be corrected?......Page 644
23.What is compartment syndrome?......Page 645
29.What are the indications for lower extremity replantation?......Page 646
36.Provide an appropriate algorithm for primary operative care of lower extremity trauma.......Page 647
Bibliography......Page 648
3.What is the differential diagnosis of leg ulcers?......Page 649
9.How do you diagnose venous hypertension?......Page 650
17.Describe the role of inflammation in the development and perpetuation of chronic venous ulcers.......Page 651
26.What is the role of free tissue transfer in the management of venous ulcers?......Page 652
33.What are the relationships among ulceration, diabetes, arterial occlusive disease, and amputation?......Page 653
35.Discuss two common misconceptions about diabetic foot infections......Page 654
40.Describe the management of plantar forefoot ulcers......Page 655
47.What is the role of the vascular surgeon and plastic surgeon in salvage of the diabetic foot?......Page 656
53.Is there any evidence to support vacuum-assisted closure in the treatment of chronic leg ulcers?......Page 657
Bibliography......Page 658
7.How do you manage spasticity in paraplegic patients?......Page 659
17.What are the advantages of the gluteal perforator flap versus the classic gluteus maximus design?......Page 660
26.Describe the surgical anatomy and applications of the posteromedial thigh fasciocutaneous flap.......Page 661
Bibliography......Page 662
5.What is lymphedema?......Page 663
10.How do you diagnose lymphedema?......Page 664
13.What are the complications of lymphedema?......Page 665
19.List the types of physiologic procedures that have been described for the treatment of lymphedema......Page 666
Controversies......Page 667
Bibliography......Page 668
6.What are the goals and components of hypospadias repair?......Page 669
15.List the categories of ambiguous genitalia.......Page 670
24.What materials or tissues have been used in plaque incision or excision and grafting?......Page 671
Bibliography......Page 672
Section IX: Burns......Page 674
7.What are the concerns in transporting a burn victim from a community hospital to a specialized burn center?......Page 676
14.Describe the management of burn wounds involving the extremities......Page 677
17.What are the various options available for managing the partial-thickness burn wound?......Page 678
23.How are thermal injuries to the perineum and genitalia managed?......Page 679
Bibliography......Page 680
7.Describe how to calculate the current that a victim might be exposed to during an electrical injury......Page 681
11.What additional portions of the history, as they relate to the electrical exposure, must be explored?......Page 682
18.In the midst of a lightning storm, describe the safest location to avoid lightning injuries.......Page 683
Bibliography......Page 684
7. How long should you irrigate a chemical burn wound?......Page 685
9. What is the difference between thermal and chemical burns?......Page 686
17. What type of alkali injuries merit special attention?......Page 687
28. What is phenol?......Page 688
Bibliography......Page 689
9. What is the pathophysiology of frostbite?......Page 690
16. Is any adjuvant therapy useful in the treatment of frostbite?......Page 692
Bibliography......Page 693
7. What is the effect of insulin therapy in critically ill patients?......Page 694
18. What is immunonutrition?......Page 695
27. What effect does insulin therapy have on the immune response to burn?......Page 696
bibliography......Page 697
2. Is a burn scar unique?......Page 698
6. How do you prevent burn scar contracture?......Page 699
7. What are the best ways to treat burn scar contracture?......Page 700
10. What are compression dressings and how are they used? What are compression garments?......Page 701
16. When was the first recorded treatment of a burn? What was the recommended treatment plan?......Page 702
21. What is microstomia?......Page 703
26. What are escharotomies, and what do they do?......Page 704
31. What are the long-term consequences of burn scars 20 years or more after a burn injury?......Page 705
Bibliography......Page 706
Section X: Tissue Transplantation......Page 708
5. How do hair follicles and sebaceous glands affect skin grafts?......Page 710
11. How does a skin graft take?......Page 711
Disadvantages......Page 712
23. What types of dressings are used for donor sites?......Page 713
27. What other effective temporary biologic dressings exist as a bridge to autografting in patients with extensive burns (total body surface area >50%)?......Page 714
Bibliography......Page 715
4. Classify skin-containing flaps in terms of their blood supply (Fig. 105-1).......Page 717
8. What is an angiosome? What is its significance in flap design?......Page 718
12. What does the term ischemia–reperfusion injury mean?......Page 719
Bibliography......Page 720
4. What are the six patterns of perforators of the deep fascia that can each supply adistinct type of fasciocutaneous flap?......Page 721
12. Define the three subtypes of fasciocutaneous flaps using either the Cormack-Lamberty or Nahai-Mathes schema.......Page 722
17. What is the arc of rotation of a fasciocutaneous flap?......Page 723
24. What is the superficial ulnar artery trap?......Page 724
29. Name the muscles that define the boundaries of the triangular space.......Page 725
34. Identify the source vessel and type of perforator in these 10 commonly used fasciaflaps.......Page 726
Bibliography......Page 728
6. If based on vascular pedicle type only, which muscles would be the most and whichthe least versatile for use as a flap?......Page 730
10. Define the standard arc of rotation of a muscle flap.......Page 731
19. Can any skin configuration overlying a muscle be expected to survive as amusculocutaneous flap?......Page 732
26. Why are muscle flaps infrequently used for coverage in the upper extremity?......Page 733
32. From the schematic (see Fig. 107-3), name the source vessel(s) and correspondingmuscle type based on blood supply of these 10 commonly used muscle flaps.......Page 734
Bibliography......Page 735
5. What is a “perforator flap”?......Page 737
10. Does the deep fascia have to be included with a perforator flap?......Page 738
16. When exploring the potential vessels for a perforator flap, what is the smallest sizethat should be chosen?......Page 739
25. Based on the aforementioned four nomenclature systems for muscle perforatorflaps, label a flap from the anterolateral thigh if based on a lateral circumflexfemoral (LCF) perforator of the vastus lateralis muscle.......Page 740
28. List the source vessels for the muscle perforator flaps identified here by thecorresponding muscle (Fig. 108-3):......Page 741
37. What is a “subdermal vascular network” flap?......Page 742
Bibliography......Page 743
7. What is the no-reflow phenomenon?......Page 745
14. How long before new endothelium covers the anastomosis site?......Page 746
21. Name several perforator flaps.......Page 747
Controversies......Page 748
Bibliography......Page 749
4. Describe the Mathes and Nahai classification of muscle circulation and list examples of muscles used for free transfers from each group.......Page 750
13. List 10 sensate cutaneous flaps and their innervation.......Page 751
22. What is the most commonly used free fascial flap? What are its advantages and disadvantages?......Page 752
Bibliography......Page 753
6. How do leeches work?......Page 754
9. How many leeches should you use?......Page 755
Bibliography......Page 756
5. Name the current surgical and technical protocols of face allotransplantation?......Page 757
13. What are the earliest clinical signs of rejection seen in face allotransplantation?......Page 758
21. What factors influence the success rate of a face allotransplantation?......Page 759
Bibliography......Page 760
8. If the “ideal” immunosuppressive drug was available, how would you describe it?......Page 762
10. Explain the importance of the human leukocyte antigen transplant rejection.......Page 763
16. How is the term “chimerism” defined? What is the difference between microchimerism and macrochimerism?......Page 765
24. Briefly describe the salient aspects of functional rehabilitation and assessment after hand transplantation.......Page 766
25. What are the important ethical considerations in undertaking hand transplantation?......Page 767
29. How can hand transplantation become a widespread clinically acceptable reconstructive option for upper extremity limb loss?......Page 768
Bibliography......Page 769
Section XI: The Hand and Upper Extremity......Page 770
10. What are the “checkrein ligaments”?......Page 772
15. Can the ulnar- and radial-sided synovial systems communicate?......Page 773
21. Why is flexion the safe position for the MP joint?......Page 774
27. What is the last muscle innervated by the ulnar nerve as it courses through the palm?......Page 775
38. Is the primary blood supply of the scaphoid distal or proximal?......Page 776
43. How do you identify the proprius tendons of the index and little fingers?......Page 777
47. What is the primary flexor of the MP joint?......Page 778
59. Which individual structures are maintained in dorsal position by the transverse retinacular ligament of Landsmeer?......Page 779
68. If the two primary tendon graft donors are missing, what is still available?......Page 780
Bibliography......Page 781
8. Why do patients with a low ulnar nerve palsy often have permanent abduction of the small finger? What is the name of this deformity?......Page 782
10. How do you test the flexor digitorum superficialis tendons of the fingers?......Page 783
18. Why is DIP joint flexion more important when the PIP joint is flexed than when the PIP joint is extended?......Page 784
20. Which clinical test is specific for de Quervain’s tenosynovitis? How is it performed?......Page 785
24. What are the etiologies of a swan neck deformity of the fingers?......Page 786
Bibliography......Page 787
4. Why is Rolando’s fracture considered a significant injury?......Page 788
10. Why is the finding of multiple enchondromas significant?......Page 789
16. What is the best way to image complex regional pain syndrome?......Page 790
18. Is magnetic resonance imaging useful in staging soft tissue tumors?......Page 791
Bibliography......Page 792
2. What is the concept of “plexus anesthesia”?......Page 793
10. Describe the axillary technique of brachial plexus block.......Page 794
14. What determines the choice of local anesthetic for brachial plexus block?......Page 795
22. How is a pneumothorax treated if it develops as a complication of interscalene orsubclavian perivascular brachial plexus block?......Page 796
28. How are wrist blocks performed?......Page 797
33. List some disadvantages of the Bier block technique.......Page 798
Bibliography......Page 799
6. What is the most important web space in the hand?......Page 800
11. Geneticists and pediatricians use the terms malformation, deformation, and disruption. What do they mean?......Page 801
13. Is any special workup needed in newborns with a duplication?......Page 802
20. What other terms have been used to describe CRS?......Page 803
28. What is the difference between clinodactyly and camptodactyly?......Page 804
35. What conditions should be considered in a child born with gross enlargement of a digit?......Page 805
41. Describe the hand in patients with Apert syndrome.......Page 806
49. A child presents with a swollen hand and forearm and an associated neck mass diagnosed as a “cystic hygroma.” What is the underlying pathophysiology?......Page 807
Bibliography......Page 808
5. What is a Kirner deformity? A pseudoepiphysis? The Pseudo-Terry Thomas sign? What is their significance?......Page 809
7. What is a Seymour fracture?......Page 810
12. How are phalangeal fractures treated in children?......Page 811
18. What is the proper course of action if the clinical suspicion of scaphoid fracture is high and radiographic evidence is low?......Page 812
23. What is the Allen classification of fingertip injuries? Discuss one special consideration of each type (Fig. 119-3).......Page 813
29. Which type of graft is most effective for grafting the hand: Split thickness or full thickness?......Page 814
Bibliography......Page 815
7. How is growth rate impacted by nailbed injury?......Page 816
15. What are the usual patterns of infection associated with the fingernail?......Page 817
21. Is there a role for adjuvant therapy in NAM?......Page 818
Bibliography......Page 819
10. Describe the lumbrical-plus finger.......Page 820
19. Describe the terminal vascular anatomy of the finger.......Page 821
25. Is there a method of systematically describing fingertip injuries?......Page 822
29. Match Figures 121-1 through 121-5 with the following flaps:......Page 823
Bibliography......Page 826
7. What is the Salter-Harris classification of epiphyseal injuries in children?......Page 827
11. What is an unstable fracture?......Page 828
16. What are the indications for internal fixation?......Page 829
24. How are closed diaphyseal fractures of the phalanges treated?......Page 830
27. How are metacarpal head fractures treated?......Page 831
32. How are metacarpal shaft fractures treated?......Page 832
38. What is a Rolando fracture?......Page 833
Bibliography......Page 834
4. What are the three types of dorsal PIP dislocations?......Page 835
11. Do digital carpometacarpal dislocations occur?......Page 836
15. What soft tissue structure provides the most stability to the thumb CMC joint?......Page 837
Bibliography......Page 838
5. What general principles must be adhered to so that a successful fusion can beobtained?......Page 839
8. Discuss the situations when external fixation may be needed for arthrodesis.......Page 840
10. Should all chronic mallet deformities be fused?......Page 841
14. What are the most important considerations for a successful small joint arthrodesis?......Page 842
22. What is the average arc of motion after PIP joint arthroplasty?......Page 843
26. What are the early and late complications associated with small joint arthroplasty?......Page 844
Bibliography......Page 845
5. What two areas of cellular activity contribute to flexor tendon healing?......Page 846
12. What are the most commonly used techniques for flexor tendon repair?......Page 847
13. Describe the zones of flexor tendon injury.......Page 848
17. When the proximal ends of the lacerated FDS and FDP tendons retract into the palm, how can you correctly orient these tendons when they are brought out more distally into the digit?......Page 849
21. Should partial tendon lacerations be repaired?......Page 850
26. When can strengthening exercises be initiated after flexor tendon repair and appropriate early therapy protocols?......Page 851
Bibliography......Page 852
4. Unlike the flexor tendons, the extensor tendons pass through discrete compartments at the level of the wrist. What is the orientation of the extensor tendons at the level of the wrist?......Page 853
8. Following a crush injury to the hand, a man has limited flexion of his fingers. How do you determine whether this is due to intrinsic muscle fibrosis and scarring or due to extensor tendon adherence?......Page 854
12. What are the different types of mallet fingers?......Page 855
18. What is the treatment protocol after extensor tendon repair?......Page 856
Bibliography......Page 857
6. In a high radial nerve injury associated with a humeral fracture, is exploration of thenerve recommended?......Page 858
8. What area is affected by low median nerve palsy? What deficits are involved?......Page 859
9. What movements are necessary for effective thumb opposition?......Page 860
13. List the standard tendon transfers for a high median nerve injury.......Page 861
17. How can you restore thumb adduction?......Page 863
24. What are the recommended tendon transfers for reconstruction?......Page 865
26. List several common hand and upper extremity deformities seen in cerebral palsythat may benefit from tendon transfers.......Page 866
34. What are the choices for transfers if the EPL is ruptured?......Page 867
43. What are the primary considerations when contemplating primary brachial plexus surgery?......Page 868
50. To facilitate thumb–index tip pinch and to provide proximal thumb abduction stabilityin combined nerve palsies, cerebral palsy, and quadriplegia, what arthrodeses canbe used?......Page 869
Bibliography......Page 870
8. Can a fasciocutaneous flap be elevated from the dorsal aspect of the forearm?......Page 871
13. What are the disadvantages of the groin flap?......Page 872
17. Which free flaps are most commonly used?......Page 873
20. How is a radial forearm flap elevated?......Page 874
26. What is a composite free flap?......Page 875
Bibliography......Page 876
8. Describe the advantages and disadvantages of the incisions listed in Question 7.......Page 878
18. What are chronic paronychia?......Page 879
27. What are the complications of untreated or inappropriately treated acute flexor tenosynovitis?......Page 880
35. What is the position of the thumb in thenar space infections?......Page 881
44. What organisms are frequently seen in dog and cat bites?......Page 882
Bibliography......Page 883
6. What do you evaluate first in an amputation patient?......Page 884
16. How many veins need to be repaired?......Page 885
24. What methods are used to monitor replants?......Page 886
bibliography......Page 887
8. How and why does the reconstructive approach differ in congenital and acquired thumb deficiencies?......Page 888
14. What techniques can be used for less severe hypoplasia of the thumb?......Page 889
19. What are the options for reconstruction of the middle third of the thumb?......Page 890
25. Describe the different options for toe-to-thumb transfer.......Page 891
Bibliography......Page 892
5. How are mutilating injuries of the hand classified?......Page 893
7. What are dorsal mutilation injuries (type I)?......Page 894
9. What are ulnar mutilation injuries (type III)?......Page 896
11. What are transverse amputations (type V)?......Page 897
15. What are degloving injuries (type VI)?......Page 900
21. What is the role of prostheses in the management of the mutilated hand?......Page 902
Bibliography......Page 903
3. What are the surgical options for treatment of Raynaud’s disease? How can you preoperatively evaluate response to a s......Page 904
9. What are the phases of a developing hemangioma?......Page 905
15. What is Kasabach-Merritt syndrome?......Page 906
23. What are lymphatic malformations?......Page 907
Bibliography......Page 908
3. What is the physiologic cause of ischemia in the upper extremity?......Page 909
10. Describe the technique of upper extremity compartment fasciotomy and the important structures that should be released.......Page 910
16. What is the most common cause of Volkmann’s contractures in developing countries?......Page 911
Bibliography......Page 912
2. How are nerve injures classified? What is the clinical importance of classification?......Page 913
7. How fast do nerves regenerate?......Page 914
14. Should all open wounds be explored?......Page 915
16. What is the best way to treat peripheral nerve injuries resulting in segmental loss of continuity?......Page 916
18. How are nerve repairs classified?......Page 917
23. What is a Martin-Gruber communication or Martin-Gruber anastomosis? Why is it important in nerve injuries of the hand?......Page 918
Bibliography......Page 919
5. How do you distinguish de Quervain’s tenosynovitis from radial sensory nerve compression?......Page 920
10. What are the analogous peripheral nerves that become entrapped at the wrist compared with at the ankle (carpal tunnel vs tarsal tunnel)?......Page 921
17. Where is the nerve entrapment site that causes scapular winging?......Page 922
23. What nerve compression is associated with chemotherapy-induced neuropathy from cisplatin or taxol?......Page 923
Bibliography......Page 924
5. How are the peripheral nerves formed in the brachial plexus?......Page 926
11. What is the significance of a preganglionic and postganglionic lesion of the brachial plexus? What findings suggest a preganglionic lesion?......Page 927
13. What findings are associated with root avulsions? What is the significance of a root avulsion?......Page 928
17. What are the degrees of nerve injury? Why are they significant in brachial plexus reconstruction?......Page 929
23. What is the cause of thoracic outlet syndrome?......Page 930
Bibliography......Page 931
7. What is the caput ulnae syndrome?......Page 933
15. What is the preferred treatment of extensor tendon ruptures?......Page 934
Bibliography......Page 935
5. Does the diseased tissue exhibit specific patterns?......Page 936
7. By what mechanism is the neurovascular bundle displaced?......Page 937
14. Is there a role for nonoperative treatment?......Page 938
20. What are the complications of surgery?......Page 939
Bibliography......Page 940
6. Who was de Quervain?......Page 941
12. What is the etiology of trigger finger?......Page 942
15. How should rheumatoid trigger finger be treated?......Page 943
Bibliography......Page 944
5. Are laboratory tests helpful in the diagnosis of hand tumors?......Page 945
9. What is the most likely diagnosis of a painful hand mass relieved only by nonsteroidal antiinflammatory drugs? What is the workup and management of this mass?......Page 946
14. Describe the clinical course of a keratoacanthoma. Why is an excisional biopsy recommended? If a patient presents with multiple keratoacanthomas, what other diagnostic modalities should be performed?......Page 948
15. What are the most likely causes of carpal tunnel syndrome in a child?......Page 949
20. What is the potential for malignant transformation of a solitary enchondroma? What is Ollier disease? What is Maffucci disease? Is there a potential for malignant transformation among these disease processes?......Page 950
23. What physical findings in a pigmented skin lesion potentially make the lesion suspicious for a malignancy? What is the appropriate workup for a skin lesion of the hand that is diagnosed as a melanoma?......Page 951
28. A mass similar to that described in Question 27 is found in a 40-year-old patient. However, the mass has recently ulcerated and drained fluid. Biopsy is consistent with a sarcoma, revealing epithelial cells with a central area of necrosis. What is this......Page 952
30. What is Kasabach-Merritt syndrome?......Page 953
35. Are neurofibromas and neurilemomas the same? Does their treatment differ? Is a neurilemoma common in the hand?......Page 954
Bibliography......Page 955
3. Does experimental evidence suggest the involvement of sympathetic nerves in some chronic pain syndromes?......Page 957
12. What is orofacial RSD, and why is it different?......Page 958
17. What complications may develop with CRPS?......Page 959
23. Is RSD (CRPS I) an autoimmune disease?......Page 960
Bibliography......Page 961
3. When are early active mobilization protocols used after flexor tendon repair?......Page 962
7. Describe splinting after MCP implant arthroplasty.......Page 963
15. What are the potential deformities and splinting needs for ulnar nerve injuries?......Page 964
19. Describe the benefits of hand therapy for patients with carpal tunnel syndrome or other forms of cumulative trauma.......Page 965
28. What are tests of maximal voluntary effort?......Page 966
34. Describe a course of treatment of reflex sympathetic dystrophy (complex regional pain syndrome type I)......Page 967
Bibliography......Page 968
Section XII: The Wrist......Page 970
4. How much of the proximal surface of the lunate normally articulates with the distal articular surface of the radius in the neutral wrist position?......Page 972
6. How does the relative length of the radius and ulna, termed ulnar variance, change with forearm rotation?......Page 973
10. Describe the normal arterial blood supply of the distal radius......Page 974
13. Where is the center of rotation of the wrist?......Page 975
19. Describe the dorsal capsular ligaments of the wrist.......Page 976
Bibliography......Page 977
6. Which maneuver directly examines the scapholunate joint?......Page 979
9. Which maneuver directly assesses the STT joint?......Page 980
12. Explain the biomechanical mechanism of the scaphoid shift maneuver......Page 981
16. How can you rule out pathology involving the DRUJ?......Page 982
21. What is triquetral impingement ligament tear? How can it be diagnosed?......Page 983
24. Do all five carpometacarpal joints demonstrate equal motion?......Page 984
34. How can you diagnose an injury or fracture of the hook of the hamate?......Page 985
Bibliography......Page 986
8. What is a Colles fracture?......Page 987
18. What are the complications of scaphoid fractures?......Page 989
23. What are the two major types of carpal dislocations?......Page 990
25. What are the advantages of magnetic resonance imaging for diagnosis of wrist disorders?......Page 991
Bibliography......Page 992
8. What is the columnar theory of carpal kinematics?......Page 994
15. How does rotary subluxation of the scaphoid affect carpal kinematics?......Page 995
Bibliography......Page 996
9. Describe Leri-Weill syndrome.......Page 997
20. What are the most common fractures in children?......Page 998
Bibliography......Page 999
5. What radiographic views should be included in the initial workup of a scaphoid fracture?......Page 1000
11. What are the indications for operation on a fracture of the scaphoid?......Page 1001
19. What rare carpal fracture is associated with cyclists?......Page 1003
Bibliography......Page 1004
8. What are the physical findings?......Page 1005
18. Does immobilization have a role in the treatment of Kienböck’s disease?......Page 1006
23. When should intercarpal arthrodesis be considered?......Page 1009
26. Are radial wedge osteotomies (closing or opening) effective procedures for Kienböck’s disease?......Page 1010
Bibliography......Page 1011
6. How can a dorsal perilunate dislocation be reduced?......Page 1012
10. Define the abbreviations CID, CIND, and CIC and describe their corresponding conditions.......Page 1013
16. What is the Watson test?......Page 1014
26. Describe the typical history and examination of a patient with a lunotriquetral ligament tear.......Page 1015
Bibliography......Page 1016
4. Tears of the TFCC are most frequently caused by what mechanism?......Page 1017
15. In patients who have undergone TFCC débridement but still have ulnar-sided wrist pain, what procedure can be used as an initial salvage procedure for relief of pain?......Page 1018
Bibliography......Page 1019
6. What is RF?......Page 1021
12. Describe the classic pattern of deformity of the radiocarpal joint and DRUJ.......Page 1022
21. What is caput ulnae syndrome?......Page 1023
31. What are surgical options in managing DRUJ involvement in RA of the wrist?......Page 1024
41. What are the types of wrist arthrodesis available in RA?......Page 1025
Bibliography......Page 1026
4. What is the most comprehensive classification system used to classify fractures of the distal radius?......Page 1027
6. What are the radiographic projections used in imaging a distal radius fracture?......Page 1028
7. What are some of the cardinal measurements on radiographs of a distal radius?......Page 1030
13. What is the management of undisplaced intraarticular and extraarticular stable fractures of the distal radius?......Page 1031
17. Which fractures are suitable for percutaneous pin fixation?......Page 1032
21. What are the characteristics of CRPS, and how is it treated?......Page 1033
Bibliography......Page 1034
7. Why must the normal external dimensions of the carpal bones included in a limited arthrodesis be preserved? Are there any exceptions?......Page 1035
12. How is a triscaphe arthrodesis performed?......Page 1036
13. What is the key to performing a successful triscaphe arthrodesis?......Page 1037
15. What is SLAC wrist?......Page 1038
19. What is the key to performing a successful SLAC wrist reconstruction?......Page 1039
27. What is the optimal bone graft donor site for intercarpal arthrodesis?......Page 1040
33. How is the wrist managed after intercarpal arthrodesis?......Page 1041
Bibliography......Page 1042
Index......Page 1044