Tips and Tricks in Plastic Surgery

Foreword
Foreword
Preface
Contents
Contributors
Abbreviations
Part I: Aesthetic Surgery
	1: Breast Reduction
		Introduction
		Inferior Pedicle
			Markings (Fig. 1.1)
				Tattooing the Markings
			Tumescence
			Seagull the Lower Part
			Dermatome Blade Resection
			Preserving Medial Breast Tissue
			Permanent Suture in Inverted-T Point
		Conclusion
		References
	2: Augmentation Mammoplasty and Mastopexy
		Introduction
		Preoperative Planning
		Breast Augmentation
			Implant Selection
			Patient Positioning
			Infiltration of Local
			Surgical Preparation and Sterile Draping
			Inframammary Incision
			Inframammary Fold Positioning
			Incision
			Implant Pocket
			Dual-Plane Submuscular Pocket
			Subglandular/Subfascial Pocket
			Implant Placement
			Closure
			Case Examples (Figs. 2.16 and 2.17)
		Management of Breast Ptosis
			Introduction
		Mastopexy
			Preoperative Evaluation
				Relevant Surgical Anatomy
			Preoperative Markings
			Intraoperative Markings
		Inferior Pedicle Inverted-T Mastopexy with or Without Mesh Reinforcement
		Superior Pedicle Circumvertical Mastopexy with Inverted-T Scar
			Option 1—Standard Approach
			Option 2—Lower Island Flap Autoaugmentation
			Postoperative Care and Expected Outcomes
			Case Examples
		Augmentation Mastopexy
			Blood Supply
			Implant Selection
				Implant Profile and Size
				Smooth Versus Textured Implants
				Shaped Implants
			Pocket Selection
		Augmentation Mastopexy
			Circumareolar
			Circumvertical
			Circumvertical with Inverted-T Skin Excision
			Lower Pole Mastopexy
		Operative Technique
			Preoperative Markings
		Vertical Mastopexy
			Surgical Technique
			Implant Placement
				Tailor Tacking
				Breast Flap and Pedicle Dissection
				Lower Pole Debulking
				Deep Fascial Sling
				Closure
		Postoperative Management
			Breast Augmentation
			Mastopexy and Augmentation Mastopexy
		Management of Complications
			Breast Augmentation
			Mastopexy
		Conclusion
		References
	3: Osteotomies in Rhinoplasty
		Introduction
			The Problem
		Principles of Osteotomy Surgery
			Indications
			Patient Example for Both Osteotomies
			Surgical Technique in Detail
		Medial Oblique Osteotomy
		Lateral (Low-to-Low) Osteotomy
			Crooked Bony Septum
			Other Maneuvers
			Cadaver Video Demonstration
		Summary
		References
	4: Facial Porous Polyethylene Implants
		Introduction
		Indications for PPFI
			Preoperative Evaluation
				Physical Examination
				Imaging Studies
		Surgical Technique
			Anesthesia
			Preparation
			Incisions
			Technique
		Upper Face Augmentation
			Forehead
			Temporal Area
			Midface Augmentation
				Infraorbital Rim
				Malar Area
				Piriform Aperture
				Nose (Figs. 4.2 and 4.3)
			Mandible Augmentation
				Chin
				Mandibular Angle Augmentation
		Postoperative Protocol
		Complications
		Conclusion
		References
	5: Treatment of Facial Aging—Minimally Invasive Surgical Procedures
		Introduction
		Patient Evaluation
		Facial Rejuvenation Techniques
			Neck
			Face
			Brow
		Conclusion
		References
	6: Nonsurgical Facial Enhancement and Rejuvenation—Fillers, Neurotoxins, and Fat Transfers
		Introduction
		Anatomy of Facial Aging
			Skin Aging
			Fat in the Aging Face
			Changes Resulting from Muscle Activity with Aging
			Bone Aging
		Patient Examination and Treatment Plan
		Treatment Options
			Dermal Fillers
				Injection Techniques for Optimal Results and Complication Avoidance
				Safety
		Facial Volumizing and Contouring
			Forehead
			Brows
			Temporal Hollows
			Infraorbital Hollows and Tear Trough
			Cheeks
			Nasolabial Folds
			Submalar Hollow
		Perioral Area and Lips
			Vertical Lip and Fine Lines
			Upper and Lower Lips
			Marionette Lines and Oral Commissures
			Jawline
			Chin
		Nonsurgical Rhinoplasty
		Improving Skin Texture and Tone
			Aesthetic Applications of Botulinum Neurotoxins
			Glabellar Frown Lines
			Horizontal Forehead Lines
			Lateral Periorbital Lines
			Nasal Rhytides
			Gummy Smile
			Perioral Lines
			Masseter Hypertrophy
			Platysmal Bands
			Oral Commissures
			Chin
			Other Aesthetic Toxin Uses
		Aesthetic Applications of Fat Transfer
		Conclusion
		References
	7: Rhytidectomy
		Introduction
		Anatomy
			Facial Aesthetics
			Facial Subunits
			Facial Ligaments
			Facial Compartments
			Danger Zones
				Frontal Nerve
				Buccal and Zygomatic Branches of the Facial Nerve
				Marginal Mandibular Branch of the Facial Nerve
				Cervical Branch of the Facial Nerve
				Great Auricular Nerve
				Patient Factors
			Safe Zones
				Frontal Nerve
				Zygomaticobuccal Branches
				Marginal Mandibular Branch
				Cervical Branch
		Physiology of Aging
			Volume Loss
			Ptosis
			Radial Expansion
		Preoperative Points
			Patient Assessment
				History
				Physical Exam
				Set Patient Expectations
			Preoperative Markings
			Surgical Prophylaxis
			Anesthesia
		Operative Technique
			Cutaneous Flap Elevation Tips
			SMAS Flap Elevation Tips
			Surgical Closure
		Postoperative Points
		Surgical Complications
		References
	8: Blepharoplasty
		Introduction
		Periocular Signs of Aging and Anatomical Changes
		History and Physical Exam
		Upper Eyelid Blepharoplasty
		Lower Eyelid Blepharoplasty
			Transconjunctival Approach
			Transcutaneous Approach
		Blepharoplasty Complications
			Retrobulbar Hematoma
			Chemosis
			Eye Dryness
			Corneal Injury
			Eyelid Malposition
			Extraocular Muscle Injury
			Infection
		References
	9: Body Contouring: New Technology and Technique for Contouring the Lower Torso
		Introduction
		Patient Considerations
			Preoperative 6-Week HCG/500 Calorie Diet
			Liposuction Followed by BodyTite® for Mild to Moderate Skin Laxity
			Descriptive Surface Anatomy Lower Body Contouring descriptive surface anatomy
			Bulging Flanks After LBL, Sagging or Massively Oversized Flanks, and Accepting Inadequate Aesthetics
			Surgical Innovation and Analyzing Results
			Dense Adherences Make Flankplasty Long-Lasting, and Flanks Are the Keystone of the Torso
			Use a Large Gel Roll Along the Spine
			Lateral Gluteal Closure Is a Poor Anchor
			Measure Hatch Marks of Oblique Flankplasty Closure
		Conclusion
		References
	10: Suction-Assisted Lipectomy and Brazilian Butt Lift
		Introduction
			Consultation
		Suction-Assisted Lipectomy (Liposuction)
			Preoperative Preparation
			Anesthesia and Wetting Solutions
		Contouring of the Neck
		Contouring of the Trunk
		Contouring of the Extremities
		Vaser-Assisted Contouring of Gynecomastia
		VASER-Assisted Contouring of the Buttocks
		Brazilian Butt Life
			Gluteal Anatomy and Ultrasound
			Preoperative Assessment
		Surgical Equipment and Setup
			Intraoperative Ultrasound Systems
		Surgical Technique
			Liposuction and Liposculpture
			Fat Grafting Using the Microaire System
			Real-Time Intraoperative Ultrasound Visualization of Fat Grafting
		Patient Cases
			Case One
				Patient’s Priorities
				Operative Challenges
				Surgical Plan
				Result
			Case Two
				Patient’s Priorities
				Operative Challenges
				Surgical Plan
				Result
		Conclusion
		References
	11: Gynecomastia: Evaluation and Surgical Tips and Tricks
		Introduction
		Etiology of Gynecomastia
			Preoperative Evaluation
			Classification of Gynecomastia
			Anatomical Considerations
			Surgical Markings for Gynecomastia
		Surgical Approaches to Gynecomastia
			Liposuction
			Ultrasound-Assisted Liposuction
			Arthroscopic Shaver
			Open Excision
		Postoperative Care for Gynecomastia
		Conclusion
		References
	12: Labiaplasty and Aesthetic Vulvovaginal Surgery
		Introduction
		Developmental Considerations
		Clinical Evaluation and Consultation
			External Anatomy
			Photography
		Technical Considerations
			Wedge Labiaplasty
			Horseshoe Labiaplasty
			Edge Labiaplasty with Clitoral Hood Reduction
			Anesthesia
			Initial Markings
		Step-by-Step Techniques
		Postoperative Management and Recovery Protocols
		Complications
		Revisions
		Follow-Up
		Additional Aesthetic Procedures
			Internal Laser Vaginal Rejuvenation
			Perineoplasty With or Without Vaginoplasty
			Labia Majora Augmentation
			Labia Majora Reduction
			Hymenorrhaphy and Hymenoplasty
			Pubic Lift Procedures and Mons Pubis Liposuction
		Conclusion
		References
Part II: Reconstructive Procedures
	13: Post-Oncologic Breast Reconstruction: Autologous and Alloplastic Approaches
		Introduction
		Autologous Reconstruction
			Preoperative Assessment and Patient Selection
			MSFTRAM Flap
			Deep Inferior Epigastric Perforator (DIEP) Flap
			Recipient Site
			Other Free Flap Options
				Superficial Inferior Epigastric Artery (SIEA) Flap
				Transverse Upper Gracilis (TUG) Flap
				Profunda Artery Perforator (PAP) Flap
		Alloplastic Reconstruction
			Submuscular Two-Stage Reconstruction
				Expander Exchange for Implant
			Direct-to-Implant Reconstruction
			Prepectoral Reconstruction
		Conclusion
		References
	14: Eyelid Reconstruction
		Introduction
		Pertinent Anatomy
		Principles of Eyelid Reconstruction
			Approach to Eyelid Reconstruction
		Preoperative Assessment
			General Considerations
			Assessing the Defect
		Anterior Lamella Reconstruction Techniques
			Direct Closure
			Local Myocutaneous Flaps
			Skin Grafts
			Autologous Grafts
			Allograft Substitutes
			Secondary Intention Healing (“Laissez Faire”)
			Full-Thickness Eyelid Defects
				Direct Closure
		Full-Thickness Reconstruction Using Local Myocutaneous Flaps
			Lower Eyelid—Medium-Sized Defects
				Tenzel Flap
				Hughes Tarsoconjunctival Flap
				Upper Eyelid Defects
				Sliding Tarsoconjunctival Flap
				Cutler-Beard Flap
				Posterior Lamellar Grafts
		Special Considerations
			Lateral Canthal Defects
			Canalicular Reconstruction
			Complications of Eyelid Reconstruction
				Scar Formation
				Eyelid Margin Notching
				Flap and Graft Necrosis
				Eyelid Retraction
				Ptosis
				Retrobulbar Hemorrhage
		Conclusion
		References
	15: Nose Reconstruction
		Introduction
		Preoperative Evaluation
			Surgical Planning
		Surgical Techniques
			Primary Closure
			Bilobed Flap (Modified by Zitelli) (Fig. 15.1a and b)
			Nasolabial Flap (Fig. 15.3)
			Forehead Flap (Figs. 15.4a and 14.4b, 15.5, 15.6, and 15.7)
			FTSGs
			Free Flaps
			Internal Lining
			Nasal Framework
		Revisions
		Postoperative Management
		Conclusion
		References
	16: Lip and Cheek Reconstruction
		Introduction
		Cheek Reconstruction
			Anatomy
		General Considerations
			Primary Closure
			Transposition Flap
			V-to-Y Advancement Flap
			Cervicofacial Flap
			Full-Thickness Skin Graft
			Tissue Expansion
		Lip Reconstruction
			Anatomy
			General Considerations
			Vermilion Reconstruction
			Reconstruction of the Cutaneous Lip
			Reconstruction of Full-Thickness Defects
			Abbe Flap
			Estlander Flap
			Karapandzic Flap
			Bernard-von Burrow Flap
			Free Tissue Transfer
		Conclusion
		References
	17: Ear Reconstruction: Congenital, Microtia, Otoplasty
		Introduction
		Treatments and Techniques
			Pre-Auricular Ear Remnants
			Ear Molding
			Cryptotia
			Auricular Size Reduction
			Microtia
			Otoplasty
		Conclusion
		References
	18: Scalp Reconstruction
		General Principles
		Reconstructive Options
			Secondary Intention
			Vacuum-Assisted Closure (VAC)
			Primary Closure
			SkinTE™ Skin Product
			Skin Substitutes
			Skin Grafting
			Local and Locoregional Flaps
			Anterior Scalp
			Parietal Region
			Vertex
			Occipital Region
			Free Tissue Transfer
			Tissue Expansion
				Expander Choice
				Expander Placement
				Rate of Expansion
			Tissue Expander Complications
		Approach to Large Defects and Case Examples
			Case Examples
		Conclusion
		References
	19: Thoracic and Abdominal Wall Reconstruction
		Introduction
		Thoracic Reconstruction
			Technique I: Oncologic Chest Wall Defect—Lateral
			Technique II: Sternal Defect
			Technique III: Intrathoracic Reconstruction for Bronchopleural Fistula Repair
		Abdominal Wall Reconstruction
			Phase 1: Prehabilitation
			Phase 2: Fascial Evaluation
			Phase 3: Component Separation
			Phase 4: Mesh Type and Placement
			Phase 5: Soft Tissue Reconstruction
		Conclusion
		References
	20: Migraine/Headache Surgery
		Patient Selection
			Pain Sketches
			Nerve Blocks
			Silent Occipital Neuralgia
		Technical Considerations
			Exploring Nerve Entrapment Directly at the Pain Site
			Approaching the Frontal and Temporal Trigger Site through an Upper Blepharoplasty Incision
		Postoperative Pain Management
		Conclusion
		References
	21: Lower Extremity Reconstruction: Local Flaps, Free Tissue Transfers
		Lower Extremity Reconstructive Principles.
		Flap Selection
			Locoregional Flaps
			Thigh
			Upper and Middle One-Third of Leg
			Knee
			Distal One-Third of the Leg
			Foot and Ankle
		Osteocutaneous Flaps for Lower Extremity Reconstruction
			Free Medial Femoral Condyle Flap
			Free Fibula Osteocutaneous Flap
		Postoperative Care
		Conclusion
		References
	22: Pressure Injuries
		Introduction
		Economic Impact
		Incidence and Prevalence
		Prevention Strategies
			Preoperative Care
			Comorbidities
			Nutrition Optimization
			Infection Control and Prevention
			Pressure Prevention
			Spasm Control
			Contractures
		Surgical Planning
		Operative Management
			Debridement
			Ostectomy
			Closure
			Ischial Defects
			Sacral Defects
			Trochanteric Defects
			Other Considerations
		Postoperative Care
		Conclusion
		References
	23: Facial Paralysis
		Introduction
		Anatomy
			Facial Nerve
			Gracilis
			Sural Nerve
		Selecting an Appropriate Donor Nerve and Ensuring Adequate Neural Input
		Cross-Face Nerve Grafting
			Sural Nerve Harvest
			Facial Nerve Mapping
		Free Functional Muscle Transfer
			Gracilis Harvest
			Facial Exposure
			Placement of Anchoring Sutures
			Donor Motor Nerve Exposure
			Inset of the Muscle
			Micro-Anastomosis, Muscle Anchoring, and Closure
		Postoperative Care
		Complications and Secondary Surgery
		Dynamic Reconstruction for Incomplete Facial Paralysis
			Surgical Technique
		Conclusion
		References
	24: Comprehensive Management of Head and Neck Burn Injuries: From Resurfacing to Reconstruction
		Introduction
		Principles
		Acute Management
			Critical Care
			Wound Care
			Excision
			Coverage
		Scar Management
		Reconstructive Techniques
			Anatomic Areas
				Panfacial Burn
				Electrical Injury to the Neck and Occiput
				Cheek with Parotid Injury
				Pinna Loss
				Neck Contracture, Child
				Neck Contracture, Focal Bands
				Recurrent Neck Contracture
				Chronic Folliculitis
				Concavity Defects, Cheek
				Ectropion Release
				Microstomia Correction
				Nasal Reconstruction
		Conclusion
		References
	25: Transgender Surgery: Feminization and Masculinization
		Introduction
			Terminology
			Patient Selection
			Surgery on Adolescents
		Sensitivity and Terminology Tips
		Transmasculine Surgery
			Transmasculine Top Surgery
			Phalloplasty
		Transfeminine Surgery
			Transfeminine Top Surgery
			Facial Feminization Surgery
		Conclusion
		References
Part III: Pediatric and Craniomaxillofacial Surgery
	26: Vascular Anomalies
		Introduction
		Diagnosis
			History
			Physical Examination
			Imaging
			Pathology
		Treatment
			Infantile Hemangiomas
				Proliferative Phase
					Pharmacotherapy
					Surgery
					Laser
			Visceral Hemangiomas
				Involutional and Involuted Phases
			Congenital Hemangiomas
			Lymphatic Malformations
				Sclerotherapy
				Surgery
				Sirolimus
				Laser
			Capillary Malformations
				Laser
				Surgery
			Venous Malformations
				Sclerotherapy
				Surgery
				Compression
			Arteriovenous Malformations (AVMs)
				Embolization
				Surgery
		Conclusion
		References
	27: Cleft Lip and Palate
		Introduction
			Embryology
			Classification of Cleft Lip and Palate
		Diagnosis of Cleft Lip and Palate
			The Multidisciplinary Cleft Team
			Timing of Interventions
		Cleft Lip
			Anatomy of the Unilateral Cleft Lip
			Anatomy of the Bilateral Cleft Lip
			Presurgical Infant Orthopedics
			Unilateral Cleft Lip Repair
			Primary Correction of Cleft Nasal Deformity at the Time of Lip Repair
			Bilateral Cleft Lip Repair
			Postsurgical Management
			Unfavorable Outcomes of Cleft Lip Repair
		Anatomy of Cleft Palate
			Cleft Palate Repair
			Unfavorable Outcomes of Palate Repair
		Velopharyngeal Insufficiency and Speech Surgery
			The Residual Cleft and Alveolar Bone Grafting
		Orthognathic Surgery in Cleft Patients
			Secondary Correction of the Cleft Nasal Deformity and Nasal Airway
		Conclusion
		References
	28: Craniofacial Surgery: Craniosynostosis and Craniofacial Syndromes
		Introduction
		Cranial Procedures (Craniectomy, Fronto-orbital Advancement, Monobloc)
			Planning
			Preparation
			Dissection
			Strip Craniectomy
			Anterior Craniotomy
			Protection
			Removal of the Orbital Bandeau
			Harvesting Bone Graft
			Fixation
			Closure
		Orbital Procedures (Facial Bipartition, Box Osteotomy)
			Planning
			Preparation
			Dissection
			Orbital Box Osteotomy
			Facial Bipartition
			Positioning
			Fixation
		Maxillary Surgery (Le Fort Osteotomies)
			Planning
			Preparation
			Dissection
			Osteotomy
			Positioning
			Fixation
		Mandibular Surgery (Sagittal Split Osteotomies, Intraoral Vertical Ramus Osteotomies)
			Planning
			Preparation
			Dissection
			Osteotomy of the Mandible
			Fixation
		Conclusion
		References
	29: Orthognathic Surgery
		Introduction
			Patient Evaluation
			Virtual Surgical Preoperative Planning
			Sequence and Timing
			Soft Tissue Consideration
			Le Fort I Osteotomy
			Sagittal Split Ramus Osteotomy
			Genioplasty
			Clinical Cases
				Case 1
				Case 2
				Case 3
		References
	30: Facial Fat Grafting
		Ideology Behind ITR2 Fat Grafting
			Introduction to Fat Grafting
			Understanding Facial Aging
			New Applications
		ITR2: Injectable Tissue Replacement and Regeneration
		Application of ITR2 Fat Grafting
			Preoperative Evaluation
			Preoperative Markings
			Preoperative Preparation and Anesthesia
			Adipose Tissue Harvest
			Fat Processing (See Fig. 30.1)
			Delivery Placement (See Fig. 30.1)
			Millifat ≥2.4 mm Parcel
			Microfat ~1 mm Parcel
			Nanofat ≤500 Micron Parcels
		Case Demonstrations
			Patient 1
			Patient 2
			Postoperative Care
			Down Time, Recovery, and Management of Complications
		Conclusion
		References
	31: Facial Trauma
		Introduction
		Tips and Tricks of Facial Fractures
			Zygomaticomaxillary Complex (ZMC) Fractures
			Orbital Fractures
			Nasal Fractures
			Mandibular Fracture
			Maxillary Fracture
			Frontal Sinus Fracture
			Nasoorbitoethmoid Fractures
		Gunshot Wounds and Panfacial Trauma
			Complications and Secondary Deformities
				Enophthalmos
				Entropion and Lid Retraction
				Telecanthus
				Malocclusion
		References
Part IV: Adjunctive Procedures
	32: Lasers and Aesthetic Devices: Skin Resurfacing, Tattoo Removal, and Body Contouring
		Laser Resurfacing
			Laser Selection
			Avoiding Unfavorable Results and Complications
				Preoperative Planning
				Intraoperative Considerations
				Postoperative Complications
		Laser Tattoo Removal
			Laser Selection
			Preoperative Planning
			Intraoperative Planning
			Postoperative Consideration
		Body-Contouring Devices
			Cryolipolysis
			Preoperative Considerations
			Intraoperative Planning
			Postoperative Considerations
			Laser Therapy
			Preoperative Considerations
			Intraoperative Considerations
			Postoperative Consideration
			Magnetic Resonance Contouring
			Radiofrequency Skin Tightening and Body Contouring
			Ultrasound Skin Tightening and Body Contouring
		Conclusion
		References
	33: Pediatric Tissue Expansion
		Reconstruction with Tissue Expansion: Principles and Pearls
		Tissue Expander Case Materials
			Tissue Expanders
			Shapes
			Sizes (Table 33.1)
				Parts
				Connector
				Port
				Surgical Instruments (Fig. 33.2)
			Sutures (Table 33.2)
				Suture Technique
				Epidermal Suture Technique
				Running Subcuticular Suture Technique
			Drains (Fig. 33.3)
		Tissue Expander Placement [2, 3]
			Principles
			General Instructions
				Markings (Fig. 33.4)
				Incision (Fig. 33.4)
				Tissue Expander Pocket Preparation (Fig. 33.4)
				Dissection Technique
				Port Placement (Fig. 33.4)
				Tissue Expander Preparation (Fig. 33.4)
				Connect Expander to Port Via Connector
				Drains
				Drain Placement (Fig. 33.4)
				Closure (Fig. 33.4)
				Initial Expander Fill (Fig. 33.4)
		Anatomic-Specific Instructions
			Head and Neck: Scalp and Forehead
				Scalp (Table 33.3; Figs. 33.5a–e, 33.6a–e, and 33.7a–e)
					Principles
				Forehead (Table 33.4; Figs. 33.5a–e, 33.6a–e, and 33.7a–e) [4]
					Principles
			Head and Neck: Midface and Lower Face
				Principles
			Cheek (Table 33.5; Figs. 33.5a–e, 33.6a–e, and 33.7a–e)
				Principles
			Nose
			Periorbital
			Trunk
				Principles
			Chest (Table 33.8 and Fig. 33.11a–i)
				Principles
			Anterior Trunk (Table 33.9 and Fig. 33.11a–i)
			Posterior Trunk (Table 33.10 and Fig. 33.11a–i)
			Extremities
				Principles
			Upper Extremity [5]
				Shoulder/Upper Arm (Table 33.11, Figs. 33.12a, b and 33.13a–d)
					Principles
				Forearm (Table 33.12 and Fig. 33.13e–j)
					Principles
			Lower Extremity [6]
				Principles
			Proximal Lower Extremity (Table 33.13 and Fig. 33.14a–e)
			Distal Lower Extremity (Table 33.14 and Fig. 33.15a–g)
				Principles
			Hand/Foot
				Principles
		Tissue Expander Removal, Lesion Excision, Flap Reconstruction [2, 3]
			Principles
			General Instructions
				Markings (Fig. 33.16)
				Incision (Fig. 33.16)
				Drains (Fig. 33.16)
		Anatomic-Specific Instructions
			Head and Neck
				Scalp (Table 33.15 and Figs. 33.5a–e, 33.6a–e, and 33.7a–e)
					Principles
				Forehead (Table 33.16 and Figs. 33.5a–e, 33.6a–e, and 33.7a–e) [4]
				Cheek (Table 33.17 and Figs. 33.5a–e, 33.6a–e, and 33.7a–e)
					Principles
			Nose (Table 33.18 and Fig. 33.9)
			Trunk
			Extremities
		Perioperative Care
			Disposition
			Pain Medications
			Drains
			Dressings
			Suture Removal
			Antibiotics
			Discharge
		Tissue Expansion Protocol
			Injection Protocol and Technique
			Tissue Expander Teaching, Surgery, and Web-Based Follow-Up
			Additional Rounds of Expansion
		Complications and Their Management
			Infections [7]
			Tissue Expander Exposure
				Threatened Exposure
				Actual Exposure
		Conclusion
		References
	34: Supermicrosurgical Lymphaticovenular Anastomosis
		Introduction
			Preoperative Preparation
		Standard Technical Performance
			Lymphaticovenular Anastomosis
			Expected Outcomes
			Postoperative Care
		Conclusion
		References
	35: Skin Tumors
		Introduction
		Benign Skin Tumors
			Melanocytic Nevi
			Benign Melanocytic Nevi: Junctional Melanocytic Nevi
			Dermal Melanocytic Nevi
			Compound (Both Junctional and Dermal Components) Melanocytic Nevi
			Dysplastic Melanocytic Nevi
			Blue Nevi
		Epidermal Tumors
			Seborrheic Keratosis
			Epidermal Cysts
		Follicular Tumors
			Trichoepithelioma
			Sweat Gland Tumors
				Syringoma
				Hidradenoma
		Dermal Tumors
			Dermatofibroma
			Lipoma
		Malignant Skin Tumors
			Melanocytic Malignant Tumors
				Melanoma
			Epidermal Tumors
				Actinic Keratosis
				Squamous Cell Carcinoma In Situ
				Squamous Cell Carcinoma
			Adnexal Tumors
				Basal Cell Carcinoma
				Dermatofibrosarcoma Protuberans
		Conclusion
		References
Part V: Hand and Upper Extremity
	36: Fractures and Dislocations
		Fractures
			Phalangeal (Fig. 36.1)
				Distal Phalanx
				Middle and Proximal Phalanx
			Metacarpal (Fig. 36.2)
				Head
				Neck
				Shaft
				Base
			Thumb
		Dislocations
			Finger DIP Joint
			Finger PIP Joint
			Finger MP Joint
		Conclusion
		References
	37: Tendon Injuries
		Tendon Anatomy, Blood Supply, and Healing
			Evaluation of Tendon Injury
			Tendon Injury Zones
			Timing of Tendon Repair
			Anesthesia
			WALANT
			Considerations on Tendon Repair
		Flexor Tendons
			Zone I
			Zone II
			Zones III–V
			Rehabilitation After Flexor Tendon Injuries
		Extensor Tendon Repair
			Zone I
			Zone II
			Zone III
			Zone IV
			Zone V
			Zone VI
			Zone VII
			Zone VIII/XI
		References
	38: Upper Extremity Nerve Injuries and Compression Syndromes
		Nerve Injuries
		Anatomy
		Etiopathogenesis
		Evaluation
			Electrodiagnostic Testing
		Prognosis
		Compression Syndromes
		Evaluation
			History
			Examination
			Testing
		Median Nerve Compression
			Carpal Tunnel Syndrome
			Pronator Syndrome
			Anterior Interosseous Nerve (AIN) Syndrome
		Ulnar Nerve Compression Syndromes
			Cubital Tunnel Syndrome
				In Situ Decompression
				Cubital Tunnel with Anterior Transposition
			Ulnar Tunnel Syndrome (UTS)
		Radial Nerve Compression
			Radial Tunnel Syndrome
			Posterior Interosseous Nerve (PIN) Syndrome
			Wartenberg’s Syndrome (Cheiralgia paresthetica)
		Nerve Injuries
			Operative Indications
			Treatment
				Nonoperative Treatments
				Principles of Nerve Surgery
			Operative Treatments
			Outcomes
		Conclusion
		References
	39: Tendon Transfers
		Introduction: What Is a Tendon Transfer?
		Indications for Tendon Transfer
			Restore Balance to Deformed Hand: Substitution of Function of Paralyzed Muscle
			Ruptured or Avulsed Tendon-Muscle
			Considerations for Reconstruction After Tendon or Muscle Injury
			Fundamental Principles of Muscle-Tendon Units Include Correction of Contracture
			Adequate Strength
			Tendon Excursion
			Disadvantages of Tendon Transfers
		How to Have a Successful Outcome with Upper Extremity Tendon Transfers [10]
			Expendability
			Setting Tension
		Functional Loss and Author’s Recommended Transfers
			Median Nerve Injuries
			Author’s Preferred Transfers
				Low Median Palsy
				High Median Nerve Palsy
			Radial Nerve Injuries
			Author’s Preferred Techniques
				Low Radial Nerve
				High Radial Nerve
			Brand Transfer [18] (Table 39.1)
				Brand Transfer for Radial Nerve Palsy (Technique)
			Ulnar Nerve
			Author’s Preferred Technique for Ulnar Nerve Palsy
				Low Ulnar Nerve Injury
				Active Transfer
				High Ulnar Nerve Palsy
				Key Pinch
			Postoperative Management
		References
	40: Congenital Hand Differences
		Introduction
		General Evaluation of Pediatric Hand Patients
			Counseling Parents
			General Timing Considerations
			Immobilization
		Specific Conditions
			Syndactyly
				Background
				Evaluation
				Treatment
				Surgical Steps (Separation of Simple Syndactyly)
		Special Situations
			Complex Syndactyly
			Minor Syndactyly, Shallow Web Spaces, and Web Creep
				Designing the “Dancing Girl” Flap for Minor Syndactyly
			Multiple Digit Syndactyly
			Pediatric Trigger Thumb
				Background
				Evaluation
				Treatment
				Surgical Steps
			Polydactylies
				Evaluation
			Preaxial Polydactyly
				Treatment
					Postaxial Polydactyly
					Preaxial Polydactyly
			Thumb Hypoplasia
				Background
				Evaluation
				Treatment
				Technique
				Steps of Pollicization
		Conclusion
		References
	41: Dupuytren Disease
		Introduction
		Dupuytren Patient Satisfaction and the Doctor–Patient Relationship
			Evaluation
				History
			Examination
				Documentation
			Cords
				Documentation
			Angle Measurements
			Unusual Findings Prompting Additional Evaluation
			Diathesis
			Patient Discussion: Ancestry
			Patient Discussion: Dupuytren Disease Without Contracture
			Patient Discussion: Dupuytren Disease with Contracture
		Treatment
			Procedure Categories
			Treatment Window
			Procedure Expectations
				Initial Correction
				Complete Correction
				Composite Contracture
			Procedure Comparison by Treatment Outcome
			Splinting
			Re-contracture
			Technical Tips for Procedures/General Recommendations
			PIP Manipulation
		Open Procedure Recommendations (Fasciectomy/Dermofasciectomy)
			Anesthesia
			Create Optimum Exposure
			Avoid Neurovascular Injury
			Avoid Marginal Skin Necrosis
			Minimize PIP Damage
			Avoid Flexion Loss
			Fasciectomy
			Dermofasciectomy
				Concept
				Do Your Homework
		Minimally Invasive Procedure Recommendations (CCH/PNF)
			Expectations
			Medications
				The Week Before Your Procedure
				Before Arriving the Day of Your Procedure
			After Your Procedure
				Wound Care after the Doctor Pulls on Your Fingers
				Activity
				Therapy and Splinting
			General Technical Tips for Minimally Invasive Dupuytren Procedures
				Antisepsis
				Manipulation
			Percutaneous Needle Fasciotomy
				Planning Portals
				Anesthesia
				Equipment
				Position
				Procedure
				Post-procedure Care
			Collagenase Clostridium histolyticum Injection
				Documentation
				Drug Preparation
				Planning Injection Sites
				Anesthesia
				Dose
				Injection
				Post-injection Care
				Manipulation
				Post-manipulation Care
		Conclusion
		References
	42: Thumb Reconstruction
		Introduction
			Assessment of the Patient
			Choice of Reconstruction
				Acute Injuries
		Replantation
			Subtotal Amputation with Insufficient Soft Tissue Coverage
			Healing by Secondary Intention
		Local Flaps
			Palmar Advancement Flap/Moberg Flap
			Cross-Finger and Innervated Cross-Finger Flaps
			First Dorsal Metacarpal Artery (FDMA) Flap
			Neurovascular Island Flap
		Free Flaps
			Venous Flaps
			Traditional Flaps
		Thumb-Lengthening Procedures
			Web Space Z-Plasty
			Bony Reconstruction
				Amputation with Preservation of the Basal Joint
			Toe-to-Thumb Transfer
			Total Loss of Thumb with Basal Joint Destruction
		Conclusion
		References
	43: Tumors
		Introduction
		Benign Tumors
			Ganglion Cysts
			Giant Cell Tumors
			Epidermal Inclusion Cyst
			Verruca Vulgaris
			Seborrheic and Actinic Keratosis
			Keratoacanthoma
			Desmoid (Aggressive Fibromatosis)
			Glomus Tumor
			Arterial/Aneurysm
			Hemangioma
			Vascular Malformations
			Pyogenic Granuloma
			Lipoma
			Lipoblastoma
			Nerve Tumors
				Lipofibromatous Hamartoma
				Neurofibroma
				Neurilemmoma (Schwannoma)
			Cartilage-Producing Tumors
				Enchondroma
				Osteochondroma
				Periosteal Chondroma
				Simple Bone Cyst
				Aneurysmal Bone Cyst
				Osteoid Osteoma
				Osteoblastoma
				Nora Lesion
				Brown Tumor
		Malignant Tumors
			Malignant Lesions of Epidermal Origin
			Soft Tissue Sarcoma
			Bone Sarcomas
		References
	44: Soft Tissue Coverage for the Hand and Upper Extremity
		Introduction
			Wound Preparation
			Timing of Soft Tissue Reconstruction
			Skin Graft
			Local Flaps
			Intrinsic Axial Pattern Hand Flaps
			Extrinsic Axial Pattern Hand Flaps
			Free Tissue Transfer
		Summary
		References
	45: Brachial Plexus Reconstruction
		Introduction
			Etiology
		Preoperative Investigation and Diagnosis
		Treatment Options
			Principles of Nerve Repair
			Timing of Nerve Repair
			Techniques of Nerve Repair
				End-to-End Repair
				End-to-Side Nerve Repair
				Nerve Grafting
				Vascularized Nerve Grafts
				Nerve Transfers
					Indications for Nerve Transfers in BP Reconstruction
		Intraoperative Diagnosis and Treatment
			Decision Algorithm for Brachial Plexus Reconstruction
				One- or Two-Root Avulsions
				Three-Root Avulsion
				Four-Root Avulsion
				Global Avulsion
		Surgical Techniques
			Intraplexus Donors
				Ipsilateral C5-Root Transfer
				Ipsilateral C7-Root Transfer
			Extraplexus Nerve Donors
				Spinal Accessory Nerve Transfer
				Intercostal Nerve Transfer
				Phrenic Nerve Transfer
				Ulnar-to-Musculocutaneous Nerve Transfer
		Rehabilitation
			Complications of Treatment
		Conclusion
		References
Index