Key notes on plastic surgery/Adrian M. Richards

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x ABBREVIATIONS SLL scapholunate ligament SLAC scapholunate advanced collapse SMAS superficial musculoaponeurotic system SMR submucous resection SNAC scaphoid nonunion advanced collapse SOOF suborbicularis oculi fat (pad) SSG split-skin graft SSM superficial spreading melanoma TBSA total body surface area TCA trichloroacetic acid TFCC triangular fibrocartilagenous complex TFL tensor fascia lata TGF transforming growth factor TLND therapeutic lymph node dissection TMJ temporomandibular joint TMN tumour, metastases, nodes TNF tumour necrosis factor t-PA tissue plasminogen activator TPN total parental nutrition TRAM transverse rectus abdominis muscle UAL ultrasonic assisted liposuction UCL ulnar collateral ligament UV ultraviolet VAC vacuum-assisted closure VCF velocardiofacial (syndrome) VISI volar intercalated segment instability VPI velopharyngeal incompetence VRAM vertical rectus abdominis myocutaneous (flap) WLE wide local excision XP xeroderma pigmentosa ZF zygomaticofrontal
1 General principles Structure and function of the skin, 1 Blood supply to the skin, 4 Classification of flaps, 8 Geometry of local flaps, 12 Wound healing and skin grafts, 21 Bone healing and bone grafts, 28 Nerve healing and nerve grafts, 31 Tendon healing, 35 Transplantation, 39 Alloplastic implantation, 41 Wound dressings, 46 Sutures and suturing, 47 Tissue expansion, 51 Further reading, 54 Structure and function of the skin The functions of the skin include: 1 Physical protection 2 Protection against UV light 3 Protection against microbiological invasion 4 Prevention of fluid loss 5 Regulation of body temperature 6 Sensation 7 Immunological surveillance. The epidermis • The epidermis is composed of stratified squamous epithelium. • It is derived from ectoderm. • Epidermal cells undergo keratinization in which their cytoplasm is replaced with keratin as the cell dies and becomes more superficial. The epidermis is composed of the following five layers, from deep to superficial. 1 Stratum germinativum • This is also known as the basal layer. • The cells within this layer have cytoplasmic projections, which firmly link them to the underlying basal lamina. 1 1
Page 1: KEY NOTES ON Plastic Surgery ADRIAN
Page 4 and 5: © 2002 by Blackwell Science Ltd a
Page 7 and 8: Foreword I am particularly critical
Page 9 and 10: Abbreviations ABPI ankle brachial p
Page 11: ABBREVIATIONS ix LME line of maximu
Page 15 and 16: Collagen fibres STRUCTURE AND FUNCT
Page 17 and 18: BLOOD SUPPLY TO THE SKIN 5 Vascular
Page 19 and 20: Neural innervation BLOOD SUPPLY TO
Page 21 and 22: CLASSIFICATION OF FLAPS 9 Circulati
Page 23 and 24: CLASSIFICATION OF FLAPS 11 • Exam
Page 25 and 26: GEOMETRY OF LOCAL FLAPS 13 • Borg
Page 27 and 28: The five-flap plasty GEOMETRY OF LO
Page 29 and 30: V-Y GEOMETRY OF LOCAL FLAPS 17 •
Page 31 and 32: The rhomboid flap The rhomboid flap
Page 33 and 34: WOUND HEALING AND SKIN GRAFTS 21 Wo
Page 35 and 36: Collagen WOUND HEALING AND SKIN GRA
Page 37 and 38: WOUND HEALING AND SKIN GRAFTS 25
Page 39 and 40: WOUND HEALING AND SKIN GRAFTS 27
Page 41 and 42: • Cortical bone consists of: BONE
Page 43 and 44: Intrinsic graft factors NERVE HEALI
Page 45 and 46: • First-degree injury NERVE HEALI
Page 47 and 48: TENDON HEALING 35 • Graft lengths
Page 49 and 50: Inflammation TENDON HEALING 37 •
Page 51 and 52: Active flexion • This results in
Page 53 and 54: ALLOPLASTIC IMPLANTATION 41 • Dis
Page 55 and 56: ALLOPLASTIC IMPLANTATION 43 • It
Page 57 and 58: Methylmethacrylate ALLOPLASTIC IMPL
Page 59 and 60: SUTURES AND SUTURING 47 • They ar
Page 61 and 62: Intradermal skin suturing SUTURES A
Page 63 and 64:
Polydioxanone TISSUE EXPANSION 51
Page 65 and 66:
• In the vicinity of an immature
Page 67 and 68:
FURTHER READING 55 Jackson IT. Loca
Page 69 and 70:
Actinic keratosis BENIGN NON- PIGME
Page 71 and 72:
BENIGN NON- PIGMENTED SKIN LESIONS
Page 73 and 74:
BENIGN PIGMENTED SKIN LESIONS 61
Page 75 and 76:
Junctional naevi BENIGN PIGMENTED S
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Naevus of Ito MALIGNANT NON- PIGMEN
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• Infiltrative MALIGNANT NON- PIG
Page 81 and 82:
MALIGNANT MELANOMA 69 • These tum
Page 83 and 84:
MALIGNANT MELANOMA 71 Clark’s lev
Page 85 and 86:
MALIGNANT MELANOMA 73 • Excision
Page 87 and 88:
Koops et al. • J Clin Oncol 1998;
Page 89 and 90:
Deep sarcomas Presentation SARCOMA
Page 91 and 92:
3 The head and neck Embryology, 79
Page 93 and 94:
CRANIOFACIAL SURGERY 81 • The lat
Page 95 and 96:
Cleft 4 • This is also known as t
Page 97 and 98:
CRANIOFACIAL SURGERY 85 • The loc
Page 99 and 100:
Apert’s syndrome CRANIOFACIAL SUR
Page 101 and 102:
CRANIOFACIAL SURGERY 89 • Median
Page 103 and 104:
Orbit CRANIOFACIAL SURGERY 91 • P
Page 105 and 106:
3 Free-tissue transfer 4 Osteotomie
Page 107 and 108:
CLEFT LIP 95 • Failure of mesench
Page 109 and 110:
Schweckendiek technique CLEFT LIP 9
Page 111 and 112:
• Advantages: • The technique i
Page 113 and 114:
CLEFT PALATE 101 • The muscle bun
Page 115 and 116:
• A: abnormal face • T: thymic
Page 117 and 118:
CLEFT PALATE 105 • The muscle sli
Page 119 and 120:
HEAD AND NECK CANCER 107 • N3: a
Page 121 and 122:
Comprehensive neck dissection HEAD
Page 123 and 124:
• Of these, the complications may
Page 125 and 126:
• Larynx • Trachea and upper br
Page 127 and 128:
Mucoepidermoid carcinoma HEAD AND N
Page 129 and 130:
HEAD AND NECK CANCER 117 • The co
Page 131 and 132:
Treatment HEAD AND NECK CANCER 119
Page 133 and 134:
HEAD AND NECK CANCER 121 • Bony r
Page 135 and 136:
FACIAL FRACTURES AND SOFT- TISSUE I
Page 137 and 138:
Page 139 and 140:
• Malocclusion FACIAL FRACTURES A
Page 141 and 142:
Page 143 and 144:
• CT scanning FACIAL FRACTURES AN
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
OCULOPLASTIC SURGERY 139 • The up
Page 153 and 154:
OCULOPLASTIC SURGERY 141 Alternativ
Page 155 and 156:
OCULOPLASTIC SURGERY 143 Excision o
Page 157 and 158:
• They occur in: • Patients wit
Page 159 and 160:
5 Cervical branch FACIAL PALSY 147
Page 161 and 162:
FACIAL PALSY 149 • A strip of spe
Page 163 and 164:
• Nerve transfers FACIAL PALSY 15
Page 165 and 166:
ABNORMALITIES OF THE EAR 153 • Th
Page 167 and 168:
ABNORMALITIES OF THE EAR 155 • Th
Page 169 and 170:
ABNORMALITIES OF THE EAR 157 Specif
Page 171 and 172:
VASCULAR ABNORMALITIES 159 • The
Page 173 and 174:
Non-invasive treatments VASCULAR AB
Page 175 and 176:
VASCULAR ABNORMALITIES 163 • They
Page 177 and 178:
• It is associated with: • Meni
Page 179 and 180:
FURTHER READING 167 Spauwen PH, Goo
Page 181 and 182:
BREAST REDUCTION 169 • The anteri
Page 183 and 184:
• This technique has the followin
Page 185 and 186:
• Herniation of the NAC • Stret
Page 187 and 188:
Excisional techniques BREAST AUGMEN
Page 189 and 190:
BREAST AUGMENTATION 177 • This te
Page 191 and 192:
• Non-invasive tumours • Ductal
Page 193 and 194:
Surgical treatment BREAST CANCER 18
Page 195 and 196:
BREAST RECONSTRUCTION 183 • Lesio
Page 197 and 198:
BREAST RECONSTRUCTION 185 • Varia
Page 199 and 200:
Superior gluteal perforator flaps B
Page 201 and 202:
CHEST WALL RECONSTRUCTING 189 • E
Page 203 and 204:
FURTHER READING 191 Pectoralis majo
Page 205 and 206:
Embryology 5 The upper limb Embryol
Page 207 and 208:
1 Failure of formation • Transver
Page 209 and 210:
CONGENITAL DEFORMITIES 197 Classifi
Page 211 and 212:
CONGENITAL DEFORMITIES 199 • Ulna
Page 213 and 214:
Camptodactyly CONGENITAL DEFORMITIE
Page 215 and 216:
CONGENITAL DEFORMITIES 203 • Clin
Page 217 and 218:
• Type 2: duplicated distal phala
Page 219 and 220:
• Microvascular free joint or bon
Page 221 and 222:
• Abnormalities of the scalene mu
Page 223 and 224:
NERVE COMPRESSION 211 • Tinel’s
Page 225 and 226:
NERVE COMPRESSION 213 1 Neurolysis
Page 227 and 228:
• Sensory signs include: • A po
Page 229 and 230:
TENDON TRANSFERS 217 Symptoms Pain
Page 231 and 232:
• The ideal tension varies betwee
Page 233 and 234:
DUPUYTREN’ S DISEASE 221 • ECRB
Page 235 and 236:
3 The lateral digital sheet 4 Grays
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Fat • Lipoma • Angiolipoma •
Page 239 and 240:
Carpometacarpal boss TUMOURS 227
Page 241 and 242:
TUMOURS 229 Giant cell tumours of t
Page 243 and 244:
• Pseudogout • Systemic lupus e
Page 245 and 246:
1 Proliferationasynovial swelling a
Page 247 and 248:
• Findings on examination include
Page 249 and 250:
ARTHRITIS 237 • The resultant imb
Page 251 and 252:
Chronic tophaceous gout HAND INFECT
Page 253 and 254:
4 Pain on passive extension. HAND I
Page 255 and 256:
6 The lower limb Leg ulcers, 243 Lo
Page 257 and 258:
• It is normally in the region of
Page 259 and 260:
Mangled extremity severity score LO
Page 261 and 262:
LOWER- LIMB TRAUMA 249 4 This fasci
Page 263 and 264:
The lymphatic system Anatomy LYMPHO
Page 265 and 266:
2Infection LYMPHOEDEMA 253 • The
Page 267 and 268:
LYMPHOEDEMA 255 • Phase twoaconse
Page 269 and 270:
4 Heel 5 Malleolus 6 Occiput. PRESS
Page 271 and 272:
• Pressure dispersion PRESSURE SO
Page 273 and 274:
FURTHER READING 261 Eshima I, Mathe
Page 275 and 276:
Embryology of the sexual organs Int
Page 277 and 278:
HYPOSPADIAS 265 • The tunica albu
Page 279 and 280:
HYPOSPADIAS 267 The Mathieu procedu
Page 281 and 282:
• The dorsal surface of the penis
Page 283 and 284:
VAGINAL AGENESIS 271 • Patients w
Page 285 and 286:
Thermal burns 8 Burns Thermal burns
Page 287 and 288:
• A high respiratory rate • Con
Page 289 and 290:
THERMAL BURNS 277 • Adults with b
Page 291 and 292:
THERMAL BURNS 279 • Full-thicknes
Page 293 and 294:
6Disability CHEMICAL BURNS 281 •
Page 295 and 296:
FURTHER READING 283 • Lightning s
Page 297 and 298:
PATHOPHYSIOLOGY OF VESSEL HEALING 2
Page 299 and 300:
TECHNIQUE 287 Equipment Successful
Page 301 and 302:
POST- OPERATIVE MANAGEMENT 289 Post
Page 303 and 304:
FURTHER READING 291 Further reading
Page 305 and 306:
BLEPHAROPLASTY 293 • This is asse
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BLEPHAROPLASTY 295 • The fat pads
Page 309 and 310:
The greater auricular nerve • Thi
Page 311 and 312:
Rhinoplasty Anatomy Skeleton The sk
Page 313 and 314:
Techniques RHINOPLASTY 301 • Some
Page 315 and 316:
• Sutures can be placed: LIPOSUCT
Page 317:
FURTHER READING 305 Hamra ST. The d
Page 320 and 321:
308 INDEX breast (cont.) screening
Page 322 and 323:
310 INDEX interpolation flaps—19
Page 324 and 325:
312 INDEX skin grafts—26-8 follow
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