Key notes on plastic surgery/Adrian M. Richards

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1 18 GENERAL PRINCIPLES Pivot flaps x Original defect y 2y Transposition flaps These flaps are transposed into the defect, leaving a donor site which is closed by some other means (often a skin graft). Pivot point Transposition flaps with direct closure of donor site 2x 2x Line of greatest tension Area of excess skin or dog ear Secondary defect Secondary defect • These include the rhomboid flap (Limberg flap) and the Dufourmontel flap. • These flaps are similar in concept but vary in geometry. • Both flaps should be designed so as to leave the donor site scar lying parallel to the RSTLs.
The rhomboid flap The rhomboid flap LME RSTL Loose skin The Dufourmontel flap Interpolation flaps GEOMETRY OF LOCAL FLAPS 19 x x 120° x 60° x x x Excised area 60° • These flaps are raised from local, but not adjacent, skin. • The pedicle must therefore be passed either over or under an intervening skin bridge. The Dufourmontel flap 150° b a c Intact skin bridge 30° Defect a Skin paddle b c De-epithelialized skin pedicle Pivot point 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 and 12: ABBREVIATIONS ix LME line of maximu
Page 13 and 14: 1 General principles Structure and
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: V-Y GEOMETRY OF LOCAL FLAPS 17 •
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
Page 77 and 78: Naevus of Ito MALIGNANT NON- PIGMEN
Page 79 and 80: • Infiltrative MALIGNANT NON- PIG
Page 81 and 82:
MALIGNANT MELANOMA 69 • These tum
Page 83 and 84:
MALIGNANT MELANOMA 71 Clark’s lev
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MALIGNANT MELANOMA 73 • Excision
Page 87 and 88:
Koops et al. • J Clin Oncol 1998;
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Deep sarcomas Presentation SARCOMA
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3 The head and neck Embryology, 79
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CRANIOFACIAL SURGERY 81 • The lat
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Cleft 4 • This is also known as t
Page 97 and 98:
CRANIOFACIAL SURGERY 85 • The loc
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Apert’s syndrome CRANIOFACIAL SUR
Page 101 and 102:
CRANIOFACIAL SURGERY 89 • Median
Page 103 and 104:
Orbit CRANIOFACIAL SURGERY 91 • P
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3 Free-tissue transfer 4 Osteotomie
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CLEFT LIP 95 • Failure of mesench
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Schweckendiek technique CLEFT LIP 9
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• Advantages: • The technique i
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CLEFT PALATE 101 • The muscle bun
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• A: abnormal face • T: thymic
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CLEFT PALATE 105 • The muscle sli
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HEAD AND NECK CANCER 107 • N3: a
Page 121 and 122:
Comprehensive neck dissection HEAD
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• Of these, the complications may
Page 125 and 126:
• Larynx • Trachea and upper br
Page 127 and 128:
Mucoepidermoid carcinoma HEAD AND N
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HEAD AND NECK CANCER 117 • The co
Page 131 and 132:
Treatment HEAD AND NECK CANCER 119
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HEAD AND NECK CANCER 121 • Bony r
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FACIAL FRACTURES AND SOFT- TISSUE I
Page 137 and 138:
Page 139 and 140:
• Malocclusion FACIAL FRACTURES A
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Page 143 and 144:
• CT scanning FACIAL FRACTURES AN
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Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
OCULOPLASTIC SURGERY 139 • The up
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OCULOPLASTIC SURGERY 141 Alternativ
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OCULOPLASTIC SURGERY 143 Excision o
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• They occur in: • Patients wit
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5 Cervical branch FACIAL PALSY 147
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FACIAL PALSY 149 • A strip of spe
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• Nerve transfers FACIAL PALSY 15
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ABNORMALITIES OF THE EAR 153 • Th
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ABNORMALITIES OF THE EAR 155 • Th
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ABNORMALITIES OF THE EAR 157 Specif
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VASCULAR ABNORMALITIES 159 • The
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Non-invasive treatments VASCULAR AB
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VASCULAR ABNORMALITIES 163 • They
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• It is associated with: • Meni
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FURTHER READING 167 Spauwen PH, Goo
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BREAST REDUCTION 169 • The anteri
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• This technique has the followin
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• Herniation of the NAC • Stret
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Excisional techniques BREAST AUGMEN
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BREAST AUGMENTATION 177 • This te
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• Non-invasive tumours • Ductal
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Surgical treatment BREAST CANCER 18
Page 195 and 196:
BREAST RECONSTRUCTION 183 • Lesio
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BREAST RECONSTRUCTION 185 • Varia
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Superior gluteal perforator flaps B
Page 201 and 202:
CHEST WALL RECONSTRUCTING 189 • E
Page 203 and 204:
FURTHER READING 191 Pectoralis majo
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Embryology 5 The upper limb Embryol
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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
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3 The lateral digital sheet 4 Grays
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Fat • Lipoma • Angiolipoma •
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Carpometacarpal boss TUMOURS 227
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TUMOURS 229 Giant cell tumours of t
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• Pseudogout • Systemic lupus e
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1 Proliferationasynovial swelling a
Page 247 and 248:
• Findings on examination include
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ARTHRITIS 237 • The resultant imb
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Chronic tophaceous gout HAND INFECT
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4 Pain on passive extension. HAND I
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6 The lower limb Leg ulcers, 243 Lo
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• 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
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The lymphatic system Anatomy LYMPHO
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2Infection LYMPHOEDEMA 253 • The
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LYMPHOEDEMA 255 • Phase twoaconse
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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
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• 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
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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
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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
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• Sutures can be placed: LIPOSUCT
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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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