Textbook of Plastic and Reconstructive Surgery Textbook of Plastic and Reconstructive Surgery Edited by Deepak M. Butler, Shadi Ghali First published in 2016 by UCL Press University College London Gower Street London WC1E 6BT Available to download free: www.uk/ucl-press Text © Contributors, 2016 Images © Contributors and copyright holders named in the captions, 2016 A CIP catalogue record for this book is available from The British Library. This book is published under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International license (CC BY-NC-ND 4. This license allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated.
Further details about CC BY licenses are available at http://creativecommons.org/ licenses/by/4.0 The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. The user is advised to always check the product information and clinical procedures with the most up-to-date published product information and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or misuse or misapplication of material in this work.978191063394 Table of Contents List of Figures viii List of Tables xvi List of Abbreviations xxi List of Contributors xxvii SECTION 1: GENERAL 1 Principles of Plastic Surgery, Wound Healing, Skin Grafts and Flaps 3 George Adigbli, Feras Alshomer, Jekaterina Maksimcuka, Shadi Ghali 2 Abdominal Wall Reconstruction 38 Ali Alhamdi, Shadi Ghali SECTION 2: CANCER 3 Skin Cancer for the Plastic Surgeon 61 Sophia Opel, Shadi Ghali 4 Oral and Oropharyngeal Cancer 77 Jatinder T. Virdee, Nicholas Kalavrezos SECTION 3: BURNS AND TRAUMA 5 Burns 103 Sebastian Salinas, Salman Mofti, Naime Moimen v vi Table of C ontents 6 Burn Reconstructive Surgery 122 Barinder Takhar, Ahmad B.
Al-Ali, Naime Moimen 7 Soft Tissue Injuries of the Hand 155 Hiba Khan, Bran Sivakumar 8 Lower Limb Trauma and Reconstruction 193 Rebecca Nicholas, Ayyaz Quddus, Jon Simmons 9 Injuries of the Facial Skeleton 208 Tom W. Andrew, Nicholas Kalavrezos SECTION 4: PAEDIATRIC PLASTIC SURGERY 10 Congenital Hand Abnormalities 229 Benjamin Way, Bran Sivakumar 11 Ear Reconstruction 248 Aurora Almadori, Abdulaziz Khurshed, Ali Jafar, Ahmad B. Al-Ali, Peter E. Butler 12 Craniofacial Surgery: Craniosynostosis Syndromes and Cleft Lip and Palate 263 Ahmed Al-Hadad, Shafiq Rahman 13 Genital Reconstruction 279 Shomari Zack-Williams, Debbie Hunt, Asif Muneer, Sarah Creighton 14 Vascular Anomalies 313 Wenceslao M.
Calonge, Juan Carlos López-Gutiérrez, Neil Bulstrode SECTION 5: AESTHETIC SURGERY 15 Liposuction 333 Nina Oliver, Omar Khan Pathan, Ash Mosahebi 16 Facial Aesthetic Surgery 346 Muholan Kanapathy, Niall Kirkpatrick 17 Blepharoplasty – Special Focus on Asian Blepharoplasty 374 Billy Ching Leung, Kimberley Lau, Hugo Henderson 18 Aesthetic Breast Surgery 387 Log Murugesan, Julia Ruston, Patrick Mallucci Tabl e of Conten ts vii 19 Body Contouring 409 Zain Bukamal, Ash Mosahebi 20 The Evolution of Hair Transplant Surgery 431 Farhana Akter, Greg Williams Index 447 List of Figures 1 PRINCIPLES OF PLASTIC SURGERY, WOUND HEALING, SKIN GRAFTS AND FLAPS 1. The skin with its separate layers and appendages. The reconstructive ladder. Simple interrupted sutures.
Simple continuous sutures. Mattress sutures: horizontal (left) and vertical (right). The skin grafting process. Cormack and Lamberty classification.
Mathes and Nahai classification. 35 2 ABDOMINAL WALL RECONSTRUCTION 2. Anterior abdominal wall layers. Blood supply to the anterior abdominal wall.
Abdominal vascular zones. 46 viii L ist of f igu res ix 2. Algorithmic approach for patients. Tensor fascia lata flap design.
Rectus femoris anatomy and flap elevation. Anterolateral thigh flap: flap design. Groin flap design. Pedicled vastus lateralis with mesh reconstruction of abdominal wall defects after tumour excision.
Latissimus dorsi anatomy and free flap design. 56 3 SKIN CANCER FOR THE PLASTIC SURGEON 3. Elliptical excision with pre-defined excision margins. The ‘ABCDE’ rule.
AJCC staging of malignant melanoma. 71 4 ORAL AND OROPHARYNGEAL CANCER 4. Anatomy of the oral cavity. Age-standardised incidence (per 100,000) of men with oral cancer in 2012.
Age-standardised incidence (per 100,000) of women with oral cancer in 2012. Age-standardised mortality (per 100,000) of men with oral cancer in 2012. Age-standardised mortality (per 100,000) of women with oral cancer in 2012. Variations in the clinical presentation of oral cancer.
Variations in the visibility of oral lesions with different diagnostic tools. Variations in dysplasia in oropharyngeal squamous cell carcinoma. HPV-positive oropharyngeal cancer. Surgical approaches to oral cancer.
Depths of burn wounds. Jackson’s areas of local response. ‘Head first, face down’ sink immersion. Distribution of inflicted and unintentional burns on young children.
Rule of nine. 119 x List o f figures 6 BURN RECONSTRUCTIVE SURGERY 6. Consultation and assessment flow diagram. Timing of surgery and procedures.
The reconstructive ladder for post-burn reconstruction. Guidelines for the reconstructive process. The stages to graft healing ‘take’. Factors affecting skin graft ‘take’.
Full-thickness skin graft. Advantages and disadvantages of tissue expansion. Guidelines for successful tissue expansion. 148 7 SOFT TISSUE INJURIES OF THE HAND 7.
Bones of the hand. Deep flexor compartment of the forearm. Extensor compartment of the forearm. Arterial supply of hand.
Diagram showing sensory innervation of the hand. Testing flexor digitorum profundus function. Testing flexor digitorum superficialis function. Testing extensor digitorum communis function.
Structure of the tendon. Flexor pulley system. Flexor tendon repair techniques. Diagrammatic representation of the extensor attachment in fingers.
Structure of the nerve. Diagrammatic representation of Seddon’s classification of nerve injury. Diagrammatic representation of the cross-section of an artery. Diagrammatic representation of the nail.
Cross-section of the fingertip. Allen’s classification of finger-tip amputation. Incision and drainage of paronychia. 185 L ist of f igu res xi 7.
Deep fascial spaces. Flexor sheaths of fingers and thumb. 188 8 LOWER LIMB TRAUMA AND RECONSTRUCTION 8. The Gustilo & Anderson classification of open tibial fractures.
The Mangled Extremity Severity Score (MESS). Cross-sectional anatomy of lower limb and approach to four-compartment fasciotomy in compartment syndrome. 199 9 INJURIES OF THE FACIAL SKELETON 9. Illustration of frontal sinus anatomy.
Illustration of naso-orbitoethmoid fracture classification. Illustration of Le Fort fractures. Illustration of facial buttresses. Illustration of mandibular fracture site frequency.
Illustrations of ‘The Horizontal Rule of Fifths’ and ‘The Vertical Rule of Thirds’. 225 10 CONGENITAL HAND ABNORMALITIES 10. Abbreviated Swanson’s classification of congenital hand abnormalities. Radial longitudinal deficiency with ulnar bowing and thumb hypoplasia.
Soft tissue distractor for radial longitudinal deficiency. Marks indicate ulnocarpal alignment. Ulnar longitudinal deficiency. Type 2 cleft hand.
Type 4 thumb hypoplasia. Simple, complete third web syndactyly with markings for interdigitating flaps. Interdigitating flaps in syndactyly release. Bilateral type 3 ulnar polydactyly.
Wassel type 4 thumb duplication. Macrodactyly of middle and ring digits. Symbrachydactyly managed by vascularised toe transfer. Constriction ring syndrome.
245 xii List o f figures 11 EAR RECONSTRUCTION 11. Lateral surface of the external ear. The main components of an elastic cartilage. The therapeutic algorithm for partial ear reconstruction.
255 12 CRANIOFACIAL SURGERY: CRANIOSYNOSTOSIS SYNDROMES AND CLEFT LIP AND PALATE 12. Lateral view of skull anatomy. Illustration of the main skull sutures (superior view). A unilateral left-sided CL/P deformity in a neonate.
A bilateral CL/P defect present in a newborn. Facial characteristics associated with Apert syndrome. Le Fort osteotomy I–III. Monobloc osteotomy with fronto-orbital advancement.
Summary of craniosynostosis syndromes and CL/P. Urogenital system at 6 weeks. Foetal Leydig cell metabolism. Neurovascular sparing clitoroplasty for clitoromegaly and corporal tissue excision.
Cryptorchidism testicular positions. Appearance of bladder exstrophy. Penile anatomy and layers. Singapore fasciocutaneous flaps.
Gracilis myocutaneous flap boundaries. Ulcerated infantile haemangiomas on the upper lip (A) and neck (B). A case of infantile haemangioma after treatment by propranolol from 6–9 months of age. 317 L ist of f igu res xiii 14.
Two cases of rapid involuting congenital haemangioma at different locations. Pyogenic granuloma of the left cheek. Three successive stages in the evolution of a kaposiform haemangioendothelioma treated by a combination of acetylsalicylate, vincristine and ticlopidine. A patient with Sturge–Weber syndrome.
Venous malformation of the right arm. Two cases of lymphatic malformations, respectively involving the neck and tongue. Arteriovenous malformation of the right buttock. Common areas of liposuction on the trunk.
Common areas of liposuction on the upper and lower limbs. Water-assisted liposuction. Zones of adherence. Mercedes type cannula (three holes).
341 16 FACIAL AESTHETIC SURGERY 16. Soft tissue layers of the face. Features of the ageing face. Surface anatomy of the eyelid.
Cross-section of the upper eyelid. Blepharoplasty approaches on the lower eyelid. Alignment of the eyebrow. Topography and anatomy of the nose.
366 17 BLEPHAROPLASTY – SPECIAL FOCUS ON ASIAN BLEPHAROPLASTY 17. Variations of Asian upper eyelids. The anatomical differences between Asian and Caucasian eyelids. Suture ligation technique.
Surgical resection technique. Sagittal view of the surgical resection technique. Epicanthoplasty Z-plasty designs. 383 xiv List o f figures 18 AESTHETIC BREAST SURGERY 18.
Mammary ridge (milk line) running from the anterior axillary line through the nipple to the pubic tubercle. Tanner stages of breast development. Surface anatomy of the female breast. Blood supply to the breast.
Components of a breast implant. Shapes of breast implants. Dimensions of an implant. Profiles of breast implants.
Pre-operative measures. Anterior pull skin stretch. Soft tissue pinch test at the inframammary fold. Lassus vertical scar mastopexy.
Lejour vertical scar mastopexy. Hammond vertical scar mastopexy. Skin pattern for inverted-T mastopexy. Cannula 1, a standard single-slot cannula.
Cannula 2, a two-slot cannula. The two subcutaneous adipose tissue layers: superficial and deep. Skin indentation as a result of liposuction overcorrection. Before and after image of mini abdominoplasty.
Illustration of the mini abdominoplasty procedure once plication of the rectus muscle fascia is completed. Pre-operative marking for a full abdominoplasty. Full abdominoplasty: the technique. Circumferential body lift markings.
Circumferential body lift markings in the posterior view, illustrating an estimation of the final scar’s position above the gluteal crease. Massive weight loss patients usually present with excessive loose skin in the upper arm as well as other areas. Pre-operative upper arm skin markings. Appearance of the medial thigh, A.
after the procedure. 427 L ist of f igu res xv 20 THE EVOLUTION OF HAIR TRANSPLANT SURGERY 20. The human hair follicle: structure of the shaft. Embryology of hair.
The human hair growth cycle. The Norwood–Hamilton classification of male pattern baldness. The Ludwig classification of female pattern baldness. Punch tool inserted.
Hair removed with forceps. Hairs placed in Petri dishes and kept hydrated. Dissection of the donor strip. The trichophytic method of wound closure.
Insertion of grafts with forceps. 443 List of Tables 1 PRINCIPLES OF PLASTIC SURGERY, WOUND HEALING, SKIN GRAFTS AND FLAPS 1. The process of wound healing. Factors affecting wound healing.
Mathes and Nahai classification. 34 2 ABDOMINAL WALL RECONSTRUCTION 2. Abdominal wall defect classification. Grading system for ventral hernia.
Indications for planned hernia. Indication of free flaps in abdominal wall reconstruction. 55 3 SKIN CANCER FOR THE PLASTIC SURGEON 3. Risk factors associated with BCC development.
Assessing the patient in clinic. Prognostic factors for BCC. Indications for Mohs micrographic surgery. Risk factors associated with SCC development.
Prognostic factors for SCC. Criteria for urgent referral to a local skin cancer multidisciplinary team. Minimum data set required in histopathological description for malignant melanoma. Follow-up for malignant melanoma.
Quick reference of surgical excision margins. 73 xvi L ist of tabl es xvii 4 ORAL AND OROPHARYNGEAL CANCER 4. T staging for tumours of the lip, oral cavity and pharynx. N staging for oropharyngeal cancers.
M staging for oropharyngeal cancers. Factors affecting treatment choice. Flaps used in oral reconstructive surgery. Classification of burns by depth and surface area.
116 6 BURN RECONSTRUCTIVE SURGERY 6. Specific challenges associated with burn reconstructive surgery. Donor sites, advantages and disadvantages of FTSG and STSG. The differences between skin grafts and flaps.
Classification of muscle flaps: Mathes and Nahai. Indications for free flaps. Sources of donor sites for free flap transfers. 151 7 SOFT TISSUE INJURIES OF THE HAND 7.
Muscles of the flexor compartment of the forearm. Muscles of the lateral compartment of the forearm. Muscles of the extensor compartment of the forearm. Small muscles of the hand.
Motor function of nerves to the hand. Motor and sensory tests specific to each nerve of the hand.
