Vạt Da Và Phẫu Thuật Tái Tạo (Flaps and Reconstructive Surgery)

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FLAPS AND
RECONSTRUCTIVE
SURGERY
2nd Edition

This page intentionally left blank

2nd Edition
FLAPS AND
RECONSTRUCTIVE
SURGERY
Fu-Chan Wei MD, FACS
Distinguished Chair Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Chang Gung University
Medical College
Taipei, Taiwan
Samir Mardini MD
Professor of Surgery
Mayo Clinic College of Medicine
Program Director, Plastic Surgery
Surgical Director
Essam and Dalal Obaid Center for
Reconstructive Transplant Surgery
Mayo Clinic
Rochester, MN, USA
For additional online content visit
Edinburgh  London  New York  Oxford  Philadelphia  St Louis  Sydney  Toronto 2017

© 2017, Elsevier Inc. All rights reserved.
First edition 2009
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instructions, or ideas contained in the material herein.
ISBN: 978-0-323-24322-3
Printed in China
Last digit is the print number:  9  8  7  6  5  4  3  2  1
Content Strategist: Belinda Kuhn
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Design: Miles Hitchen
Illustration Manager: Karen Giacomucci
Illustrator: Antbits
Marketing Manager: Melissa Fogarty

v
Contents
9 Robotic Applications in Plastic and
Reconstructive Surgery,  e36
Jesse Selber
Expert Commentary Philippe Liverneaux
PART 2 CLINICAL ANATOMY
AND RECIPIENT VESSEL
ANATOMY, SELECTION,
AND EXPOSURE
10 Clinical Anatomy of the Head and Neck, and
Recipient Vessel Selection,  61
Peter C. Neligan, Basel Sharaf
11 Clinical Anatomy and Recipient Vessel
Selection in the Chest, Abdomen, Groin,
and Back,  75
Joshua Fosnot, Joseph M. Serletti
12 Clinical Anatomy and Recipient Vessel Selection
in the Upper Extremity,  89
Karim Bakri
13 Clinical Anatomy and Recipient Vessel
Selection and Exposure in the Lower
Extremity,  115
Christopher J. Pannucci, T. Shane Johnson,
L. Scott Levin
PART 3 RECONSTRUCTION
14 Head and Neck Reconstruction,  138
Michael Sosin, Mark Fisher, Eduardo D. Rodriguez
Expert Commentary Paul N. Manson;
Richard E. Hayden
15 Facial Reanimation: Evolution and
Refinements,  162
Julia K. Terzis, Dimitrios Karypidis
16 Breast Reconstruction,  183
Maurice Y. Nahabedian
Expert Commentaries David W. Chang;
Venkat V. Ramakrishnan
Video Table of Contents,  ix
List of Chapter Contributors,  xv
List of Expert Commentary Contributors,  xxiv
Video Contributor List,  xxx
Preface,  xxxix
Dedication,  xli
Acknowledgments,  xlii
PART 1 PRINCIPLES
1 Problem Analysis in Reconstructive Surgery:
Reconstructive Ladders, Elevators, and Surgical
Judgment,  1
Nicholas B. Vedder
Expert Commentary William Lineaweaver
2 Classification of Flaps,  e1
Geoffrey G. Hallock, Reza Ahmadzadeh,
Steven F. Morris
Expert Commentary Michel Saint-Cyr
3 Considerations in Flap Selection,  6
Geoffrey G. Hallock
Expert Commentary Milomir Ninković
4 Emerging Technology in Reconstructive
Surgery,  e11
Matthew M. Hanasono
Expert Commentary Uros Ahcan
5 Prefabrication and Prelamination,  16
Indranil Sinha, Lifei Guo, Julian J. Pribaz
6 Tissue Engineering,  e25
Jan Jeroen Vranckx, Margot Den Hondt
Expert Commentary James Chang
7 Percutaneous Aponeurotomy and Lipofilling
(PALF): A Regenerative Alternative to
the Flap,  28
Roger Karl Khouri Jr, Roger K. Khouri
Expert Commentary Peter Rubin
8 Lymphedema: Microsurgical
Reconstruction,  40
Joseph H. Dayan, Jaume Masia Ayala, Isao Koshima
Expert Commentaries David W. Chang;
Ming-Huei Cheng

vi
CONTENTS
17 Chest and Back Reconstruction,  203
Amanda K. Silva, David H. Song
Expert Commentary Lawrence J. Gottlieb
18 Abdominal Wall Reconstruction,  218
Donald P. Baumann, Charles E. Butler
Expert Commentary Jan Jeroen Vranckx
19 Pelvic and Urogenital Reconstruction,  e43
Jens U. Berli, Richard J. Redett III
Expert Commentary Christopher J. Salgado
20 Upper Extremity Reconstruction,  227
Michael W. Neumeister
Expert Commentary Francisco Del Piñal
21 Adult Brachial Plexus Injury (A-BPI)
Reconstruction,  242
David Chwei-Chin Chuang
Expert Commentary Wieslawa De Pawlikowski
22 Lower Extremity Reconstruction,  255
Frank Fang, Chih-Hung Lin
Expert Commentary Lawrence Colen
23 Functional Muscle Transfers for Various
Purposes,  275
Milomir Ninković, P. Niclas Broer, S. Voigt, Marina Ninković
Expert Commentary Milan Stevanovic and Frances Sharpe
SECTION A MICROSURGERY
TECHNIQUES,  295
24 Nerves,  295
Kazuteru Doi, Alison Snyder-Warwick
Expert Commentaries Ivica Ducic;
Huan Wang and Robert J. Spinner
25 Vessels,  310
S. Raja Sabapathy
Expert Commentary Joon Pio (JP) Hong
SECTION B FLAP HANDLING AND
TECHNICAL TIPS,  e62
26 Thinning and Tailoring,  e62
Naohiro Kimura
Expert Commentary Hung-Chi Chen
27 Avoiding Complications,  323
Jeremy L. Wilson, Andrew N. Morritt, Kenneth L. Fan,
Karen Kim Evans, Wayne A. Morrison
Expert Commentary Edward J. Caterson,
Stephanie A. Caterson, and Julian J. Pribaz
28 Flap Re-exploration and Salvage,  333
Jonathan Bank, Lawrence J. Gottlieb
Expert Commentary Roman Skoracki
SECTION C PRE AND POSTOPERATIVE
MANAGEMENT,  348
29 Postoperative Care,  348
Jonathan Rimler, Audrey Nguyen, Gregory R.D. Evans
Expert Commentary Lucie Lessard
30 Reconstructive Options Following Flap
Failure,  357
Michael J. Miller, Rajiv Chandawarkar
Expert Commentary Stefan O.P. Hofer
PART 4 CONVENTIONAL
WORKHORSE FLAPS
SECTION A LOCAL AND FREE FLAPS IN
THE HEAD AND NECK,  367
31 Local Flaps in the Head and Neck: Forehead,
FAMM, Submental, Nasolabial and
Cervicofacial Flaps,  367
Robert L. Walton, Thomas Willson, Elliot Hirsch
32 Temporoparietal Fascia Flap,  e72
Steven L. Moran, Eric Santamaria
Expert Commentary Zung-Chung Chen
SECTION B LOCAL AND FREE FLAPS IN
THE CHEST,  387
33 Supraclavicular Artery Flap,  387
Michael R. Zenn
Expert Commentary Michael W. Chu and Ernest S. Chiu
34 Pectoralis Major Flap,  396
William Ignace Wei, Chan Yu Wai
Expert Commentary Hung-Chi Chen
35 Deltopectoral Flap and Internal Mammary Artery
Perforator Flap,  e87
J.R. Castro, Charles E. Stewart IV, Mark L. Urken
Expert Commentary Eric M. Genden
SECTION C LOCAL AND FREE FLAPS IN
THE ABDOMEN,  e98
36 Omentum, Superior Epigastric, and External/
Internal Oblique Flaps,  e98
Marina Barandun, Anne O’Neill, Stefan O.P. Hofer
Expert Commentary Bien-Keem Tan
37 Rectus Abdominis Flap,  416
Marcus Castro Ferreira, Luis Henrique Ishida,
Lincoln Saito Millan
Expert Commentary Brian T. Carlsen
38 Jejunum Flap,  e112
Hung-Chi Chen, Stefano Spanio di Spilimbergo,
Karen Kim Evans, Samir Mardini
Expert Commentaries John J. Coleman III;
Michael J.A. Klebuc
SECTION D LOCAL AND FREE FLAPS IN
THE BACK,  e134
39 Trapezius Flap,  e134
Franz Haas, Andreas Weiglein, Neal D. Futran
Expert Commentary Bassem T. Elhassan

CONTENTS
vii
40 Scapular and Parascapular Flaps,  432
Claudio Angrigiani, Matthew M. Hanasono
Expert Commentary Geoffrey G. Hallock
41 Latissimus Dorsi Flap,  446
Günter Germann, Matthias Reichenberger
Expert Commentary Theodore A. Kung and Paul S. Cederna
SECTION E LOCAL AND FREE FLAPS IN
THE PELVIS, GROIN, AND
BUTTOCK,  464
42 Iliac Flap,  464
James S. Brown
Expert Commentary Roberto Puxeddu
43 Groin Flap and Superficial Circumflex Iliac
Artery Perforator Flap,  478
Isao Koshima, Kensuke Tashiro, Samir Mardini,
Fu-Chan Wei
Expert Commentary Joon Pio (JP) Hong
44 Gluteus Flap,  e157
Moustapha Hamdi
SECTION F LOCAL AND FREE FLAPS IN THE
UPPER EXTREMITY,  491
45 Pedicled Flaps of the Hand,  491
James P. Higgins, Ryan D. Katz
Expert Commentary Don Lalonde
46 Lateral Arm Flap,  511
Milomir Ninković, Ulf Dornseifer
Expert Commentary Yu-Te Lin and Chih-Hung Lin
47 Radial Forearm Flap,  525
Amir H. Taghinia, Joseph Upton
Expert Commentary Hani Sbitany
SECTION G LOCAL AND FREE FLAPS IN THE
LOWER EXTREMITY,  540
48 Local Flaps in the Foot,  540
Kevin D. Han, Karen Kim Evans, Christopher E. Attinger
Expert Commentary Randy Sherman
49 Gracilis Flap,  559
Ronald M. Zuker, Robert D. Bains
Expert Commentary Yuan-Kun Tu
50 Gastrocnemius Flap,  570
Alain-Charles Masquelet, Paolo Sassu, Marco Innocenti
Expert Commentary Geoffrey G. Hallock
51 Soleus Flap,  581
Jacques Baudet, Philippe Pelissier, Vincent Casoli,
Philippe Caix, Félix J. Farías, Wieslawa De Pawlikowski
Expert Commentary Randy Sherman and
Michael J. A. Klebuc
52 Fibula Flap,  596
Christopher J. Salgado, Harvey Chim, Steven L. Moran,
Fu-Chan Wei, Samir Mardini
Expert Commentary Marco Innocenti
53 Glabrous Skin Flaps,  e176
Gregory M. Buncke, Rudolf F. Buntic
Expert Commentary Mohammad M. Al-Qattan
54 Toe Flaps and Toe Transplantation,  613
Chih-Hung Lin, Paolo Sassu
Expert Commentaries David T.W. Chiu and
Wenhai Sun; Fu-Chan Wei
55 Medial Femoral Condyle and Descending
Genicular Artery Perforator Flaps,  636
Matthew Houdek, Heinz Bürger, Steven L. Moran
Expert Commentary Tarek Abdalla El-Gammal
PART 5 PERFORATOR-BASED
WORKHORSE FLAPS
56 Perforator Flaps in the Lateral Thoracic
Region,  648
Jeong-Tae Kim
Expert Commentary Stephanie A. Caterson and
Edward J. Caterson
57 Deep and Superficial Inferior Epigastric Artery
Perforator Flaps,  668
Alain R. Gagnon, Phillip N. Blondeel
Expert Commentary Aldona J. Spiegel and
Robert J. Allen Sr
58 Superior and Inferior Gluteal Artery Perforator
Flaps,  687
Robert J. Allen Sr, Joshua L. Levine,
Katherine A. Impastato
Expert Commentary Moustapha Hamdi
59 Anterolateral and Anteromedial
Thigh Flaps,  700
Samir Mardini, Harvey Chim, Fu-Chan Wei
Expert Commentary Peirong Yu
60 Tensor Fascia Lata Flap,  e190
Ömer Özkan, O. Koray Coşkunfırat,
Özlenen Özkan
Expert Commentary Bishara Atiyeh
and Fadel M. Chahine
61 Posterior Tibial Artery Perforator Flap,  717
Niri S. Niranjan
Expert Commentary Alexandru V. Georgescu
62 Free-style Flaps,  729
Fu-Chan Wei, Seng-Feng Jeng, Samir Mardini
Expert Commentary Michel Saint-Cyr
PART 6 RECONSTRUCTIVE
TRANSPLANT SURGERY
63 Starting a Reconstructive Transplantation
Program,  e204
Laurant Lantieri, Hatem Amer
Expert Commentary Palmina Petruzzo

viii
CONTENTS
64 Face Transplantation,  739
Joseph A. Ricci, Bohdan Pomahac
Expert Commentary Samir Mardini and
Hatem Amer
65 Hand and Upper Extremity
Transplantation,  754
Jaimie T. Shores, Gerald Brandacher, W.P. Andrew Lee
Expert Commentary L. Scott Levin
66 Laryngeal, Abdominal Wall, and Uterus
Transplantation,  770
Ömer Özkan, Özlenen Özkan
Expert Commentary David W. Mathes
67 Immunology and Research in Reconstructive
Transplantation,  e210
Maria Z. Siemionow, Bahar Bassiri Gharb,
Antonio Rampazzo
Expert Commentary Yur-Ren Kuo
68 Peripheral Nerve Allotransplantation,  779
Amy M. Moore, James T.W. Saunders,
Susan E. Mackinnon
Expert Commentary Yur-Ren Kuo
Index,  799

ix
Video Table of Contents

3.1 Scalp Split Thickness Skin Graft
Geoffrey G. Hallock

7.1 Lipografter / Jackhammer Grafting
Roger Karl Khouri Jr and Roger K. Khouri

7.2 Fat Grafting for Breast Reconstruction
Michel Saint-Cyr

8.1 LV Bypass Preoperative Planning in Lower
Extremity Lymphedema
Michel Saint-Cyr

8.2 Lymphovenous Bypass
Edward I-Fei Chang

8.3 Vascularized Groin Lymph Node
Transfer for Upper Extremity
Lymphedema
Jaume Masia Ayala, Gemma Pons

8.4 Superficial Circumflex Iliac Artery Perforator
Flap (SCIP Flap) for Lymph Node Transfer in
Lymphedema Treatment
Jaume Masia Ayala

8.5 Axillary Lymph Node Transfer for Lower
Extremity Lymphedema
Joseph H. Dayan

9.1 Trans Oral Robotic Surgery
Jesse Selber

9.2 External View of Robotic LD
Jesse Selber

9.3 Robotic Harvest of Rectus Abdominis
Jesse Selber

9.4 Robotic Harvest of Latissimus Dorsi
Jesse Selber

9.5 Robotic Microvascular Anastomosis
Jesse Selber

9.6 Robotic Lymphaticovenous Bypass
Jesse Selber
10.01 Exposure of Superficial Temporal Vessels
Basel Sharaf
10.02 Exposure of the Facial Vessels
Basel Sharaf
10.03 Exposure of the Transverse Cervical Vessels
Basel Sharaf
10.04 Facial Nerve Anatomy
Michael J.A. Klebuc
10.05 Facial Nerve Anatomy, Clinical Case
Samir Mardini
10.06 Facial Nerve Anatomy and Stimulation
Samir Mardini
10.07 Facial Reanimation: Masseteric nerve to
Facial Nerve Transfer, Cross Facial
Nerve Grafting
Shai Rozen
10.08 Facial Reanimation: Preoperative Facial
Markings, Preparation of Face on Recipient
Side, Harvest of Partial Gracilis Functional
Muscle Flap, Masseter Nerve Dissection, and
Insetting of Gracilis to Paralyzed Side
Shai Rozen
11.01 Trunk Anatomy, Internal Mammary Artery
Exposure
Basel Sharaf
12.01 Exposure of the Brachial Artery in the Medial
Arm
Karim Bakri and Marissa Suchyta
12.02 Exposure of the Distal Brachial Artery and Its
Bifurcation in the Antecubital Fossa
Karim Bakri and Marissa Suchyta
12.03 Exposure of the Radial Artery in the Wrist
and Anatomic Snuffbox
Karim Bakri and Marissa Suchyta
12.04 Exposure of the Ulnar Artery at the Wrist and
Guyon’s Canal
Karim Bakri and Marissa Suchyta
13.01 Groin and Lower Extremity Landmarks
Basel Sharaf
13.02 Exposure of Posterior Tibial Vessels
Basel Sharaf
13.03 Exposure of the Dorsalis Pedis and Tibialis
Anterior
Basel Sharaf

x
Video Table of Contents
13.04 Dorsalis Pedis Exposure
Christopher J. Pannucci, T. Shane Johnson, and
L. Scott Levin
14.01 Ileocolon Flap for Reconstruction of the
Hypopharynx, Cervical Esophagus,
and Voice
Hung-Chi Chen and Samir Mardini
15.01 Babysitter Principle in Facial Reanimation
Julia K. Terzis
15.02 Techniques of Cross Facial Nerve Grafting
Julia K. Terzis
15.03 Gracilis Free Muscle Transfer for Facial
Reanimation
Julia K. Terzis
15.04 Pectoralis Minor Free Muscle Transfer for
Facial Reanimation
Julia K. Terzis
16.01 DIEP
Maurice Y. Nahabedian
16.02 Muscle Sparing Latissimus Dorsi
Michel Saint-Cyr
16.03 Breast Reconstruction with DIEP Flap Using 3
Dimensional Molding
Uros Ahcan
17.01 Chest Wall and Diaphragm Mesh
Reconstruction Moving With Respirations
Amanda K. Silva and David H. Song
17.02 Chest Wall Defect and Expanding Lung
Amanda K. Silva and David H. Song
17.03 Flap Inset
Amanda K. Silva and David H. Song
18.01 Component Separation
Samir Mardini
18.02 Pedicled Innervated Vastus Lateralis Muscle
for Abdominal Wall Reconstruction Case 1
Jan Jeroen Vranckx
18.03 Pedicled Innervated Vastus Lateralis Muscle
for Abdominal Wall Reconstruction Case 2
Jan Jeroen Vranckx
18.04 Pedicled Innervated Vastus Lateralis Muscle
for Abdominal Wall Reconstruction:
Dissection
Jan Jeroen Vranckx
19.01 Radial Forearm Free Flap Phalloplasty
Jessica Lynch, Jens U. Berli,
Richard J. Redett III
20.01 Great Toe Pulp Transfer to Reconstruct Non-
Painful Sensate Index Pulp Part 1
Fu-Chan Wei, Jay Hsin-Hung Chen,
Christopher G. Wallace
20.02 Great Toe Pulp Transfer to Reconstruct Non-
Painful Sensate Index Pulp Part 2
Fu-Chan Wei, Jay Hsin-Hung Chen,
Christopher G. Wallace
20.03 Second Toe Flap for Index Finger
Reconstruction
Fu-Chan Wei
21.01 Brachial Plexus Exploration and Exposure of
Transverse Cervical Artery
David Chwei-Chin Chuang
21.02 Adult Brachial Plexus Injury Clip 1
David Chwei-Chin Chuang
21.03 Adult Brachial Plexus Injury Clip 2
David Chwei-Chin Chuang
21.04 Shoulder Abduction Reconstruction By
Transfer of Latissimus, Teres Major, and
Clavicular Portion of Pectoralis Major
David Chwei-Chin Chuang
22.01 Reconstruction of Foot Dorsiflexion with Rectus
Femoris Functioning Muscle Transfer
David Chwei-Chin Chuang
22.02 Keystone Island Perforator Flaps for Thigh
Defects
Michel Saint-Cyr
22.03 Endoscopically-Assisted Medial Sural Artery
Perforator Flap Transfer for Foot
Reconstruction
Cheng-Hung Lin and Wyatt Ho
22.04 Pedicled Peroneal Artery Perforator Flap for
Reconstruction of a Soft Tissue Defect Over
the Tibia
Cheng-Hung Lin
22.05 Peroneal Artery Perforator Propeller Flap
Michel Saint-Cyr
22.06 Rectus Femoris Myocutaneous Flap
David Chwei-Chin Chuang
23.01 Peroneus Function After Reconstruction
Milomir Ninković
23.02 Facial Movement After Reconstruction
Milomir Ninković
24.01 Cross-Tongue Nerve Grafting for Lingual
Nerve Reconstruction
Federico Biglioli

Video Table of Contents
xi
39.01 Contralateral Trapezius Transfer
Bassem T. Elhassan
40.01 Scapular and Parascapular Flaps
Geoffrey G. Hallock
41.01 Latissimus Dorsi Flap
Günter Germann
41.02 Latissimus Dorsi Muscle Flap
Geoffrey G. Hallock
41.03 Latissimus Dorsi Flap
Yener Demirtas and Ömer Özkan
41.04 Preoperative Markings Extended Latissimus
Dorsi
Michel Saint-Cyr
41.05 Latissimus Dorsi Flap for Breast
Reconstruction
Michel Saint-Cyr
41.06 Composite Osteomuscular Flap of Latissimus
Dorsi and Rib
Alexandru V. Georgescu
42.01 Iliac Flap
Chih-Hung Lin
43.01 Groin Flap
Chih-Hung Lin
43.02 SCIP
Joon Pio (JP) Hong and Hyun-suk Suh
43.03 Groin Flap With Iliac Bone Harvest Based on
the Superficial Circumflex Iliac Artery
Chung-Chen Hsu
45.01 First Dorsal Metacarpal Artery Flap
Steven L. Moran
45.02 Posterior Interosseous Flap
Hung-Chi Chen
46.01 Extended Lateral Arm Flap
Milomir Ninković
46.02 Lateral Arm Flap for Reconstruction of a
Webspace Defect After Contracture Release
Fu-Chan Wei
47.01 Reverse Radial Forearm Flap
Joseph Upton and Amir H. Taghinia
47.02 Radial Forearm Flap
Geoffrey G. Hallock
47.03 The Suprafascial Harvest of the Radial
Forearm Flap
Fu-Chan Wei, Jason Su Shiuan-tzuen, Wyatt Ho,
and Nidal Farhan Al Deek
25.01 Microvascular Anastomosis of an Artery and
Vascular Coupling of a Vein
Robert J. Allen Sr
25.02 Microvascular Anastomosis of an Artery
and Vein
Hung-Chi Chen
25.03 Airborne Suture Tying Technique
Hung-Chi Chen and Samir Mardini
31.01 Forehead Flap
Julian J. Pribaz
31.02 Facial Artery Myo Mucosal Flap
Julian J. Pribaz
31.03 Submental Flap
Julian J. Pribaz
32.01 Temporoparietal Fascia Flap for Auricular
Reconstruction
Zung-Chung Chen
32.02 Scalp Fascia Flap (Temporoparietal
Fascia Flap)
Geoffrey G. Hallock
32.03 Temporoparietal Fascia Flap
Julian J. Pribaz
32.04 Bilateral Pedicled Temporalis Muscle Flaps
for Reconstruction of a Complete
Maxillectomy Defect
Ernesto Padula, Stefano Spanio Di Spilimbergo,
Roberto Squaquara, and Ugo Baciliero
33.01 Flaps
Michael R. Zenn
34.01 Pectoralis Major Flap
Geoffrey G. Hallock
34.02 Pectoralis Major Flap
Geoffrey L. Robb
35.01 Deltopectoral and Internal Mammary Artery
Perforator Flaps
Geoffrey L. Robb
37.01 Rectus Abdominis Flap
Geoffrey G. Hallock
38.01 Jejunum Flap for Esophageal Reconstruction
Hung-Chi Chen
38.02 Jejunum Flap
Hung-Chi Chen
38.03 Supercharged Pedicled Jejunum Interposition
for Esophageal Replacement
Shanda H. Blackmon

xii
Video Table of Contents
49.10 Stage 1 – Cross-Facial Nerve Grafting
for Smile
Ronald M. Zuker, Gregory H. Borschel,
Karen W.Y. Wong, Alison Snyder-Warwick,
and Andrew Yee
49.11 Double innervated gracilis free-flap transfer
for smiling reanimation
Federico Biglioli
49.12 Diagonal Upper Gracilis Flap
Joseph H. Dayan
50.01 Medial Gastrocnemius Flap
Geoffrey G. Hallock
50.02 Lateral Gastrocnemius Flap
Geoffrey G. Hallock
50.03 Medial Sural Artery Perforator Flap
Seng-Feng Jeng
50.04 Medial Sural Artery Perforator Flap and
Lateral Gastrocnemius Flap
Geoffrey G. Hallock
50.05 Medial Sural Artery Perforator Flap
Geoffrey G. Hallock
51.01 The Soleus Muscle Flap
Geoffrey G. Hallock
51.02 Hemi-Soleus Distally Based for Lower
Extremity Defect
Nidal Farhan Al Deek and Chung-Chen Hsu
52.01 Fibula Osteoseptocutaneous Flap
Fu-Chan Wei and Nidal Farhan Al Deek
52.02 Free Fibula Osteocutaneous Flap
Harvest
Edward I-Fei Chang
52.03 Harvest of the Fibula Osteoseptocutaneous
Flap Via Anterior Approach
Fu-Chan Wei
52.04 Fibula Osteoseptocutaneous Flap with Primary
Osteointegrated Implants for Mandible
Reconstruction
Fu-Chan Wei
52.05 Fibula Flap for Obliteration and Osseous
Reconstruction of a Persistent Frontal Basilar
Fracture Infection Associated with Nasofrontal
Outflow Tract Obstruction
Eduardo D. Rodriguez
52.06 Reconstruction of the Mandible with the
Preformed Matrixmandible and Fibula
OSC Flap
Nidal Farhan Al Deek, Duretti Fufa, and Fu-Chan Wei
47.04 Radial Forearm Flap, Suprafascial Dissection
Fu-Chan Wei
47.05 Radial Forearm Flap, Suprafascial
Fu-Chan Wei
47.06 Radial Forearm Flap for Buccal Defect
Reconstruction
Fu-Chan Wei
47.07 Radial Forearm Flap for Reconstruction of an
Upper Lip Defect
Fu-Chan Wei
47.08 Radial Forearm Fascia Flap Reverse Pedicled
Nicholas B. Vedder
47.09 Radial Forearm Flap Dissection and
Management of the Donor Site with a Full
Thickness Skin
Fu-Chan Wei
48.01 Distal Sural Flap
Geoffrey G. Hallock
49.01 Segmental Gracilis Muscle Transfer for Smile
in a Case of Möbius Syndrome
Ronald M. Zuker, Gregory H. Borschel,
Karen W.Y. Wong, Alison Snyder-Warwick,
and Andrew Yee
49.02 Gracilis Flap
Geoffrey G. Hallock
49.03 Facial Reanimation (Second Stage)
Reconstruction with a Gracilis Functioning
Muscle Transfer
David Chwei-Chin Chuang
49.04 Finger Flexion Reconstruction with Gracilis
Functioning Muscle Transfer
David Chwei-Chin Chuang
49.05 Gracillis Myocutaneous Flap Harvested for
Functional Muscle Transfer
David Chwei-Chin Chuang
49.06 Endoscopic Harvest of the Gracilis Muscle
Chih-Hung Lin
49.07 Preoperative Markings for Transverse Upper
Gracilis Myocutaneous Flap for Bilateral
Breast Reconstruction
Michel Saint-Cyr
49.08 Flap Harvest of Transverse Upper Gracilis
Myocutaneous Flap for Breast Reconstruction
Michel Saint-Cyr
49.09 Vertical Design Upper Gracilis Flap for Breast
Reconstruction
Michel Saint-Cyr

Video Table of Contents
xiii
54.13 Microsurgical Transplantation of the PIP Joint
of the Second Toe: Flap Harvest
Yu-Te Lin, Chung-Chen Hsu, Cheng-Hung Lin, and
Nidal Farhan Al Deek
54.14 Microsurgical Transplantation of the PIP Joint
of the Second Toe: Flap Inset
Yu-Te Lin, Chung-Chen Hsu, Cheng-Hung Lin, and
Nidal Farhan Al Deek
55.01 Medial Femoral Condyle Flap Based on
Descending Geniculate Vessel
Steven L. Moran
55.02 Medial Femoral Condyle Flap
Steven L. Moran
56.01 Perforator Flaps in the Lateral Thoracic
Area: Latissimus Dorsi Perforator Flap,
Thoracodorsal Perforator Flap, and
Lateral Thoracic Perforator Flap
Jeong-Tae Kim
57.01 Preoperative Deep Inferior Epigastric
Perforator (DIEP) Marking in a High
BMI Patient
Michel Saint-Cyr
57.02 Deep Inferior Epigastric Perforator Flap
Harvest and Dissection Summary
Michel Saint-Cyr
57.03 Deep Inferior Epigastric Artery Perforator
(DIEP) Flap for Breast Reconstruction
Ming-Huei Cheng
57.04 Deep Inferior Epigastric Artery
Perforator Flap
Ming-Huei Cheng
57.05 DIEP Free Flap Harvest
Edward I-Fei Chang
57.06 Superficial Inferior Epigastric
Artery (SIEA) Flap for Breast
Reconstruction
Aldona J. Spiegel
58.01 Inferior Gluteal Artery Perforator (IGAP) Flap
for Breast Reconstruction
Robert J. Allen Sr and Julie V. Vasile
59.01 Anterolateral Thigh Flap
Geoffrey G. Hallock
59.02 Anteriolateral Thigh Flap
Chih-Hung Lin
59.03 Suprafascial Harvest of the Anterolateral
Thigh Flap
Fu-Chan Wei, Dennis Yeh, Thomas Constantinescu,
and Nidal Farhan Al Deek
52.07 Proximal Fibula Flap with Growth
Plate
Marco Innocenti
52.08 Proximal Fibula Epiphyseal Transplant
Marco Innocenti
54.01 Great Toe Transfer for Reconstruction of
Metacarpal Hand: Planning and Recipient
Site Preparation
Fu-Chan Wei, Hsin-Yu Sirena Chen, Ketan M. Patel,
and Nidal Farhan Al Deek
54.02 Great Toe Transfer for Reconstruction
of Metacarpal Hand: Great
Toe Harvest
Fu-Chan Wei, Hsin-Yu Sirena Chen, Ketan M. Patel,
and Nidal Farhan Al Deek
54.03 Great Toe Transfer for Reconstruction of
Metacarpal Hand: Great Toe Inset
Fu-Chan Wei, Hsin-Yu Sirena Chen, Ketan M. Patel,
and Nidal Farhan Al Deek
54.04 Trimmed Great Toe Flap
Fu-Chan Wei
54.05 Trimmed Great Toe Transfer
Fu-Chan Wei
54.06 Second Toe Flap
Hung-Chi Chen
54.07 Bilateral Second Toe Transfer for
Reconstruction of Distal Fingertip
Amputations: Markings
Fu-Chan Wei and Wyatt Ho
54.08 Bilateral Second Toe Transfer for
Reconstruction of Distal Fingertip
Amputations: Recipient Prep
Fu-Chan Wei, Wyatt Ho, and Jason Su Shiuan-tzuen
54.09 Bilateral Second Toe Transfer for
Reconstruction of Distal Fingertip
Amputations: Flap Harvest
Fu-Chan Wei, Wyatt Ho, and Jason Su Shiuan-tzuen
54.10 Bilateral Second Toe Transfer for
Reconstruction of Distal Fingertip
Amputations: Inset
Fu-Chan Wei, Wyatt Ho, and Jason Su Shiuan-tzuen
54.11 Second and Third Toe Flap for Metacarpal
Hand Reconstruction
Fu-Chan Wei
54.12 Microsurgical Transplantation of the
PIP Joint of the Second Toe: Recipient
Site Preparation
Yu-Te Lin, Chung-Chen Hsu, Cheng-Hung Lin, and
Nidal Farhan Al Deek

xiv
Video Table of Contents
61.01 Posterior Tibial Artery Perforator
Propeller Flap
Michel Saint-Cyr
62.01 Intraoperative PAP Flap Markings and
Flap Harvest
Michel Saint-Cyr
62.02 Profunda Artery Perforator (PAP) Flap for
Head and Neck Reconstruction
Jerry Chih-Wei Wu
62.03 Pedicled Superficial Femoral Artery
Perforator Flap
Michel Saint-Cyr
62.04 Superficial Femoral Artery Perforator Flap for
Knee Coverage
Michel Saint-Cyr
62.05 Proximal Free-style Superficial Femoral Artery
Perforator Flap for Medial Thigh Defect
Michel Saint-Cyr
63.01 Face Transplantation: Donor Restoration
Gillian F. Duncan and Michaela Calhoun
64.01 Facial Transplant
Joseph A. Ricci and Bohdan Pomahac
64.02 Face Transplant Postoperative Result
Edward J. Caterson, Julian J. Pribaz, and
Bodan Pomahac
64.03 Face Transplant Postoperative Result: Showing
Spontaneous Emotion
Edward J. Caterson, Julian J. Pribaz, and Bodan
Pomahac
64.04 Face Transplant: Recipient Preparation
Samir Mardini, Marissa Suchyta, Uldis Bite
64.05 Face Transplant: Lower Face Donor
Procurement
Samir Mardini, Marissa Suchyta, Karim Bakri
64.06 Face Transplant: Recipient Reconstruction
Samir Mardini, Marissa Suchyta, and
Elizabeth A. Bradley
66.01 Uterus Transplantation: Surgical Technique
Ömer Özkan and Özlenen Özkan
68.01 Jumping the Nerve Gap
Susan E. Mackinnon and Andrew Yee
59.04 Anterolateral Thigh Perforator Flap, Dissection
Fu-Chan Wei
59.05 Vastus Lateralis Myocutaneous Flap
Chih-Hung Lin
59.06 Chimeric Anterolateral Thigh Perforator Skin
Flap and Vastus Lateralis Muscle Flap for
Reconstruction of a Defect in the Maxilla
Chung-Kan Tsao
59.07 Anterolateral Thigh Flap for Wound
Coverage and Flow Through Reconstruction
of the Radial Artery
Ye-Tin Lin
59.08 Free Vastus Lateralis Muscle Flap
Michel Saint-Cyr
59.09 Different Designs of the Anterolateral
Thigh Flap
Fu-Chan Wei and Nidal Farhan Al Deek
59.10 Pedicled ALT Flap for Groin
Michel Saint-Cyr
59.11 Pedicled Anterolateral Thigh Myocutaneous
Flap (Vastus Lateralis Myocutaneous Flap) for
Reconstruction of a Medial Thigh Defect
Chung-Ho Feng
59.12 Reconstruction of Hemiglossectomy Defect
with the ALT Flap
Fu-Chan Wei, Jay Hsin-Hung Chen, and
Christopher G. Wallace
59.13 Anterolateral Thigh Perforator Flap for
Reconstruction of a Palate Defect
Fu-Chan Wei
59.14 Anterolateral Thigh Perforator Flap for
Hypopharyngeal and Cervical Esophagus
Reconstruction
Fu-Chan Wei
59.15 Reverse Pedicled Anterolateral Thigh
Perforator Flap With Venous Supercharge
for Reconstruction of a Popliteal Defect
Chung-Ho Feng
59.16 Maxillary Reconstruction with the
Anterolateral Thigh Free Flap
Matthew M. Hanasono
60.01 Tensor Fascia Lata Flap
Chih-Hung Lin

xv
List of Chapter Contributors
The editor would also like to acknowledge and offer
grateful thanks for the input of all previous editions’ con­
tributors, without whom this new edition would not have
been possible.
Reza Ahmadzadeh MD, FRCSC
Assistant Professor
Division of Plastic Surgery
Department of Surgery
Dalhousie University
Halifax, Nova Scotia, Canada
Ch 2 Classification of Flaps
Robert J. Allen Sr MD
Clinical Professor in Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Ch 58 Superior and Inferior Gluteal Artery Perforator Flaps
Hatem Amer MD, FASN, FAST
Associate Professor of Medicine
Medical Director Essam and Dalal Obaid
Center for Reconstructive Transplant Surgery
Mayo Clinic
Rochester, MN, USA
Ch 63 Starting a Reconstructive Transplantation Program
Claudio Angrigiani MD
Chief, Plastic Surgery
Hospital Santojanni
Buenos Aires, Argentina
Ch 40 Scapular and Parascapular Flaps
Christopher E. Attinger MD
Chief, Wound Healing Center
Interim Chairman
Department of Plastic Surgery
Professor of Plastic and Orthopedic Surgery
Georgetown University Hospital
Washington, DC, USA
Ch 48 Local Flaps in the Foot
Robert D. Bains FRCS(Plast)
Consultant
Department of Plastic and Reconstructive Surgery
Leeds General Infirmary
Leeds, UK
Ch 49 Gracilis Flap
Karim Bakri MBBS
Assistant Professor of Plastic Surgery
Associate Program Director Plastic Surgery
Division of Plastic Surgery
Mayo Clinic
Rochester, MN, USA
Ch 12 Clinical Anatomy and Recipient Vessel Selection in the
Upper Extremity
Jonathan Bank MD
Associate Plastic Surgeon
New York Breast Reconstruction Associates
Great Neck, NY, USA
Ch 28 Flap Re-exploration and Salvage
Marina Barandun MD
Consultant
Plastic, Reconstructive, Aesthetic and Hand Surgery
University Hospital Basel, Switzerland
Ch 36 Omentum, Superior Epigastric, and External/Internal
Oblique Flaps
Jacques Baudet MD
Professor of Plastic Surgery
Service de Chirurgie Plastique
Hôpital du Tondu
Bordeaux, France
Ch 51 Soleus Flap
Donald P. Baumann MD, FACS
Associate Professor
Department of Plastic and Reconstructive Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
Ch 18 Abdominal Wall Reconstruction
Jens U. Berli MD
Assistant Professor
Division of Plastic Surgery
Department of Surgery
Oregon Health Science University
Portland, OR, USA
Ch 19 Pelvic and Urogenital Reconstruction
Phillip N. Blondeel MD, PhD, FCCP
Professor of Plastic, Reconstructive and Aesthetic Surgery
Department of Plastic Surgery
University Hospital Gent
Gent, Belgium
Ch 57 Deep and Superficial Inferior Epigastric Artery
Perforator Flaps

xvi
List of Chapter Contributors
Gerald Brandacher MD
Scientific Director
Plastic and Reconstructive Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Ch 65 Hand and Upper Extremity Transplantation
P. Niclas Broer MD
Klinikum Bogenhausen
Department of Plastic, Reconstructive, Hand, and Burn
Surgery
Academic Teaching Hospital Technical University
Munich
Munich, Germany
Ch 23 Functional Muscle Transfers for Various Purposes
James S. Brown BDS, LRCP, MRCS, FDSRCS, FRCS,
MD
Oral and Maxillofacial Surgery
Aintree University Hospital
Liverpool, UK
Ch 42 Iliac Flap
Gregory M. Buncke MD
Director
The Buncke Clinic
San Francisco, CA, USA
Ch 53 Glabrous Skin Flaps
Rudolf F. Buntic MD
Fellowship Directory
The Buncke Clinic
San Francisco, CA, USA
Ch 53 Glabrous Skin Flaps
Heinz Bürger MD
Head of the Hand Surgical Department
Privat Clinic Maria Hilf
Klagenfurt, Austria
Ch 55 Medial Femoral Condyle and Descending Genicular
Artery Perforator Flaps
Charles E. Butler MD, FACS
Chairman and Professor
Department of Plastic and Reconstructive Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
Ch 18 Abdominal Wall Reconstruction
Philippe Caix MD
Professor of Anatomy
Department of Maxillofacial Surgery
Hôpital Pellegrin-Tondu
Bordeaux, France
Ch 51 Soleus Flap
Vincent Casoli MD
Professor of Anatomy
Department of Plastic and Hand Surgery
Hôpital Pellegrin-Tondu
Bordeaux, France
Ch 51 Soleus Flap
J.R. Castro MD
Resident
Beth Israel Medical Center
New York, NY, USA
Ch 35 Deltopectoral Flaps and Internal Mammary Artery
Perforator Flap
Rajiv Chandawarkar MD
Associate Professor of Plastic Surgery
Department of Plastic Surgery
The Ohio State University
Columbus, OH, USA
Ch 30 Reconstructive Options Following Flap Failure
Hung-Chi Chen MD, PhD, FACS
Director, International Medical Service Center of China
Medical University Hospital
Professor, Department of Plastic Surgery, China Medical
University
Taichung, Taiwan
Ch 38 Jejunum Flap
Harvey Chim MD
Assistant Professor in Plastic Surgery
Division of Plastic Surgery
University of Miami Miller School of Medicine
Miami, FL, USA
Ch 52 Fibula Flap
Ch 59 Anterolateral and Anteromedial Thigh Flaps
David Chwei-Chin Chuang MD
Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital, Chang Gung University
Taipei, Taiwan
Ch 21 Adult Brachial Plexus Injury (A-BPI) Reconstruction
O. Koray Coşkunfırat MD
Department of Plastic and Reconstructive Surgery
Akdeniz University Hospital
Antalya, Turkey
Ch 60 Tensor Fascia Lata Flap
Joseph H. Dayan MD
Co-director, Lymphatic Surgery & Research Program
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Ch 8 Lymphedema: Microsurgical Reconstruction
Wieslawa De Pawlikowski MD, FACS
Head of Microsurgery Unit
Plastic Surgery
Instituto Nacional De Salud Del Niño
Director of International Scientific Cooperation Office
Lima
Lima, Peru
Ch 51 Soleus Flap
Margot Den Hondt MD
Resident Plastic Surgery
Plastic & Reconstructive Surgery Department
University Hospitals Leuven
Leuven, Belgium
Ch 6 Tissue Engineering

List of Chapter Contributors
xvii
Kazuteru Doi MD
President
Department of Orthopedic Surgery
Ogori Daiichi General Hospital
Ogori, Yamaguchi, Japan
Ch 24 Nerves
Ulf Dornseifer MD
Principal Investigator
Department of Plastic, Reconstructive, Hand and Burn
Surgery
Academic Hospital Bogenhausen
Munich, Germany
Ch 46 Lateral Arm Flap
Gregory R.D. Evans MD
Professor of Surgery
Chair, Department of Plastic Surgery
Department of Plastic Surgery
University of California Irvine
Orange, CA, USA
Ch 29 Postoperative Care
Karen Kim Evans MD
Associate Professor
Plastic Surgery
Georgetown University Medical Center
Washington, DC, USA
Ch 27 Avoiding Complications
Ch 38 Jejunum Flap
Ch 48 Local Flaps in the Foot
Kenneth L. Fan MD
Resident Physician
Department of Plastic Surgery
Medstar Georgetown University Hospital
Washington, DC, USA
Ch 27 Avoiding Complications
Frank Fang MD
Microsurgery Fellow
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Linkou, Taiwan
Ch 22 Lower Extremity Reconstruction
Félix J. Farías MD
Professor of Plastic Surgery
Hospital Nacional Daniel Alcides Carrión
Callao, Peru
Ch 51 Soleus Flap
Marcus Castro Ferreira MD
Professor of Plastic Surgery
University of São Paulo Medical School
São Paulo, Brazil
Ch 37 Rectus Abdominis Flap
Mark Fisher MD
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Ch 14 Head and Neck Reconstruction
Joshua Fosnot MD
Assistant Professor of Surgery
Division of Plastic Surgery
The University of Pennsylvania Health System
Philadelphia, PA, USA
Ch 11 Clinical Anatomy and Recipient Vessel Selection in the
Chest, Abdomen, Groin, and Back
Neal D. Futran MD, DMD
Professor and Chair, Director of Head and Neck Surgery
Otolaryngology-HNS
University of Washington
Seattle, WA, USA
Ch 39 Trapezius Flap
Alain R. Gagnon MD, CM, FRCSC
Assistant Clinical Professor
Division of Plastic and Reconstructive Surgery
University of Montreal
Montreal, Quebec, Canada
Ch 57 Deep and Superficial Inferior Epigastric Artery
Perforator Flaps
Günter Germann MD, PhD
Professor of Plastic Surgery
ETHIANUM Clinic for Plastic, Reconstructive and
Aesthetic Surgery at Heidelberg University
Heidelberg, Germany
Ch 41 Latissimus Dorsi Flap
Bahar Bassiri Gharb MD
Craniofacial Fellow
Plastic Surgery
Cleveland Clinic
Cleveland, OH, USA
Ch 67 Immunology and Research in Reconstructive
Transplantation
Lawrence J. Gottlieb MD, FACS
Professor of Surgery
Director of Burn & Complex Wound Center
Section of Plastic and Reconstructive Surgery
Department of Surgery
The University of Chicago Medicine & Biological Sciences
Chicago, IL, USA
Ch 28 Flap Re-exploration and Salvage
Lifei Guo MD PhD
Associate Professor of Surgery
Chief, Department of Plastic Surgery
Lahey Hospital and Medical Center
Burlington, MA, USA
Ch 5 Prefabrication and Prelamination
Franz Haas MD
Division of Plastic Surgery
Department of Surgery
Karl-Franzens University
Graz, Austria
Ch 39 Trapezius Flap

xviii
List of Chapter Contributors
Geoffrey G. Hallock MD
Consultant
Plastic Surgery
Sacred Heart Hospital
Allentown, PA, USA
Ch 2 Classification of Flaps
Ch 3 Considerations in Flap Selection
Moustapha Hamdi MD, PhD
Chairman and Professor of the Plastic and Reconstructive
Surgery Department
Brussels University Hospital
Vrije Universiteit Brussel, VUB
Brussels, Belgium
Ch 44 Gluteus Flap
Kevin D. Han MD
Department of Plastic Surgery
Center for Wound Healing
Georgetown University Hospital
Washington, DC, USA
Ch 48 Local Flaps in the Foot
Matthew M. Hanasono MD
Professor
Department of Plastic Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
Ch 4 Emerging Technology in Reconstructive Surgery
Ch 40 Scapular and Parascapular Flaps
James P. Higgins MD
Chief
The Curtis National Hand Center
MedStar Union Memorial Hospital
Baltimore, MD, USA
Ch 45 Pedicled Flaps of the Hand
Elliot Hirsch MD
Resident
Surgery, Division of Plastic Surgery
Northwestern University, Feinberg School of Medicine
Chicago, IL, USA
Ch 31 Local Flaps of the Head and Neck: Forehead, FAMM,
Submental, Nasolabial and Cervicofacial Flaps
Stefan O.P. Hofer MD, PhD, FRCS(C)
Wharton Chair in Reconstructive Plastic Surgery Professor
of Surgery
University of Toronto
Chief, Division of Plastic Surgery
Department of Surgery and Department of Surgical
Oncology
University Health Network
Toronto, Ontario, Canada
Ch 36 Omentum, Superior Epigastric, and External/Internal
Oblique Flaps
Matthew Houdek MD
Mayo Clinic
Rochester, MN, USA
Ch 55 Medial Femoral Condyle and Descending Genicular
Artery Perforator Flaps
Katherine A. Impastato MD
Resident
Plastic and Reconstructive Surgery
University of Washington Medical Center
Seattle, WA, USA
Ch 58 Superior and Inferior Gluteal Artery Perforator Flaps
Marco Innocenti MD
Professor of Plastic Surgery
University of Florence
Director, Plastic & Reconstructive
Microsurgery Department
Careggi University Hospital
Florence, Italy
Ch 50 Gastrocnemius Flap
Luis Henrique Ishida MD, PhD
Department of Plastic Surgery
Hospital das Clinicas
University of São Paulo
São Paulo, Brazil
Ch 37 Rectus Abdominis Flap
Seng-Feng Jeng MD FACS
Professor of Surgery
Plastic Surgery
E-Da hospital
Kaohsiung, Taiwan
Ch 62 Free-style Flaps
T. Shane Johnson MD
Associate Professor
Division of Plastic Surgery
Penn State University
Hershey, PA, USA
Ch 13 Clinical anatomy and recipient vessel selection and
exposure in the lower extremity
Dimitrios Karypidis MD, MSc, PhD, FICS
Plastic Surgeon
Post-doctoral Clinical Research Fellow
International Institute of Reconstructive Microsurgery
Long Island City
New York, NY, USA
Ch 15 Facial Reanimation: Evolution and Refinements
Ryan Katz MD
The Curtis National Hand Center
MedStar Union Memorial Hospital
Baltimore, MD, USA
Ch 45 Pedicled Flaps of the Hand
Roger K. Khouri MD, FACS
Volunteer Professor
Herbert Wertheim College of Medicine
University Park, FL, USA;
Medical Director
Miami Breast Center & Miami Hand Center
Miami, FL, USA
Ch 7 Percutaneous Aponeurotomy and Lipofilling (PALF):
A Regenerative Alternative to Flaps

List of Chapter Contributors
xix
Roger Karl Khouri Jr BS
Medical Student
University of Michigan Medical School
Ann Arbor, MI, USA;
Research Assistant
Miami Breast Center & Miami Hand Center
Miami, FL, USA
Ch 7 Percutaneous Aponeurotomy and Lipofilling (PALF): A
Regenerative Alternative to Flaps
Jeong-Tae Kim PhD
Hanyang University Medical Center
Seongdong-gu
Seoul, Korea
Ch 56 Perforator Flaps in the Lateral Thoracic Region
Naohiro Kimura MD
Director
Tsukiji Dermatology
Plastic and Hand Surgery Clinic
Chuo City, Tokyo, Japan
Ch 26 Thinning and Tailoring
Isao Koshima MD
Professor and Chief
Plastic Reconstructive Surgery
The University of Tokyo
Tokyo, Japan
Ch 8 Lymphedema: Microsurgical Reconstruction
Ch 43 Groin Flap and Superficial Circumflex Iliac Artery
Perforator Flap
Laurent Lantieri MD, PhD
Professor of Plastic Surgery
Head of Department of Plastic Surgery
Georges Pompidou European Hospital
Paris, France
Ch 63 Starting a Reconstructive Transplantation Program
W.P. Andrew Lee MD
Professor and Chairman
Department of Plastic and Reconstructive Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Ch 65 Hand and Upper Extremity Transplantation
L. Scott Levin MD, FACS
Paul B. Magnuson Professor of Bone and Joint Surgery
Chairman, Department of Orthopaedic Surgery
Professor of Surgery (Plastic Surgery)
Perelman School of Medicine, University of Pennsylvania
Philadelphia, PA, USA
Ch 13 Clinical Anatomy and Recipient Vessel Selection and
Exposure in the Lower Extremity
Joshua L. Levine MD
Director
The Center for the Advancement of Breast Reconstruction
New York Eye and Ear Infirmary
New York, NY, USA
Ch 58 Superior and Inferior Gluteal Artery Perforator Flaps
Chih-Hung Lin MD
Professor and Chairman
Department of Plastic Surgery
Chang Gung Memorial Hospital
Linkou, Taiwan
Ch 22 Lower Extremity Reconstruction
Ch 54 Toe Flaps and Toe Transplantation
Susan E. Mackinnon MD
Shoenberg Professor, Plastic and Reconstructive Surgery
Chief, Division of Plastic and Reconstructive Surgery
Washington University
St. Louis, MO, USA
Ch 68 Peripheral Nerve Allotransplantation
Samir Mardini MD
Professor of Surgery
Mayo Clinic College of Medicine
Program Director, Plastic Surgery
Surgical Director,
Essam and Dalal Obaid Center for Reconstructive
Transplant Surgery
Mayo Clinic
Rochester, MN, USA
Ch 38 Jejunum Flap
Ch 43 Groin Flap and Superficial Circumflex Iliac Artery
Perforator Flap
Ch 52 Fibula Flap
Ch 59 Anterolateral and Anteromedial Thigh Flaps
Ch 62 Free-style Flaps
Jaume Masia Ayala MD, PhD
Professor of Plastic Surgery
Chief Plastic Surgery Department
Director European School of
Reconstructive Microsurgery
Barcelona, Spain
Ch 8 Lymphedema: Microsurgical Reconstruction
Alain-Charles Masquelet MD
Reconstructive and Hand Surgeon
Orthopaedic and Traumatology
Hôpital Saint Antoine
University Paris
Paris, France
Ch 50 Gastrocnemius Flap
Lincoln Saito Millan MD, PhD
Plastic Surgeon, Microsurgeon
Consultant at Institute of Cancer of the State of São Paulo
(ICESP)
University of São Paulo School of Medicine
Consultant
São Paulo State Public Servant Hospital (IAMSPE)
São Paulo, Brazil
Ch 37 Rectus Abdominis Flap
Michael J. Miller MD
Professor and Chairman, Department of Plastic Surgery
The Ohio State University Wexner Medical Center
Columbus, OH, USA
Ch 30 Reconstructive Options Following Flap Failure

xx
List of Chapter Contributors
Amy M. Moore MD
Assistant Professor in Plastic Surgery
Division of Plastic Surgery
Washington University
St. Louis, MO, USA
Ch 68 Peripheral Nerve Allotransplantation
Steven L. Moran MD
Professor and Chair of Plastic Surgery, Professor of
Orthopedic Surgery
Mayo Clinic
Rochester, MN, USA
Ch 32 Temporoparietal Fascia Flap
Ch 52 Fibula Flap
Ch 55 Medial Femoral Condyle and Descending Genicular
Artery Perforator Flaps
Steven F. Morris MD, MSc, FRCS(C)
Professor of Surgery
Surgery
Dalhousie University
Halifax, Nova Scotia, Canada
Ch 2 Classification of Flaps
Wayne A. Morrison MBBS, MD, FRACS
Director, O’Brien Institute
Department of Surgery
University of Melbourne
Australian Catholic University
Melbourne, Victoria, Australia
Ch 27 Avoiding Complications
Andrew N. Morritt MB, ChB, MRCS
Microsurgery Research Fellow
Bernard O’Brien Institute of Microsurgery
Fitzroy, Melbourne, Victoria, Australia
Ch 27 Avoiding Complications
Maurice Y. Nahabedian MD
Professor
Department of Plastic Surgery
Georgetown University
Washington, DC, USA
Ch 16 Breast Reconstruction
Peter C. Neligan MB, FRCS(I), FRCSC, FACS
Professor of Surgery
Surgery, Division of Plastic Surgery
University of Washington
Seattle, WA, USA
Ch 10 Clinical Anatomy of the Head and Neck, and Recipient
Vessel Selection
Michael W. Neumeister MD
Professor and Chairman
Surgery
SIU School of Medicine
Springfield, IL, USA
Ch 20 Upper Extremity Reconstruction
Audrey Nguyen BS
University of California at Irvine
School of Medicine
Irvine, CA, USA
Ch 29 Postoperative Care
Marina Ninković
Department of Visceral, Transplant and Thoracic Surgery
Center of Operative Medicine
Innsbruck, Austria
Ch 23 Functional Muscle Transfers for Various Purposes
Milomir Ninković MD, PhD
Professor of Plastic Surgery
Chairman Department of Plastic, Reconstructive,
Hand and Burn Surgery
Academic Hospital Munich Bogenhausen
Technical University
Munich, Germany
Ch 23 Functional Muscle Transfers for Various Purposes
Ch 46 Lateral Arm Flap
Niri S. Niranjan MBBS MS FRCS FRCS(Plast)
Consultant Plastic Surgeon
Plastic and Burn Surgery
St Andrews Centre, Broomfield Hospital
Chelmsford, UK
Ch 61 Posterior Tibial Artery Perforator Flap
Anne O’Neill MBBCh, MMedSci, MSc, FRCS(Plast),
PhD
Assistant Professor
University of Toronto
Division of Plastic Surgery
Department of Surgery
Department of Surgical Oncology
University Health Network
Toronto, Ontario, Canada
Ch 36 Omentum, Superior Epigastric, and External/Internal
Oblique Flaps
Ömer Özkan MD
Professor of Plastic Surgery
Omer Ozkan Clinic and Akdeniz University
Hospital
Antalya, Turkey
Ch 60 Tensor Fascia Lata Flap
Ch 66 Laryngeal, Abdominal Wall, and Uterus
Transplantation
Özlenen Özkan MD
Associate Professor
Akdeniz University Hospital
Head of Plastic and Reconstructive
Surgery Department
Antalya, Turkey
Ch 60 Tensor Fascia Lata Flap
Ch 66 Laryngeal, Abdominal Wall, and Uterus
Transplantation

List of Chapter Contributors
xxi
Christopher J. Pannucci MD, MS
Assistant Professor
Division of Plastic Surgery
University of Utah
Salt Lake City, UT, USA
Ch 13 Clinical Anatomy and Recipient Vessel Selection and
Exposure in the Lower Extremity
Philippe Pelissier MD
Professor of Plastic Surgery
Department of Plastic and Hand Surgery
Hôpital Pellegrin-Tondu
Bordeaux, France
Ch 51 Soleus Flap
Bohdan Pomahac MD
Director, Plastic Surgery Transplantation
Medical Director, BWH Burn Center
Associate Professor
Harvard Medical School
Boston, Massachussetts
Ch 64 Face Transplantation
Julian J. Pribaz MD
Professor, Division of Plastic Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Ch 5 Prefabrication and Prelamination
Antonio Rampazzo MD
Craniofacial Surgery Fellow
Plastic Surgery
University of Michigan
Ann Arbor, MI, USA
Ch 67 Immunology and Research in Reconstructive
Transplantation
Richard J. Redett III MD
Associate Professor
Department of Plastic and Reconstructive Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Ch 19 Pelvic and Urogenital Reconstruction
Matthias Reichenberger MD, PhD
ETHIANUM Clinic for Plastic, Reconstructive and
Aesthetic Surgery
Heidelberg University
Heidelberg, Germany
Ch 41 Latissimus Dorsi Flap
Joseph A. Ricci MD
Plastic Surgery Resident
Harvard Medical School
Brigham and Women’s Hospital
Boston, MA, USA
Ch 64 Face Transplantation
Jonathan Rimler MD
Department of Plastic Surgery
University of California, Irvine
Orange, CA, USA
Ch 29 Postoperative Care
Eduardo D. Rodriguez MD, DDS
Chair, Hansjorg Wyss Department of Plastic Surgery
Helen L. Kimmel Professor of Reconstructive Plastic
Surgery
NYU Langone Medical Center
New York, New York
Ch 14 Head and Neck Reconstruction
S. Raja Sabapathy MS(Gen), M.Ch(Plastic),
DNB(Plastic), FRCS(Edin)
Chairman
Division of Plastic Surgery
Hand Surgery
Reconstructive Microsurgery and Burns
Adjunct Professor
Tamil Nadu Dr MGR Medical University
Ganga Hospital
Coimbatore, India
Ch 25 Vessels
Christopher J. Salgado MD
Professor of Surgery
Division of Plastic Surgery
Section Chief, University of Miami Hospital
Medical Director, Gender and Sexual Health Program
Miami, FL, USA
Ch 52 Fibula Flap
Eric Santamaria MD
Professor
Reconstructive Microsurgery
Universidad Nacional Autónoma de México;
Attending Surgeon
Plastic and Reconstructive Surgery
Hospital General Dr. Manuel Gea Gonzalez
Mexico City, Mexico
Ch 32 Temporoparietal Fascia Flap
Paolo Sassu MD, PhD
Senior Consultant
Director, Hand Surgery Transplant Program
Sahlgrenska University Hospital
Gothenburg, Sweden
Ch 50 Gastrocnemius Flap
Ch 54 Toe Flaps and Toe Transplantation
James T.W. Saunders MD, FRCSC
Plastic and Reconstructive Surgery
Washington University
St. Louis, MO, USA
Ch 68 Peripheral Nerve Allotransplantation

xxii
List of Chapter Contributors
Jesse Selber MD, MPH, FACS
Associate Professor, Director of Clinical Research
Department of Plastic Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
Ch 9 Robotic Applications in Plastic and Reconstructive
Surgery
Joseph M. Serletti MD, FACS
The Henry Royster-William Maul Measey Professor of
Surgery
Chief, Division of Plastic Surgery
The University of Pennsylvania Health System
Philadelphia, PA, USA
Ch 11 Clinical Anatomy and Recipient Vessel Selection in the
Chest, Abdomen, Groin, and Back
Basel Sharaf MD, DDS, FACS, FRCDC
Assistant Professor in Plastic Surgery
Mayo Clinic College of Medicine
Division of Plastic Surgery
Rochester, MN, USA
Ch 10 Clinical Anatomy of the Head and Neck, and Recipient
Vessel Selection
Jaimie T. Shores MD
Clinical Director of Hand and Upper Extremity
Transplantation
Assistant Professor
Plastic and Reconstructive Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Ch 65 Hand and Upper Extremity Transplantation
Maria Z. Siemionow MD, PhD
Professor of Orthopaedics
Director of Microsurgery Research
University of Illinois at Chicago
Chicago, Illinois
Ch 67 Immunology and Research in Reconstructive
Transplantation
Amanda K. Silva MD
The University of Chicago Medicine & Biological Sciences
Chicago, IL, USA
Ch 17 Chest and Back Reconstruction
Indranil Sinha MD
Fellow, Division of Plastic Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Ch 5 Prefabrication and Prelamination
Alison Snyder-Warwick MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Ch 24 Nerves
David H. Song MD, MBA, FACS
Cynthia Chow Professor of Surgery
Chief, Section of Plastic and Reconstructive Surgery
Vice-Chair, Department of Surgery
Associate Dean, Continuing Medical Education
The University of Chicago Medicine & Biological Sciences
Chicago, IL, USA
Ch 17 Chest and Back Reconstruction
Michael Sosin MD
Postdoctoral Research Fellow
R. Adams Cowley Shock Trauma Center
University of Maryland Medical Center
Baltimore, MD, USA
Ch 14 Head and Neck Reconstruction
David S. Soutar FRCS
Consultant Plastic Surgeon
West of Scotland Regional Plastic Surgery Unit
Glasgow Royal Infirmary
Glasgow, UK
Ch 47 Radial Forearm Flap
Stefano Spanio di Spilimbergo MD
Maxillofacial Surgery
Regional Hospital S. Bortolo
Vicenza, Italy
Ch 38 Jejunum Flap
Charles E. Stewart IV MD
Fellow, Beth Israel Deaconess Medical Center
New York, NY, USA;
Assistant Professor of Surgery
Department of Otolaryngology Head and Neck Surgery
Loma Linda University School of Medicine
Loma Linda, CA, USA
Ch 35 Deltopectoral Flaps and Internal Mammary Artery
Perforator Flap
Amir H. Taghinia MD, MPH
Staff Surgeon
Boston Children’s Hospital
Assistant Professor of Surgery
Harvard Medical School
Boston, MA, USA
Ch 47 Radial Forearm Flap
Kensuke Tashiro MD
Department of Plastic and Reconstructive Surgery
Graduate School of Medicine
University of Tokyo
Tokyo, Japan
Ch 43 Groin Flap and Superficial Circumflex Iliac Artery
Perforator Flap
Julia K. Terzis MD, PhD, FACS, FRCS (C)
Adjunct Professor
Department of Plastic and Reconstructive Surgery
New York University Medical Center
Medical Director, International Institute of Reconstructive
Microsurgery,
New York, NY
Ch 15 Facial Reanimation: Evolution and Refinements

List of Chapter Contributors
xxiii
Joseph Upton MD
Staff Surgeon
Boston Children’s Hospital
Shriner’s Hospital for Children
Beth Israel-Deaconess Medical Center
Professor of Surgery
Harvard Medical School
Boston, MA, USA
Ch 47 Radial Forearm Flap
Mark L. Urken MD, FACS
Professor
Department of Otolaryngology-Head and Neck Surgery
Albert Einstein College of Medicine
Chief of Head and Neck Surgical Oncology
Beth Israel Medical Center
New York, NY, USA
Ch 35 Deltopectoral Flaps and Internal Mammary Artery
Perforator Flap
Nicholas B. Vedder MD
Professor of Surgery and Orthopaedics
Chief Plastic Surgery
Vice Chair, Department of Surgery
University of Washington
Seattle, Washington
Ch 1 Problem Analysis in Reconstructive Surgery:
Reconstructive Ladders, Elevators, and Surgical Judgment
S. Voigt MD
Klinikum Bogenhausen
Department of Plastic, Reconstructive, Hand, and Burn
Surgery
Academic Teaching Hospital Technical University Munich
Munich, Germany
Ch 23 Functional Muscle Transfers for Various Purposes
Jan Jeroen Vranckx MD, PhD
Professor & Chief
Dept. of Plastic & Reconstructive Surgery
Leuven University Hospitals
Leuven, Belgium
Ch 6 Tissue Engineering
Chan Yu Wai MS, FRCSE, FHKAM(Surg)
Assistant Professor
Department of Surgery
The University of Hong Kong
Hong Kong, Special Administrative Region of the People’s
Republic of China
Ch 34 Pectoralis Major Flap
Robert L. Walton MD
Professor
Surgery, Division of Plastic Surgery
Northwestern University, Feinberg School of Medicine
Chicago, IL, USA
Ch 31 Local Flaps of the Head and Neck: Forehead, FAMM,
Submental, Nasolabial and Cervicofacial Flaps
Fu-Chan Wei, MD, FACS
Distinguished Chair and Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Chang Gung University, Medical College
Taipei, Taiwan
Ch 43 Groin Flap and Superficial Circumflex Iliac Artery
Perforator Flap
Ch 52 Fibula Flap
Ch 59 Anterolateral and Anteromedial Thigh Flaps
Ch 62 Free-style Flaps
William Ignace Wei MS, FRCS, FRCSE, FRACS(Hon.),
FACS(Hon.), FHKAM(ORL), FHKAM(Surg)
Emeritus Professor
Department of Surgery
The University of Hong Kong
Director of Li Shu Pui ENT Head & Neck Surgery Centre
Hong Kong Sanatorium & Hospital
Hong Kong, Special Administrative Region of the People’s
Republic of China
Ch 34 Pectoralis Major Flap
Andreas Weiglein MD
Associate Professor
Institute of Anatomy
Medical University of Graz
Graz, Austria
Ch 39 Trapezius Flap
Thomas Willson MD
Resident
Division of Plastic Surgery
Northwestern University, Feinberg School of Medicine
Chicago, IL, USA
Ch 31 Local Flaps of the Head and Neck: Forehead, FAMM,
Submental, Nasolabial and Cervicofacial Flaps
Jeremy L. Wilson MBBS, FRACS(Plas)
Consultant Plastic Surgeon
Department of Plastic Surgery
Royal Melbourne Hospital;
Consultant Plastic Surgeon
Department of Surgical Oncology
Peter MacCallum Cancer Centre
Melbourne, Victoria, Australia
Ch 27 Avoiding Complications
Michael R. Zenn MD, MBA
Professor
Plastic and Reconstructive Surgery
Duke University
Durham, NC, USA
Ch 33 Supraclavicular Artery Flap
Ronald M. Zuker MD, FRCSC, FACS, FRCSEd(Hon)
Professor of Surgery
Department of Surgery
University of Toronto;
Staff Plastic and Reconstructive Surgeon
Department of Surgery
The Hospital for Sick Children
Toronto, Ontario, Canada
Ch 49 Gracilis Flap

xxiv
List of Expert Commentary Contributors
Uros Ahcan MD, PhD
Professor and Head
Department of Plastic Surgery and Burns
University Medical Centre
Ljubljana, Slovenia
Ch 4 Expert Commentary Emerging Technology in
Reconstructive Surgery
Robert J. Allen Sr MD
Clinical Professor in Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Ch 57 Expert Commentary Deep and Superficial Inferior
Epigastric Artery Perforator Flaps
Mohammad M. Al-Qattan MBBS
Professor of Plastic Surgery
Senior Consultant Plastic Surgeon
Head, Division of Plastic and Hand Surgery
Director, College of Medicine Research Center
King Saud University
Riyadh, Saudi Arabia
Ch 53 Expert Commentary Glabrous Skin Flaps
Hatem Amer MD, FASN, FAST
Associate Professor of Medicine
Medical Director Essam and Dalal Obaid
Center for Reconstructive Transplant Surgery
Mayo Clinic
Rochester, MN, USA
Ch 64 Expert Commentary Face Transplantation
Bishara Atiyeh MD, FACS
Professor of Surgery
Department of Surgery
Division, Plastic & Reconstructive Surgery
American University of Beirut Medical Center
Beirut, Lebanon
Ch 60 Expert Commentary Tensor Fascia Lata Flap
Brian T. Carlsen MD
Associate Professor Orthopedic and Plastic Surgery
Consultant, Orthopedic and Plastic Surgery
Mayo Clinic
Rochester, MN, USA
Ch 37 Expert Commentary Rectus Abdominis Flap
Edward J. Caterson MD, PhD
Instructor in Surgery
Plastic and Reconstructive Surgery
Director of Craniofacial Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Ch 27 Expert Commentary Avoiding Complications
Ch 56 Expert Commentary Perforator Flaps in the Lateral
Thoracic Region
Stephanie A. Caterson MD
Instructor in Surgery
Plastic and Reconstructive Surgery
Director of Microsurgery Breast Reconstruction
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Ch 27 Expert Commentary Avoiding Complications
Ch 56 Expert Commentary Perforator Flaps in the Lateral
Thoracic Region
Paul S. Cederna MD
Chief, Section of Plastic Surgery
Robert Oneal Professor of Plastic Surgery
Professor of Biomedical Engineering
University of Michigan Health System
Ann Arbor, MI, USA
Ch 41 Expert Commentary Latissimus Dorsi Flap
Fadel M. Chahine MD
Resident, Division of Plastic and Reconstructive Surgery
Department of Surgery
American University of Beirut Medical Center
Beirut, Lebanon
Ch 60 Expert Commentary Tensor Fascia Lata Flap
David W. Chang MD, FACS
Professor of Surgery
Section of Plastic and Reconstructive Surgery
Department of Surgery
The University of Chicago Medicine & Biological Sciences
Chicago, IL, USA
Ch 8 Expert Commentary Lymphedema: Microsurgical
Reconstruction
Ch 16 Expert Commentary Breast Reconstruction

List of Expert Commentary Contributors
xxv
James Chang MD
Chief, Division of Plastic & Reconstructive Surgery
Professor of Surgery (Plastic Surgery) & Orthopedic
Surgery
Hand & Microsurgery
Stanford University Medical Center
Palo Alto, CA, USA
Ch 6 Expert Commentary Tissue Engineering
Hung-Chi Chen MD, PhD, FACS
Director, International Medicine
Professor, Department of Plastic Surgery
China Medical University
Taichung, Taiwan
Ch 26 Expert Commentary Thinning and Tailoring
Ch 34 Expert Commentary Pectoralis Major Flap
Zung-Chung Chen MD
Assistant Professor
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Chief of Craniofacial Surgery
Taiyuan, Taiwan
Ch 32 Expert Commentary Temporoparietal Fascia Flap
Ming-Huei Cheng MD, MBA, FACS
Professor, Department of Plastic and Reconstructive
Surgery
Chief, Center for Tissue Engineering
Chairman, International Medical Center
Superintendent, Chang Gung Memorial Hospital
College of Medicine, Chang Gung University
Taoyuan, Taiwan
Ch 8 Expert Commentary Lymphedema: Microsurgical
Reconstruction
Michael W. Chu MD
Assistant Professor
Division of Plastic & Reconstructive Surgery
Indiana University
Indianapolis, IN, USA
Ch 33 Expert Commentary Supraclavicular Artery Flap
Ernest S. Chiu MD, FACS
Associate Professor of Plastic Surgery
Director
Helen L. & Martin S. Kimmel Hyperbaric and Advanced
Wound Healing Center
Hansjörg Wyss Department of Plastic Surgery
New York University
Langone Medical Center
New York, NY, USA
Ch 33 Expert Commentary Supraclavicular Artery Flap
David T.W. Chiu, MD, FACS, FAAP
Center for Restorative Surgery
New York, NY, USA
Ch 54 Expert Commentary Toe Flaps and Toe Transplantation
John J. Coleman III MD
Professor of Surgery
Emeritus Chief of Plastic Surgery
Indiana University School of Medicine
Indianapolis, IN, USA
Ch 38 Expert Commentary Jejunum Flap
Lawrence Colen MD, FACS
Professor of Surgery (Plastic & Reconstructive)
Eastern Virginia Medical School
Norfolk, VA, USA
Ch 22 Expert Commentary Lower Extremity Reconstruction
Wieslawa De Pawlikowski MD, FACS
Head of Microsurgery Unit
Plastic Surgery
Instituto Nacional De Salud Del Niño
Director of International Scientific Cooperation Office
Lima
Lima, Peru
Ch 21 Expert Commentary Adult Brachial Plexus Injury
(A-BPI) Reconstruction
Francisco Del Piñal MD
Hand-Wrist and Plastic-Reconstructive Surgery
Private Practice and Head Hospital Mutua Montañesa
Santander, Spain
Ch 20 Expert Commentary Upper Extremity Reconstruction
Ivica Ducic MD, PhD
Clinical Professor of Surgery
Director, Plastic Surgery, Nerve & Headache Institute
The George Washington University
Washington, DC
Ch 24 Expert Commentary Nerves
Tarek Abdalla El-Gammal MD
Professor, Orthopedic Surgery
Chief, Reconstructive Microsurgery Unit
Assiut University Hospitals and School of Medicine
Assiut, Egypt
Ch 55 Expert Commentary Medial Femoral Condyle and
Descending Genicular Artery Perforator Flaps
Bassem T. Elhassan MD
Professor of Orthopedics
Mayo Clinic College of Medicine
Department of Orthopedic Surgery
Mayo Clinic
Rochester, MN, USA
Ch 39 Expert Commentary Trapezius Flap
Eric M. Genden MD, MHCA, FACS
Isadore Friesner Professor
Otolaryngology- Head and Neck Surgery
The Icahn School of Medicine at Mount Sinai
New York, NY, USA
Ch 35 Expert Commentary Deltopectoral Flaps and Internal
Mammary Artery Perforator Flap

xxvi
List of Expert Commentary Contributors
Alexandru V. Georgescu MD, PhD
Professor of Plastic Surgery and Reconstructive
Microsurgery
University of Medicine Iuliu Hatieganu;
Chairman, Clinic of Plastic Surgery and Reconstructive
Microsurgery
Clinical Hospital of Rehabilitation
Cluj Napoca, Romania
Ch 61 Expert Commentary Posterior Tibial Artery Perforator
Flap
Lawrence J. Gottlieb MD, FACS
Professor of Surgery
Section of Plastic and Reconstructive Surgery
Department of Surgery
The University of Chicago Medicine & Biological Sciences
Chicago, IL, USA
Ch 17 Expert Commentary Chest and Back Reconstruction
Geoffrey G. Hallock MD
Consultant, Division of Plastic Surgery
Department of Surgery
Sacred Heart Hospital
Allentown, PA, USA;
Consultant
Plastic Surgery
St. Luke’s Hospital
Bethlehem, PA, USA
Ch 40 Expert Commentary Scapular and Parascapular Flaps
Ch 50 Expert Commentary Gastrocnemius Flap
Moustapha Hamdi MD, PhD
Head of Department of Plastic & Reconstructive Surgery
Head of Microsurgery Section in Royal Belgian Society of
Plastic Surgery;
CEO Brussels Seminars
Brussels University Hospital
Edith Cavell Medical Institute
Brussels, Belgium
Ch 58 Expert Commentary Superior and Inferior Gluteal
Artery Perforator Flaps
Richard E. Hayden MD
Professor of Otolaryngology
Mayo Clinic
Phoenix, AZ, USA
Ch 14 Expert Commentary Head and Neck Reconstruction
Stefan O.P. Hofer MD, PhD, FRCS(C)
Wharton Chair in Reconstructive Plastic Surgery
Professor of Surgery
University of Toronto;
Chief
Division of Plastic Surgery at the Department of Surgery
and Department of Surgical Oncology
University Health Network
Toronto, Ontario, Canada
Ch 30 Expert Commentary Reconstructive Options Following
Flap Failure
Joon Pio (JP) Hong MD, PhD, MMM
Professor and Chairman of Plastic Surgery
Asan Medical Center, University of Ulsan
Seoul, Korea
Ch 25 Expert Commentary Vessels
Ch 43 Expert Commentary Groin Flap and Superficial
Circumflex Iliac Artery Perforator Flap
Marco Innocenti MD
Professor of Plastic Surgery
University of Florence
Director Plastic & Reconstructive
Microsurgery Department
Careggi University Hospital
Florence, Italy
Ch 52 Expert Commentary Fibula Flap
Michael J.A. Klebuc MD
Associate Clinical Professor of Plastic and
Reconstructive Surgery
Weill Cornell Medical College
Director, Center for Facial Paralysis Surgery
and Functional Restoration
Methodist Hospital
Houston, Texas
Ch 38 Expert Commentary Jejunum Flap
Ch 51 Expert Commentary Soleus Flap
Theodore A. Kung MD
Chief Resident
University of Michigan Hospital and Health Systems
Department of Surgery
Section of Plastic Surgery
Ann Arbor, MI, USA
Ch 41 Expert Commentary Latissimus Dorsi Flap
Yur-Ren Kuo MD, PhD
Professor of Plastic Surgery
Center for Stem Cell Research
Kaohsiung Medical University and Hospital
Department of Biological Sciences
National Sun Yat-sen University
Kaohsiung, Taiwan
Ch 67 Expert Commentary Immunology and Research in
Reconstructive Transplantation
Ch 68 Expert Commentary Peripheral Nerve
Allotransplantation
Don Lalonde BSc, MD, MSc, FRCSC
Professor of Surgery
Dalhousie University
Chief of Division of Plastic Surgery
Saint John Regional Hospital
Saint John, New Brunswick, Canada
Ch 45 Expert Commentary Pedicled Flaps of the Hand

List of Expert Commentary Contributors
xxvii
Lucie Lessard MD, CSPQ(O), CSPQ(P), FRCSC(O),
FRCSC(P), FACS
Associate Professor
McGill University Health Centre
The Montreal Children’s Hospital
Montreal, Quebec, Canada
Ch 29 Expert Commentary Postoperative Care
L. Scott Levin MD, FACS
Paul B. Magnuson Professor of Bone and Joint Surgery
Orthopaedic Surgery
Chairman, Department of Orthopaedic Surgery
Professor of Orthopaedic Surgery
Professor of Surgery, Division of Plastic Surgery
The University of Pennsylvania Health System
Philadelphia, PA, USA
Ch 65 Expert Commentary Hand and Upper Extremity
Transplantation
Chih-Hung Lin MD
Professor and Chairman
Department of Plastic Surgery
Chang Gung Memorial Hospital
Linkou, Taiwan
Ch 46 Expert Commentary Lateral Arm Flap
Yu-Te Lin MD, MS
Associate Professor of Plastic Surgery
College of Medicine, Chang Gung University
Consultant, Division of Trauma Plastic Surgery
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Linkou, Taiwan
Ch 46 Expert Commentary Lateral Arm Flap
William Lineaweaver MD, FACS
Medical Director, JMS
Burn and Reconstruction Center
Merit Center Hospital
Jackson, MS, USA
Ch 1 Expert Commentary Problem Analysis in Reconstructive
Surgery: Reconstructive Ladders, Elevators, and Surgical
Judgment
Philippe Liverneaux MD, PhD
Hand Surgery Department
Strasbourg University Hospital
Illkirch, France
Ch 9 Expert Commentary Robotic Applications in Plastic
Reconstructive Surgery
Paul N. Manson MD
Distinguished Service Professor
Johns Hopkins University School of Medicine;
Professor of Surgery
University of Maryland School of Medicine
Department of Plastic and Reconstructive Surgery
Baltimore, MD, USA
Ch 14 Expert Commentary Head and Neck Reconstruction
Samir Mardini MD
Professor of Surgery
Mayo Clinic College of Medicine
Program Director, Plastic Surgery
Surgical Director
Essam and Dalal Obaid Center for Reconstructive
Transplant Surgery
Mayo Clinic
Rochester, MN, USA
Ch 64 Expert Commentary Face Transplantation
David W. Mathes MD, FACS
Professor of Surgery
Chief, Division of Plastic and Reconstructive Surgery
University of Colorado
Anschutz Medical Campus
Aurora, CO, USA
Ch 66 Expert Commentary Laryngeal, Abdominal Wall, and
Uterus Transplantation
Milomir Ninković MD
Professor of Plastic Surgery
Chairman, Department of Plastic, Reconstructive, Hand
and Burn Surgery
Academic Hospital Munich Bogenhausen
Technical University
Munich, Germany
Ch 3 Expert Commentary Considerations in Flap Selection
Palmina Petruzzo MD
Professor of Vascular Surgery
University of Cagliari, Italy;
Department of Transplantation
Hopital Edouard Herriot
Lyon, France
Ch 63 Expert Commentary Starting a Reconstructive
Transplantation Program
Julian J. Pribaz MD
Professor, Division of Plastic Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Ch 27 Expert Commentary Avoiding Complications
Roberto Puxeddu MD, FRCS (Eng.)
Professor of Otorhinolaryngology,
University of Cagliari, School of Medicine;
Chief of Otorhinolaryngology,
Department of Surgery,
Azienda Ospedaliero Universitaria
Cagliari, Sardinia, Italy
Ch 42 Expert Commentary Iliac Flap
Venkat V. Ramakrishnan MS, FRCS, FRACS(Plastic
Surgery)
Consultant Plastic Surgeon
St. Andrews Centre for Plastic Surgery
Broomfield Hospital
Chelmsford, UK
Ch 16 Expert Commentary Breast Reconstruction

xxviii
List of Expert Commentary Contributors
Peter Rubin MD, FACS
Chief, Plastic & Reconstructive Surgery
University of Pittsburgh Medical Center;
Associate Professor, Surgery
University of Pittsburgh
Pittsburgh, PA, USA
Ch 7 Expert Commentary Percutaneous Aponeurotomy and
Lipofilling (PALF): A Regenerative Alternative to Flaps
Michel Saint-Cyr MD, FRSC(C)
Wigley Professor in Plastic Surgery
Director, Division of Plastic Surgery
Baylor Scott and White
Temple, Texas
Ch 2 Expert Commentary Classification of Flaps
Ch 62 Expert Commentary Free-style Flaps
Christopher J. Salgado MD
Professor of Surgery
Division of Plastic Surgery
Section Chief, University of Miami Hospital
Medical Director, Gender and Sexual Health Program
Miami, FL, USA
Ch 19 Expert Commentary Pelvic and Urogenital
Reconstruction
Hani Sbitany MD, FACS
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
University of California, San Francisco
San Francisco, CA, USA
Ch 47 Expert Commentary Radial Forearm Flap
Frances Sharpe MD
Orthopedic Surgeon
Fontana, CA, USA
Ch 23 Expert Commentary Functional Muscle Transfers for
Various Purposes
Randy Sherman MD, FACS
Professor & Vice Chair – Surgery
Cedars Sinai Medical Center;
Clinical Professor of Surgery
Keck School of Medicine
University of Southern California
Los Angeles, CA, USA
Ch 48 Expert Commentary Local Flaps in the Foot
Ch 51 Expert Commentary Soleus Flap
Roman Skoracki MD, FRCSC, FACS
Professor
Division Chief of Reconstructive Oncological Plastic
Surgery
Department of Plastic Surgery
Columbus, OH, USA
Ch 28 Expert Commentary Flap Re-exploration and Salvage
Aldona J. Spiegel MD
Associate Professor of Plastic Surgery, Weill Cornell
Medical College
Director, The Center for Breast Restoration
Houston Methodist Institute for Reconstructive Surgery
Houston, TX, USA
Ch 57 Expert Commentary Deep and Superficial Inferior
Epigastric Artery Perforator Flaps
Robert J. Spinner MD
Chairman, Department of Neurosurgery
Professor of Neurosurgery, Orthopedics, and Anatomy
Mayo Clinic, College of Medicine
Mayo Clinic
Rochester, MN, USA
Ch 24 Expert Commentary Nerves
Milan Stevanovic MD
Professor of Orthopaedics and Surgery
Department of Surgery
Keck School of Medicine of USC
University of Southern California
Los Angeles, CA, USA
Ch 23 Expert Commentary Functional Muscle Transfers for
Various Purposes
Wenhai Sun MD
Center for Restorative Surgery
New York, NY, USA
Ch 54 Expert Commentary Toe Flaps and Toe Transplantation
Bien-Keem Tan FRCS
Adjunct Associate Professor, Duke-NUS Graduate Medical
School;
Consultant, Department of Plastic Surgery,
Singapore General Hospital
Singapore
Ch 36 Expert Commentary Omentum, Superior Epigastric, and
External/Internal Oblique Flaps
Yuan-Kun Tu MD, PhD, FICS
President, APFSSH (Asian-Pacific Federations of Society
for Surgery of Hand)
Professor in Orthopedics
College of Medicine, I-Shou University
Superintendent, E-DA Hospital
Kaohsiung City, Taiwan
Ch 49 Expert Commentary Gracilis Flap
Jan Jeroen Vranckx MD, PhD
Professor & Chief
Dept. of Plastic & Reconstructive Surgery
Leuven University Hospitals
Leuven, Belgium
Ch 18 Expert Commentary Abdominal Wall Reconstruction

List of Expert Commentary Contributors
xxix
Huan Wang MD, PhD
Associate Professor of Neurosurgery
Associate Professor of Orthopedics
Mayo Clinic
Rochester, MI, USA
Ch 24 Expert Commentary Nerves
Fu-Chan Wei MD, FACS
Distinguished Chair and Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Chang Gung University, Medical College
Taipei, Taiwan
Ch 54 Expert Commentary Toe Flaps and Toe Transplantation
Peirong Yu MD, FACS
Professor, Dept. of Plastic Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
Ch 59 Expert Commentary Anterolateral and Anteromedial
Thigh Flaps

xxx
Video Contributor List
Uros Ahcan MD, PhD
Professor and Head
Department of Plastic Surgery and Burns
University Medical Centre
Ljubljana, Slovenia
16.03  Breast Reconstruction with DIEP Flap Using 3
Dimensional Molding
Nidal Farhan Al Deek MSc MD
Reconstructive Microsurgery Fellow
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital and Chang Gung
University
Taipei, Taiwan
47.03  The Suprafascial Harvest of the Radial Forearm Flap
51.02  Hemi-Soleus Distally Based for Lower Extremity Defect
52.01  Fibula Osteoseptocutaneous Flap
52.06  Reconstruction of the Mandible With the Preformed
Matrixmandible and Fibula OSC Flap
54.01  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 1
54.02  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 2
54.03  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 3
54.12  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 1
54.13  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 2
54.14  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 3
59.03  Suprafascial Harvest of the Anterolateral Thigh Flap
59.09  Different Designs of the Anterolateral Thigh Flap
Robert J. Allen Sr MD
Clinical Professor in Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
25.01  Microvascular Anastomosis of an Artery and Vascular
Coupling of a Vein
58.01  Inferior Gluteal Artery Perforator (IGAP) Flap for
Breast Reconstruction
Ugo Baciliero MD
Head of Maxillofacial Surgery
Regional Hospital S. Bortolo
Vicenza, Italy
32.04  Bilateral Pedicled Temporalis Muscle Flaps for
Reconstruction of a Complete Maxillectomy Defect
Karim Bakri MBBS
Assistant Professor of Plastic Surgery
Associate Program Director Plastic Surgery
Division of Plastic Surgery
Rochester, Minnesota, USA
12.01  Exposure of the Brachial Artery in the Medial Arm
12.02  Expsoure of the Distal Brachial Artery and Its
Bifurcation in the Antecubital Fossa
12.03  Exposure of the Radial Artery in the Wrist and
Anatomic Snuffbox
12.04  Exposure of the Ulnar Artery at the Wrist and
Guyon’s Canal
64.05  Face Transplant: Lower Face Donor Procurement
Jens U. Berli MD
Assistant Professor
Division of Plastic Surgery
Department of Surgery
Oregon Health Science University
Oregon, USA
19.01  Radial Forearm Free Flap Phalloplasty
Federico Biglioli MD
Head of Maxillofacial Surgical Unit
San Paolo and San Carlo Hospitals
University of Milan
Milan, Italy
24.01  Cross-Tongue Nerve Grafting for Lingual Nerve
Reconstruction
49.11  Double Innervated Gracilis Free-flap Transfer for
Smiling Reanimation
Uldis Bite
Professor of Plastic Surgery
Director
Cleft and Craniofacial Clinic
Mayo Clinic
Rochester, MN, USA
64.04  Face Transplant: Recipient Preparation
Shanda H. Blackmon MD, MPH, FACS
Associate Professor of Surgery
Division of Thoracic Surgery
Department of Surgery
Mayo Clinic
Rochester, MN, USA
38.03  Supercharged Pedicled Jejunum Interposition for
Esophageal Replacement
Gregory H. Borschel MD
Associate Professor
University of Toronto and The Hospital for Sick Children
Division of Plastic Surgery
Toronto, Canada
49.01  Segmental Gracilis Muscle Transfer for Smile in a Case
of Möbius Syndrome
49.10  Stage 1 – Cross-Facial Nerve Grafting for Smile

Video Contributor List
xxxi
Elizabeth A. Bradley MD
Associate Professor of Ophthalmology
Department of Opthalmology
Mayo Clinic
Rochester, MN, USA
64.06  Face Transplant: Recipient Reconstruction
Michaela Calhoun MS, CCA
Director of Anaplastology
Prosthetics at Graphica Medica, LLC
Bloomington, MN, USA
63.01  Face Transplantation: Donor Restoration
Edward J. Caterson MD, PhD
Instructor in Surgery
Plastic and Reconstructive Surgery
Director of Craniofacial Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
64.02  Face Transplant Postoperative Result
64.03  Face Transplant Postoperative Result: Showing
Spontaneous Emotion
Edward I-Fei Chang MD, FACS
Assistant Professor
Department of Plastic and Reconstructive Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
8.2  Lymphovenous Bypass
52.02  Free Fibula Osteocutaneous Flap Harvest
57.05  DIEP Free Flap Harvest
Zung-Chung Chen MD
Assistant Professor,
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Chief of Craniofacial Surgery
Taiyuan, Taiwan
32.01  Temporoparietal Fascia Flap for Auricular
Reconstruction
Hung-Chi Chen MD, PhD, FACS
Director, International Medicine
Professor, Department of Plastic Surgery
China Medical University
Taichung, Taiwan
14.01  Ileocolon Flap for Reconstruction of the Hypopharynx,
Cervical Esophagus, and Voice
25.02  Microvascular Anastomosis of an Artery and Vein
25.03  Airborne Suture Tying Technique
38.01  Jejunum Flap for Esophageal Reconstruction
38.02  Jejunum Flap
45.02  Posterior Interosseous Flap
54.06  Second Toe Flap
Jay Hsin-Hung Chen MD
Attending staff
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Keelung, Taiwan;
College of Medicine
Chang Gung University
Taoyuan, Taiwan
20.01  Great Toe Pulp Transfer to Reconstruct Non-Painful
Sensate Index Pulp Part 1
20.02  Great Toe Pulp Transfer to Reconstruct Non-Painful
Sensate Index Pulp Part 2
59.12  Reconstruction of Hemiglossectomy Defect with the ALT
Flap
Hsin-Yu Sirena Chen MD
Division of Craniofacial Surgery
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
54.01  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 1
54.02  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 2
54.03  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 3
Ming-Huei Cheng MD, MBA, FACS
Professor, Department of Plastic and Reconstructive
Surgery
Chief, Center for Tissue Engineering;
Chairman, International Medical Center;
Superintendent, Chang Gung Memorial Hospital
College of Medicine, Chang Gung University
Taoyuan, Taiwan
57.03  Deep Inferior Epigastric Artery Perforator (DIEP) Flap
for Breast Reconstruction
57.04  Deep Inferior Epigastric Artery Perforator Flap
David Chwei-Chin Chuang MD
Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital, Chang Gung University
Taipei, Taiwan
21.01  Brachial Plexus Exploration and Exposure of
Transverse Cervical Artery
21.02  Adult Brachial Plexus Injury Clip 1
21.03  Adult Brachial Plexus Injury Clip 2
21.04  Shoulder Abduction Reconstruction By Transfer of
Latissimus, Teres Major, and Clavicular Portion of Pectoralis
Major
22.01  Reconstruction of Foot Dorsiflexion with Rectus Femoris
Functioning Muscle Transfer
22.06  Rectus Femoris Myocutaneous Flap
49.03  Facial Reanimation (Second Stage) Reconstruction with
a Gracilis Functioning Muscle Transfer
49.04  Finger Flexion Reconstruction With Gracilis
Functioning Muscle Transfer
49.05  Gracilis Myocutaneous Flap Harvested for Functional
Muscle Transfer

xxxii
Video Contributor List
Thomas Constantinescu MD, CM, FRCSC
Fellow in Reconstructive Microsurgery
Department of Plastic Surgery
Chang Gung Memorial Hospital
Chang Gung University
Taipei, Taiwan
59.03  Suprafascial Harvest of the Anterolateral Thigh Flap
Joseph H. Dayan MD
Co-Director Lymphatic Surgery Program
Memorial Sloan Kettering Cancer Center
Division of Plastic Surgery
New York, NY USA
8.5  Axillary Lymph Node Transfer for Lower Extremity
Lymphedema
49.12  Diagonal Upper Gracilis Flap
Yener Demirtas MD
Associate Professor in Plastic Surgery
Director of Lymphest Clinic for Plastic Surgery
Istanbul, Turkey
41.03  Latissimus Dorsi Flap
Stefano Spanio di Spilimbergo MD
Maxillofacial Surgery
Regional Hospital S. Bortolo
Vicenza, Italy
32.04  Bilateral Pedicled Temporalis Muscle Flaps for
Reconstruction of a Complete Maxillectomy Defect
Gillian F. Duncan MS, CMI, CCA
Clinical Anaplastologist
Prosthetics at Graphica Medica
Rochester, MN, USA
63.01  Face Transplantation: Donor Restoration
Bassem T. Elhassan MD
Professor of Orthopedics
Mayo Clinic College of Medicine
Department of Orthopedic Surgery
Mayo Clinic
Rochester, MN, USA
39.01  Contralateral Trapezius Transfer
Chung-Ho Feng MD
Director
Vendome Aesthetic Medical Center
Taipei, Taiwan
59.11  Pedicled Anterolateral Thigh Myocutaneous Flap
(Vastus Lateralis Myocutaneous Flap) for Reconstruction of a
Medial Thigh Defect
59.15  Reverse Pedicled Anterolateral Thigh Perforator Flap
With Venous Supercharge for Reconstruction of a Popliteal
Defect
Duretti Fufa MD
Assistant Professor of Orthopaedic Surgery
Weill Cornell Medical College
Assistant Attending Orthopaedic Surgeon
Hospital for Special Surgery
New York, NY, USA
52.06  Reconstruction of the Mandible With the Preformed
Matrixmandible and Fibula OSC Flap
Alexandru V. Georgescu MD, PhD
Professor of Plastic Surgery and Reconstructive
Microsurgery
University of Medicine Iuliu Hatieganu;
Chairman, Clinic of Plastic Surgery and Reconstructive
Microsurgery
Clinical Hospital of Rehabilitation
Cluj Napoca, Romania
41.06  Composite Osteomuscular Flap of Latissimus Dorsi and
Rib
Günter Germann MD, PhD
Professor of Plastic Surgery
ETHIANUM Clinic for Plastic, Reconstructive and
Aesthetic Surgery at Heidelberg University
Heidelberg, Germany
41.01  Latissimus Dorsi Flap
Geoffrey G. Hallock MD
Consultant
Plastic Surgery
Sacred Heart Hospital,
Allentown, PA, USA
3.1  Scalp Split Thickness Skin Graft
32.02  Scalp Fascia Flap (Temperoparietal Fascia Flap)
34.01  Pectoralis Major Flap
37.01  Rectus Abdominis Flap
40.01  Scapular and Parascapular Flaps
41.02  Latissimus Dorsi Muscle Flap
47.02  Radial Forearm Flap
48.01  Distal Sural Flap
49.02  Gracilis Flap
50.01  Medial Gastrocnemius Flap
50.02  Lateral Gastrocnemius Flap
50.04  Medial Sural Artery Perforator Flap and Lateral
Gastrocnemius Flap
50.05  Medial Sural Artery Perforator Flap
51.01  The Soleus Muscle Flap
59.01  Anterolateral Thigh Flap
Matthew M. Hanasono MD
Professor
Department of Plastic Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX USA
59.16  Maxillary Reconstruction with the Anterolateral Thigh
Free Flap
Wyatt Ho MD
Private Practice Plastic Surgeon
Saint Francis Hospital
Tulsa, OK, USA
22.03  Endoscopically-Assisted Medial Sural Artery Perforator
Flap Transfer for Foot Reconstruction
47.03  The Suprafascial Harvest of the Radial Forearm Flap
54.07  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Markings
54.08  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Recipient Prep
54.09  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Flap Harvest
54.10  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Inset

Video Contributor List
xxxiii
Joon Pio (JP) Hong MD, PhD
Professor and Chairman
Department of Plastic Surgery
Asian Medical Center
University of Ulsan
School of Medicine
Seoul, Korea
43.02  SCIP
Chung-Chen Hsu MD
Division of Trauma Plastic Surgery
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Linkou, Taiwan
43.03  Groin Flap With Iliac Bone Harvest Based on the
Superficial Circumflex Iliac Artery
51.02  Hemi-Soleus Distally Based for Lower Extremity Defect
54.12  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 1
54.13  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 2
54.14  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 3
Marco Innocenti MD
Professor of Plastic Surgery
University of Florence,
Director Plastic & Reconstructive
Microsurgery Department
Careggi University Hospital,
Florence, Italy
52.07  Proximal Fibula Flap with Growth Plate
52.08  Proximal Fibula Epiphyseal Transplant
Seng-Feng Jeng MD FACS
Professor of Surgery
Plastic Surgery
E-Da hospital
Kaohsiung, Taiwan
50.03  Medial Sural Artery Perforator Flap
T. Shane Johnson MD
Associate Professor of Surgery, Orthopaedics and
Rehabilitation
Program Director, Division of Plastic Surgery
Penn State Hershey Medical Center and School of
Medicine
Hershey, PA, USA
13.04  Dorsalis Pedis Exposure
Roger K. Khouri MD, FACS
Volunteer Professor
Herbert Wertheim College of Medicine
University Park, FL, USA;
Medical Director
Miami Breast Center & Miami Hand Center
Miami, FL, USA
7.1  Lipografter / Jackhammer Grafting
Roger Karl Khouri Jr BS
Medical Student
University of Michigan Medical School
Ann Arbor, MI, USA;
Research Assistant
Miami Breast Center & Miami Hand Center
Miami, FL, USA
7.1  Lipografter / Jackhammer Grafting
Jeong-Tae Kim PhD
Hanyang University Medical Center
Seongdong-gu
Seoul, Korea
56.01  Perforator Flaps in the Lateral Thoracic Area:
Latissimus Dorsi Perforator Flap, Thoracodorsal Perforator
Flap, and Lateral Thoracic Perforator Flap
Michael J.A. Klebuc MD
Associate Clinical Professor of Plastic and
Reconstructive Surgery
Weill Cornell Medical College
Director, Center for Facial Paralysis Surgery
and Functional Restoration
Methodist Hospital
Houston, Texas
10.04  Facial Nerve Anatomy
L. Scott Levin MD, FACS
Paul B. Magnuson Professor of Bone and Joint Surgery
Orthopaedic Surgery
Chairman, Department of Orthopaedic Surgery
Professor of Orthopaedic Surgery
Professor of Surgery, Division of Plastic Surgery
University of Pennsylvania Health System,
Philadelphia, PA, USA
13.04  Dorsalis Pedis Exposure
Cheng-Hung Lin MD
Associate Professor
Division of Trauma and Emergency Surgery
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Kuei-Shan, Taiwan
22.03  Endoscopically-Assisted Medial Sural Artery Perforator
Flap Transfer for Foot Reconstruction
22.04  Pedicled Peroneal Artery Perforator Flap for
Reconstruction of a Soft Tissue Defect Over the Tibia
54.12  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 1
54.13  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 2
54.14  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 3
Chih-Hung Lin MD
Chairman of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Linkou, Taiwan
42.01  Iliac Flap
43.01  Groin Flap
49.06  Endoscopic Harvest of the Gracilis Muscle
59.02  Anteriolateral Thigh Flap
59.05  Vastus Lateralis Myocutaneous Flap
60.01  Tensor Fascia Lata Flap

xxxiv
Video Contributor List
Yu-Te Lin MD, MS
Associate Professor of Plastic Surgery
College of Medicine, Chang Gung University;
Consultant, Division of Trauma Plastic Surgery
Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Linkou, Taiwan
54.12  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 1
54.13  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 2
54.14  Microsurgical Transplantation of the PIP Joint of the
Second Toe Part 3
59.07  Anterolateral Thigh Flap for Wound Coverage and
Flow Through Reconstruction of the Radial Artery
Jessica Lynch MB, BCh, BAO
Plastic Surgery Intern
Department of Plastic and Reconstructive Surgery
Beaumont Hospital
Dublin, Ireland
19.01  Radial Forearm Free Flap Phalloplasty
Susan E. Mackinnon MD
Plastic and Reconstructive Surgery
Washington University
St. Louis, MO, USA
68.01  Jumping the Nerve Gap
Samir Mardini
Professor of Surgery
Mayo Clinic College of Medicine
Program Director, Plastic Surgery
Surgical Director
Essam and Dalal Obaid Center for Reconstructive
Transplant Surgery
Mayo Clinic
Rochester, MN, USA
10.05  Facial Nerve Anatomy, clinical case.
10.06  Facial Nerve Anatomy and Stimulation
14.01  Ileocolon Flap for Reconstruction of the Hypopharynx,
Cervical Esophagus and Voice
18.01  Component Separation
25.03  Airborne Suture Tying Technique
64.04  Face Transplant: Recipient Preparation
64.05  Face Transplant: Lower Face Donor Procurement
64.06  Face Transplant: Recipient Reconstruction
Jaume Masia Ayala MD, PhD
Professor of Plastic Surgery
Chief, Plastic Surgery Department
Director, European School of Reconstructive Microsurgery
Barcelona, Spain
8.3  Vascularized Groin Lymph Node Transfer for Upper
Extremity Lymphedema
8.4  Superficial Circumflex Iliac Artery Perforator Flap (SCIP
Flap) for Lymph-Node Transfer in Lymphedema Treatment
Steven L. Moran MD
Professor and Chair of Plastic Surgery, Professor of
Orthopedic Surgery
Mayo Clinic
Rochester, MN, USA
45.01  First Dorsal Metacarpal Artery Flap
55.01  Medial Femoral Condyle Flap Based on Descending
Geniculate Vessel
55.02  Medial Femoral Condyle Flap
Maurice Y. Nahabedian MD
Professor
Department of Plastic Surgery
Georgetown University
Washington, DC, USA
16.01  DIEP
Milomir Ninković MD, PhD
Professor of Plastic Surgery
Chairman, Department of Plastic, Reconstructive, Hand
and Burn Surgery
Academic Hospital Munich Bogenhausen,
Technical University
Munich, Germany
23.01  Peroneus Function After Reconstruction
23.02  Facial Movement After Reconstruction
46.01  Extended Lateral Arm Flap
Ömer Özkan MD
Professor of Plastic and Reconstructive Surgery
Department of Plastic and Reconstructive Surgery
Akdeniz University Hospital
Antalya, Turkey
41.03  Latissimus Dorsi Flap
66.01  Uterus Transplantation: Surgical Technique
Özlenen Özkan, MD
Associate Professor
Akdeniz University Hospital
Head of Plastic and Reconstructive Surgery Department
Antalya, Turkey
66.01  Uterus Transplantation: Surgical Technique
Ernesto Padula MD
Maxillofacial Surgery
Regional Hospital S. Bortolo
Vicenza, Italy
32.04  Bilateral Pedicled Temporalis Muscle Flaps for
Reconstruction of a Complete Maxillectomy Defect
Christopher J. Pannucci MD, MS
Assistant Professor
Division of Plastic Surgery
University of Utah
Salt Lake City, UT, USA
13.04  Dorsalis Pedis Exposure

Video Contributor List
xxxv
Ketan M. Patel MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Keck Medical Center of USC
University of Southern California
Los Angeles, CA, USA
54.01  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 1
54.02  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 2
54.03  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 3
Bohdan Pomahac MD
Director, Plastic Surgery Transplantation
Medical Director, BWH Burn Center
Associate Professor
Harvard Medical School
Boston, Massachussetts
64.01  Facial Transplant
64.02  Face Transplant Postoperative Result
64.03  Face Transplant Postoperative Result: Showing
Spontaneous Emotion
Gemma Pons MD, PhD
Head of the Microsurgery Unit
Department of Plastic Surgery
Hospital de la Santa Creu i Sant Pau
Universitat Autònoma de Barcelona
Barcelona, Spain
8.3  Vascularized Groin Lymph Node Transfer for Upper
Extremity Lymphedema
Julian J. Pribaz MD
Professor, Division of Plastic Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
31.01  Forehead Flap
31.02  Facial Artery Myo Mucosal Flap
31.03  Submental Flap
32.03  Temporoparietal Fascia Flap
64.02  Face Transplant Postoperative Result
64.03  Face Transplant Postoperative Result: Showing
Spontaneous Emotion
Richard J. Redett III MD
Associate Professor
Department of Plastic and Reconstructive Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
19.01  Radial Forearm Free Flap Phalloplasty
Joseph A. Ricci MD
Plastic Surgery Resident
Harvard Medical School
Brigham and Women’s Hospital
Boston, MA, USA
64.01  Facial Transplant
Geoffrey L. Robb MD, FACS
Professor of Plastic Surgery
Department of Plastic Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
34.02  Pectoralis Major Flap
35.01  Delto Pectoral and Internal Mammary Artery Perforator
Flaps
Eduardo D. Rodriguez MD, DDS
Helen L. Kimmel Professor of Reconstructive Plastic Surgery
Chair, Hansjörg Wyss Department of Plastic Surgery
NYU School of Medicine
NYU Langone Medical Center
New York, NY, USA
52.05  Fibula Flap for Obliteration and Osseous Reconstruction
of a Persistent Frontal Basilar Fracture Infection Associated
with Nasofrontal Outflow Tract Obstruction
Shai Rozen MD, FACS
Associate Professor
Director of Microsurgery
Director of the Facial Palsy Program
Department of Plastic Surgery
UT Southwestern Medical Center
Dallas, TX, USA
10.07  Facial Reanimation: Masseteric Nerve to Facial Nerve
Transfer, Cross Facial Nerve Grafting
10.08  Facial Reanimation: Preoperative Facial Markings,
Preparation of Face on Recipient Side, Harvest of Partial
Gracilis Functional Muscle Flap, Masseter Nerve Dissection,
and Insetting of Gracilis to Paralyzed Side
Michel Saint-Cyr MD, FRSC(C)
Wigley Professor in Plastic Surgery
Director, Division of Plastic Surgery
Baylor Scott and White
Temple, TX, USA
7.2  Fat Grafting for Breast Reconstruction
8.1  LV Bypass Preoperative Planning in Lower Extremity
Lymphedema
16.02  Muscle Sparing Latissimus Dorsi
22.02  Keystone Island Perforator Flaps for Thigh Defects
22.05  Peroneal Artery Perforator Propeller Flap
41.04  Preoperative Markings Extended Latissimus Dorsi
41.05  Latissimus Dorsi Flap for Breast Reconstruction
49.07  Preoperative Markings for Transverse Upper Gracilis
Myocutaneous Flap for Bilateral Breast Reconstruction
49.08  Flap Harvest of Transverse Upper Gracilis
Myocutaneous Flap for Breast Reconstruction
49.09  Vertical Design Upper Gracilis Flap for Breast
Reconstruction
57.01  Preoperative Deep Inferior Epigastric Perforator (DIEP)
Marking in a High BMI Patient
57.02  Deep Inferior Epigastric Perforator Flap Harvest and
Dissection Summary
59.08  Free Vastus Lateralis Muscle Flap
59.10  Pedicled ALT Flap for Groin
61.01  Posterior Tibial Artery Perforator Propeller Flap
62.01  Intraoperative PAP Flap Markings and Flap Harvest
62.03  Pedicled Superficial Femoral Artery Perforator Flap
62.04  Superficial Femoral Artery Perforator Flap for Knee
Coverage
62.05  Proximal Free-style Superficial Femoral Artery Perforator
Flap for Medial Thigh Defect

xxxvi
Video Contributor List
Jesse Selber MD, MPH, FACS
Associate Professor, Director of Clinical Research
Department of Plastic Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
9.1  Trans Oral Robotic Surgery
9.2  External View of Robotic LD
9.3  Robotic Harvest of Rectus Abdominis
9.4  Robotic Harvest of Latissimus Dorsi
9.5  Robotic Microvascular Anastomosis
9.6  Robotic Lymphaticovenous Bypass
Basel Sharaf MD, DDS, FACS, FRCDC
Assistant Professor in Plastic Surgery
Mayo Clinic College of Medicine
Division of Plastic Surgery
Rochester, MN, USA
10.01  Exposure of Superficial Temporal Vessels
10.02  Exposure of the Facial Vessels
10.03  Exposure of the Transverse Cervical Vessels
11.01  Trunk Anatomy, Internal Mammary Artery Exposure
13.01  Groin and Lower Extremity Landmarks
13.02  Exposure of Posterior Tibial Vessels
13.03  Exposure of the Dorsalis Pedis and Tibialis Anterior
Amanda K. Silva MD
The University of Chicago Medicine & Biological Sciences
Chicago, IL, USA
17.01  Chest Wall and Diaphragm Mesh Reconstruction
Moving With Respirations
17.02  Chest Wall Defect and Expanding Lung
17.03  Flap Inset
Alison Snyder-Warwick MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
49.01  Segmental Gracilis Muscle Transfer for Smile in a Case
of Möbius Syndrome
49.10  Stage 1 – Cross-Facial Nerve Grafting for Smile
David H. Song MD, MBA, FACS
Cynthia Chow Professor of Surgery
Chief, Section of Plastic and Reconstructive Surgery
Vice-Chair, Department of Surgery
Associate Dean, Continuing Medical Education
The University of Chicago Medicine & Biological Sciences
Chicago, IL, USA
17.01  Chest Wall and Diaphragm Mesh Reconstruction
Moving With Respirations
17.02  Chest Wall Defect and Expanding Lung
17.03  Flap Inset
Aldona J. Spiegel, MD
Associate Professor of Plastic Surgery, Weill Cornell
Medical College
Director, The Center for Breast Restoration
Houston Methodist Institute for Reconstructive Surgery
Houston, TX, USA
57.06  Superficial Inferior Epigastric Artery (SIEA) Flap for
Breast Reconstruction
Roberto Squaquara MD
Maxillofacial Surgery
Regional Hospital S. Bortolo
Vicenza, Italy
32.04  Bilateral Pedicled Temporalis Muscle Flaps for
Reconstruction of a Complete Maxillectomy Defect
Jason Su Shiuan-tzuen
Chang Gung Memorial Hospital
Plastic & Reconstructive Department
Gueishan Township,Taiwan
47.03  The Suprafascial Harvest of the Radial Forearm Flap
54.08  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Recipient Prep
54.09  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Flap Harvest
54.10  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Inset
Marissa Suchyta BS
Research Assistant
Department of Plastic Surgery
Mayo Clinic
Rochester, MN, USA
12.01  Exposure of the Brachial Artery in the Medial Arm
12.02  Exposure of the Distal Brachial Artery and Its
Bifurcation in the Antecubital Fossa
12.03  Exposure of the Radial Artery in the Wrist and
Anatomic Snuffbox
12.04  Exposure of the Ulnar Artery at the Wrist and Guyon’s
Canal
64.04  Face Transplant: Recipient Preparation
64.05  Face Transplant: Lower Face Donor Procurement
64.06  Face Transplant: Recipient Reconstruction
Hyun-Suk Suh MD, PhD
Clinical Assistant Professor
Plastic Surgery
Asan Medical Center University of Ulsan
Seoul, Korea
43.02  SCIP
Amir H. Taghinia MD, MPH
Staff Surgeon
Boston Children’s Hospital
Assistant Professor of Surgery
Harvard Medical School
Boston, MA, USA
47.01  Reverse Radial Forearm Flap
Julia K. Terzis MD, PhD, FACS, FRCS(C)
Adjunct Professor
Department of Plastic and Reconstructive Surgery
New York University Medical Center
Medical Director, International Institute of Reconstructive
Microsurgery
New York, NY
15.01  Babysitter Principle in Facial Reanimation
15.02  Techniques of Cross Facial Nerve Grafting
15.03  Gracilis Free Muscle Transfer for Facial Reanimation
15.04  Pectoralis Minor Free Muscle Transfer for Facial
Reanimation

Video Contributor List
xxxvii
Chung-Kan Tsao MD
Assistant Professor in Plastic Surgery
Chief of Division of Plastic Reconstructive Microsurgery
Department of Plastic Surgery
Chang Gung Memorial Hospital
Taipei, Taiwan
59.06  Chimeric Anterolateral Thigh Perforator Skin Flap and
Vastus Lateralis Muscle Flap for Reconstruction of a Defect in
the Maxilla.
Joseph Upton MD
Staff Surgeon
Boston Children’s Hospital
Shriner’s Hospital for Children
Beth Israel-Deaconess Medical Center
Professor of Surgery
Harvard Medical School
Boston, MA, USA
47.01  Reverse Radial Forearm Flap
Julie V. Vasile MD, FACS
Division of Plastic and Reconstructive Surgery
Northern Westchester Hospital
New York Eye and Ear Infirmary of Mt. Sinai
New York, NY, USA
58.01  Inferior Gluteal Artery Perforator (IGAP) Flap for
Breast Reconstruction
Nicholas B. Vedder MD
Professor of Surgery and Orthopaedics
Chief Plastic Surgery
Vice Chair, Department of Surgery
University of Washington
Seattle, Washington
47.08  Radial Forearm Fascia Flap Reverse Pedicled
Jan Jeroen Vranckx MD, PhD
Professor & Chief
Dept. Plastic & Reconstructive Surgery
Leuven University Hospitals
Leuven, Belgium
18.02  Pedicled Innervated Vastus Lateralis Muscle for
Abdominal Wall Reconstruction Case 1
18.03  Pedicled Innervated Vastus Lateralis Muscle for
Abdominal Wall Reconstruction Case 2
18.04  Pedicled Innervated Vastus Lateralis Muscle for
Abdominal Wall Reconstruction: Dissection
Christopher G. Wallace MD, MS, FRCS(Plast)
Consultant Plastic, Reconstructive and Aesthetic Surgeon,
Department of Plastic Surgery,
Royal Devon and Exeter NHS Foundation Trust
Exeter, UK
20.01  Great Toe Pulp Transfer to Reconstruct Non-Painful
Sensate Index Pulp Part 1
20.02  Great Toe Pulp Transfer to Reconstruct Non-Painful
Sensate Index Pulp Part 2
59.12  Reconstruction of Hemiglossectomy Defect with the ALT
Flap
Fu-Chan Wei MD, FACS
Distinguished Chair and Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Chang Gung University, Medical College
Taipei, Taiwan
20.01  Great Toe Pulp Transfer to Reconstruct Non-Painful
Sensate Index Pulp Part 1
20.02  Great Toe Pulp Transfer to Reconstruct Non-Painful
Sensate Index Pulp Part 2
20.03  Second Toe Flap for Index Finger Reconstruction
46.02  Lateral Arm Flap for Reconstruction of a Webspace
Defect After Contracture Release
47.03  The Suprafascial Harvest of the Radial Forearm Flap
47.04  Radial Forearm Flap, Suprafascial Dissection
47.05  Radial Forearm Flap, Suprafascial
47.06  Radial Forearm Flap for Buccal Defect Reconstruction
47.07  Radial Forearm Flap for Reconstruction of an Upper
Lip Defect
47.09  Radial Forearm Flap Dissection and Management of
the Donor Site with a Full Thickness Skin
52.01  Fibula Osteoseptocutaneous Flap
52.03  Harvest of the Fibula Osteoseptocutaneous Flap Via
Anterior Approach
52.04  Fibula Osteoseptocutaneous Flap with Primary
Osteointegrated Implants for Mandible Reconstruction
52.06  Reconstruction of the Mandible With the Preformed
Matrixmandible and Fibula OSC Flap
54.01  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 1
54.02  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 2
54.03  Great Toe Transfer for Reconstruction of Metacarpal
Hand Part 3
54.04  Trimmed Great Toe Flap
54.05  Trimmed Great Toe Transfer
54.07  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Markings
54.08  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Recipient Prep
54.09  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Flap Harvest
54.10  Bilateral Second Toe Transfer for Reconstruction of
Distal Fingertip Amputations: Inset
54.11  Second and Third Toe Flap for Metacarpal Hand
Reconstruction
59.03  Suprafascial Harvest of the Anterolateral Thigh Flap
59.04  Anterolateral Thigh Perforator Flap, Dissection
59.09  Different Designs of the Anterolateral Thigh Flap
59.12  Reconstruction of Hemiglossectomy Defect with the ALT
Flap
59.13  Anterolateral Thigh Perforator Flap for Reconstruction
of a Palate Defect
59.14  Anterolateral Thigh Perforator Flap for Hypopharyngeal
and Cervical Esophagus Reconstruction

xxxviii
Video Contributor List
Karen W.Y. Wong MD, MSc, FRCSC
Assistant Professor
Division of Plastic and Reconstructive Surgery
The Hospital for Sick Children
Department of Surgery
University of Toronto
Toronto, Ontario, Canada
49.01  Segmental Gracilis Muscle Transfer for Smile in a Case
of Möbius Syndrome
49.10  Stage 1 – Cross-Facial Nerve Grafting for Smile
Jerry Chih-Wei Wu MD
Plastic Surgeon
Chang Gung Memorial Hospital
Keelung, Taiwan
62.02  Profunda Artery Perforator (PAP) Flap for Head and
Neck Reconstruction
Andrew Yee BS
Staff Scientist
Division of Plastic and Reconstructive Surgery,
Department of Surgery
Washington University School of Medicine
St. Louis, MO, USA
49.01  Segmental Gracilis Muscle Transfer for Smile in a Case
of Möbius Syndrome
49.10  Stage 1 – Cross-Facial Nerve Grafting for Smile
68.01  Jumping the Nerve Gap
Dennis Yeh MD
Plastic Surgeon
Chang Gung Memorial Hospital
Keelung, Taiwan
59.03  Suprafascial Harvest of the Anterolateral Thigh Flap
Michael R. Zenn MD, MBA
Professor
Plastic and Reconstructive Surgery
Duke University
Durham, NC, USA
33.01  Flaps
Ronald M. Zuker MD, FRCSC, FACS, FRCSEd(Hon)
Professor of Surgery
Department of Surgery
University of Toronto;
Staff Plastic and Reconstructive Surgeon
Department of Surgery
The Hospital for Sick Children
Toronto, Ontario, Canada
49.01  Segmental Gracilis Muscle Transfer for Smile in a Case
of Möbius Syndrome
49.10  Stage 1 – Cross-Facial Nerve Grafting for Smile

xxxix
Preface
Remarkable advances in research, technology, and clinical
experience in medicine over the past few decades have
resulted in a strong surge of development in reconstructive
surgery. Each field of medicine brings about a unique per­
spective on a disease and its treatment. The patients are the
direct beneficiaries of these advances and we, as surgeons,
are rewarded with the gift of knowing that we have given
hope and provided new opportunities for those who have
been disfigured or rendered dysfunctional. The change to
the patients’ lives and the reward we derive from providing
them with a chance to become “normal” again are equally
gratifying. The field of surgery is truly rewarding; we are
often able to eradicate a disease, improve a condition,
rewire a circuit, or recreate form and function. We truly
believe that no specialty in medicine is as rewarding as
reconstructive surgery, where conditions that were impos­
sible to correct only a few decades ago are now treated with
sophisticated and technically advanced procedures on a
routine basis.
In order to truly appreciate the significance of this spe­
cialty, visualize the following scenarios and the vast number
of possibilities that reconstructive surgery offers in dealing
with these clinical challenges: a child with missing fingers
trying to play with a toy; a young girl unable to symmetrically
animate her face trying to explain to her classmates why she
looks “funny” when she tries to smile; a teenage boy with an
open wound on his leg who has been told that he may need
to have his leg amputated; a middle-aged man with a defect
in his esophagus being told that he will not be able to eat
or drink from his mouth for the rest of his life; a 35-year-old
woman trying to conceal a deformed chest after a mastec­
tomy; the family of a 50-year-old man being told that their
loved one who underwent a routine coronary bypass proce­
dure may not leave the hospital because of a sternal wound
infection that may take his life; and a 14-year-old girl with a
brachial plexus injury being unable to reach her hand to
her mouth. As a reconstructive surgeon, one may have been
exposed to some or all of these situations and may also know
that through our field we are capable of bringing hope in
a bleak situation.
Reconstructive surgery spans all ages and all specialties.
This is part of what makes this specialty unique, challenging,
exciting, and unusually rewarding. Elegance and surgical
skill are easily noticed and appreciated by our patients. It is
difficult to be a reconstructive surgeon and not take special
pride in every procedure performed and in positive out­
comes seen. Likewise, every surgeon has experienced the
consequences of a heroic effort that was unsuccessful. We
are able to survive these experiences as surgeons because of
our human nature of being able to forget, but, more impor­
tantly, for us to be able to forget, we need to know that we
have learned as much as we can about a procedure before
performing it and have gathered as much information as
possible and reviewed all the necessary material before
embarking on a reconstructive effort. Every contributing
author has detailed the anatomic basis for the way the
described procedures are performed and made every effort
to share as much detail of the technique, with colorful and
detailed illustrations and pictures, and to provide as many
tips as possible from the knowledge and wisdom they have
gained during the course of their career. We have been
fortunate to be able to bring together a phenomenal group
of surgeons and scientists who have had a tremendous
amount of experience with reconstructive surgery, and we
have tried very hard to bring consistency and clarity to the
presentation of this work.
This book is unique. It begins with a comprehensive
section on principles of reconstruction which covers the
types of reconstructive options that exist and how to choose
which one is best for the patient, then discusses how to avoid
complications in reconstructive surgery, how to deal with
complications when they arise, and how to monitor the
reconstructive patient. In this section, several new topics
have been added including fat grafting, robotics, tissue engi­
neering and lymphedema surgery. A special section is now
dedicated to clinical anatomy of every part of the body along
with detailed topics on recipient vessel selection and expo­
sure with clear and detailed pictures and illustrations. An
entire new section is dedicated to the topic of reconstruc­
tion, focusing on each area of the body and providing an
algorithm for reconstruction using the flaps outlined later
in the textbook. All of the topics on reconstruction are new,
with leaders in the field detailing their thought process and
techniques on how to deal with a defect and manage com­
plications when they arise. Two sections of the book focus
on all the important flaps that are needed to complete the
reconstruction of a defect: workhorse non-perforator type
flaps and workhorse perforator type flaps. Our intent while
putting this book together was to provide a reference that
would provide the reader with a comprehensive way of
understanding the anatomy of the region where the flap is
being harvested from, appreciating the anatomy of the flap
itself, understanding the issues involved in reconstructing
different parts of the body, appreciating and fully realizing
the way to plan and execute flap harvest, tailoring a flap to
fit the need of a defect, and reconstructing the defect in the
way that yields the most functional and aesthetic result. In
the final and totally new section, world leaders in the field
of reconstructive transplantation discuss topics of how to
start a reconstructive transplant program, the latest advances
in research in the field of reconstructive transplantation
along with techniques and outcomes of hand, face, uterus,
nerve, and abdominal wall transplantation. This entire
project is completed and detailed through clear and

xl
Preface
thorough writing, beautiful and abundant illustrations and
pictures, and a unique library of reconstructive surgical
procedures.
We hope that this textbook and video collection will
provide a core course for beginners and a reference for
experienced surgeons who aim to restore aesthetically
appealing form and function to their patients. Every chapter
in this book has been written by world renowned surgeons
who have had proven successes over the years and have
generously given their time and effort to sharing their
knowledge and experience with us. The reader will be
exposed to the most cutting edge surgical procedures in the
field. The curious surgeon who has the drive to find optimal
surgical solutions to situations rendered as hopeless will
benefit from the materials in this book.
With true appreciation for the contributions of our expert
colleagues, and great gratitude to our families, teachers,
students and colleagues, we sincerely hope that each reader
from every specialty practicing reconstructive surgery will
find this textbook to be useful in treating their patients and
be an inspiration in providing a resource for them to con­
tinue to advance this specialty which is so intense and has a
never-ending potential to help those in desperate need of
care.
Fu-Chan Wei and Samir Mardini
2016

xli
Dedication
To my wife Nancy, my son William, my daughter
Shirley, my son-in-law Darren and my wonderful
grandson Kyle whose support and love have made my
journey possible.
Fu-Chan Wei MD
To my wife Rawan, and my children Celine and Tarek,
your support and love fills my life with joy; to my mother
who is so loving, to my father who is so wise and caring,
to my teachers who have been so generous, and to my
friends who make the journey of life so beautiful; for the
love, support and guidance you have given me; from the
bottom of my heart, I thank you.
Samir Mardini MD

xlii
Acknowledgments
This textbook would not have been possible without the
hard work and efforts of so many around us. We would like
to thank our families, friends, our teachers, students and
colleagues and all those around us in our daily lives.
We would first like to thank Belinda Kuhn, Senior Content
Strategist at Elsevier. Her incredible work ethic, talent, kind­
ness, dedication, and insight made this high quality work
possible. We owe deep gratitude to Alexandra Mortimer,
now an Associate Content Strategist at Elsevier, who was the
development editor for this project. Alex took this project
from start to finish dealing with massive additions, changes
and expansions; her creativity, patience, organizational skill,
and talent made the biggest difference. We thank Andrew
Riley (Project Manager) for his incredible intelligence, kind
nature and attention to detail.
We would like to thank our administrators who work
closely with us on a daily basis to make our lives better and
make things happen for us. Mrs Tina Lo has put a tremen­
dous amount of work into this project and we appreciate
her for this. Mrs Shirley Walter who is most talented, intel­
ligent and patient, has taken care of everything else in our
clinical and administrative lives so that we can focus on this
book. We would also like to list some of our teachers, col­
leagues and students who have had a significant influence
on us throughout the years: Samuel Noordhoff, Ralph T.
Manktelow, Ronald Zuker, Steven Tsai, Tsu-Ming Tsai, Yu-Ray
Chen, Hung-Chi Chen, David C.C. Chuang, Phillip K.T.
Chen, Sen-Feng Jeng, Chih-Hung Lin, Ming-Huei Cheng,
Scott L. Spear, Jeffrey Posnick, Christopher Attinger, Amir
Jamali, Christopher J. Salgado, Steven Evans, Karen Kim
Evans, Paolo Sassu, Russel Nauta, Eric Hubli, Brooks
Edwards, Michael Sarr, Claude Deschamps and Julia Terzis.
Every procedure demonstrated in the video library within
this book required enormous effort on the part of the
surgeon and team involved in executing the surgical proce­
dure, taping it and narrating every procedure. We owe Mr.
Hsu-Chun Chen so much for shooting many of the videos,
Marissa Suchyta and Anita Mohan for editing many of the
videos, Fiona Townsend for developing the videos, making
them presentable and allowing us to be able to provide so
many procedures in this second edition.
Anybody working on a project which requires teamwork,
particularly a project as large as this, realizes very clearly that
it is the collaborative effort of the team that makes such an
endeavour possible. We are indebted to so many for their
hard work and special talents in helping prepare and
produce this work and for being there for us during our
career and during the time this work was being produced.

1
HISTORY OF RECONSTRUCTIVE SURGERY
As one of my professors, the late Bradford Cannon, noted,
the field of plastic surgery, unlike most other surgical spe­
cialties, has no anatomic or functional area to which it can
lay claim; the plastic surgeon practices methods and tech­
niques applicable to all specialties and anatomic areas.
Plastic surgery as a specialty was based on, and continues to
be defined by, the process of developing creative solutions
to the most difficult and challenging problems everywhere
in the human body – literally from the head to the toe. As
such, the plastic surgeon of today is, in fact, the last true
“general surgeon.” Though plastic surgery is comprised of
two distinct “spheres,” reconstructive surgery and aesthetic
surgery, the two are closely intertwined and have great
overlap. Many of the techniques employed in modern aes­
thetic surgery have their basis in reconstructive surgery.
Similarly, reconstructive surgery focuses on restoring both
function and form, such that many techniques used in aes­
thetic surgery are also employed in modern reconstructive
surgery, such as flap contouring, fat grafting, etc.
Reconstructive surgery is the process of restoring the
human body to “whole” following tumor extirpation, infec­
tion, trauma, or congenital or acquired deformity – restor­
ing both form and function. Because the result of tumor,
infection, trauma, or deformity has such a major effect on
a patient’s life, health, and well-being, reconstructive surgery
can have the powerful effect of truly rebuilding a patient’s
life. The professional and personal gratification this brings
to the reconstructive surgeon is profound.
Clearly, not all reconstructive surgery is performed by plas­
tic surgeons. Indeed, orthopedic surgeons, otolaryngology/
head and neck surgeons, oral surgeons, ophthalmologic
surgeons, urologic surgeons, pediatric surgeons, gynecologic
surgeons, and general surgeons perform a great deal of out­
standing reconstructive surgery. But what they all have in
common in performing reconstructive surgery is that all
follow the same goals and principles of restoring both form
and function.
The techniques employed in reconstructive surgery have
come a long way from the days of Tagliacozzi, reconstruct­
ing noses with pedicled flaps from the arm, in the 1500s.
Yet, only 50 years ago, those same techniques of random
pedicled flaps still formed the basis of much of reconstruc­
tive surgery. In the 1930s, split skin grafts came into regular
use, and in many ways defined the specialty of plastic surgery
at its origin.1 Over the past 50 years, there has been an
explosion in the development of reconstructive techniques
and approaches. In the 1960s, it was recognized that design­
ing a flap based on an axial vessel could greatly increase
the viable length of the flap to include the entire length of
the axial vessel, plus a random component distal to it. This
led to McGregor’s description of the forehead flap in 1963
and Bakamjian’s description of the deltopectoral flap in
1965.2,3 Then, the introduction of the two-headed operating
microscope in 1960, and Buncke’s pioneering laboratory
work in the early 1960s, including his rabbit ear replanta­
tion in 1964, opened the door to microvascular surgery.4,5
The first clinical application of the operating microscope
was in replantation, with Konatsu and Tamai’s successful
complete thumb replantation.6 The first microvascular
composite tissue transplantation in a human was a second
toe to thumb transfer, by Yang and Gu in 1966.7 In 1972
McLean and Buncke performed a free microvascular
omental flap to cover a cranial defect, and the following
year, both Daniel and Taylor performed the first free cuta­
neous flaps – free groin flaps, and thus the microsurgery
revolution began.8,9
THE RECONSTRUCTIVE LADDER
In the 1970s, Mathes and Nahai,10 as well as others, intro­
duced the concept of muscle and myocutaneous flaps that
had a tremendous influence on reconstructive choices
throughout the body – head and neck, trunk, as well as
upper and lower extremity. In their two seminal textbooks,
first an atlas of muscle and myocutaneous flaps in 1979,
then a text on clinical applications in 1982,11 they defined
Problem Analysis in
Reconstructive Surgery:
Reconstructive Ladders,
Elevators, and Surgical
Judgment
Nicholas B. Vedder
1 
PART 1  —  PRINCIPLES

2
PART 1 — PRINCIPLES
• Do not be afraid to choose a complex reconstructive
method, if it will provide the best long-term outcome.
• Not everything needs a free flap.
• Base the choice of reconstructive method on the quality
of the reconstruction in terms of type of tissue, shape,
contour, durability, and function; not the mechanics of
the reconstruction, whether it be skin graft, random flap,
pedicle flap, or free flap.
• Consider the individual patient’s problem, needs, health,
risks, and long-term outcome, and tailor the reconstruc­
tive choice to the patient and the problem.
Some examples of these principles include facial recon­
struction and pressure sore reconstruction. In most facial
tumor resection defects, although a skin graft might suffice
to close the wound, a local flap is almost always preferable,
in terms of both form and function and also contour and
aesthetics, and is often just as simple to perform. In a pres­
sure sore reconstruction, although primary closure or a skin
graft may be simplest, neither has the durability of a myocuta­
neous flap. One must choose the best reconstruction to
achieve optimal, long-term form and function, and balance
that with the complexity of the reconstruction, patient
needs and overall health, and, in the current medical envi­
ronment, what provides the best value to the patient and
society.
SURGICAL JUDGMENT
THE PRESENT STATE OF RECONSTRUCTIVE
SURGERY
In the end, problem analysis and surgical planning in recon­
structive surgery come down to exercising one’s best surgi­
cal judgment. But, as Mark Twain said, “Good judgment
is the result of experience, and experience the result of
bad judgment.” Hopefully, those practicing reconstructive
surgery will have taken advantage of the experience of their
mentors during their training, and texts such as this,
evidence-based outcomes studies in the literature, and at
professional meetings, as well as the experience of col­
leagues and mentors in their daily practice, when selecting
the most appropriate reconstructive option for the particu­
lar case at hand.
Surgical judgment in reconstructive surgery involves first
analyzing the clinical problem, whether it be tumor, infec­
tion, trauma, or deformity, then determining what steps
need to be taken to set the stage for an optimal reconstruc­
tion. If it is tumor, then complete resection is paramount to
achieving a successful reconstruction. Similarly, with infec­
tion or trauma, excisional debridement, as with a tumor
resection, back to healthy, well-vascularized tissue is critical
before beginning reconstruction. If it is a deformity, then
complete release or removal of scarred, contracted, or
deformed tissue must be performed first. Sometimes this
requires a staged approach to reconstruction, awaiting final
pathology margins for a tumor, or ensuring that a trauma
debridement removed all non-viable tissue.
Next is the critical step of choosing the best reconstruc­
tive approach. Here, one must begin by assessing what com­
ponents are missing; what the functional requirements
and laid out the clinical application of these flaps in an
anatomically-based manner with the goal of providing a
complete algorithm of whole body reconstruction. In the
latter text, they also described the concept of a “reconstruc­
tive ladder,” which was a principle-based algorithm of recon­
structive choices, based on Occam’s Razor – the simplest
solution is the best – whereby the entire spectrum of recon­
structive options, including the vast variety of options devel­
oped in recent years, formed rungs of a ladder, with the
simplest options at the bottom of the ladder and the most
complex options at the top rung of the ladder.
According to this concept, one would choose the simplest
form of reconstruction that would serve to solve any particu­
lar reconstructive problem. For example, primary closure
would form the first rung of the ladder, and, if feasible,
should be the reconstruction of choice. Farther up the
rungs would be closure by secondary intent (i.e., wound
contracture), skin graft, local flap, distant flap, and at the
top, free flap. The concept was beautiful in its simplicity,
and had an immediate and lasting effect on reconstructive
decision to this day. But, to quote Albert Einstein, “Every­
thing should be made as simple as possible, but not simpler.”
In the quest to provide a simple algorithm for reconstructive
surgery that could be applied throughout the human body,
a number of nuances were overlooked, and with the growing
plethora of reconstructive options in the next few decades,
the “reconstructive ladder” was soon in need of some
“reconstruction.”
THE RECONSTRUCTIVE ELEVATOR
The reconstructive ladder has since come under criticism
for its focus on simplicity in wound closure, without explic­
itly highlighting the importance of form and function in the
final outcome. In 1994, Gottlieb wrote that the simplest is
not necessarily always the best, and that reconstructive
surgery calls for “creative parallel thought rather than
simple sequential thought.” He proposed the concept of a
“reconstructive elevator,” whereby one would not simply
choose the simplest technique that could achieve wound
closure, but should instead ride the reconstructive elevator,
bypassing simpler reconstructive methods that may not
achieve the best outcome in terms of form and function, up
to the most appropriate reconstructive method for the indi­
vidual situation, even if it meant choosing a more complex
method.12 The two editors of this text, and others, have
similarly called for a “reconstruction of the reconstructive
ladder” with the goal of focusing on the optimum method
of reconstruction, rather than merely the simplest.13,14 At its
inception, the reconstructive ladder was never meant to be
a rigid algorithm, confined to choosing the simplest method
possible, but instead was merely a framework to consider all
of the various reconstructive options available, in light of
their cost/risk and benefit (Foad Nahai, MD pers. comm.
2014). In the end, everyone who has considered this ques­
tion is really saying the same thing. The true principles
therefore are:
• Do not merely use the simplest technique possible; use
the simplest technique that will achieve optimal form and
function.

CHAPTER 1 — PROBLEM ANALYSIS IN RECONSTRUCTIVE SURGERY
3
with microvascular surgery and free tissue transfer. Micro­
surgery literally freed us to pursue limitless reconstructive
possibilities. In addition, the introduction of the operating
microscope opened new possibilities for micro-nerve, and
more recently, microlymphatic surgery.
The field of hand surgery, and in particular hand trauma
surgery, exploded with the advent of microsurgery, by
making it possible to replant amputated digits, hands, and
more. The ability to transfer free vascularized tissue allowed
missing digits to be reconstructed with functioning, sensate
toes. Free flaps allowed coverage of complex defects that in
the past were treated with an awkward tube pedicled groin
flap, and allowed the vascularized transfer of a myriad of
tissue types, including bone and nerve with sensate skin.
The free functioning muscle transfer used both microvascu­
lar and microneural techniques to restore muscle function
in an extremity when it was literally absent, and has done
the same in facial reanimation surgery.
Oncologic reconstruction is another area that has been
truly transformed by microsurgery. Defects that in the past
could only be reconstructed by grafts or pedicled flaps of
limited tissue type, with the most critical portion of the flap
often the most vulnerable to ischemia, can now be recon­
structed with large or small, well-tailored, well-vascularized
segments of tissue that can include a myriad of tissue types,
including skin, fat, fascia, muscle, and bone, usually in one
stage. The result is not only a far more aesthetic result, but
a better functional result as well. Perhaps this is best illus­
trated in head and neck cancer reconstruction where local
tissues are often limited, and the ability to bring in well-
vascularized tissue of the correct size, shape, and type is
critical for both appearance and function.15
(sensory, motor, skeletal, skin) are; what secondary proce­
dures will be required (e.g., tendon grafting, nerve grafting,
implant placement, etc.); what the durability requirements
(plantar or palmar surfaces, weightbearing surfaces, e.g.,
ischial, trochanter, other joints) are; and finally, what the
contour and aesthetic requirements (e.g., low profile at
hand/wrist and foot/ankle) are. Following the algorithm of
the reconstructive ladder/elevator, one would choose the
simplest method, among the vase myriad of reconstructive
options that currently exist, that would achieve the optimal
long-term outcome. Both local and distant tissue options
need to be considered, as well as the potential donor site
disability. For some problems, simply allowing closure by
secondary intention may in fact result in the best outcome,
as in a volar soft tissue defect of a digit, where healing by
wound contracture for defects up to 1–2 cm2 will bring sur­
rounding sensate skin in to close the defect, resulting in a
sensate and durable reconstruction that is preferable to any
flap or graft that one might consider. The same choice may
be true for a facial tumor defect in an unhealthy elderly
individual. For another young and healthy patient with bilat­
eral hand amputation or a severe facial deformity from burn
or trauma, the highest rung of the ladder/elevator may be
the most appropriate, i.e., vascularized composite tissue allo­
transplantation (VCA) – hand or face transplantation, along
with its burden of lifelong immunomodulatory therapy, as
the lifelong rewards may outweigh the risks and costs. Every
choice should be tailored to the individual problem and the
individual patient.
A MODIFIED RECONSTRUCTIVE
LADDER/ELEVATOR
In recent years, numerous additional reconstructive options
have been presented and embraced, including tissue expan­
sion, negative pressure therapy, perforator flaps, freestyle
free flaps, as well as simple expansions of current flap
approaches, e.g., the keystone flap for large defects. These
are, of course, in addition to the paradigm-changing intro­
duction of VCA, whereby like can truly be reconstructed
with like, although currently with a commensurate penalty
of lifelong immunomodulatory therapy. In light of the
above, a modified reconstructive ladder/elevator could be
considered, taking into account most of the current recon­
structive options, their risk and donor morbidity, and most
importantly, their long-term outcomes. In this ladder/
elevator (Fig. 1.1), not only should the simplest option be
chosen, but also the simplest option that will achieve the
best long-term outcome in terms of form and functions, and
with the least donor morbidity. Again, it is all about surgical
judgment.
RECONSTRUCTIVE MICROSURGERY
There is no question that the advent of microsurgery opened
the potential of reconstructive surgery to possibilities never
contemplated in the past. In the past we had to rely upon
either devascularized grafts that were by necessity either
small or thin so that they could revascularize from the graft
bed, or pedicled flaps that were limited in size or length,
Figure 1.1  The reconstructive “ladder” or “elevator.” Both are
really saying the same: do not merely use the simplest technique
possible; use the simplest technique that will achieve optimal form
and function. It all comes down to surgical judgment.
Free flap
Distant flap
Negative pressure therapy
?
Local flap
Skin graft
Wound contracture
Primary closure

4
PART 1 — PRINCIPLES
done under local anesthesia with significant demonstrated
success.21
Robotic surgery has been used for over a decade to assist
in surgical approaches where access is limited, without creat­
ing a wide new defect for approach. With the additional
benefit of eliminating hand tremors, it would seem ideal for
microsurgical applications. Its extremely high upfront cost
and steep learning curve, however, have kept its application
limited in microsurgery, but where it has been successfully
applied, such as in microsurgical reconstruction after oro­
pharyngeal tumor resection, it has transformed treatment.22
The emerging field of VCA is one of the most exciting
devel­opments in all of reconstructive surgery. The ability to
replace a complex anatomic structure, such as a hand or an
entire face, with actual like tissue is truly the ultimate
reconstruction.23–26 The challenges, though, include the
extremely advanced technical requirements; the enormous
infrastructure required to support such a program, with
exceedingly high costs; the need for lifelong immunosup­
pression, with its attendant risks; and the limited supply of
donors. The induction and maintenance of immunologic
tolerance is the “holy grail” of transplantation, and is the
focus of intense current research. As long as these barriers
remain, VCA will be limited to a few advanced centers with
a limited patient population.
THE FUTURE OF MICROSURGERY
The development of microsurgery has been a paradigm-
altering technology, whose course has merely begun. The
education and broader skills acquisition by microsurgeons
in freestyle flaps, supermicrosurgery, prelamination and
prefabrication of flaps, and robotics, are all areas where
expanded application seems inevitable, as technology pro­
gresses. Certainly, VCA is an area that is in the process of
exploding, as more and more centers around the country
and around the world are developing clinical VCA pro­
grams. As the science of immunology progresses toward the
development of true immune tolerance, VCA will widely
become acknowledged as the standard of care for many
complex situations.
The emerging fields of tissue engineering and regenera­
tive medicine may someday supplant some applications of
microsurgery, and create new opportunities for the applica­
tion of microsurgery. The use of adipose-derived stem cells
to reconstruct a breast may someday replace the free DIEP
flap. Yet, at the same time, the ability to engineer autologous
composite tissue, including a vascular supply, and transfer
it with microsurgical techniques is an equally exciting pos­
sibility. The future potential for microsurgical applications
in patient care is truly without limit.
The treatment of complex surgical infection has also
been revolutionized by microsurgery. In the past, advanced
tibial osteomyelitis often resulted in amputation. With the
advent of free muscle flaps, a thorough excisional debride­
ment of the osteomyelitis was possible, and coverage with a
large free muscle flap and later bone grafting resulted in
both cure and limb salvage.16
The first free flaps performed in the 1960s were fasciocu­
taneous flaps – the free groin flap. With the development
of myocutaneous flaps, free myocutaneous flaps became the
more dominant type of free flap employed. But they tended
to be very bulky, so the skin and fat were often left behind,
and a thinner free muscle flap used, with skin graft cover­
age, especially in extremity reconstruction. More recently
there has been a shift toward the use of perforator flaps,
i.e., skin plus subcutaneus tissue alone, without the underly­
ing muscle or fascia, by carefully dissecting out and preserv­
ing the supplying perforator vessels, down through, and
preserving the muscle, to the deeper major pedicle vessels
that can then be used for microvascular anastomosis.17
Though technically demanding to perform, these flaps have
the advantage of skin with just the right amount of underly­
ing fat, which can be tailored as needed, while preserving
the underlying muscle function. The two most common
examples are the anterolateral thigh (ALT) flap, typically
used for extremity or head and neck reconstruction, and
the deep inferior epigastric artery (DIEP) flap, used for
breast reconstruction. A further extension of the perforator
flap concept is the development of “freestyle” flaps, often
based on a single perforator vessel, identified by Doppler,
dissected down to its larger feeding vessels, and transferred
locally, or distantly as a free flap.18 The versatility and flex­
ibility of this approach is obviously profound, the technical
demands of this approach notwithstanding.
A further expansion of versatility and customizability of
reconstruction that microsurgery brought was the concept
of prelaminated and prefabricated flaps.19 These composite
flaps can be created de novo by bringing together multiple
autologous tissue types, including skin, subcutaneous tissue,
cartilage, bone, etc. to create a unique body part, such as a
nose, from multiple donor tissues, all built and based on an
arteriovenous vascular pedicle that is later transferred to the
recipient site with microvascular anastomosis. Again, the
potential of such reconstructions is nearly limitless.
Supermicrosurgery, which involves anastomosis of vessels
ranging from 0.3 to 0.8 mm in diameter, has further
expanded the field of microsurgery and allowed fingertip
replantation with small venule grafts, toetip transfers for
tip loss, and lymphaticovenular anastomoses for lymph­
edema.20 Lymphaticovenous anastomosis with standard
microsurgical techniques, to larger veins, proved to be
unsuccessful, but with supermicrosurgery, using 12–0 suture
and small, low-pressure venules, such procedures can be

CHAPTER 1 — PROBLEM ANALYSIS IN RECONSTRUCTIVE SURGERY
5
3. McGregor JC, McLean NR. Reconstruction of a large nasal defect
using a bilobed forehead flap. Ann Plast Surg 1982;9(5):419–24.
4. Buncke HJ Jr, Schulz WP. Experimental digital amputation and
reimplantation. Plast Reconstr Surg 1965;36:62–70.
5. Buncke HJ Jr, Schulz WP. Total ear reimplantation in the rabbit
utilising microminiature vascular anastomoses. Br J Plast Surg
1966;19(1):15–22.
6. Masuhara K, Tamai S, Fukunishi H, et al. [Experience with reanas­
tomosis of the amputated thumb]. Seikei Geka 1967;18(4):403–4.
7. Gu YD, Cheng DS, Zhang GM, et al. Long-term results of toe trans­
fer: retrospective analysis. J Reconstr Microsurg 1997;13(6):405–8.
8. McLean DH, Buncke HJ Jr. Autotransplant of omentum to a large
scalp defect, with microsurgical revascularization. Plast Reconstr
Surg 1972;49(3):268–74.
9. Taylor GI, Watson N. One-stage repair of compound leg defects
with free, revascularized flaps of groin skin and iliac bone. Plast
Reconstr Surg 1978;61(4):494–506.
10. Mathes SJ, Nahai F. Classification of the vascular anatomy of
muscles: experimental and clinical correlation. Plast Reconstr Surg
1981;67(2):177–87.
11. Mathes SJ, Nahai F. Clinical applications for muscle and musculo­
cutaneous flaps. St Louis: Mosby; 1982. p. xvi, 733pp.
12. Gottlieb LJ, Krieger LM. From the reconstructive ladder to the
reconstructive elevator. Plast Reconstr Surg 1994;93(7):1503–4.
13. Mardini S, Wei FC, Salgado CJ, et al. Reconstruction of the recon­
structive ladder. Plast Reconstr Surg 2005;115(7):2174.
14. Lineaweaver WC. Microsurgery and the reconstructive ladder.
Microsurgery 2005;25(3):185–6.
15. Chana JS, Wei FC. A review of the advantages of the anterolateral
thigh flap in head and neck reconstruction. Br J Plast Surg 2004;
57(7):603–9.
16. May JW Jr, Gallico GG 3rd, Lukash FN. Microvascular transfer of
free tissue for closure of bone wounds of the distal lower extremity.
N Engl J Med 1982;306(5):253–7.
17. Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution,
classification, and applications. Ann Plast Surg 2003;50(1):90–9.
18. Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004;
114(4):910–16.
19. Pribaz JJ, Fine NA. Prefabricated and prelaminated flaps for head
and neck reconstruction. Clin Plast Surg 2001;28(2):261–72, vii.
20. Koshima I, Yamamoto T, Narushima M, et al. Perforator flaps and
supermicrosurgery. Clin Plast Surg 2010;37(4):683–9, vii–iii.
21. Koshima I, Inagawa K, Urushibara K, et al. Supermicrosurgical
lymphaticovenular anastomosis for the treatment of lymphedema
in the upper extremities. J Reconstr Microsurg 2000;16(6):437–42.
22. Selber JC. Robotic surgery. J Reconstr Microsurg 2012;28(7):
433–4.
23. Dubernard JM, Sirigu A, Seulin C, et al. Fifteen years later: main
lessons from composite tissue allografts. Clin Transpl 2013;113–19.
24. Devauchelle B, Badet L, Lengele B, et al. First human face allograft:
early report. Lancet 2006;368(9531):203–9.
25. Siemionow M. Impact of reconstructive transplantation on the
future of plastic and reconstructive surgery. Clin Plast Surg
2012;39(4):425–34.
26. Shores JT, Imbriglia JE, Lee WP. The current state of hand trans­
plantation. J Hand Surg [Am] 2011;36(11):1862–7.
Expert Commentary
William Lineaweaver, MD, FACS
A metaphor can inspire images, but cannot always sustain
analysis. A picture of an assembled chess set, for example,
can teach someone how to arrange the pieces but not how
to play the game.
The reconstructive ladder and its associated elevator
provide a framework for organizing procedures into patterns
of relative complexity. These patterns, however, are only a
small part of the surgeon’s thought processes. How does a
surgeon get a cleft lip onto the ladder or off the elevator?
In my practice, I have come to use grammatical patterns
of diagnosis and treatment for problem analysis. These
grammars are verbal, not pictorial, and consist of interlocking
sets of rules. For primary disease processes, I define a
problem element (tumor, osteomyelitis, etc.) and match it to
a treatment strategy. Completion of this sequence is neces-
sary prior to reconstructive planning.
I define three kinds of reconstructive elements: wounds
(separation of parts); defects (absence of parts); and deformi-
ties (distortion of parts). These elements match three strate-
gies: repair; replacement; and reconfiguration.
The significance of this kind of analysis is evident in the
history of classic plastic surgery problems. Cleft lip had been
treated as a kind of wound or a defect, until Millard consid-
ered it as a deformity and proceeded to operative approaches
that reassembled distorted parts. Cleft palate was consid-
ered a deformity until Furlow proposed that it is a defect in
length better managed by a Z-plasty. This simple pattern is
capable of sustaining ongoing refinement of elements and
strategies. Traumatic loss of a thumb, for example, is a
defect. Simpler levels of technique resulted in defining the
defect as loss of a post for opposition and a treatment strat-
egy of bone grafts and staged skin flaps. Microsurgical tech-
nique redefined the defect as a loss of bone, joint, tendons,
nerves, and an aesthetic unit treated by a toe transplant.
The reconstructive surgeon has the great good fortune
of a career of exploration, in which problem analysis and
technical achievements can evolve throughout a professional
lifetime.
REFERENCES
1. Cannon B. The flowering of plastic surgery. JAMA 1990;263(6):
862–4.
2. Bakamjian VY. Total reconstruction of pharynx with medially based
deltopectoral skin flap. N Y State J Med 1968;68(21):2771–8.

e1
INTRODUCTION
A BRIEF HISTORY OF FLAPS
The history of plastic surgery is in many ways a recapitula­
tion of the history and corresponding evolution of flaps
(Fig. 2.1). The earliest flaps were, as would be considered
today, random skin flaps, as the skin was raised without
regard to any known blood supply other than to maintain
the presence of the subdermal vascular plexus.1,2 The clas­
sification of flaps in the beginning was relatively easy, since
they could be distinguished from one another only accord­
ing to how they were constructed. This included how they
were transposed (e.g., as an advancement, rotation, or trans­
position flap), their geometrical configuration (e.g., as a
tubed flap), or by their destination (e.g., as a local or distant
flap).3 Because of their limited blood supply, there was a
belief that random flaps had to be restricted to rigid length–
width ratios to ensure viability. Still, some flaps lived and
others died.
Such simplicity faded after Milton4 disproved flap length–
width ratios, and asserted instead that flap viability was
dependent on the vascular supply of the given flap territory.
This led to a renaissance in flap construction, based on an
improved understanding of the anatomic basis of the circu­
lation to the skin, initiated by McGregor and Morgan,5 when
they discovered that some regions of the body had discrete
and relatively large subcutaneous vessels that had pierced
the deep fascia to follow a predictable course. Compara­
tively large cutaneous flaps, if oriented along the axis of that
vascular pathway, consistently maintained complete viability,
and appropriately were called axial flaps (e.g., deltopectoral
flap, groin flap).
Orticochea6 reported that the inclusion of muscle in the
flap could result in larger skin flap survival. McCraw et al.7
more precisely explained the reasoning behind this associa­
tion, and called the vessels coursing from the muscle to the
skin “musculocutaneous” arteries. Interestingly, Tanzini8 in
1906 had published the first report of such a musculocuta­
neous flap. Tanzini et al.,9,10 were well aware of the existence
of branches from the muscle necessary to form these com­
pound flaps. Nevertheless, it was not until the late 1970s that
musculocutaneous flaps became a standard reconstructive
option.
The zeal to adopt cutaneous flaps relying on musculocu­
taneous vessels perhaps delayed the recognition of other
important contributions to the “fascial plexus” that would
Classification of Flaps
Geoffrey G. Hallock  |  Reza Ahmadzadeh  |  Steven F. Morris 2 
Figure 2.1  The evolution of flaps has reflected a progression to
better ensure the adequacy of their intrinsic circulation, beginning
with the least reliable, nourished only via the subdermal plexus, and
ultimately coming back again full circle to the subdermal vascular
network “supercharged” by retained perforators.
Random
Musculocutaneous
Fasciocutaneous
Perforator
Muscle
Source
vessel
Fascia
Subdermal vascular network
PART 1  —  PRINCIPLES