Operative Technique in Plastic Surgery – Kevin C.Chung

tissue expander removal, 1394, 1394f
Extended skin paddle option, 1657, 1657f
Extended SMAS facelift and necklift
anatomy, 211, 211f
complications, 214
definition, 211
merits and demerits, 214b
outcomes, 214, 214f
patient history and physical findings, 211
postoperative care, 214
surgical management, 211
approach, 211
patient positioning, 211
preoperative planning, 211
techniques, 212b
incisions and dissection, 212–213, 212f
redraping and fixation, 213, 213f
Extended vertical rectus myocutaneous (eVRAM) flap, 2518f
Extended vertical thigh lift, 1652–1653, 1652f–1653f
Extended V-Y flap, 1183
Extensive lateral mandible defect, 1048, 1049f
Extensor carpi radialis brevis (ECRB), 2026, 2026f–2027f
to adductor pollicis, 2022, 2023f
to adductor pollicis with tendon graft, 2022, 2023f
to AdP tendon transfer, 2037
to AdP with tendon graft, 2037, 2038f–2039f
anatomy, 2196
to lateral bands with tendon graft, 2022, 2022f
tendon transfer, brachioradialis, 2198, 2198f–2199f
Extensor carpi radialis longus (ECRL), 2001b, 2001f, 2002f
to flexor digitorum profundus transfer, 2212, 2212f
tenodesis, for scapholunate dissociation, 1903
Extensor carpi ulnaris (ECU) tendon subluxation

anatomy, 2085
complications, 2089
definition, 2085
differential diagnosis, 2086
exposure, 2087
imaging, 2086
merits and demerits, 2088b
natural history, 2085
nonoperative management, 2086
outcomes, 2089
pathogenesis, 2085
patient history and physical findings, 2085–2086
postoperative care, 2089
surgical management
patient positioning, 2086
preoperative planning, 2086
Extensor compartmental artery (ECA) vascularized bone flap,
1881–1882, 1882f
Extensor digitorum communis
flexor carpi radialis, 2027, 2028f
flexor carpi ulnaris, 2027, 2028f
flexor digitorum superficialis, 2028–2029, 2029f
Extensor digitorum longus (EDL) tendons, 2363
Extensor hallucis longus (EHL) tendon, 2344, 2346, 2363
Extensor indicis proprius (EIP), 2033f, 2036–2037
to abductor pollicis brevis, 2015–2016, 2016f
Extensor pollicis longus (EPL) tendon, 2023, 2023f
palmaris longus, 2029, 2030f
Extensor retinaculum, anterior approach to, 2494
Extensor tendon injuries
anatomy, 2078–2079, 2078f–2079f
complications, 2084
definition, 2078

differential diagnosis, 2080
imaging, 2080
merits and demerits, 2084b
natural history, 2080
nonoperative management, 2080–2081
outcomes, 2084
pathogenesis, 2079
patient history and physical findings, 2080, 2080f
postoperative care, 2084
surgical management
approach, 2081
patient positioning, 2081
preoperative planning, 2081
Extensor tendon rehabilitation, 2077
Extensor tenolysis with/without dorsal capsular release, 2075, 2075f
External auditory meatus, 1133
External dacryocystorhinostomy, 2874, 2874f
External distraction, Le Fort III osteotomy of
anatomy, 621
complications, 631, 632f
curved tip osteotomy, 623f, 626
definition, 621
device placement, 627, 627f–628f
exposure, 625–626, 625f
imaging, 622, 624f
lateral orbital wall osteotomy, 621f, 626, 628, 629f
merits and demerits, 625b
mobilization, 626, 626f
nasofrontal osteotomy, 621f, 626
outcomes, 630–631, 630f–631f
pathogenesis, 621
patient history and physical findings, 622, 623f
postoperative care, 630

skull-cranial bones and facial bones, 621, 623f
surgical management, 624
traditional lines, 621, 621f
External mandibular distraction
with pins
corticotomy, 725, 726f
exposure and dissection, 725, 725f
placement, 725–726, 726f
uniplanar or multiplanar distraction devices, 726, 727f
with rigid external device, 727–728, 728f–729f
External nasal nerve, 966, 966f
External nasal valve repair, nasal airway obstruction, 384, 384f
External oblique aponeurotomy, 1557, 1557f, 1559, 1564, 1564f
External oblique muscle, 1563
External transfacial mandibular distraction
anatomy, 733
complications, 737, 738f
definition, 733
differential diagnosis, 733
exposure, 734, 735f
imaging, 733
merits and demerits, 734b
nonoperative management, 733–734
osteotomy and completion, 736, 736f
outcomes, 737
pathogenesis, 733
patient history and physical findings, 733
pin passage, 735, 735f–736f
postoperative care, 737, 737f
surgical management
patient positioning, 734–737
preoperative planning, 734
External valve stenosis, 381

Extramucosal internal stents, 332
Extraoral approach, 602
Extremity lymphedema, fasciocutaneous debulking of
anatomy, 2567
complications, 2570
definition, 2567
imaging, 2567
merits and demerits, 2568b, 2569b
outcomes, 2570
patient history and physical exam, 2567
postoperative care, 2570
radical debridement with split-thickness skin grafts, 2568–2569,
2569f
staged excision, 2569
surgical management
approach, 2568
patient positioning, 2568
preoperative planning, 2568
Extubation, 2694
Eye contracture, 2766, 2766f–2767f
Eyebrow, position of, 3
Eyelid(s)
anatomy, 2777
definition, 2777
merits and demerits, 2779b
nonoperative management, 2777
pathogenesis, 2777
patient history and physical findings, 2777
surgical management, 2777–2778
lower lid, 2777
patient positioning, 2778
preoperative planning, 2778
upper lid, 2777

Eyelid coloboma
anatomy, 2842
complications, 2847
definition, 2842
differential diagnosis, 2843
merits and demerits, 2847b
natural history, 2842
nonoperative management, 2843
outcomes, 2847
pathogenesis, 2842
patient history and physical findings, 2842, 2842f
postoperative care, 2847
surgical management, 2843–2847
approach, 2843–2847
patient positioning, 2843
preoperative planning, 2843
Eyelid defects
assessment, 1078
full-thickness, 1078, 1080f–1081f
incomplete closure, 1078
Eyelid ectropion/entropion, 2871
Eyelid lacerations, 3080, 3080f
Eyelid reconstruction
Cutler-Beard flap (see Cutler-Beard flap)
direct closure and lateral cantholysis
anatomy, 1078, 1079f
canthotomy, 1081, 1081f–1082f
complications, 1082
definition, 1078
merits and demerits, 1080b
natural history, 1078
nonoperative management, 1079
outcomes, 1082

pathogenesis, 1078
patient history and physical findings, 1078–1079
postoperative care, 1082
primary wound closure, 1080, 1080f–1081f
surgical management, 1079
techniques, 1081
wound preparation, 1080
Hughes flap (see Hughes flap)
lateral tarsal strip canthoplasty
anatomy, 1103
complications
definition, 1103
imaging, 1104
markings and anesthesia, 1103f, 1105
merits and demerits, 1105b
natural history, 1104
nonoperative management, 1104
outcomes, 1107
pathogenesis, 1103–1104
patient history and physical findings, 1104
postoperative care, 1107
removal of, 1103f–1104f, 1105–1106
strip placement, 1107
surgical management, 1104
with palatal grafts
complications, 1098
definition, 1094
hard palate, 1095–1097, 1095f, 1097f
lamellar anatomy, 1094–1095, 1094f
merits and demerits, 1096b
patient history, 1095
physical examination, 1096
postoperative care, 1098

surgical management, 1096
tenzel semicircular rotational flap
anatomy, 1084
complications, 1088
definition, 1084
design and flap elevation, 1086, 1086f
donor-site repair, 1087, 1087f
flap inset, 1086f, 1087
merits and demerits, 1086b
nonoperative management, 1084
outcomes, 1088
patient history and physical findings, 1084
posterior lamellar flap, 1087
postoperative care, 1088
surgical management, 1085
tarsal edges, 1086, 1086f
Eyelid retractors
lower, 1090
upper, 1090
Eyelid-cheek junction, 50

F
Face
dermabrasion to
anatomy67
approach, 67
complications, 68
definition, 67
mechanical dermabrasion, 67, 68f
merits and demerits, 68b
outcomes, 68
patient history and physical findings, 67
patient positioning, 67
postoperative care, 68
preoperative planning, 67
surgical management, 67
laser resurfacing of
ablative fractional resurfacing, 52f, 54
ablative nonfractional resurfacing, 54
anatomy, 52, 52f
complications, 55–56
definition, 52
imaging, 54
nonablative fractional resurfacing, 52f, 54
outcomes, 55, 55f–56f
pathogenesis, 52
patient history and physical findings, 52, 54b
postoperative care, 55
surgical management, 54
local anesthesia (see Local Anesthesia)
sensory and motor nerve anatomy, 1123f
TCA peel to

anatomy, 57
awake patient, cotton tip applicator on, 58
complications, 58–59
definition, 57
merits and demerits, 58b
outcomes, 58
patient history and physical findings, 57
postoperative care, 58
sedated patient, cotton tip applicator on, 57, 58f
surgical management, 57
vital structures, 975, 975f
Face-lifting and neck lifting techniques, 201
anatomy, 201
anterior neck treatment, 206–208, 207f
complications, 209–210, 210f
imaging, 201
incisions, 203, 204f
merits and demerits, 209b
outcomes, 209
patient history and physical findings, 201
postoperative care, 209
skin flap elevation, 204–205, 204f–205f
SMAS treatment options, 205–206, 206f
surgical management, 202–203
patient positioning, 203
patient preparation, 202–203
preoperative planning, 202
Facial aging, 201
Facial artery, 1122
dissection and exposure, 1176, 1176f
musculomucosal flap, 2701, 2701f, 2704
myomucosal flap, 1220
perforator flap

arterial anatomy, 1188, 1188f
basal cell carcinoma, 1189f–1190f
complications, 1192
definition, 1188
imaging, 1189
merits and demerits, 1190b
outcomes, 1192
patient history and physical findings, 1188–1189, 1189f–1190f
postoperative care, 1192
to repair perioral defect, 1190–1191, 1191f
secondary revision surgery, 1191, 1191f
small cell carcinoma
surgical management, 1189
venous, 1188, 1188f
Facial artery musculomucosal (FAMM) flap
arterial anatomy, 1193
buccal mucosal defects, 1222–1223, 1223f
complications, 1197
definition, 1193
inferiorly based FAMM flap, 1194
intact upper jaw dentition vs. edentulous alveolar cleft deformities,
1194
merits and demerits, 1195b
outcomes, 1197
patient history and physical findings, 1194
postoperative care, 1197
superiorly based FAMM flap, 1194
surgical management
approach, 1195
patient positioning, 1195
preoperative planning, 1195
venous anatomy, 1193
Facial bipartition

anatomy, 542–543, 543f
anterior vault reconstruction, 550, 550f
central wedge excision, 549
circumferential orbital osteotomies, 548, 548f
complications, 553–554
definition, 542, 542f
differential diagnosis, 545
downfracture, 549
exposure, 547–548, 547f
frontonasal osteotomies, 549
hypertelorism, 543, 547b
imaging, 545, 545f
mechanisms of arrest, 543
merits and demerits, 551t
natural history, 544
nonoperative management, 545
outcomes, 552, 552f–553f
patient history and physical findings, 544, 544f
postoperative care, 552
soft tissue reconstruction, 551, 551f
surgical management
approach, 546
hypertelorism, 545
indications, 545
osteotomy, 545, 546f
patient positioning, 546
preoperative planning, 546, 547f
timing, 545
two halves stabilization, 549, 550f
zygomatic and maxillary osteotomies, 549
Facial clefts
complications, 655
definition, 650

differential diagnosis, 653
imaging, 653
merits and demerits, 655t
nonoperative management, 653
outcomes, 655
pathogenesis, 650
patient history and physical findings, 650–653
postoperative care, 655
surgical management
patient positioning, 653
preoperative planning, 653
Z-plasty approach, 653
surgical technique, 654–655, 654f
Tessier classification, 650, 650f, 654b
Facial fat, 164
Facial hair transplantation, 429
Facial harmony, 338
Facial laceration emergency room closure techniques, 3074–3083
Facial laceration locations, 3078t
Facial lacerations
anatomy, 975, 975f
definition, 975
differential diagnosis, 976
imaging, 976
natural history, 975–976
nonoperative management, 976
outcomes, 979
pathogenesis, 975
patient history, 976
physical findings, 976
postoperative care, 979
surgical management
approach, 977

indications, 976
patient positioning, 976–977
preoperative planning, 976
techniques
facial nerve injuries, 978
lacrimal system/eyelid injuries, 978
local anesthetic, administration of, 977, 977f
parotid duct injuries, 978
suture techniques, 978, 978f
wound irrigation, 977
wound preparation, 977
Facial nerve
anatomy, 2932, 2933f
condyle fractures, 916
injury, 200, 978, 3081–3082, 3082f
skin-only face and neck lifting, 196
Facial nerve blocks
infraorbital nerve block, 970, 970f
mental nerve block, 971, 971f
supraorbital and supratrochlear nerves, 970, 970f
Facial osteotomy, 538, 539f
Facial paralysis, 297
anatomy, 2933f
causes, 2936b
complications, 1271
definition, 1262, 2932
imaging, 1264
lengthening temporalis myoplasty
completion process, 1269
definition, 1262
elevation and advancement, 1269, 1270f
flap harvest, 1268–1269, 1268f–1269f
surgical management, 1264, 1264f

merits and demerits, 1265b
outcomes, 1271
pathogenesis of, 2932
patient history, 1262
physical examination, 1262
postoperative care, 1271
smile assessment, 1263
surgical management
approach, 1264
patient positioning, 1264
preoperative planning, 1264, 1265f
temporalis muscle flap
definition, 1262
dissection, 1265, 1265f
flap elevation, 1265–1266, 1266f
flap inset and completion, 1267, 1267f
interposition graft, 1266–1267
neurovascular supply, 1262, 1263f
retrograde temporalis flap, 1264
superficial and deep layers, 1262, 1263f
surgical management, 1264
Facial reanimation. See also Pediatric facial reanimation
anatomy, 1255–1256
Babysitter nerves
complications, 1285
cross face nerve graft, 1282–1283, 1283f–1284f
definition, 1277
exposure, 1280–1281, 1280f–1281f
flowchart, 1279, 1279f
mandibular branch, 1277f, 1278
merits and demerits, 1280b
motor nerve to masseter, 1281–1282, 1282f
outcomes, 1285

pathogenesis, 1278
patient history and physical findings, 1278
postoperative care, 1284–1285
superficial muscle fibers, 1277–1278, 1277f
surgical management, 1279–1280
temporal branch, 1277f, 1278
zygomatic division, 1277f, 1278
cross-face nerve grafts
donor nerve selection, 1259–1260
facial nerve exposure, 1259
tunnel creation and nerve reconstruction, 1260, 1260f
definition, 1255
dual minihypoglossal and masseteric nerve transfers, 1259, 1259f
free flap defect repair, 1258, 1258f
merits and demerits, 1257b
nerve grafting, 1257–1258, 1257f
nerve-to-masseter transfer, 1258–1259, 1258f
outcomes, 1261, 1261f
patient history and physical findings, 1256
surgical management, 1256
Facial reconstruction, autologous vs. prosthetic techniques for,
3086b
Facial soft tissue injury
anatomy, 3074, 3074f–3075f, 3078b
complications, 3083, 3083f
definition, 3074
merits and demerits, 3082b
nonoperative management, 3076
outcomes, 3083
pathogenesis, 3074–3075
patient history and physical findings, 3076
postoperative care, 3083
surgical management, 3076–3078, 3076f

approach, 3077–3078
patient positioning, 3077
preoperative planning, 3076–3077
FAMM. See Facial artery musculomucosal (FAMM) flap
Fascia graft
for dorsal augmentation
anatomy, 362
complications, 365
deep temporal fascia harvest, 363, 363f
definition, 362
differential diagnosis, 362
imaging, 362
merits and demerits, 364b
nonoperative management, 362
pathogenesis, 362
patient history and physical findings, 362
postoperative care, 364
surgical management, 362–363, 363f
techniques, 363, 364f
in rhinoplasty
anatomy, 366
combined techniques, 371
complications, 372
DCFG, placement of, 370, 371f
definition, 366
fascial wrapping, 370, 370f
harvest, 368–369, 368f
imaging, 366
merits and demerits, 371b
nonoperative management, 367
outcomes, 372
patient history and physical findings, 366
postoperative care, 371–372

surgical management, 367–368, 372f–371f
techniques, 369, 369f
temporal fascia harvest, 369, 369f
Fascial closure techniques, 3033–3035
delayed fascial approximation anticipated, 3034, 3034f
fascial approximation anticipated, 3033–3034, 3034f
negative pressure wound therapy, 3034–3035, 3035f
Fascial sparing technique, 1418, 1418f
Fascial wrapping, 366, 370, 370f
Fasciocutaneous debulking of extremity lymphedema
anatomy, 2567
complications, 2570
definition, 2567
imaging, 2567
merits and demerits, 2568b, 2569b
outcomes, 2570
patient history and physical exam, 2567
postoperative care, 2570
radical debridement with split-thickness skin grafts, 2568–2569,
2569f
staged excision, 2569
surgical management
approach, 2568
patient positioning, 2568
preoperative planning, 2568
Fasciocutaneous flap, 2381–2383, 2440
Fasciocutaneous free flaps, 2394
Fasciocutaneous grotting flap transposition, 2829, 2829f
Fasciotomy
definition, 2331
foot, 2333, 2333f
central central compartment, 2331
deep central compartment, 2331

intrinsic compartment, 2331
lateral compartment, 2331
medial compartment, 2331
superficial central compartment, 2331
forearm
dorsal, 1764, 1764f
with two longitudinal incisions, 1764, 1764f
volar forearm with curvilinear incision, 1763, 1763f
hand, 1762–1763, 1762f, 1763f
lower leg, 2332, 2333f
anterior, 2331
deep posterior compartment, 2331
diagnosis, 2331
lateral, 2331
superficial posterior, 2331
merits and demerits, 2334b
outcomes, 2334
postoperative care, 2334
thigh, 2332, 2332f
anterior, 2331
medial (adductor), 2331
posterior, 2331
Fat aspirate processing, 1492
Fat grafting
anatomy, 48, 2810
approach, 48
and closure, 111, 112f
complications, 51, 2813
definition, 48, 2810
differential diagnosis, 2810
imaging, 48, 2810
large-volume (see Large-volume fat grafting)
low-volume (see Low-volume fat grafting, contour correction)

merits and demerits, 50b, 2813b
natural history, 2810
outcomes, 51, 51f, 2813
pathogenesis, 2810
patient history and physical findings, 48, 2810
patient positioning, 48
for periorbital rejuvenation
anatomy, 162–164, 162f–164f, 178
arcus marginalis release, 166, 167f
complications, 168, 184
definition, 162, 178
eye brow and temporal region, 165
fat harvest, 165, 180–183, 180f, 183f
imaging, 178
injection technique, 165
lower eyelid, 162, 166, 166f
malar fat grafting, 166, 166f
merits and demerits, 167b, 183b
nonoperative management, 164, 178
outcomes, 167, 184
patient history and physical findings, 164, 165f, 178
postoperative care, 167, 184
surgical management, 164, 178–180, 179f
upper eyelid, 162, 166
postoperative care, 51, 2813
preoperative planning, 48
surgical management, 48, 2810–2811
approach, 2811
patient positioning, 2811
preoperative planning, 2811
techniques, 49b, 49f, 50f
Fat harvest
and injection technique, 165

for periorbital rejuvenation, 180–183, 180f, 183f
Fat injection
anatomy, 171
complications, 176, 177f
definition, 170
differential diagnosis, 172
merits and demerits, 176b
nonoperative management, 172
outcomes, 176
pathogenesis, 171–172
patient history and physical findings, 172, 172f
postoperative care, 176
surgical management, 172
Fat-sensitive images
soft tissue tumors, knee, 2457
soft tissue tumors of thigh, 2498
FCR (flexor carpi radialis), 1754, 2027, 2028f
to PIN, 2052
reverse radial forearm flap, 2114, 2114f, 2116, 2118
FCU (flexor carpi ulnaris), 1203, 1992
digitorum communis, 2027, 2028f
ulnar artery perforator flap, 2120–2123
FD. See Fibrous dysplasia (FD)
FDB (flexor digitorum brevis), 2363, 2366
FDL (flexor digitorum longus), 2363
FDMA (first dorsal metacarpal artery) flap, 2105, 2107, 2109,
2110f–2111f, 2113
FDP. See Flexor digitorum profundus (FDP)
FDS. See Flexor digitorum superficialis (FDS)
Fee flap reconstruction, wound preparation for, 2441f
Female pattern hair loss (FPHL), 416–417
Feminizing genitoplasty, 3065
Femoral artery, 2400, 2402, 2402f

Femoral bone debridement
anatomy, 2506
chronic osteomyelitis of distal femur, 2508, 2508f
complications, 2509
definition, 2506
imaging, 2506–2507, 2506f–2507f
merits and demerits, 2509b
natural history, 2506
nonoperative management, 2507
outcomes, 2509
pathogenesis, 2506
patient history and physical findings, 2506
postoperative care, 2509
surgical management, 2507
approach, 2507, 2507f
patient positioning, 2507
preoperative planning, 2507
Femoral bone marrow margin, 2973, 2973f
Femoral nerve
anatomy, 2310, 2532f, 2533–2534
complications, 2313–2314
definition, 2310, 2533
imaging, 2310, 2310f–2311f, 2534
merits and demerits, 2313b
nerve stimulator technique, 2312, 2312f
nonoperative management, 2534
outcomes, 2313
pathogenesis, 2534
patient history and physical exam, 2310, 2534
postoperative care, 2313
surgical management, 2310–2311, 2534
approach, 2311
patient positioning, 2311

preoperative planning, 2311
ultrasound-guided technique, 2311–2312, 2311f
Femoral vessels, 2972, 2972f
Femoropopliteal bypass, 2402–2403, 2402f
above-knee popliteal exposure, 2403, 2403f
below-knee popliteal exposure, 2403, 2404f
femoral artery identification, 2402
longitudinal incision, 2402
Femur, bone tumors of
anatomy, 2502
complications, 2505
definition, 2502
differential diagnosis for, 2502
femur resection and allograft reconstruction, 2503, 2504f
functional outcomes, 2505
imaging, 2502, 2503f
merits and demerits, 2504b
natural history, 2502
oncological outcomes, 2505
pathogenesis, 2502
patient history and physical findings, 2502
postoperative care, 2505
surgical management, 2502–2503
approach, 2503
patient positioning, 2503
preoperative planning, 2503
Femur isthmus, intraoperative measurement of, 2477f
Femur reconstruction
anatomy, 2510, 2511f
Capanna method, 2514–2515, 2514f
complications, 2516
definition, 2510
double barrel fibula technique, 2515, 2515f

free fibula flap, 2513–2514, 2513f
imaging, 2511, 2511f
merits and demerits, 2515b
outcomes, 2516
patient history and physical findings, 2510
postoperative care, 2515
surgical management
approach, 2512
patient positioning, 2512, 2512f
preoperative planning, 2512, 2512f
FFA (frontal fibrosing alopecia), 418, 418f
Fiberoptic nasendoscopy, 2690
Fibrous dysplasia (FD)
anatomy, 762, 762f
complications, 773
definition, 762
differential diagnosis, 764
imaging, 763–764, 764f
indications, 764
lower zone
exposure, 768, 768f
reconstruction, 769–771, 770f–771f
resection, 768–769, 769f
merits and demerits, 766b
natural history, 763
nonoperative management, 764
outcomes, 772, 772f
pathogenesis, 762
patient history, 763
physical examination, 763, 763f
postoperative care, 772
surgical management
approach, 766

patient positioning, 766
preoperative planning, 765–766
timing of intervention, 765
upper zone
exposure, 766–767, 767f
reconstruction, 767–768
resection, 767
Fibula flap, 1116, 2433, 2512
elevation, 1032–1033
harvest
design, 1025
incisions and flap elevation, 1025–1026
reconstruction, 1053, 1053f
with templates
anatomy, 1030
closing wedge osteotomies, 1034–1035, 1034f
complications, 1036
creating anatomic templates, 1031, 1032f
definition, 1030
fibula flap elevation, 1032–1033
imaging, 1030
maintaining native condyle position and occlusion, 1031
merits and demerits, 1031b
outcomes, 1035, 1036f
patient history and physical findings, 1030
patient positioning, 1030
postoperative care, 1035
surgical management, 1030–1031
Fibula flap osteotomy, 1026–1027, 1026f
Fibula free flap reconstruction, with CAD/CAM techniques
anatomy, 1022f, 1023
complications, 1029
definition, 1022

dental implants, 1027
flap inset, 1027
harvest, 1025–1026
imaging, 1023–1024, 1024f
mandibular osteotomy, 1026
merits and demerits, 1025b
microsurgical anastomosis, 1027
osteotomy, 1026–1027, 1026f
outcomes, 1029, 1029f
pathogenesis, 1023
patient history and physical findings, 1023
postoperative care, 1028–1029
surgical management, 1024–1025
Fibular fracture, 2411
Filler injection
anatomy, 37, 37f–38f
complications, 40
definition, 37
in glabella, forehead and brow, 21
anatomy, 20, 20f
approach, 20
complications, 22
definition, 20
merits and demerits, 21b
nonoperative management, 20
outcomes, 21
patient history and physical findings, 20
positioning, 20
postoperative care, 21
malar region
anatomy, 26
complications, 28
definition, 26

imaging, 27
merits and demerits, 28b
nonoperative management, 27
outcomes, 27f, 28
pathogenesis, 26–27
patient history and physical findings, 27
postoperative care, 27
surgical management, 27
techniques, 27b
merits and demerits, 40b
nonoperative management, 38
to nose
anatomy, 42, 42f
complications, 46, 47f
definition, 42
imaging, 42
merits and demerits, 44b
nasal dorsum injection, 43, 43f
nasal sidewall injection, 44, 44f
nasal tip/ala injection, 44, 44f
outcomes, 43f, 44f, 45
patient history and physical findings, 42
postoperative care, 45
surgical management, 42–43
techniques, 43b
outcomes, 40, 40f–41f
patient history and physical findings, 37–38
postoperative care, 40
techniques, 38b
lips, 38–39
marionette lines, 39
oral commissures, 39
in prejowl area, 39

upper periorbital area
anatomy, 23
approach, 23
complications, 25
definition, 23
merits and demerits, 24b
outcomes, 25
patient history and physical findings, 23, 23f
patient positioning, 23
postoperative care, 25
preoperative planning, 23
techniques, 24, 24f
Finasteride, 418
Finger clawing, low combined median and ulnar nerve palsy,
2038–2039
Finger extension procedures, 2027–2029
anatomy, 2201, 2201f
complications, 2204–2205
definition, 2201
imaging, 2202
merits and demerits, 2202b, 2204b
outcomes, 2204
patient history and physical findings, 2201–2202, 2202f
postoperative care, 2204
surgical management
algorithm, 2203f
patient positioning, 2202
preoperative planning, 2202
Finger flexion
combined median and ulnar nerve injury, 2038f, 2040
restoration, 2023
Finger syndactyly release, dorsal rectangular flap
anatomy, 2216, 2216f–2217f

complications, 2222
definition, 2216
dorsal markings, 2218, 2219f
dressings and immobilization, 2221–2222, 2222f
flap creation, 2219, 2221f
grafting, 2219–2221, 2221f
imaging, 2216–2217, 2217f
merits and demerits, 2218b, 2222b
natural history, 2216
outcomes, 2222
patient history and physical findings, 2216
postoperative care, 2222
surgical management
approach, 2218
patient positioning, 2218
preoperative planning, 2217–2218
volar markings, 2219, 2219f
Fingertip
amputations, 2149
anatomy, 1766, 1766f–1767f
complications, 1770
definition, 1766
imaging, 1767
merits and demerits, 1769b
nail ablation, 1768, 1769f
nonoperative management, 1767
outcomes, 1770
pathogenesis, 1766
patient history and physical findings, 1767
postoperative care, 1770
with primary closure, revision, 1767, 1768f
surgical management, 1767
injuries, flap coverage

anatomy, 2096
complications, 2103–2104
definition, 2096
imaging, 2097
merits and demerits, 2102b
nonoperative management, 2097
outcomes, 2103
pathogenesis, 2096
patient history and physical findings, 2096–2097
postoperative care, 2103
surgical management, 2097f–2098f
First dorsal compartment release, 2094, 2094f
First dorsal metatarsal artery (FDMA) variants, 2168
First metatarsal, 2344, 2344f–2345f, 2369f
First plantar metatarsal artery, 2378–2379
First plantar metatarsal vein
First-generation cephalosporin, 284
1st DMTA (reverse first dorsal metatarsal artery) flap, 2368,
2368f–2369f
Fistula, 2682, 2689, 2696. See also Palatal fistula
intentional, 2696
Pittsburgh fistula classification, 2696
unintentional, 2696
Fixed plate position technique, 442
Flank and lumbar defects
anatomy, 1721, 1721f
complications, 1726
definition, 1721
imaging, 1722
natural history, 1722
nonoperative management, 1722
outcomes, 1726
pathogenesis, 1722

patient history and physical findings, 1722
postoperative care, 1726
surgical management
approach, 1723
patient positioning, 1722–1723
preoperative planning, 1722
Flank defects, 1589
Flankplasty, with lipoaugmentation, 1631, 1631f–1632f
Flap coverage of thumb defects
anatomy, 2105
complications, 2113
definition, 2105
imaging, 2105
merits and demerits, 2112b
nonoperative management, 2105
outcomes, 2113, 2113f
patient history, 2105
physical findings, 2105
postoperative care, 2113
surgical management, 2105–2106, 2106f
approach, 2106
first dorsal metacarpal artery flap, 2109, 2110f–2111f
moberg flap, 2107–2109, 2108f
reverse dorsoradial homodigital flap, 2112
Flap creation
Cutler-Beard flap, 1091–1092, 1092f
Hughes flap, 1090, 1091f
Flap necrosis, 2674, 2689
Flap separation
Cutler-Beard flap, 1092, 1092f
Hughes flap, 1091
Flexor carpi radialis (FCR), 1754, 2027, 2028f
to PIN, 2052

reverse radial forearm flap, 2114, 2114f, 2116, 2118
Flexor carpi ulnaris (FCU), 1203, 1992
digitorum communis, 2027, 2028f
ulnar artery perforator flap, 2120–2123
Flexor digiti minimi, 1986–1987, 1986f
Flexor digitorum brevis (FDB), 2363, 2366
Flexor digitorum longus (FDL), 2363
Flexor digitorum profundus (FDP), 1935
index and long finger flexion reconstruction, 2016, 2016f
side-to-side transfer, 2023
tendon transfer for FPL rupture, 1942–1944, 1945f
transfer
extensor carpi radialis longus, 2212, 2212f
flexor digitorum superficialis, 2213, 2213f
Flexor digitorum superficialis (FDS), 1203, 1935
to abductor pollicis brevis, 2013–2015, 2014f
to AdP tendon transfer, 2037, 2038f–2039f
to ECRB, 2052
to extensor digitorum communis, 2028–2029, 2029f, 2202, 2203f
to flexor digitorum profundus transfer, 2213, 2213f
lasso, 2020, 2021f
Stiles-Bunnell transfer, 2021–2022, 2021f
tendon transfer for ruptured FPL tendon reconstruction,
1942–1944, 1945f
tenodesis for correction of swan-neck deformity, 1945, 1946f
Flexor hallucis longus (FHL), 1026, 2343, 2346, 2363, 2419, 2419f,
2432, 2510, 2514
Flexor pollicis brevis, 1986–1987, 1986f
Flexor tendon injury, 1930
Flexor tendon reconstruction
anatomy, 2065
complications, 2072
definition, 2065

differential diagnosis, 2066
imaging, 2065
merits and demerits, 2071b
natural history, 2065
nonoperative management, 2066
outcomes, 2072
pathogenesis, 2065
patient history and physical findings, 2065
postoperative care
stage 1, 2072
stage 2 (Modified Duran), 2072
surgical management
approach, 2066
patient positioning, 2066
preoperative planning, 2066
Flexor tendon rehabilitation, 2077
Flexor tendon repair
anatomy, 2054–2055
complications, 2060
definition, 2054
differential diagnosis, 2055
imaging, 2055
merits and demerits, 2056b, 2059b
outcomes, 2060
pathogenesis, 2055
patient history and physical findings, 2055
postoperative care, 2059–2060
surgical management
approach, 2056
patient positioning, 2056
preoperative planning, 2056
zone I repair
primary suture, 2056, 2056f

pull-through button, 2056–2057, 2057f
zone II to V repair
locked cruciate, 2058, 2058f
modified Becker/Massachusetts General Hospital, 2058, 2058f
modified Kessler suture, 2058, 2058f
Tajima modification, 2057, 2057f
Flexor tendon sheath
anatomy and, 1771, 1771f
closed irrigation of, 1772–1773, 1772f, 1773f
complications, 1774
definition, 1771
differential diagnosis, 1771–1772
imaging, 1771
merits and demerits, 1774b
natural history, 1771
nonoperative management, 1772
open debridement of, 1773–1774, 1773f, 1774f
outcomes, 1774
pathogenesis, 1771
patient history and physical findings, 1771, 1772f
postoperative care, 1774
surgical management, 1772
approach, 1772
patient positioning, 1772
preoperative planning, 1772
Flexor tenolysis with/without volar capsular release, 2075,
2075f–2076f
Floating ribs, 994, 994f
Floor of mouth (FOM) reconstruction
anatomy, 1209, 1209f
complications, 1214
imaging, 1210
merits and demerits, 1211b

pathogenesis, 1209–1210
patient history, 1210
physical examination, 1210
postoperative care, 1214
radial forearm free flap
flap dissection, 1212, 1212f
flap inset, 1212, 1213f
recipient site preparation, 1211–1212, 1211f
soft tissue flaps
anterolateral thigh flap, 1211
medial sural artery perforator flap, 1211
pectoralis major musculocutaneous flap, 1211
radial forearm fasciocutaneous free flap, 1210
Fluid-sensitive images
soft tissue tumors, knee, 2457
soft tissue tumors of thigh, 2498
Fluoroscopy, 2424, 2477f, 2478, 2503
Follicular unit extraction (FUE), 416, 421, 425–426
Follicular unit transplantation (FUT), 416
Follicular units (FUs), 416
FOM reconstruction. See Floor of mouth (FOM) reconstruction
Foot
abscesses drainage
anatomy, 2335, 2335f
approach, 2336
complications, 2337
differential diagnosis, 2336
imaging, 2336
merits and demerits, 2336b
necrotic right lateral foot wound, 2336, 2337f
nonoperative management, 2336
patient history and physical findings, 2336
postoperative care, 2337

preoperative planning, 2336
supine position, 2336
bone tumors of
anatomy, 2342
benign bone tumor of the talus, 2343, 2343f
complications, 2348
definition, 2342
differential diagnosis, 2342
imaging, 2342
malignant bone tumors, 2343–2347, 2344f, 2346f, 2347f
merits and demerits, 2343b
nonoperative management, 2342
outcomes, 2348
patient history, 2342
patient positioning, 2342
physical findings, 2342
postoperative care, 2347–2348
preoperative planning, 2342
primary, 2342
surgery, 2342
surgical management, 2342
soft tissue infections, debridement of, 2351, 2351f
anatomy, 2349–2350, 2349f
complications, 2351
definition, 2349
differential diagnosis, 2350
imaging, 2350
merits and demerits, 2351
nonoperative management, 2350
pathogenesis, 2350
patient history and physical findings, 2350
postoperative care, 2351
preoperative planning, 2350

supine position, 2350
surgical management, 2350
Foot exposure and second toe harvest, 2170–2172, 2171f–2172f
Foot fasciotomy, 2333, 2333f
central central compartment, 2331
deep central compartment, 2331
intrinsic compartment, 2331
lateral compartment, 2331
medial compartment, 2331
superficial central compartment, 2331
Foot reconstruction, keystone flaps for, 1746, 1746f
Forced duction test, 817, 817f
pediatric orbital fractures, 943
Forearm pronation, combined median and ulnar nerve injury,
2040–2041
Forearm reconstruction. See also Neonatal brachial plexus palsy
(NBPP)
biceps rerouting, 2964, 2964f
compartment syndrome
anatomy, 1760, 1761t, 1761f
fasciotomy (see Fasciotomy)
complications, 2968
outcomes, 2968
postoperative care, 2967
PT release/rerouting, 2964, 2965f
Forefoot reconstruction
anatomy, 2363–2364
bones, 2363
cutaneous sensation, 2363
digit extending muscles, 2363
dorsal forefoot sensation, 2363
extrinsic and intrinsic muscles, 2363
flexor digitorum brevis, 2363

medial and lateral compartments, 2363
plantar flexion, 2363
plantar surface, 2363
vascular supply, 2363
complications, 2372
definition, 2363
differential diagnosis, 2365
free flap
for distal skin defect, 2370, 2370f
latissimus, 2370–2371, 2371f
free gracilis for osteomyelitis, 2369, 2369f
imaging, 2365
merits and demerits, 2371b
natural history, 2365
nonoperative management, 2365–2366
outcomes, 2372
pathogenesis, 2364–2365
patient history and physical findings
forefoot wounds, evaluation of, 2365
gait cycle and biomechanics, 2365
postoperative care, 2371–2372
reverse fasciocutaneous flap, 2368, 2368f–2369f
secondary healing using regenerative matrix, 2367, 2368f
surgical management
approach, 2366–2367, 2367f
patient positioning, 2366
preoperative planning, 2366
Forefoot wounds, evaluation of, 2365
Forehead
botulinum toxin injection to
anatomy, 5, 5f
complications, 6
definition, 5

merits and demerits, 6b
nonoperative management, 5
outcome, 6, 6f
patient history and physical findings, 5
postoperative care, 6
injectable fillers in, 21
anatomy, 20, 20f
approach, 20
complications, 22
definition, 20
merits and demerits, 21b
nonoperative management, 20
outcomes, 21
patient history and physical findings, 20
patient positioning, 20
postoperative care, 21
Foreign body sensation, 119
Four-flap Z-plasty for first web space, 2228, 2228f
Four-handed technique, 219, 219f
FPHL (female pattern hair loss), 416–417
FPL (flexor pollicis longus), 2105
FPL (split flexor pollicis longus), 2023, 2023f
Fractional CO2 laser
anesthesia, 2807
application, 2807–2808, 2808f
wound care, 2808
Fractional lengthening of flexor tendons, 2203, 2204f
Fracture, naso-orbital-ethmoid
anatomy, 865, 866f
complications, 870
definition, 865
differential diagnosis, 865
imaging, 865, 867f

merits and demerits, 870b
natural history, 865, 866f
nonoperative management, 865
open reduction internal fixation, 868–869, 869f
outcomes, 870
pathogenesis, 865
patient history and physical findings, 865, 866f
postoperative care, 870
surgical management, 865–867
Free fibula flap, midface reconstruction, 2433–2435, 2434f,
2513–2514, 2513f
anatomy, 1001–1002, 1001f–1003f
anticipated secondary surgeries, 1008
classification, 1002
complications, 1010
customization, skeletal fixation, and inset, 1008, 1008f
definition, 1001
horizontal and vertical skeletal buttresses, 1002
imaging, 1002
lateral approach
completion process, 1008, 1008f
deep posterior compartment dissection, 1007, 1007f
distal osteotomy, 1007, 1007f
donor site markings, 1006, 1006f
incision and skin paddle dissection, 1006, 1006f
lateral and anterior compartment dissection, 1006–1007, 1007f
posterior compartment dissection, 1007, 1007f
proximal osteotomy, 1007, 1007f
merits and demerits, 1005b
midface defect, 1005
nonoperative management, 1004
outcomes, 1010
patient history and physical findings, 1002, 1004f

postoperative care, 1009, 1009f
surgical management
approach, 1005
patient positioning, 1005
preoperative planning, 1004–1005, 1005f
Free flap reconstruction, 2115, 2126, 2366, 2518
ankle
anatomy, 2392, 2393f
anterolateral thigh, 2396
complications, 2398
definition, 2392
gracilis, 2397
imaging, 2392
latissimus dorsi, 2397–2398
merits and demerits, 2398b
non operative management, 2392
outcomes, 2398, 2398f
pathogenesis, 2392, 2393f
patient history, 2392
physical findings, 2392
postoperative care, 2398
rectus abdominis, 2397
surgical management, 2392–2395
vastus lateralis, 2392–2395, 2396f
choice, 2366
for distal skin defect, 2370, 2370f
heel and plantar defects, 2378–2380
anterior tibial-dorsalis pedis artery, 2378–2379, 2378f–2382f
assessment of defect, 2384
complications, 2387
definition, 2378
final inset, 2385, 2386f
flap harvest, 2384, 2385f

imaging, 2380
lateral plantar artery
merits and demerits, 2386b
microanastomosis with temporary inset, 2385, 2385f
outcomes, 2387, 2387f
patient history, 2380
peroneal-lateral calcaneal artery, 2380
physical findings, 2380
posterior tibial-medial plantar artery, 2379–2380
postoperative care, 2386–
recipient vessel preparation, 2384, 2384f
superficial venous system of foot
surgical management, 2380–2383
wound preparation, 2384, 2384f
hemi-tongue
anatomy, 1198, 1198f
anterolateral thigh flap, 1204, 1204f
closure, 1206
complications, 1207
definition, 1198
flap inset, 1205–1206, 1205f
imaging, 1199
merits and demerits, 1200b
outcomes, 1207
pathogenesis, 1198–1199
patient history and physical findings, 1199
postoperative care, 1207
radial forearm free flap, 1201–1202, 1202f
sensory reinnervation, 1206, 1206f
surgical management, 1199–1200
ulnar artery perforator flaps, 1203, 1203f–1204f
knee, soft tissue coverage of
anatomy, 2486, 2486f–2487f

assessment of the defect, 2489
benefits of, 2486
complications, 2492, 2492f
definition, 2486
final inset, 2490, 2490f–2491f
flap harvest, 2489, 2489f–2490f
imaging, 2487
merits and demerits, 2491b
microanastomosis with temporary inset, 2490
outcomes, 2492
pathogenesis, 2487
patient history and physical findings, 2487
postoperative care, 2491–2492
recipient vessel preparation, 2488–2489, 2488f
surgical management, 2487–2488
wound preparation, 2488, 2488f
latissimus, 2370–2371, 2371f
lower leg, soft tissue coverage of
anatomy, 2438
anterior tibial vessels for recipient vessel.
assessment of defect, 2442
complications, 2445
definition, 2438
distal third of leg, 2438
final inset, 2443, 2443f
flap harvest, 2442, 2442f
imaging, 2440
main arteries and veins, 2438f–2439f
medial sural vessels as recipient vessel, 2439f–2440f
merits and demerits, 2444b
microanastomosis with temporary inset, 2442–2443, 2443f
middle third of leg, 2438
outcomes, 2444, 2444f–2445f

patient history and physical findings, 2440
peroneal artery perforators for recipient vessel
peroneal vessels for recipient vessel
posterior tibial vessels for recipient vessel
postoperative care, 2444
recipient vessel preparation, 2441, 2441f
surgical management, 2440–2441
upper third of lower leg, 2438
wound preparation, 2441, 2441f
scalp
anatomy, 984
complications, 989
definition, 984
graft sources, 985, 986b
imaging, 984
merits and demerits, 988t
microsurgery, 987, 987f
outcomes, 988, 988f
pathogenesis, 984
patient history, 984
physical examination of, 984
postoperative care, 988
specific donor-site dissections, 986
superficial temporal artery preparation, 986
surgical management, 984–985
thigh, soft tissue defects of
adductor canal, approach to, 2524, 2525f
anatomy, 2522
complications, 2528
definition, 2522
flap and anastomosis, 2526, 2526f
flap inset, skin grafting, 2526–2527, 2527f
groin, approach to, 2524, 2524f

imaging, 2522–2523
outcomes, 2527–2528
patient history and physical findings, 2522
patient positioning, 2523, 2523f
pearls and pitfalls, 2527b
postoperative care, 2527, 2528f
preoperative planning, 2523
saphenous vein, dissection of, 2525, 2525f
surgical approach, 2523
surgical management, 2523
viability rates, 2372
Free flap transposition, 1540
Free flaps graft sources, 985, 986b
Free floating orbital rim technique, 442
Free gracilis for osteomyelitis, 2369, 2369f
Free groin flap
anatomy, 2137–2138
flap size, 2138
lateral cutaneous branch, 2138
SCIA, 2137, 2137f–2138f
vascular and regional, 2137f–2138f
venous drainage, 2138
definition, 2137
design, 2142
harvest, 2142, 2142f
imaging, 2138
merits and demerits in, 2142b
outcomes, 2142–2143
patient history and physical findings, 2138, 2139f
postoperative care, 2142
surgical management, 2138–2139
approach, 2139
patient positioning, 2139

preoperative planning, 2139
Free lateral arm flap
anatomy, 2134, 2134f
complications, 2136, 2136f
definition, 2134
flap design, 2135, 2135f
flap harvest, 2135, 2135f
imaging, 2134
merits and demerits in, 2136b
outcomes, 2136
patient history, 2134
physical findings, 2134
postoperative care, 2136
surgical management, 2134
Free medial plantar flap, 2373
Free muscle flap, 2381–2383
Free tissue transfer, palatal fistula, 2703, 2703f
Free transverse rectus abdominis myocutaneous flap
abdominal closure, 1421, 1421f
anatomy, 1414
complications, 1422
definition, 1414
fascial dissection, 1418, 1418f
imaging, 1415
intramuscular dissection, 1419, 1419f
markings, 1416, 1416f–1417f
merits and demerits, 1421b
microsurgery and flap inset, 1420–1421, 1420f
outcomes, 1421
patient history and physical findings, 1414–1415
perforator identification, 1417, 1418f
postoperative care, 1421
recipient vessel dissection, 1419, 1420f

surgical management
approach, 1416
patient positioning, 1416
preoperative planning, 1415–1416
Fresh-frozen allografts, 2342–2343, 2346–2347
Froment sign, 1987, 1993
Frontal bone, medial orbit wall fractures, 829, 829f
Frontal cephalogram, chin deformities, 412
Frontal fibrosing alopecia (FFA), 418, 418f
Frontal pneumatization patterns, 801–802, 802f
Agger nasi cell, 801, 802f
frontal bullar cell, 802
intersinus septal cell, 802
suprabullar cell, 802
supraorbital ethmoid cell, 802
Frontal recess, 801
Frontal region, panfacial fractures, 934
Frontal sinus cranialization
anatomy, 779–780, 779f–780f
complications, 784–785, 785f
definition, 779
differential diagnosis, 781, 781f
imaging, 780, 781f
merits and demerits, 781b
natural history, 780
nonoperative management, 781
outcomes, 784
pathogenesis, 780
patient history and physical findings, 780, 780f
postoperative care, 784
preparation and exposure, 781–782, 782f
repair and closure, 782–784, 783f
in situ, 779f–780f

surgical management
approach, 781
patient positioning, 781
preoperative planning, 781
Frontal sinus drainage pathway (FSDP), 794f–795f
Frontal sinus fractures
algorithm, 796, 797f
complications, 800
definition, 794
delayed endoscopic cranioplasty, 797
endoscopic correction
endoscopic reduction and internal fixation, 799
endoscopic repair, incisions, 798, 798f
mesh/polyethylene plate, 799, 799f
endoscopic cranioplasty and fixation techniques, 797
endoscopic endonasal sinus procedures, 797
frontal sinus drainage pathway, 794, 794f–795f
imaging, 796, 796f
merits and demerits, 798b
natural history, 795
outcomes, 800
pathogenesis, 795
patient history, 795
physical examination, 796
postoperative care, 800
supratrochlear and supraorbital neurovascular bundles, 794f–795f,
795
surgical management
approach, 798
patient positioning, 798
preoperative planning, 797, 797f
traditional open surgical techniques, 797
vertical and horizontal components, 794

Frontal sinus mucocele
anatomy, 801
complications, 808
definition, 801
differential diagnosis, 803
endoscopic endonasal marsupialization
anterior ethmoidectomy, 804, 805f
completion process, 806
frontal dissection, 805, 805f
maxillary antrostomy, 804, 805f
uncinectomy, 804f
frontal sinus trephination, 806–807, 806f
imaging, 803, 803f
merits and demerits, 804b
natural history, 802
outcomes, 808
pathogenesis, 802
patient history and physical findings, 802–803
postoperative care, 808
surgical management
approach, 804
combined endonasal-external approach, 807
patient positioning, 804
preoperative planning, 803
Frontal sinus obliteration
with fat
anatomy, 786, 786f
complications, 789
definition, 786
differential diagnosis, 787
imaging, 787, 787f
merits and demerits, 788b
nonoperative management, 787