Operative Technique in Plastic Surgery – Kevin C.Chung

techniques, 442
bone manipulation and stabilities, 435
complications, 443
definition, 434
disadvantages, 435–436
“fixed plate” position technique, 442
“free floating” orbital rim technique, 442
imaging, 435, 436f
merits and demerits, 437b
metopic synostosis
anatomy, 434
definition, 434
orbital roof osteotomy, 441
patient history and physical findings, 434–435
resorbable plate, 441, 441f
outcomes, 443
pathogenesis, 434
postoperative care, 443
surgical management
approach, 437
patient positioning, 436
preoperative planning, 436
Tilt procedure, 437, 437f–438f
unilateral coronal synostosis
anatomy, 434
bony fixation, 440, 440f–441f
completion, 440
definition, 434
exposure and bur hole placement, 438, 438f
patient history and physical findings, 435
supraorbital rim osteotomy and advancement, 438–439, 439f
Fronto-orbital distraction
anatomy, 445

complications, 450
craniosynostosis, 446
definition, 445
device application, 448
differential diagnosis, 446
epidemiology, 445
imaging, 446, 446f
merits and demerits, 447b
metopic synostosis, 448–449, 449f
natural history, 445–446
outcomes, 450, 450f–451f
pathogenesis, 445
postoperative care, 450
surgical management
approach, 447
patient positioning, 447
preoperative planning, 447
unicoronal synostosis, 447, 448f
Frontotemporal angle, 97
Frozen biopsy, 2747–2748, 2747f
FSDP (frontal sinus drainage pathway), 794f–795f
FTSG (fullthickness skin graft), 2105, 2107, 2109, 2112
Fuducials, CT scan with, 2345
FUE (follicular unit extraction), 416, 421, 425–426
Full scar brachioplasty-bicipital groove scar, 1646–1647, 1647f
Full-thickness eyelid defects, 1078, 1080f–1081f
Full-thickness skin grafting, contracture release with, 2774–2775,
2775f
Full-thickness skin grafts, 2769
harvesting of, 2771
Functional burn reconstruction
airway, eyes, and lips, 2766, 2766f–2767f
anatomy, 2765

burn scar contractures, 2767, 2767f
contracture release, 2766
definition, 2765
imaging, 2766
merits and demerits, 2766b
natural history, 2765
nonoperative management, 2766
pathogenesis, 2765
patient history and physical findings, 2765
surgical management, 2766
Functional remodeling process, 691
Furlow palatoplasty
anatomy, 2662
closure, 2666
complications, 2667
definition, 2662
hard palate, 2664
imaging, 2663
merits and demerits, 2664b
nasal layer, 2665
oral layer, 2664
outcomes, 2667
palatal fistula conversion by, 2699
patient history and physical findings, 2662–2663
postoperative care, 2667
surgical management
approach, 2663
patient positioning, 2663
preoperative planning, 2663
velopharyngeal insufficiency
dissection, 2708, 2709f
markings, 2708, 2708f
surgical management, 2707

Z-plasty with intravelar veloplasty
FUs (follicular units), 416
FUT (follicular unit transplantation), 416
G
G' (G-prime), 26
Gabapentin, peroneal nerve injury, 2414
Gait, 2355, 2456
analysis, 2365
cycle and biomechanics, 2365
Galea aponeurotica, 69–70, 97
Galeotomies, hairline lowering, 103, 103f
Gamekeeper deformity, 1938
GAN (great auricular nerve), 198
Ganglion cysts
anatomy, 2280, 2280f–2281f
complications, 2286
definition, 2280
differential diagnosis, 2282
dorsal wrist, 2281, 2282f, 2283, 2283f
imaging, 2282
merits and demerits, 2286b
natural history, 2281
nonoperative management, 2282
outcomes, 2286
pathogenesis, 2281
patient history and physical findings, 2281, 2282f
postoperative care, 2286
surgical management, 2282
volar wrist, 2281, 2282f, 2284, 2284f
Gastrocnemius muscle flap, 2463
anatomy, 2482

complications, 2485
definition, 2482
elevation of, 2483–2484, 2484f
imaging, 2482
merits and demerits, 2485b
pathogenesis, 2482
patient history and physical findings, 2482
postoperative care, 2485, 2485f
surgical management
approach, 2483
patient positioning, 2483
preoperative planning, 2483
Gastroschisis
complications, 3029
definition, 3026
diagnostic studies, 3026
differential diagnosis, 3026
imaging, 3026
merits and demerits, 3029b
patient history and physical findings, 3026, 3027f
postoperative care, 3029
repair
closure, 3028, 3028f
delayed closure with silo placement, 3028, 3028f
immediate reduction, 3028
surgical management
patient positioning, 3027
preoperative planning, 3026–3027
Gavello procedure, 1138
Gender-affirming surgery
anatomy, 1687, 1688f–1689f
complications, 1697
definition, 1687

imaging, 1689
outcomes, 1696
pathogenesis, 1687
patient history and physical findings, 1687–1689
penile inversion vaginoplasty
approach, 1689
patient positioning, 1689
preoperative planning, 1689
postoperative care, 1696
Genioplasty, chin reduction, 408–409, 408f, 409f
Genital system, conjoined twins, 3095
Genitography, 3063
Gentamicin, 2471
Giant cell tumors
anatomy, 2281
of bone, 2423
complications, 2286
definition, 2280
differential diagnosis, 2282
imaging, 2282
merits and demerits, 2286b
natural history, 2281
nonoperative management, 2282
outcomes, 2286
pathogenesis, 2281
patient history and physical findings, 2282
postoperative care, 2286
surgical management, 2282
Gilles approach, 872–873, 873f
Gillies incision, 955
GILLS score, 2691
Gingivobuccal sulcus, 395, 395f
incision, 2610

Gingivoperiosteoplasty (GPOP)
anatomy, 656, 657f–658f
complications, 662
definition, 656
flap elevation, 659–660
imaging, 656
markings and incisions, 659, 659f
merits and demerits, 659b
nonoperative management, 657
outcomes, 662
patient history and physical findings, 656
postoperative care, 661
repositioning of elements, 660, 660f
Skoog’s technique, 658
surgical management
approach, 658–659
patient positioning, 658, 658f
preoperative planning, 658, 658f
surgical management, patient positioning, 658
suturing and completion, 660, 660f–661f
Glabella, injectable fillers in, 20–22
Glabellar muscles, 93, 93f
Glabellar region, botulinum toxin injection into
anatomy, 2
complications, 4
definition, 2
outcomes, 4
patient history and physical findings, 3
postoperative care, 4
surgical management
approach, 3
merits and demerits, 4b
patient positioning, 3

preoperative planning, 3
Glanuloplasty, 3048
Glioma, 2745
Glomus tumors of hand
anatomy, 2287
complications, 2290
definition, 2287
differential diagnosis, 2287
imaging, 2287, 2287f
lateral approach, 2289, 2290f
location based on palpation, 2288, 2288f
merits and demerits, 2290b
natural history, 2287
outcomes, 2290
pathogenesis, 2287
patient history and physical findings, 2287
postoperative care, 2290
surgical management, 2288, 2288f
patient positioning, 2288
preoperative planning, 2288
transungual approach, 2288, 2289f
zigzag incision, 2288, 2288f
Glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency
EMLA, 967
Gluteal augmentation
completion, 1629–1630, 1631f
island flap harvesting and placement, 1629, 1630f
Gluteal autoaugmentation, lower body lift, 1621, 1622f
Gluteal flaps, for sacral pressure injuries. See Sacral pressure injury
Gluteal muscles, bilateral V-to-Y advancement of, 2788, 2788f
Gluteal rotation flap, 1701, 1702f
Gluteal thigh flap for perineal reconstruction. See Perineal
reconstruction

Gluteus maximus myocutaneous flap, 2788, 2788f
Gout, 2456
GPOP. See Gingivoperiosteoplasty (GPOP)
Gracilis flap, 2397, 2518
perineal and vaginal reconstruction (see Perineal reconstruction)
Gracilis muscle
anatomy, 1682, 1682f, 2933, 2933f
harvest, 2938–2939, 2939f
inset, 2939, 2940f
Graf technique, 1336, 1336f
Graft harvest, 2916
medial orbit wall fractures, 835
Graft implantation, 429
Graft passage and completion, 2917
Graft, resorption of, 996
Grafts, closed rhinoplasty, narrow midvault in, 275
Granulomas, 147
Grasp improvement procedures
anatomy, 2210
complications, 2215
definition, 2210
imaging, 2210
merits and demerits, 2212b, 2214b
nonoperative management, 2211
outcomes, 2215
patient history and physical findings, 2210
postoperative care, 2214
surgical management
approach, 2212
patient positioning, 2211
preoperative planning, 2211
Great auricular nerve (GAN), 198, 215, 226f–227f
anatomy, 966f, 967

of ear, 1129
Greater arc injury, 1895–1896, 1895f, 1896f
Greater occipital nerve, 97, 966f, 967
Greater palatine artery, 2671
Greater palatine vessels isolation, 2685–2686, 2686f
Greenstick-type fractures, 908
Groin, approach to, 2524, 2524f
Grouped fascicular repair, 2004–2005, 2004f
Gruss types NOE fractures, 867, 868f
GSW (gunshot wounds), 934
Gummy smile, botulinum toxin injection, 10
anatomy, 9, 9f
approach, 9
complications, 10
definition, 9
merits and demerits, 10b
nonoperative management, 9
outcome, 10, 10f
patient history and physical findings, 9
patient positioning, 9
postoperative care, 10
Gunshot wounds (GSW), 934
Gustilo classification system, 2466
Guyon canal, 1986
Gynecomastia
anatomy, 1355, 1355f, 1635, 2983, 2983f–2984f
complications, 1360, 1638–1639, 2991
definition, 1355, 1635, 2983
differential diagnosis, 1356, 2985
imaging, 1356, 1635, 2985
merits and demerits, 1357b, 1360b, 1638b, 2990b
natural history, 2984, 2984f
nonoperative management, 1356, 2985

outcomes, 1360, 1636f–1637f, 1638, 2990, 2991f
pathogenesis, 1355, 1635, 2983–2984
patient history and physical findings, 1356, 1635, 2984–2985
postoperative care, 1360, 1638, 2990
surgical management, 1635, 2985–2986
approach, 1356–1357, 2986
patient positioning, 1356, 2986
preoperative planning, 1356, 2985

H
Hair restoration surgeons (HRS), 419
Hair transplantation
anatomy, 416
cicatricial alopecia, trauma/postrhytidoplasty, 428
complications, 432
definition, 416
differential diagnosis, 418
donor site closure, 424–425, 425f
donor strip harvest, 424, 424f
facial hair transplantation, 429
FUE harvest, 425–426
graft preparation, 426–427, 427f
imaging, 418
implantation of grafts, 429
merits and demerits, 429b
natural history, 417, 418f
nonoperative management, 418–419, 419f
outcomes, 430–432
pathogenesis, 416–417
patient history and physical findings, 417–418
postoperative care, 430
recipient sites, creation of, 427–428, 428f
surgical management, 419–424, 420f, 421f, 424b
hairline design, 422–423, 422f–423f
patient positioning, 423–424
preoperative planning, 421–423, 421f
in women, 427f, 428
Hairline lowering
anatomy, 97
complications, 105

definition, 97, 98f
flap elevation, 101, 102f
galeotomies, 103, 103f
incision and dissection, 101, 101f
local anesthesia, 100, 100f
merits and demerits, 105b
outcomes, 105
patient history and physical findings, 97
postoperative care, 105
preoperative planning and positioning, 98, 100f
scalp advancement, 103, 103f–104f
scalp fixation and wound closure, 104, 104f–105f
surgical management, 97–98, 99f
Halitosis, palatal fistula, 2704
Hammer’s key area, 847, 847f
Hammond modification, skate flap, 1479–1480, 1479f, 1480f
Hamstring muscle, 2465
Hamstring V-Y flap, 1712, 1713f
Hand
compartment syndrome
anatomy, 1760, 1760f, 1762b
fasciotomy of, 1762–1763, 1762f, 1763f
flexor tendon sheaths of, 1771, 1771f
lumps and bumps of (see Ganglion cysts; Giant cell tumors)
malignant skin tumors (see Skin tumors, malignant)
osteoarthritis (see Osteoarthritis (OA))
rheumatoid arthritis
boutonniere deformity (see Boutonniere deformities)
MCPJ and PIPJ arthritic changes, 1936, 1936f–1937f
MCPJ volar subluxation and ulnar deviation, 1936–1937,
1936f–1937f
sparing of DIPJ, 1936
swan-neck deformity (see Swan-neck deformity)

Handlebar palsy, 1987
Hard palate
harvest, 1096–1097, 1097f
mucosal graft, 190, 191f
posterior lamellar reconstruction, 1097, 1097f
repair, 2659–2660, 2660f
Harvesting bone marrow, 2478, 2479f
Hearing, 2618
Heberden nodes, on DIPJs, 1956, 1957f
Heel defect, 2376f–2377f
Helical-scaphal defect., 1131f
Helical-scaphal-antihelix defect, 1131, 1131f
Helix defect, 1130, 1130f
Hemangioma(s), 2759–2760
definition, 2291
of hand
cavernous, 2291
complications, 2294
congenital, 2291
differential diagnosis, 2292
excision, 2292–2293, 2293f
imaging, 2292
incision and dissection, 2292, 2292f–2293f
infantile, 2291
merits and demerits, 2294b
natural history, 2291
nonoperative management, 2292
outcomes, 2294
pathogenesis, 2291
patient history and physical findings, 2291, 2291f
postoperative care, 2294
surgical management, 2292
zigzag incision, 2292, 2292f–2293f

natural history, 2275
nonoperative management, 2276
Hemangioma resection of, nasal tip hemangioma, 2890, 2890f
Hematoma(s), 200, 1741, 1991, 2387, 2428, 2445, 2485, 2492
antia-buch flaps, 1132
auricular, 3083
deep plane face-lift, 237
face-lifting and neck lifting, 209
formation, 2321
orbital floor blow-out fractures, 815
to prevent reaccumulation of, 2896f
Hemicortical resection, 2424
Hemifacial microsomia (HFM), 671, 2729
Hemiglossectomy
defects, 1199–1200, 1200f–1201f
indications, 1198
Hemihamate arthroplasty (HHA), 1818
advantage, 1822
autograft harvest, 1826, 1827f
contraindications, 1824
definition, 1822
graft fixation and closure, 1827, 1828f
Hemi-tongue reconstruction, free flap
anatomy, 1198, 1198f
closure, 1206
complications, 1207
definition, 1198
flap harvest
anterolateral thigh flap, 1204, 1204f
radial forearm free flap, 1201–1202, 1202f
ulnar artery perforator flaps, 1203, 1203f–1204f
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
sensory reinnervation, 1206, 1206f
surgical management
patient positioning, 1199–1200
preoperative planning, 1199
Hemitransfixion incision, 2895
Hemorrhage, Le Fort I fractures, 892
Hemosiderin, 2428
Hemostasis, 144, 1058, 1061, 1072, 2115, 2122
emergency room anesthesia, 3077
palatal grafts, 1098
partial auriculectomy defects, 1144
Hemothorax, 996
Heparin, 2444
Hepatobiliary tree, conjoined twins, 3095
Hernia, definition of, 1572
Hernia repair
anatomy, 1556
anterior component separation
endoscopic, 1559, 1559f
minimally invasive, 1558
open, 1557–1558, 1557f
definition, 1556
imaging, 1556
merits and demerits, 1557b
outcomes, 1561
patient history and physical findings, 1556
postoperative care, 1561
surgical management

approaches, 1557
patient positioning, 1556
preoperative planning, 1556
transversus abdominis release, 1559–1560, 1560f
Herniated orbital fat, lower eyelid
anatomy, 132, 132f
anesthesia and eye preparation, 133
complications, 137
definition, 132
excision of, 134, 135f
eyelid retractors, isolating, 133, 134f
merits and demerits, 136b
outcomes, 137, 137f
patient history and physical findings, 132
postoperative care, 136
repositioning, 135–136, 136f
surgical management, 132
Hertel exophthalmometry, 848
Heterotopic ossification (HO), 2481, 2765
Hetinoblastoma gene mutation, 2338
HFM (hemifacial microsomia), 671, 2729
HHA. See Hemihamate arthroplasty (HHA)
High combined median and ulnar nerve injuries
finger flexion, 2040
forearm pronation, 2040–2041
sensory nerve transfers, 2041
thumb flexion, 2040
High radial nerve palsy
anatomy, 2048–2049
complications, 2053
definition, 2048
imaging, 2049
merits and demerits, 2050b, 2053b

outcomes, 2053
patient history and physical findings, 2049
postoperative care, 2053
surgical management
algorithm, 2050f
patient positioning, 2049
preoperative planning, 2049
High-energy trauma, 2467
High-frequency linear transducer, 2310–2311
High-grade chondrosarcoma, 2423, 2503f
High-grade osteosarcoma, 2502
Hildreth’s test, 2287
Hip and buttock pathology, 2531
HO (heterotopic ossification), 2481, 2765
Hook of hamate fractures, 1987
Horner syndrome, 2850, 2949
HRS (hair restoration surgeons), 419
Huber transfer, 2015, 2015f
Hughes flap
anatomy
anterior lamella, 1089
blood supply, 1090
external carotid, 1090
lower eyelid retractors, 1090
posterior lamella, 1089
upper eyelid retractors, 1090
complications, 1093
definition, 1089
flap creation, 1090, 1091f
flap separation, 1091
imaging, 1090
merits and demerits, 1090b
outcomes, 1093

patient history and physical findings, 1090
postoperative care, 1093
surgical management
patient positioning, 1090
preoperative Planning, 1090
Human bites, 3074
Hunsuck modification, 697
Hyaluronic acid, 20–21, 37, 42
Hyaluronic acid fillers, 164
Hydrocephalus, with syndromic craniosynostosis, 446
Hydrogen peroxide, 2471
Hydrosurgery system, 2429, 2429f
Hydroxyapatite, 2361
Hyperbaric oxygen (HBO) treatment, 2366
Hypercontraction, of corrugator muscles, 3
Hyperdynamic glabellar musculature, 2
Hyperfunctioning of muscles, 2
Hypernasal speech, 2707
Hyperparathyroidism, 2460
Hypertelorism, 543, 547b, 2745
Hypertrophic healing tendency, 210
Hypertrophic hypothenar muscles, 1987
Hypertrophic nonunion, 2506, 2509
Hypertrophic scars, 66, 2765, 2806
Hypervascularity, 2752
Hypogastric plexiform tumor, 2755, 2756f
Hypoglobus, 847
Hypomastia., 1290, 1290f
Hypomegakaryocytic thrombopenia, 2268
Hypopigmentation, 66
Hypoplasia, 2617
Hypoplastic mandible, 672, 672f
Hypoplastic medial/lateral lip element, 2650–2651

Hypoplastic thumb reconstruction
anatomy, 2225
complications, 2233
definition, 2225
imaging, 2226
merits and demerits, 2233b
natural history, 2225
nonoperative management, 2226
outcomes, 2233
pathogenesis, 2225
patient history and physical findings, 2225–2226, 2226f
postoperative care, 2233
surgical management
approach, 2227
patient positioning, 2227
preoperative planning, 2227
Hypospadias
anatomy, 3041
complications, 3050
definition, 3041
imaging, 3041
merits and demerits, 3049b
nonoperative management, 3042
outcomes, 3050
pathogenesis, 3041
patient history and physical findings, 3041
postoperative care, 3049–3050
prevalence of, 3041
repair, algorithm for, 3043f
surgical management, 3042
approach, 3042, 3043f
patient positioning, 3042
preoperative planning, 3042

Hypothenar compartment release, 1762, 1763f
Hypothenar fascia, 1986, 1986f, 1989, 1990f
Hypothenar fat flap, carpal tunnel release, 1984, 1984f
Hypothenar hammer syndrome, 1987, 2160
HypoThermosol, 426
I
IAN (inferior alveolar nerve), 398, 697, 907, 1047
Iatrogenic airway obstruction, 275
Iatrogenic injury, 1991, 2411
ICAP flap, 1370, 1370f
ICSRA (intercompartmental supraretinacular artery) vascularized
bone flap, 1882–1883, 1883f
Iliac crest, 2355, 2360
Iliac crest bone graft
harvesting, 648, 648f
cancellous, 2359, 2359f
tricortical structural, 2358, 2358f–2359f
nonunion of a mandible fracture, 929–930, 929f
Iliac crest harvest site, 2358f
Ilizarov technique, 2424
ILO. See Inverted L osteotomy (ILO)
IMA (internal mammary artery), 1515
Imaging
free groin flap, 2138
free lateral arm flap, 2134
pedicled groin flaps, 2138
posterior interosseous artery flap, 2127
reverse radial forearm flap, 2115
soft tissue tumors, excision of, 2339
ulnar artery perforator flap, 2121
IMAP (internal mammary artery perforator) flap, 1230

Immediate tissue expander placement
and closure, 1390–1391, 1391f
complications, 1392
definition, 1385
implant pocket creation, 1386–1390, 1387f–1389f
merits and demerits, 1386b, 1391b
outcomes, 1392
patient history and physical findings, 1385
postoperative care, 1392
preparation of, 1390, 1390f
surgical management
implant selection, 1385–1386
patient positioning, 1386
preoperative planning, 1385–1386
wound assessment, 1386
Impaired blood flow, 2392
Impaired visual acuity, 140
Implant(s)
chin augmentation with
anatomy, 386, 387f–388f
complications, 390–391
definition, 386, 388b
external (submental) approach, 388–389, 388f, 389f
imaging, 387
implant selection, 387
intraoral approach, 390
merits and demerits, 390b
outcomes, 390, 391f
pathogenesis, 386
patient history and physical findings, 386–387
postoperative care, 390
surgical management, 387
malar

anatomy, 392, 392f
complications, 396
definition, 392
imaging, 393
intraoral approach, 395, 395f
merits and demerits, 396b
nonoperative management, 393
outcomes, 396, 396f–397f
pathogenesis, 392–393, 393f
patient history and physical findings, 393
periorbital approach, 394, 394f
postoperative care, 396
preoperative preparation, 394b
surgical management, 393–394
types of, 943–944
Implant deviation, correction of, 359, 359f
IMS (intermuscular septum), 2130
In situ cubital tunnel decompression, 1994, 1995f
Inadequate tip projection, 288
Incisional hernias
abdominal wall closure, 1577–1578, 1577f
anatomy, 1572
complications, 1579
definition, 1572
external abdominal oblique release, 1574–1575
imaging, 1572
laparotomy, 1574, 1574f
merits and demerits, 1578b
mesh inset, 1576, 1576f–1577f
nonoperative management, 1573
outcomes, 1579
pathogenesis, 1572
patient history and physical findings, 1572

postoperative care, 1578–1579
surgical management
approach, 1574
positioning, 1574
preoperative planning, 1573–1574
suture pull-through, 1572, 1573f
Incisive nerve, 1047
Inclusion cysts, 147
Incomplete clefts, 2606
Index finger abduction, 2037–2038
Induced membrane, with intramedullary autogenous bone grafting,
2474–2475, 2475f
cement spacer placement and internal fixation, 2475–2476, 2475f
completion of reaming, 2478
graft placement, 2478, 2479f
harvesting bone marrow, 2478, 2479f
inserting guidewire, 2476–2477, 2477f
reaming graft material, 2477–2478, 2478f
RIA preparation, 2477, 2477f
soft tissue coverage and monitoring, 2476, 2476f
spacer removal and bone preparation, 2476, 2476f
Infected lateral malleolar wound, 2351f
Infection(s)
bone tumors of foot and ankle, 2348
closed rhinoplasty, narrow midvault in, 275
deep plane face-lift, 237
face-lifting and neck lifting, 209
Le Fort III fracture, 902
open treatment of nasal fractures, 864
Inferior alveolar nerve (IAN), 398, 697, 907, 1047
Inferior gluteal artery perforator flap breast reconstruction
anatomy, 1452–1454
approach, 1454

complications, 1457
definition, 1452
flap design and markings, 1455, 1455f
harvesting, 1455–1456, 1456f
imaging, 1454
merits and demerits, 1456b
outcomes, 1457
patient history and physical exam, 1454
patient positioning, 1454
postoperative care, 1457
recipient vessel exposure, 1456
surgical management, 1454
Inferior labial artery, 1063, 1063f
Inferior orbital fissure, 809
Inferior pedicle
anatomy, 1345
complications, 1348–1349
definition, 1345
imaging, 1345
internal shaping sutures, 1347–1348, 1348f
merits and demerits, 1348b
nipple dissection, 1347, 1347f
nipple incision, 1346, 1346f
nipple resection, 1347, 1347f
outcomes, 1348
patient history and physical findings, 1345
postoperative care, 1348
surgical management
approach, 1346
patient positioning, 1346
preoperative planning, 1345–1346, 1346f
Inferior retinacular lateral canthopexy/canthoplasty, 159–160, 160f
Inferior retinaculum, 157

Inferior turbinates, 380
Inflamed deep peroneal nerve
Inflatable orbital expanders, 2882
Inframammary approach, breast augmentation plane
dual plane type II placement, 1316–1317, 1317f
Keller funnel, 1316–1317, 1317f
partial subpectoral placement, 1316–1317
partial subpectoral placement and dual plane creation
closure, 1323, 1324f
implant placement, 1323, 1323f
incision and dissection, 1322, 1322f
pocket creation, 1322–1323, 1323f
smooth round silicone implant, 1316–1317
with subfascial placement, 1324
Infraorbital artery, 1122
Infraorbital nerve, 392, 889, 2640
anatomy, 966, 966f
surgical management, intraoral approach, 970, 970f
Infraorbital rim (IOR), 809, 878, 882, 2724f
Infrapopliteal disease, 2400
Infratrochlear nerve, 966, 966f
Inguinal defects, 1589
Inguinal vascularized lymph node harvest, 2563, 2563f
Injection of fillers, 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
Inner canthal distance (ICD), 542, 543f
Inner preputial inlay graft, 3045, 3046f
Inner preputial skin flap, 3047
Innervated flap, 2383
In-plane needle insertion approach, ultrasound-guided, 2316
imaging, 2318
needling, 2319
patients positioning, 2318
lateral decubitus position, 2318
prone position, 2318
supine position, 2318
Insulated Desmarres retractor, 159
Integumentary system, conjoined twins, 3096
Intense pulsed light (IPL) device, 2802, 2802f
Intercompartmental supraretinacular artery (ICSRA) vascularized
bone flap, 1882–1883, 1883f
Interleukin-6 (IL-6), 1931
Intermaxillary fixation. See Maxillomandibular fixation (MMF)
Internal mammary artery (IMA), 1515
Internal mammary artery perforator (IMAP) flap, 1230
Internal mammary vessels, 1447, 1449, 1449f
Internal mandibular distraction
anatomy, 718, 718f–719f
complications, 722
definition, 718
differential diagnosis, 719
imaging, 719
inverted “L” osteotomy, 720
merits and demerits, 720b
nonoperative management, 719
outcomes, 722
pathogenesis, 718

patient history and physical findings, 718
placement, 720
postoperative care, 722
removal, 721
surgical management
patient positioning, 720
preoperative planning, 719
Internal nasal valve, 269, 297, 380
repair, nasal airway obstruction, 383, 383f
Internal/endoscopic dacryocystorhinostomy, 2873, 2873f
International Classification for Surgery of the Hand in Tetraplegia
(ICT), 2210
Interorbital distance (IOD), 542, 543f
Interossei, 1986–1987, 1986f
Interosseous ligament complex, wrist. See Scapholunate
interosseous ligament (SLIL) injury
Interpositional genioplasty, 4
Interpupillary distance (IPD), 542, 543f
Intra-abdominal pressure, 1572
Intralesional curettage, 2503
Intramedullary autogenous bone grafting, 2475, 2475f
Intranasal deformity, 380
Intranasal glioma
endoscopic excision of, 2750, 2750f
pathogenesis, 2745
Intraneural topography of median nerves, 2004, 2005f
Intraoral approach, 603
alloplastic chin augmentation, 759
malar implants, 395, 395f
mandibular setback, 740–749
Intraoral cheek surface, 1219, 1219f
Intraoral vertical ramus osteotomy (IVRO)
inferior osteotomy, 715, 715f

setback procedure, 714
superior osteotomy, 715, 715f, 716f
surgical management, mandible repositioning, 715, 716f
Intravascular injection, 2325
Intravelar veloplasty, Z-plasty with
Intravenous antibiotics, 2469, 2471
Intrinsic release, 2076
Introitoplasty, 3054–3055, 3054f, 3055f
Inverted L osteotomy (ILO)
anatomy, 706
combined extraoral-intraoral ILO, 709–710, 710f
complications, 711
definition, 706
differential diagnosis, 706
extraoral
exposure, 707–709, 708f
osteotomy, 707–709, 709f
imaging, 706
internal mandibular distraction, 720
intraoral, 710, 710f
merits and demerits, 707b
neonates and children, 706
postoperative care, 711
preoperative planning, 706
skeletally mature patients, 706
surgical management
approach, 707
patient positioning, 707, 707f
Inverted V deformity, 270
Inverted-T excision, 2655–2656, 2656f
Involucrum, 2466
IOM (interosseous membrane), 2126
IOR (infraorbital rim), 809, 878, 882, 2724f

Ipsilateral fibula flap, 1025
Ipsilateral flap, 1031
Ipsilateral mucoperichondrial septal _flap, 1165f
Ipsilateral vein, 2404
Ischemia
breast, plastic surgery of, 1412
free fibula flap for midface reconstruction, 1010
irreversible muscle damage, 1760
Ischemic claudication, 2400
Ischemic rest pain, 2400
Ischial pressure injury, 2787, 2793, 2793f
debridement with gluteal rotation flap, 2788, 2788f
V-Y advancement flap for, 2787, 2787f
Ischial ulcers, posterior thigh and hamstring flaps for
anatomy, 1705, 1706f–1707f
complications, 1714
definition, 1705
differential diagnosis, 1707
imaging and other diagnostic studies, 1707
natural history, 1706
nonoperative management, 1707–1708
outcomes, 1714
pathogenesis, 1705–1706
patient history and physical findings, 1706–1707
postoperative care, 1713–1714
surgical management
approach, 1708, 1710b
positioning, 1708
preoperative planning, 1708
Ischiopagus conjoined twins, 3092, 3093f–3094f, 3097–3100. See
also Conjoined twin
I-shaped silicone implants, 351, 351f
Island flap, 2107

Islandized propeller flaps, 2592–2593, 2592f
Isolated neck lift
anatomy, 238, 238f
complications, 240
definition, 238
imaging, 238
merits and demerits, 240b
outcomes, 240, 241f
patient history and physical findings, 238
postoperative care, 240
surgical management, 238–240
approach, 239–240
positioning, 239
preoperative planning, 238–239
techniques, 239b, 239f
IVRO. See Intraoral vertical ramus osteotomy (IVRO)

J
Jackson-Pratt drains, 1531
Jackson-Weiss syndrome, 616
Jahss technique, metacarpal neck, 1788, 1788f–1789f
Jamshidi needle, 2361, 2361f
Jeanne test, 1987, 1993
Jejunum flap, for pharyngeal reconstruction
after laryngopharyngectomy, 1231, 1231f
anatomy, 1229, 1229f
complications, 1235
definition, 1229
donor-site closure, 1234
flap harvest, 1231, 1232f
flap inset, 1232–1233, 1233f
imaging, 1230
merits and demerits, 1231b
outcomes, 1235
patient history and physical findings, 1229–1230
postoperative care, 1234, 1235f
surgical management
open or a laparoscopic approach, 1230
patient positioning, 1230
preoperative planning, 1230
Joint loss, 2473
Joseph periosteal elevator, 327, 2699
Jumping genioplasty, 413
Juvederm, 42
Juvederm Ultra XC, 27
Juvederm Ultra/Juvederm Ultra Plus, 43
Juvenile breast hypertrophy
anatomy, 2992, 2993f

complications, 3000
definition, 2992
differential diagnosis, 2993
imaging, 2993
merits and demerits, 2999b
natural history, 2992
nonoperative management, 2994
outcomes, 3000
pathogenesis, 2992
patient history and physical findings, 2992–2993
postoperative care, 3000
surgical management, 2994–2996
patient position, 2995–2996, 2995f
preoperative planning, 2994–2995, 2994f–2995f
K
Kaposiform hemangioendothelioma, 2759
Karapandzic flaps
anatomy, 1059, 1059f
bilateral, large midline lower lip defect, 1060, 1060f–1061f
complications, 1061
definition, 1059
imaging, 1059
merits and demerits, 1061b
outcomes, 1061, 1061f
patient history and physical findings, 1059
postoperative care, 1061
surgical management
approach, 1060
patient positioning, 1060
Keen-type approach
zygomatic arch fractures, closed reduction and treatment, 874,

874f
zygomaticomaxillary complex, 887, 887f
Keratin-filled cysts, 66
Ketamine, 3077
Keystone area, 857
Keystone flaps
anatomy, 1738, 1743–1744, 1743f, 2537–2538
for back reconstruction, 1746, 1746f
to close donor-site defect, 1747, 1747f
complications, 1741, 1748, 2543
definition, 1738, 1743, 2537, 2537f–2538f
design, technique for, 1745, 1746f
for foot reconstruction, 1746, 1746f
history, 1744
imaging, 1738, 1744, 2539
merits and demerits, 2540b, 2542b
nonoperative management, 2539
outcomes, 1741, 1748, 2543
pathogenesis, 1738
patient history and physical findings, 1738, 1744, 2538–2539
postoperative care, 1741, 1748, 2543
surgical management, 1744, 1744f, 1745f
approach, 1738, 1745, 2539
patient positioning, 2539
positioning, 1738, 1745
preoperative planning, 1738, 1745, 2539
Keystone osteotomy, 2747–2748, 2748f
Kidney ureter bladder radiograph (KUB), 3022
Kienbock disease, 1905, 1957
Killian incision, 300–302, 301f
Kirschner wire (K-wire)
fixation
distal phalanx fractures, 1776–1777

into dorsal lunate and triquetrum, 1861, 1862f
metacarpal neck fractures, 1788, 1788f–1789f
thumb trapeziometacarpal joint, 1836
uses of, 347–348, 347f–348f, 2271
Knee
bone tumors of
anatomy, 2460
complications, 2464
definition, 2460
differential diagnosis for, 2460
distal femur resection, 2461, 2461f
endoprosthetic reconstruction, 2461, 2461f
endoprosthetic reconstruction of proximal tibia, 2463, 2463f
estimated incidence of 3260, 2460
imaging, 2460
merits and demerits, 2464b
natural history, 2460
outcomes, 2464
pathogenesis, 2460
patient history and physical findings, 2460
postoperative care, 2464
reconstruction, 2462, 2462f
surgical management, 2460–2461
disarticulation, 2461
dislocation, 2411, 2413
soft tissue tumors
anatomy, 2456
complications, 2458
definition, 2456
differential diagnosis, 2457
functional outcomes, 2458
imaging, 2456–2457, 2457f
knee sarcoma, wide resection of, 2457, 2458f

merits and demerits, 2458b
natural history, 2456
oncological outcomes, 2458
pathogenesis, 2456
patient history, 2456
physical findings, 2456
postoperative care, 2458
surgical management, 2457
Knee, bony and soft tissue debridement
anatomy, 2465–2466
blood supply, 2465–2466
distal femur, 2465
dynamic stabilizers, 2465
extensor mechanism, 2465
femoral nerve, 2466
patellofemoral articulations, 2465
sciatic nerve, 2466
static stabilizers, 2465
superficial femoral artery, 2465
tibiofemoral articulation, 2465
bone infection management, 2470, 2470f
complications, 2472
definition, 2465
imaging
infection after TKA, 2468
open fractures, 2468
osteomyelitis, 2468
merits and demerits, 2471b
outcomes
infection after TKA, 2472
open fractures, 2472
osteomyelitis, 2472
pathogenesis, 2466–2467

open fractures, 2466
osteomyelitis, 2466
total knee arthroplasty, infection after, 2466–2467
patient history and physical findings
infection after TKA, 2467, 2467f
open fractures, 2467
osteomyelitis, 2467, 2467f
postoperative care
infection after TKA, 2471
open fractures, 2471
osteomyelitis, 2471
soft tissue infection management
hydrogen peroxide, 2471
irrigation and debridement, 2470, 2471f
local antibiotics, 2471
negative pressure wound therapy, 2471
surgical management
medial parapatellar approach, 2469
open fractures, 2468
osteomyelitis, 2468–2469
patient positioning, 2469
total knee arthroplasty, infection after, 2469
Krackow sutures, 2494, 2494f
KUB (kidney ureter bladder radiograph), 3022
Kybella, 238

L
L flap
on lateral lip element, 2608f–2609f, 2609
suturing, 2610
Labbé procedure
anatomy, 1272
definition, 1272
imaging, 1272
lengthening temporalis myoplasty
myeloplasty, 1274, 1274f–1275f
superficial aponeurosis, 1273, 1273f–1274f
zigzag Cairns approach, 1273, 1273f–1274f, 1276
local infection, 1276
merits and demerits, 1273b
nonoperative management, 1272
outcomes, 1276
patient history and physical findings, 1272
postoperative care, 1276
postoperative hematoma, 1276
surgical management, 1272–1276
nasogenial approach, 1276
patient positioning, 1273
preoperative planning, 1273
LABC (lateral antebrachial cutaneous nerve), 2052, 2052f,
2115–2116, 2118–2119
Labia, 3062
Labial artery, 1055, 1055f
Labial mucosal flap, palatal fistula, 2700, 2700f
Labioplasty, 3053, 3058, 3058f, 3071, 3071f
Laceration closure techniques, 3078–3079, 3079f
Lacri-Lube, 814–815

Lacrimal apparatus, 823, 823f
Lacrimal bone, medial orbit wall fractures, 829, 829f
Lacrimal caruncle, 830, 830f
Lacrimal nerve, 966, 966f
Lacrimal sac, lacrimal system, 830f, 831
Lacrimal sump syndrome, 2876
Lacrimal system
eyelid injuries, 978
of medial canthal tendon, 831
Lambdoid synostosis
craniosynostosis, 531
natural history, 445
Lamella, with palatal grafts, 1094, 1094f
anterior, 1094
middle, 1095
posterior, 1095
Lamellar high SMAS face-lift
anatomy, 215, 226f–227f
complications, 225–227
definition, 215, 216f
imaging, 216
merits and demerits, 225b
outcomes, 225f–226f
patient history and physical findings, 215–216
postoperative care, 225
skin flap elevation, 219–220, 219f
skin flap repositioning, trimming, and closure, 223–224, 224f
SMAS dissection, 221–222, 221f
SMAS suspension, 222–223, 222f
surgical management, 216–227
approach, 218–227
positioning, 218
preoperative planning, 216–218

temple dissection, 220, 220f
Lamina papyracea, 829
Laparoscopic component separation, 1565, 1565f
Laparoscopic harvest of pedicled omental flap, 1669
Laparotomy, incisional hernias, 1574, 1574f
Large-volume fat grafting
anatomy, 1496
complications, 1501
definition, 1496
fat harvest, 1497
fat injection, 1498–1499, 1498f–1500f
fat processing, 1498, 1498f
imaging, 1496
merits and demerits, 1500b
outcomes, 1501
patient history and physical exam, 1496
postoperative care, 1501
surgical management
approach, 1497
patient positioning, 1497
preoperative planning, 1497
Laryngeal mask airway (LMA), 3
Laser burn scar revision. See Burn injury
Laser handpiece, 2802f
Laser resurfacing of face
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
approach, 54
positioning, 54
preoperative planning, 54
Laser therapy
skin grafts, 1127
of vascular lesions, 2802, 2802f
LAST (local anesthetic systemic toxicity), 973, 1759, 2314, 2330
Late infections, 396, 1115, 2469
Lateral arm flap, 1116
Lateral brow approach, orbital roof fractures, 842–843, 842f
Lateral calcaneal vessels, dissection of, 2384f
Lateral canthal lines. See Crow’s feet, botulinum toxin injection to
Lateral canthal manipulation, with canthopexy/canthoplasty
anatomy, 157, 158f–159f
complications, 161
definition, 157
inferior retinacular lateral canthopexy/canthoplasty, 159–160, 160f
merits and demerits, 160b
outcomes, 160, 161f
pathogenesis, 157–158
patient history and physical findings, 158–159
postoperative care, 160
Lateral canthal-orbital rim distance (LC-OR), 158–159
Lateral canthopexy, 619f
Lateral canthoplasty, 2864f–2865f, 2865–2867
creation, 2865–2867, 2866f
suturing, 2867, 2867f
Lateral canthus
bone canthopexy, bridge of

anatomy, 185, 185f–186f
closure, 189
complications, 189
definition, 185
drill holes and positioning of, 187–189
figure-of-8 suture fixation of, 187, 187f
imaging, 186
operative approach, 186, 187f
outcomes, 189
pathogenesis, 186
patient history and physical findings, 186
postoperative care, 189
preoperative preparation, 186
surgical management, 186
drill holes and positioning of, 187–189
Lateral cephalogram, chin deformities, 412
Lateral circumflex femoral artery (LCFA), 1715, 1718
Lateral collateral ligament, 2473
Lateral crural strut grafts, 312, 312f
Lateral decubitus position with appropriate padding, 1717, 1717f
Lateral femoral circumflex artery, 1580, 1581f
Lateral forefoot defect, on dorsalis pedis artery
Lateral key pinch reconstruction
anatomy, 2206, 2206f
complications, 2209
definition, 2206
imaging, 2206
merits and demerits, 2208b
outcomes, 2209
patient history and physical findings, 2206, 2207f
postoperative care, 2209
surgical management
approach, 2207

patient positioning, 2207
preoperative planning, 2207
Lateral lip elements
anatomy, 2606
hypoplastic, 2650–2651
Millard/Mohler modifications
alar base and L flap, 2608, 2608f–2609f
dissection, 2609–2610, 2610f
markings, 2607, 2608f–2609f
Lateral mandible reconstruction, with soft tissue flaps
anatomy, 1047
completion, 1051
complications, 1051
definition, 1047
horizontally oriented flaps, 1048, 1049f
imaging, 1048
indication, 1047
merits and demerits, 1048b
nonhorizontally oriented flaps, 1049, 1049f–1050f
outcomes, 1051
patient history and physical findings, 1047–1048
postoperative care, 1051
surgical management, 1048
Lateral mucosa fullness, 2648, 2650f–2651f
Lateral nasolabial element
matching nasolabial lengths, 2600–2602, 2602f
nasal sill, 2600, 2601f
Nordhoff point, 2600, 2601f
Lateral orbital wall fractures
anatomy, 823, 823f
complications, 827
definition, 823
exposure, 825, 825f–826f

fracture repair, 826, 826f
imaging, 824
lateral cantholysis and completion, 826–827, 827f
markings, 825, 825f
merits and demerits, 827b
nonoperative management, 824
outcomes, 827
pathogenesis, 823
patient history and physical findings, 823–824
postoperative care, 827
surgical management, 824
Lateral orbital wall osteotomy, 621f, 626, 628, 629f
Lateral osseous flap, 1039
Lateral plantar midfoot defect
Lateral sural cutaneous nerve, 2456
Lateral tarsal strip. See Lateral canthoplasty
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
patient positioning, 1105–1106

preoperative planning, 1105
Lateral thigh-based flaps, 1589f
Laterally based cervicofacial flap
arterial blood supply, 1103, 1103f–1104f
complications, 1107
deep-plane elevation or tissue expansion, 1103
definition, 1103, 1103f
flap elevation, 1105, 1105f
imaging, 1104
markings, 1105, 1105f
merits and demerits, 1105b
outcomes, 1107, 1107f–1108f
patient history and physical findings, 1103–1104
postoperative care, 1107
reconstructive zones, 1103
surgical management
approach, 1104
patient positioning, 1104
preoperative planning, 1104
Latham device, 2630
Latissimus dorsi, 2397–2398
Latissimus dorsi flap (LDF), 1525
anatomy, 1543, 1543f
axillary tunnel dissection, 1545
complication, 989
complications, 1546
definition, 1543
flap elevation, 1544–1545, 1545f
graft sources, 986b
merits and demerits, 1545b
outcomes, 1546
patient history and physical findings, 1543–1544
postoperative care, 1546

specific donor-site dissections, 986
surgical management, 985
positioning, 1544
preoperative markings, 1544, 1544f
preoperative planning, 1544
Latissimus dorsi muscle, 1041
mandibular defects, 1038
vascularized rib with blood supply, 1038
Latissimus dorsi (LD) muscle
anatomy, 1543, 1543f
Latissimus dorsi muscle transfer, 2979–2980, 2979f
Latissimus dorsi musculocutaneous flap, 2487–2488
Latissimus dorsi (LD) myocutaneous flap, 1405–1406, 1406f
anatomy, 1404, 1404f
complications, 1407
definition, 1404
imaging, 1404
merits and demerits, 1407b
nonoperative management, 1405
outcomes, 1407
pathogenesis, 1404
patient history and physical findings, 1404
postoperative care, 1407
surgical management
approach, 1405
patient positioning, 1405
preoperative planning, 1405
Latissimus dorsi transfer, 2962–2963, 2962f
LCFA (lateral circumflex femoral artery), 1715, 1718, 2395, 2488
LC-OR (lateral canthal-orbital rim distance), 158–159
LD myocutaneous flap, Latissimus dorsi (LD) myocutaneous flap
LDF. See Latissimus dorsi flap (LDF)
Le Fort fracture, 950

Le Fort I distraction osteogenesis (DO)
anatomy, 584
bony release, 586, 587f–588f
complications, 590
definition, 584
imaging, 584
merits and demerits, 585b
outcomes, 590, 590f
patient history and physical findings, 584, 584f
postoperative care, 590
rigid external distraction, 589, 589f
rigid external distraction device, 588, 588f
soft tissue release, 585–586, 586f
surgical management
approach, 585–590
patient positioning, 585
preoperative planning, 585
Le Fort I fractures, 952
anatomy, 889, 889f–890f
complications, 892
definition, 889
exposure and reduction, 891, 891f
imaging, 890
maxillomandibular fixation, 891, 891f
merits and demerits, 892b
open reduction internal fixation, pediatric midface fractures, 953,
953f
pathogenesis, 889
patient history and physical findings, 890
postoperative care, 892
surgical management, 890
approach, 890
positioning, 890

preoperative planning, 890
Le Fort I osteotomy
anatomy
muscular structures, 572
osseous structures, 571–572, 571f
vascular, 572
complications, 583
definition, 571
dental examination, 573
growth evaluation, 572
imaging, 573
merits and demerits, 574b
nonoperative management, 573
outcomes, 583
patient history, 572
postoperative care, 583
skeletal examination, 572
soft tissue examination, 573
surgical management
approach, 573
patient positioning, 573, 573f
preoperative planning, 573
surgical technique
vertical patient positioning of maxilla, 579f–580f, 579
surgical technique
fixation, occlusal check, and closure, 580, 581f–582f
incision and exposure, 574, 576f
lateral nasal wall osteotomies, 577, 577f
lateral osteotomies, 577, 577f
maxillary down-fracture and mobilization, 578, 578f
preparation and external reference, 574, 574f
Pterygoid plate separation, 576, 576f–577f
removal of interferences, 578, 579f

septal osteotomy, 576, 576f–577f
TMJ examination, 572
Le Fort II advancement, with distraction osteogenesis
anatomy, 606, 607f
complications, 615
definition, 606, 606f
imaging, 606
indications, 609b
merits and demerits, 614t
outcomes, 615
postoperative care, 614–615
pyramidal pattern, 609, 609f
quadrangular osteotomy, 610–613, 610f–611f
surgical management, 606–608
zygomatic repositioning, 610, 610f
Le Fort II fracture, 952
anatomy, 893, 893f
completion, 895
complications, 896
definition, 893
epidemiology, 893–894
fixation, 895, 895f
imaging, 893
merits and demerits, 896b
nonsurgical management, 894
open reduction internal fixation, pediatric midface fractures, 954,
954f
outcomes, 896
pathogenesis, 893
patient history and physical findings, 893
postoperative care, 896
reduction, 894, 894f
surgical management, 894, 894f