Operative Technique in Plastic Surgery – Kevin C.Chung

inner preputial inlay graft, 3045, 3046f
transverse preputial island flap, 3045
Midvault narrowing. See Narrow midvault
Minimally invasive component separation (MICS), 1566–1567,
1566f
Minor clefts, 2606
Minoxidil, 418, 421
Mitek anchor, 90
Mixed dentation stage
MMC. See Myelomeningocele (MMC)
MMF. See Maxillomandibular fixation (MMF)
Moberg flap, 2105, 2106f, 2107–2109, 2108f, 2113
Modified Allen test
reverse flow radial forearm flap, 2115, 2115f
ulnar artery thrombosis, 2162
Modified Becker/Massachusetts General Hospital (MGH) Repair,
2058, 2058f
Modified Fasanella-Servat procedure, 116–117, 116f–117f
Modified Hotz technique, markings and incisions, 2860, 2860f,
2861f
Modified Kessler suture repair, 2058, 2058f
Modified Sistrunk procedure
hyoid and tongue base dissection, 2907–2909, 2908f
modifications, 2909, 2909f
neck and wound incision preparation, 2907, 2907f
thyroglossal cyst and tract exposure, 2907, 2908f
wound closure, 2909, 2909f
Mohler back cut, 2608–2609, 2608f–2609f
Mohs micrographic surgery, 1122, 2305–2306
Monfort approach, prune belly, 3023–3024, 3024f
Monobloc distraction
anatomy, 499
complications, 503

coronal (or bitemporal) zigzag incision, 500
definition, 499
differential diagnosis, 500
due to maxillary hypoplasia, 500, 500f
exposure, 501, 501f
imaging, 499
indications, 500
merits and demerits, 501b
natural history, 499
nonoperative management, 500
osteotomies and distractor placement, 501–502, 502f
outcomes, 503
pathogenesis, 499
patient history and physical findings, 499
postoperative care, 503
removal of, 502
surgical management
patient positioning, 500
preoperative planning, 500
transoral (Keen) incision, 500
Monobloc frontofacial advancement
BO-Fort procedure, 490
complications, 496, 498f
definition, 490
with facial bipartition, 495, 495f
grafting and fixation, 493, 494f–495f
imaging, 490
Le Fort III procedure, 490, 490f–492f
merits and demerits, 493b
normal facial features, 490
osteotomies and advancement, 493, 494f
outcomes, 496, 497f
patient history and physical findings, 490

postoperative care, 496
preparation and exposure, 493
surgical management
approach, 491
patient positioning, 491
preoperative planning, 491
Tessier sign, 493, 493f
Monostotic fibrous dysplasia (MFD), 762
Mons pubis
anatomy, 1640, 1640f
central wedge excision of, 1642, 1642f
complications, 1644
conjunction with abdominoplasty, 1642, 1642f
conjunction with medial thighplasty, 1642, 1643f
definition, 1640
horizontal excision with lipoplasty, 1642, 1642f
imaging, 1641
labia majora, lateral wedge excision, 1642, 1643f
liposuction, 1641, 1641f
merits and demerits, 1643b
outcomes, 1643
pathogenesis, 1640, 1641f
patient history and physical findings, 1640–1641
postoperative care, 1643
surgical management, 1641
Monsplasty, 3053, 3058, 3058f
Motor deficits, 1987
Motor innervation, 1068, 1069f, 1073
Motor nerve branch, 2927, 2927f
Motor nerves, 70, 82
Motor vehicle collisions (MVC), 934
MPB (male pattern baldness), 416–417
MRD (margin reflex distance), 115

MRI. See also Magnetic resonance imaging (MRI)
cubital tunnel syndrome, 1993
radial nerve palsy, 2025
MS-TRAM flap. See Muscle-sparing free transverse rectus
abdominis myocutaneous (MS-TRAM) flap
MTX (methotrexate), 1939–1940
Mucoepidermoid carcinoma, FOM, 1210
Mucoperichondrial perforation correction, 329
Mucosa
closure, Millard/Mohler modifications, 2610–2611, 2611f–2612f
deformities, 2648–2652
repair, 2645
Z-plasty, 2651
Mucosal flaps, 2659
Mucous cysts
anatomy, 2281
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
Mucus-secreting respiratory mucosa, 779
Muenke syndrome, 616
Mulliken technique, 2639
Multiple flexor tendon injury repair
anatomy, 2061

complications, 2064
definition, 2061
imaging, 2061
injured structures repair, 2063, 2063f
merits and demerits, 2062b, 2063b
outcomes, 2064
pathogenesis, 2061
patient history and physical findings, 2061
postoperative care, 2064
proximal structures, tagging, 2063, 2063f
surgical management
patient positioning, 2062
preoperative planning, 2062
wound presentation, exposed injuries, 2062, 2062f
Multiple-digit artery sympathectomy incision, 2157, 2157f
Multisuture synostosis, natural history, 445
Muscle dissection, 2461
Muscle flaps, 1728–1729, 1728f–1729f, 2394–2395, 2440, 2470,
2526–2527
Muscle of Riolan, 1094–1095
Muscle-chimeric perforator flap, 2383, 2440, 2489, 2490f–2491f
Muscle-sparing free transverse rectus abdominis myocutaneous
(MS-TRAM) flap
abdominal donor-site closure, 1426
anatomy, 1423
complications, 1428
definition, 1423
harvest, 1425, 1425f
imaging, 1424
inset, 1426
merits and demerits, 1425b, 1427b
outcomes, 1428
patient history and physical exam, 1423

postoperative care, 1428
recipient vessel dissection, 1425–1426, 1426f
surgical management
approach, 1424
patient positioning, 1424
preoperative planning, 1424
Muscular dehiscence, 2645
Muscular flap, 2371
Musculature, 1068, 1069f, 1073, 1073f
Musculoperiosteal vessels, 2432, 2510
Musculoskeletal system, conjoined twins, 3096
Musculoskeletal Tumor Society functional score, 2341
Mustardé’s radiated suture techniques
Mycobacterium fortuitum, 209
Myelomeningocele (MMC)
postnatal repair
anatomy, 3007, 3007f
definition, 3007
merits and demerits, 3011b
natural history, 3007
pathogenesis, 3007
patient history and physical findings, 3007–3008, 3008f
postoperative care, 3011
surgical management, 3008, 3009f
prenatal (fetal) repair
anatomy, 3012, 3012f
definition, 3012
evaluation, 3012, 3014b
merits and demerits, 3015b
natural history, 3012
pathogenesis, 3012
postoperative care, 3016
surgical management, 3012–3013

Myeloplasty, 1274, 1274f–1275f
Myocutaneous flap, 2518
Myocutaneous gracilis flap, 1683, 1683f–1684f
Myofascial gracilis flap, 1684
Myoplasty techniques. See Lengthening temporalis myoplasty
Myotomy, 248, 248f–249f
Myxofibrosarcoma, 2421

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Q
Quadrangular osteotomy
design and exposure, 610, 610f–611f
maxillary device placement, 611, 612f
osteotomy and completion, 611–613, 613f
R
RA. See Rheumatoid arthritis (RA), hand and wrist
Radial artery anatomy, 1171–1172, 1172f
Radial forearm fasciocutaneous free flap, 1221
buccal mucosal defects, 1224, 1224f
FOM, 1210
Radial forearm flap (RFF), 2440
advantage, 1116
anatomy, 1116, 1117f
complications, 1121
definition, 1116
flap design, 1118, 1118f
flap dissection, 1118, 1118f
flap inset, 1119–1120, 1120f
imaging, 1116
merits and demerits, 1118b
outcomes, 1121
patient history, 1116
physical examination, 1116
postoperative care, 1121
subfascial dissection, 1119, 1119f
surgical management, 1117
approach, 1117
patient positioning, 1117
preoperative planning, 1117

Radial forearm free flap (RFFF)
anterolateral thigh flap, 1074
closure of forearm donor site, 1177, 1177f
complications, 1077, 1178–1179
definition, 1073, 1171
detached flap reader, 1176, 1176f
dissection and exposure, 1176, 1176f
external anatomy, 1073, 1073f
flap harvest, 1174–1175, 1175f
flap inset, 1176–1177, 1177f
FOM reconstruction
flap dissection, 1212, 1212f
flap inset, 1212, 1213f
recipient site preparation, 1211–1212, 1211f
full-thickness lower lip defects, 1074
hemi-tongue reconstruction, free flap, 1201–1202, 1202f
imaging studies, 1074, 1173
innervation, 1074
internal anatomy, 1073, 1073f
large, full-thickness defects, 1074
larger partial-thickness defects, 1074
lateral arm flap, 1074
merits and demerits, 1075b, 1174b
motor innervation, 1073
nerve supply, 1172–1173, 1172f
operative management, 1074
outcomes, 1077, 1178
parascapular flap, 1074
patient history and physical findings, 1074, 1173
postoperative care, 1077, 1178
radial artery, 1171–1172
recipient site preparation and insetting, 1075, 1076f
sensory innervation, 1073

skin graft closure, 1075, 1075f
surgical management
approach, 1074
patient positioning, 1074
preoperative planning, 1074, 1173
templating and flap design, 1173, 1174f
vascular anatomy, 1171, 1172f
vascular supply, 1074
Radial forearm phalloplasty
closure of donor site and dressings, 1694–1695
construction of neourethra, 1694
flap dissection, 1693–1694
flap transfer, vascular anastomoses, and nerve coaptation, 1694,
1695f
preparation of recipient site, 1694
Radial longitudinal deficiency (RLD)
centralization/radialization, 2268, 2271, 2272f
classification system
Bayne and Klug, 2266
modification, 2267
complications, 2273
definition, 2266
differential diagnosis, 2268
imaging, 2268, 2268f
merits and demerits, 2272b
natural history, 2267
nonoperative management, 2268
outcomes, 2272–2273
pathogenesis, 2267
patient history and physical findings, 2267
postoperative care, 2272
soft tissue distraction
preoperative, 2268, 2270–2271

surgical management, 2268–2269
approach, 2269
patient positioning, 2269
preoperative planning, 2269
wrist and forearm anatomy in, 2266–2267, 2266f–2267f
Radial nerve
identification, decompression and dissection, 2049f, 2051
palsy
anatomy, 2025
complications, 2030
definition, 2025
differential diagnosis, 2025
imaging, 2025
merits and demerits, 2026b, 2030b
natural history, 2025
nonoperative management, 2025
outcomes, 2030
pathogenesis, 2025
patient history and physical findings, 2025
postoperative care, 2030
surgical management, 2025–2026
superficial branch of, 1754
Radial polydactyly repair
anatomy, 2234, 2234f
complications, 2241
definition, 2234
imaging, 2234–2235
Iowa classification of, 2234, 2234f
merits and demerits, 2241b
methods for, 2235–2236
acral transposition, 2236, 2236f
resection and reconstruction, 2235
sharing technique, 2235–2236, 2235f–2236f

natural history, 2234
outcomes, 2241
pathogenesis, 2234
patient history and physical findings, 2234
postoperative care, 2241
Rotterdam system classification, 2234
surgical management, 2235–2236
approach, 2236
patient positioning, 2236
preoperative planning, 2236
type IV
disarticulation, osteotomy, and fixation, 2237–2238, 2239f
flap creation, 2237, 2239f
markings and exposure, 2237, 2237f–2238f
reattachment and closure, 2240, 2241f
tendon correction, 2238–2240, 2240f
Radial tunnel decompression. See also Radial tunnel syndrome
(RTS)
exposure, 2001
release of entrapment, 2001–2002
Radial tunnel syndrome (RTS)
anatomy, 2000
complications, 2003
definition, 2000
differential diagnosis, 2001
imaging, 2000–2001
nonoperative management, 2001
outcomes, 2003
pathogenesis, 2000
patient history and physical findings, 2000
postoperative care, 2003
surgical management, 2001
Radial/ulnar forearm flaps, 1230

Radiation therapy, 2523
nasolabial flap, 1070
osteoradionecrosis, 1023
Radiesse, 42
Radiocarpal joint with avascular proximal scaphoid pole and
cartilage fragmentation, 1880
Radiographic fistulograms, 2697
Radiographs
bone reconstruction of knee, 2473, 2474f
posterior interosseous artery flap, 2127
Radioscaphocapitate ligament, anatomy, 1905, 1905f
Radiotherapy, 2456, 2458, 2460, 2497
RAE (Ring-Adair-Elwyn) tube, 2638, 2639f
“Ramirez-style” open anterior component separation, 1557–1558,
1557f
Ramus fractures, mandible fractures, open treatment of, 911–912,
911f–912f
Range of motion, 2456, 2482, 2498
Range-of-motion (ROM) exercises, 2118, 2124, 2372
Rapid fixation hybrid MMF systems, 905
Rapid palatal expansion (RPE)
anatomy, 562
bilateral transverse L-shaped maxillary osteotomy, 564, 565f
complications, 566
definition, 562
differential diagnosis, 562, 563f
exposure, 563, 563f
imaging studies, 562, 562f
indications, 562
merits and demerits, 563b
nonoperative management, 562
osteotomies, 563, 564f
outcomes, 565–566

patient history and physical findings, 562
postoperative care, 565, 565f
surgical management
patient positioning, 563
preoperative planning, 562, 562f
Rare tessier clefts
anatomy, 663
imaging studies, 664
natural history, 664
outcomes, 668
patient history and physical findings, 664
surgical management, 665
surgical technique, 667, 669f
Raynaud disease (RD). See Digital artery sympathectomy
Raynaud phenomenon (RP). See Digital artery sympathectomy
RCA (radial collateral artery), 2134
RDI (respiratory distress index), 636
Recipient site fat grafting, 1493–1494, 1493f
Recipient site preparation, 1040, 2937–2938, 2937f
Recipient site preparation and microanastomosis
advantages and disadvantages, 2564t
axilla, 2564
dorsal ankle, 2565
dorsal wrist, 2564–2565
groin, 2565
medial elbow, 2564
posterior knee, 2565
Recipient vessel preparation, 2384, 2384f, 2488–2489, 2488f
descending genicular artery, approach to, 2488, 2488f
lateral circumflex femoral artery, approach to, 2488
medial sural artery, approach to, 2488, 2488f
recipient vein, selection of, 2489
superior medial and lateral genicular artery, approach to, 2489

Recipient vessels for microsurgical breast reconstruction
anatomy
internal mammary vessels, 1447
thoracodorsal vessels, 1447
complications, 1451
definition, 1447
imaging, 1448
merits and demerits, 1450b
outcomes, 1451
patient history and physical findings, 1448
postoperative care, 1451
surgical management
approach, 1448–1449
patient positioning, 1448, 1448f
preoperative planning, 1448
Rectus abdominis, 2397
Rectus abdominis flap, 1116, 1525
anatomy, 1528
complications, 1531
definition, 1528
imaging, 1529
merits and demerits, 1531b
nonoperative management, 1529
outcomes, 1531
pathogenesis, 1528
patient history and physical findings, 1528
postoperative care, 1531
surgical management
approach, 1529–1530
positioning, 1529
preoperative planning, 1529
Rectus abdominis muscle flap, 2487–2488
Rectus abdominis musculocutaneous flap, 1529–1530, 1530f

Rectus abdominis myocutaneous flaps
graft sources, 986b
specific donor-site dissections, 986
surgical management
patient positioning, 985
Rectus diastasis, 1596
Rectus elevation, 1678
Rectus femoris, 2395
Rectus femoris flap
anatomy, 1580, 1581f
complications, 1586
definition, 1580
imaging, 1580
merits and demerits, 1586b
outcomes, 1586, 1586f
patient history and physical findings, 1580
postoperative care, 1586
surgical management
positioning, 1582
preoperative planning, 1580–1582
surgical markings, 1583, 1583f
Rectus femoris flap, for abdominal wall reconstruction
anatomy, 1580, 1581f
complications, 1586
definition, 1580
imaging, 1580
merits and demerits, 1586b
outcomes, 1586, 1586f
patient history and physical findings, 1580
postoperative care, 1586
surgical management, 1580–1582
surgical markings, 1583, 1583f
Rectus femoris muscle, 1580, 1581f

RED (rigid external device)
advantages, 729
disadvantages, 729
external mandibular distraction, 727–728, 728f–729f
RED (rigid external distraction), 588, 588f
Red lip, 2596
Redo hypospadias repair, buccal mucosa graft for, 3048–3049
Reduction labioplasty
hybrid approach, 3060, 3060f
simple excision and closure, 3059, 3059f
wedge excision with advancement, 3059, 3059f
Reduction mammaplasty
anatomy, 1340, 1340f–1341f
central mound
completion, 1343, 1343f
excision of parenchyma, 1342–1343, 1343f
markings, 1342, 1342f
complications, 1344
definition, 1340
differential diagnosis, 1341
imaging, 1341
merits and demerits, 1342b, 1344b
natural history, 1340
nonoperative management, 1341
outcomes, 1344
pathogenesis, 1340
patient history and physical findings, 1340–1341
postoperative care, 1344
surgical management
approach, 1341
patient positioning, 1341
preoperative planning, 1341
Redundant skin excision, 1358

Reflex sympathetic dystrophy, 1930
Regional flaps, 2114–2115
Regional nerve blocks, local anesthetic, administration of, 977, 977f
Regnault scale for breast ptosis, 1340
Repetitive microtrauma, chronic, 1987
Replantation of digits
anatomy, 2147–2148, 2148f
complications, 2155
definition, 2147, 2147f
imaging, 2149, 2150f
merits and demerits, 2151b, 2154b
midlateral incisions, 2151, 2151f
natural history, 2149
nonoperative management, 2149
outcomes, 2154–2155, 2154f
pathogenesis, 2148, 2148f
patient history and physical findings, 2149
postoperative care, 2154
skin closure, 2153, 2153f
surgical management
approach, 2150
patient positioning, 2150
preoperative planning, 2150
Respiratory distress index (RDI), 636
Respiratory system, conjoined twins, 3095
Restylane, 43
Restylane Lyft, 32
Restylane Refyne, 27
Restylane-L, 27
Retinacular sling reconstruction, ECU subsheath, 2087,
2087f–2088f
Retinoblastoma gene mutation, 2460
Retrobulbar hematoma, orbital floor blow-out fractures, 810

Retrograde masseter-to-facial nerve transfer, 2926–2927, 2926f,
2927f, 2928f
Retrograde posterior interosseous artery flap, 2129–2132, 2129f
harvest with skin bridge, 2130–2131, 2131f
inset, 2131–2132, 2132f
island flap harvest, 2130, 2130f
Retromandibular approach, condyle fractures, open treatment of,
919, 919f, 920f
Retro-orbicularis oculi fat (ROOF), 70
Retroperitoneal femoral nerve exposure, pelvic pathology, 2535
Retrorectus space, 1575
mesh positioning in, 1576, 1576f–1577f
Revascularization and replantation of digits. See Replantation of
digits
Reverse dorsalis pedis fasciocutaneous flap, 2366
Reverse dorsoradial homodigital flap, 2112–2113
Reverse fasciocutaneous flap, 2368, 2368f–2369f
Reverse first dorsal metatarsal artery (1st DMTA) flap, 2368,
2368f–2369f
Reverse medial plantar artery flap, 2366
Reverse orbicularis oculi tightening (ROOT), 151
lower blepharoplasty via subciliary incision, 153–154, 154f
Reverse radial forearm flap (RRFF)
anatomy, 2114–2115, 2114f
complications, 2119
definition, 2114
imaging, 2115
merits and demerits, 2118b
nonoperative management, 2115
outcomes, 2118–2119
patient history, 2115, 2115f
physical findings, 2115, 2115f
postoperative care, 2118

reverse flow radial forearm flap, 2116–2118, 2117f
reverse radial forearm flap
surgical management, 2115–2116
approach, 2116
patient positioning, 2116
preoperative planning, 2115–2116, 2116f
Reverse sural artery flap, lower extremity reconstruction
anatomy, 2388
complications, 2390
definition, 2388
delayed reverse sural artery flap, 2390
fasciocutaneous pedicle incised, flap dissection with, 2389f
imaging, 2388
merits and demerits, 2390b
outcomes, 2390
patient history and physical findings, 2388
postoperative care, 2390
supercharged reverse sural artery flap, 2390
surgical management, 2388f
patient positioning, 2389
patient positioningapproach, 2389
preoperative planning, 2388, 2388f
RFF. See Radial forearm flap (RFF)
RFFF. See Radial forearm free flap (RFFF)
Rhabdomyolysis, 1760, 1765
Rhabdomyosarcoma, 2421
Rheumatoid arthritis (RA), hand and wrist
ACR criteria for, 1931, 1942b
ACR/EULAR classification criteria for, 1931, 1932t
boutonniere deformities
finger, 1938, 1938f
ligament reconstruction to correct, 1948
Nalebuff classification of, 1940, 1941t

reconstructive surgery for, 1940
thumb, 1938
carpal ligaments and TFCC, 1933, 1933f–1934f
carpal tunnel syndrome, 1936
definition, 1931
diagnosis, 1931
differential diagnosis, 1931–1932
extensor tendons of
finger, 1936, 1936f–1937f
hands and wrist, 1933–1935, 1934f, 1935t–1936t, 1935t
imaging, 1932, 1932f
merits and demerits, 1952b
nonoperative management, 1939–1940
outcomes, 1953, 1954f
pathogenesis, 1931
patient history and physical findings, 1932–1939, 1933f
postoperative care, 1945, 1948, 1950–1951
radiographs of, 1932, 1932f
surgical management, 1940–1941, 1941f
patient positioning, 1941
preoperative planning, 1940–1941
swan-neck deformity (see Swan-neck deformity)
tendon transfer for
extensor tendon ruptures, 1942, 1943f, 1944f
FPL rupture, 1942–1944, 1945f
options after, 1935, 1935t–1936t
tendon ruptures, 1942
thumb deformity, 1938
trigger fingers in, 1938–1939
wrist joint, 1933
Rheumatoid hand deformity, 2090–2091
Rheumatoid nodules, 2421
Rhinitis closed rhinoplasty, narrow midvault in, 275

Rhinoplasty
anesthesia, controlling tip rotation in
anatomy, 283, 283f
complications, 287
definition, 283
elastic rotation, securing, 285, 285f
imaging, 283
long lateral crus, shortening, 286, 286f
long upper lateral, shortening, 286, 286f
merits and demerits, 286b
natural history, 283
nonoperative management, 283
outcomes, 287, 287f
pathogenesis, 283
patient history and physical findings, 283
postoperative care, 287
projection, 286
surgical management, 283–285, 284f
diced cartilage and fascia grafting in
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
fascia graft, 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
secondary cleft (see Secondary cleft rhinoplasty)
Rhytides, 55
Rhytids
dynamic, 5
perioral
anatomy, 11, 11f
complications, 13
definition, 11
marionette lines, 12
merits and demerits, 13b
outcomes, 13, 13f
pathogenesis, 11
patient history and physical findings, 11
postprocedural care, 13
vertical rhytids, 12
static, 5
RIA (reamer-irrigator-aspirator) system, 2474–2475, 2478f

preparation, 2477, 2477f
Rib graft harvest, 995, 995f
Rib/thoracic cage, 994, 994f
Right gastroepiploic pedicle, omental flap harvest with
dissection, 1665, 1665f
flap positioning, 1666, 1667f
ligation and division, 1665–1666, 1666f
Right leg lymphedema, 2552f
Rigid external device (RED)
advantages, 729
disadvantages, 729
external mandibular distraction, 727–728, 728f–729f
Rigid external distraction (RED), 584, 588–589, 588f, 589f
Rigid spherical orbital implants, 2881, 2881f–2884f
Rigotomy, 2811
Ring finger FDS, to APB tendon transfer, 2036
Ring-Adair-Elwyn (RAE) tube, 2638, 2639f
Risdon (submandibular) approach
condyle fractures, 918, 920, 920f–921f
nonunion of a mandible fracture, 930, 931f–932f
RLD. See Radial longitudinal deficiency (RLD)
Robin sequence, 2675
Rolando fractures
anatomy
closed reduction and pinning of
complications
definition
imaging
merits and demerits
natural history
open reduction and internal fixation
outcomes
pathogenesis

patient history and physical findings
plain radiographs
postoperative care
surgical management
patient positioning
preoperative planning
Wagner approach
ROM (range-of-motion) exercises, 2118, 2124, 2372
ROOF (retro-orbicularis oculi fat), 70
ROOT (reverse orbicularis oculi tightening), 151
lower blepharoplasty via subciliary incision, 153–154, 154f
Ropivacaine, 2329
Rose-Thompson effect, 2598, 2599f
Rotation advancement flap
harvest
approaching pedicle, 1518
blunt finger dissection, 1518, 1518f
humeral insertion, 1518
skin incision, 1517
submuscular dissection, 1517
scalp reconstruction, 981, 981f–982f
Rotation flaps reconstruction
anatomy, 980
chronic wounds, 980
complications, 983
definition, 980
imaging, 981
merits and demerits, 981b
nonoperative management, 981
outcomes, 982
pathogenesis, 980
patient history, 980
physical examination, 980

postoperative care, 982
rotation advancement flap, 981, 981f–982f
surgical management, 981
Rotationplasty, of lower extremity
anatomy, 2970, 2970f
complications, 2976
definition, 2970
imaging, 2970
merits and demerits, 2975b
outcomes, 2975–2976
patient history and physical findings, 2970
postoperative care, 2975, 2975f
surgical management, 2971
approach, 2971, 2971f
patient position, 2971
preoperative planning, 2971
Rotation/reconstruction, distal limb, 2973, 2974f
Rotterdam/extended L rhinotomy approach, 2890
Round implants
anatomy, 1319
complications, 1326
definition, 1319
imaging, 1320, 1320f
merits and demerits, 1324b
outcomes, 1325
pathogenesis, 1319
patient history and physical findings, 1319–1320
postoperative care, 1325
surgical management
approach, 1321
patient positioning, 1321
preoperative planning, 1320–1321
Rowe disimpaction forceps, 891, 891f, 899, 900f–901f

RPE. See Rapid palatal expansion (RPE)
RRFF. See Reverse radial forearm flap (RRFF)
RTS. See Radial tunnel syndrome (RTS)
“Rule of nines” test, 2000

S
SAAP flap, 1370
Sacral and trochanteric pressure injury, 2793, 2793f
Sacral pressure injury, 2787
anatomy, 1698, 1698f
complications, 1704
definition, 1698
differential diagnosis, 1700
history and physical findings, 1699–1700
imaging, 1700
natural history, 1699, 1699f
nonoperative management, 1700
outcomes, 1704
pathogenesis, 1698–1699
postoperative care, 1704
surgical management
approach, 1701
positioning, 1700, 1700f
preoperative planning, 1700
Sacrococcygeal teratoma (SCT), 3019
anatomy, 3017
complications, 3021
debulking, 3019, 3020f
definition, 3017
differential diagnosis, 3017
imaging, 3017, 3017f–3018f
merits and demerits, 3021b
outcomes, 3021
pathogenesis, 3017
postoperative care, 3021
surgical management, 3018, 3018f

Saethre-Chotzen syndrome, 445
SAF. See Serratus anterior flap (SAF)
Safe donor area (SDA), 419, 420f
Sagittal craniosynostosis
anatomy, 485, 485f
asymmetric transverse distraction osteogenesis, 486–487, 487f
complications, 489
definition, 485
imaging studies, 486
merits and demerits, 486b
outcomes, 488
patient history, 485
physical examination, 485
postoperative care, 488
surgical management
patient positioning, 486, 486f
preoperative planning, 486
Sagittal split osteotomy, 407, 407f
Sagittal synostosis
anatomy, 477
complications, 483
cranial sutures, 477, 477f
craniosynostosis, 530, 532, 532f
definition, 477
differential diagnosis, 478
endoscopy-assisted technique
incisions and endoscope insertion, 481, 481f
spring placement, 481, 482f
spring removal, 481
family history, 478
imaging studies, 478
merits and demerits, 479b
natural history, 445, 478

nonoperative management, 479
open technique
exposure, 479, 480f
spring placement, 477, 480f
spring removal, 480, 480f–481f
outcomes, 483
pathogenesis, 477–478
perinatal history, 478
physical examination, 478
postoperative care, 483
surgical management
approach, 479
patient positioning, 479, 479f
preoperative planning, 479
Salivary gland
carcinomas, hemiglossectomy, 1198
tumors, FOM, 1209
Salyer unilateral cleft lip/nose repair
Abyholm closure of anterior palate, 2624, 2626f–2628f
anatomy
abnormal cleft lip/nose, 2616–2617
normal upper lip, 2616
complications, 2626
definition, 2616
differential diagnosis, 2618
imaging, 2618
lateral lip element elevation, 2621
marking, 2619–2621, 2620f–2623f
medial lip incision, 2621
merits and demerits, 2619b
muscle repair, 2618
natural history, 2617
nonoperative management, 2618

Noordhoff’s vermilion flap technique, 2624, 2624f
nose repair, 2618
outcomes, 2626
pathogenesis, 2617
patient history and physical findings, 2618
postoperative care, 2626
skin flap for lip lengthening, 2623–2624, 2623f
surgical management, 2618–2619
approach, 2619
patient position, 2619
preoperative planning, 2618–2619
Saphenous nerve, 2324, 2324f
Saphenous vein, 2395
dissection of, 2525, 2525f
Sarcoma
FOM, 1209
subtypes, 2339
Sartorius, 2403
flap, 2518
muscle, 1583, 1583f
SBRN (superficial branch of radial nerve)
anatomy, 1754
at wirst, 1758
SCAIF. See Supraclavicular artery island flap (SCAIF)
Scalp
advancement, hairline lowering, 103, 103f–104f
fixation and wound closure, hairline lowering, 104, 104f–105f
lacerations, 3079, 3079f
Scalp reconstruction
with free flaps
anatomy, 984
complications, 989
definition, 984

graft sources, 985, 986b
imaging studies of, 984
merits and demerits, 987f
microsurgery, 987, 987f
outcomes, 988, 988f
pathogenesis of, 984
patient history, 984
physical examination of, 984
postoperative care, 988
specific donor-site dissections, 986
superficial temporal artery preparation, 986
surgical management of, 984–985
with rotation flaps
anatomy, 980
chronic wounds, 980
complications, 983
definition, 980
imaging, 981
merits and demerits, 981b
nonoperative management, 981
outcomes, 982
pathogenesis, 980
patient history, 980
physical examination, 980
postoperative care, 982
rotation advancement flap, 981, 981f–982f
surgical management, 981
with tissue expansion
advancement of flap, 992, 992f
anatomy, 990
base diameter, 990
complications, 993
definition, 990

insertion, 991, 991f
merits and demerits, 991b
outcomes, 993, 993f
pathogenesis, 990, 990f
patient history, 990
physical examination, 990
postoperative care, 993
shapes, 990
surgical management, 990–991
Scaphal cartilage, 1130
Scaphocephaly, 477
Scaphoid
fractures, 1957
normal orientation of, 1899, 1899f–1900f
Scaphoid fracture nonunion
anatomy, 1880
complications, 1888
definition, 1880
imaging, 1881
merits and demerits, 1886b
outcomes, 1887–1888
patient history, 1880
postoperative care, 1886–1887
scaphoid preparation and fixation, 1885, 1885f
surgical management
contraindications, 1881
patient positioning, 1881
Scaphoid fractures fixation
anatomy, 1865–1866, 1865f–1866f
complications, 1872
definition, 1865
differential diagnosis, 1867
imaging, 1866–1867

merits and demerits, 1871b
natural history, 1866
nonoperative management, 1867
open reduction and internal fixation
dorsal approach, 1868–1869
volar approach, 1870
outcomes, 1871
pathogenesis, 1866
patient history and physical findings, 1866
postoperative care, 1871
surgical management
approach, 1868
patient positioning, 1868
preoperative planning, 1867–1868
Scaphoid nonunion
anatomy, 1873
complications, 1879
definition, 1873, 1873f
dorsal approach
closure, 1877
scaphoid fixation, 1877
site exposure and preparation, 1876–1877, 1877f
imaging, 1873–1874
merits and demerits, 1874b, 1877b
outcomes, 1878–1879
patient history and physical findings, 1873
postoperative care, 1878
surgical management
approach, 1874
patient positioning, 1874
volar approach
bone graft, 1874–1875, 1875f
scaphoid fixation, 1875–1876, 1876f

site exposure and preparation, 1874, 1875f
site stabilization, 1875, 1876f
Scaphoid nonunion advanced collapse (SNAC), 1887f–1888f, 1880,
1957
Scapholunate advanced collapse (SLAC), 1899, 1957
Scapholunate (SL) dissociation
anatomy and, 1899
complications, 1903
definition, 1899
dorsal capsulodesis for, 1899
advantage of, 1899
complications, 1903
disadvantage of, 1899
merits and demerits, 1903b
outcomes, 1903
postoperative care, 1903
using suture anchors, 1901, 1901f
extensor carpi radialis longus, 1899
closure, 1902
exposure and reduction, 1901–1902
outcomes, 1903
tendon transfer, 1899–1900, 1902
imaging studies, 1899
merits and demerits, 1903b
outcomes, 1903
patient history and physical findings, 1899
postoperative care, 1903
slider-crank model of wrist, 1899–1900
surgical management, 1899–1900, 1899f–1900f
approach, 1900, 1900f
patient positioning, 1900
preoperative planning, 1900
Scapholunate instability, 1899. See also Scapholunate dissociation

Scapholunate interosseous ligament (SLIL) injury
differential diagnosis, 1853
direct repair for, 1853
nonoperative management, 1853
pathogenesis, 1851
radiograph imaging of, 1852, 1852f
rupture of, 1851
scapholunate advanced collapse, 1851
Scapholunate ligament reconstruction
anatomy, 1851, 1852f
ballottement test, 1851
capsulodesis in, 1853
complications, 1856
definition, 1851
differential diagnosis, 1853
exposure in, 1853, 1853f
fixed vs. reducible deformity in, 1851
imaging, 1852–1853, 1852f
merits and demerits, 1855b
natural history, 1851
nonoperative management, 1853
outcomes, 1855–1856, 1856f
pathogenesis, 1851
patient history and physical findings, 1851
postoperative care, 1855
scaphoid and lunate, reduction of
flexor carpi radialis graft, 1853–1854, 1854f, 1855f
K-wire placement, 1854, 1854f
static vs. dynamic instability, 1851
surgical management, 1853
approach, 1853
patient positioning, 1853
preoperative planning, 1853

volvar and dorsal wrist incision, 1853, 1853f
Watson scaphoid shift test, 1851, 1852f
Scaphotrapeziotrapezoid (STT) joint arthritis, 1957
Scapula flap, mandible reconstruction
anatomy, 1037–1038
bone harvest, 1041–1043, 1042f–1043f
definition, 1037
diagnostic studies, 1038
flap variations, 1044, 1044f
imaging studies, 1038
latissimus dorsi muscle, 1041
merits and demerits, 1040b
outcomes, 1045
patient history and physical findings, 1038
postoperative care, 1045
preparation and inset of the flap, 1043
recipient site preparation, 1040
skin flap harvest, 1040, 1041f
surgical management, 1038–1040
Scapular fasciocutaneous flap, 1039
Scapular flap, 1116
Scapular osteocutaneous flaps, 1038
Scar contracture
anatomy, 2580, 2580f–2581f
definition, 2580
imaging, 2581, 2582f
merits and demerits, 2582b, 2587b
outcomes, 2588, 2588f
patient history and physical exam, 2580, 2581f
postoperative care, 2588
surgical management
approach, 2582
indications, 2581

patient positioning, 2581–2582
preoperative planning, 2581
Scarpa fascia, 1649
Scarring
of lip, 2635
of ostium, 2876
SCC. See Squamous cell carcinoma/cancer (SCC)
Schrudde angle rotation flap, 1109
Schwannoma, 2456–2457, 2498
anatomy, 2299
complications, 2302
definition, 2299
differential diagnosis, 2300
enucleation, 2301, 2301f
imaging, 2300, 2300f
merits and demerits, 2302b
natural history, 2299
nonoperative management, 2300
outcomes, 2302
pathogenesis, 2299
patient history and physical findings, 2299, 2299f
postoperative care, 2302
surgical management, 2300
approach, 2300
patient positioning, 2300
preoperative planning, 2300
SCIA. See Superficial circumflex iliac artery (SCIA)
SCIA (superficial circumflex iliac artery), 2137–2138
free groin flap, 2142, 2142f
pedicled groin flap, 2140
Sciatic nerve, 2315, 2318–2319, 2502, 2972
anatomy, 2529, 2529f–2530f
innervation/function, 2529

mechanisms of injury, 2529
complications, 2533
definition, 2529
imaging, 2530–2531, 2531f
merits and demerits, 2531b, 2532b
nonoperative management, 2531
outcomes, 2533, 2533t
patient history and physical exam, 2530
postoperative care, 2533
surgical management, 2531, 2531f
Sciatic pathology, 2412
SCIP (superficial circumflex iliac artery perforator) flap, 2487–2488
Scleral show, 158
Sclerotherapy, for vascular tumors of hand, 2276
SCM (sternocleidomastoid), 212
Scoliosis, 2752
Scratch collapse test, 1993, 2411
tibial nerve, 2452
SCT. See Sacrococcygeal teratoma (SCT)
Sculptra, 42
SDA (safe donor area), 419, 420f
SEAP flaps, 1371
Sebaceous cell carcinoma
direct closure and lateral cantholysis, 1078
tenzel semicircular rotational flap, 1084
Second toe-to-thumb transfer
anatomy, 2250–2251, 2250f
angiography and, 2251
complications, 2258
definition, 2250
merits and demerits, 2257b
osteosynthesis, 2256, 2256f–2257f
outcomes, 2257–2258

patient history and physical findings, 2251, 2251f
plain radiographs of, 2251, 2251f
postoperative care, 2257
preparation of, 2255, 2255f–2256f
second toe flap
artery and nerve dissection, 2254, 2254f
closure, 2255, 2255f
incision placement for, 2253, 2253f
metatarsal osteotomy and flap placement, 2255, 2255f
soft tissue dissection, 2253–2254, 2254f
surgical management, 2251–2252
patient positioning, 2252
preoperative planning, 2252
Secondary cleft rhinoplasty
anatomy, 2714
complications, 2718
definition, 2714
dorsal correction, 2717
imaging, 2715
merits and demerits, 2718b
nasal framework correction, 2717
nostril correction, 2717
open cleft lip rhinoplasty
incision and dissection, 2716, 2716f
shape correction, 2716–2717, 2716f
outcomes, 2718
patient history and physical findings, 2714–2715, 2715t, 2716b
postoperative care, 2718
surgical management, 2715
approach, 2715
patient position, 2715
preoperative planning, 2715
tip and ala, reshaping, 2717

Secondary deformities, of lip and nose
Abbe flap, 2652–2653, 2652f–2653f
anatomy, 2644
complications, 2657
Cupid’s bow, 2645b, 2645f
asymmetry more than 2 mm high, 2647, 2647f
mismatch of 1 to 2 mm, 2646, 2646f
definition, 2644
lip pits, 2654–2656
acellular dermal allograft, 2656, 2656f
inverted-T excision, 2655–2656, 2656f
split lip advancement technique, 2655, 2655f
transverse elliptical excision, 2654, 2655f
vertical elliptical wedge excision, 2654, 2655f
merits and demerits, 2656b
outcomes, 2657
pathogenesis, 2644
patient history and physical findings, 2644
postoperative care, 2657
surgical management
approach, 2644–2645
patient position, 2644
preoperative planning, 2644
vermilion and mucosa, 2648–2652
hypoplastic medial/lateral lip element, 2650–2651
lateral mucosa fullness, 2648, 2650f–2651f
notch in free edge, 2651–2652
red line malalignment, 2648
Secondary healing using regenerative matrix, 2367, 2368f
Secondary hyperhidrosis, 1749
Secondary infections, 2430
Secondary patency, 2401
Secondary pedicle technique, breast reconstruction, 1364

Secondary post-traumatic enophthalmos, 847
Segmental Le Fort I advancement
anatomy, 592–593
Angle’s classification, 592, 592f–593f
complications, 601
imaging studies, 594–595, 595f
incision and dissection, 596
of maxilla
closure, 599
down-fracture, 597
fixation, 599, 599f
Le Fort I osteotomy, 596–597, 597f
MMF and alar base width, 599
segmentation, 597–598, 598f
transverse expansion and advancement, 598
merits and demerits, 596b
natural history, 594
outcomes, 601
pathogenesis, 594
patient history and physical findings, 594, 594f
postoperative care, 600
surgical management
patient positioning, 595–596, 596f
preoperative planning, 595–596
three-piece segmental advancement, 592
two-piece segmental advancement, 592
Semmes-Weinstein monofilament test, 2352, 2374, 2408
Sensate flap, 2383
Sensory distribution of leg, 2315f
Sensory innervation, 1068, 1069f
buccal mucosa, 1219
of ear, 1129
FOM, 1211

nose, 1154
radial forearm free flap, 1073
SCAIF flap, 1249
skin grafts, 1122
Sensory nerve, 70
subcutaneous lateral brow lifting, 82
transfers, combined median and ulnar nerve injury, 2041
Septal cartilage, 326
Septal collapse, closed rhinoplasty, narrow midvault in, 275
Septal deformities, 957
Septal extension graft, short nose, 338, 340f–341f
Septal fractures/dislocations, 860
Septal hematoma, open treatment of nasal fractures, 864
Septal perforation, closed rhinoplasty, narrow midvault in, 275
Septal resection, open rhinoplasty, controlling tip rotation in, 312,
312f
Septal stents, 328–329
Septal tilt correction, 328, 328f–330f
Septoplasty, 273–274, 273f, 291
crooked nose, 327–329, 328f–330f
nasal airway obstruction, 383, 383f
Septum, 2617
anatomy, 2606, 2607f
reconstruction, 2895–2896, 2896f
Sequestrum, 2466
Serial puncture injection technique, 44, 44f
Seromas, 200, 1618, 1638, 1741
Serratus anterior flap (SAF)
anatomy, 1547, 1548f–1551f
complications, 1555
definition, 1547
flap harvest, 1553–1554, 1553f–1554f
imaging, 1549

intrathoracic flap insetting, 1554, 1554f
merits and demerits, 1554, 1554b
outcomes, 1555
pathogenesis, 1547
patient history and physical findings, 1547–1549
postoperative care, 1554–1555
surgical management
approaches, 1551
incision and initial dissection, 1552, 1552f
positioning, 1551
postdissection wound, 1552, 1552f
preoperative markings, 1552, 1552f
preoperative planning, 1549–1551
Seymour fractures
complications, 1776
definition, 1775
indications for surgical management, 1776
merits and demerits, 1778
natural history, 1775
open debridement and pinning, 1776–1777, 1778f
outcomes, 1779
pathogenesis, 1775
SFA (superficial femoral artery), 2400, 2402, 2497, 2502
SFS (superficial fascial system), 1619
SGAP flap. See Superior gluteal artery perforator (SGAP) flap
Shaft fractures
closed reduction and pinning, 1791, 1791f
nonoperative management, 1787–1788
open reduction and internal fixation, 1792–1793, 1792f
pathogenesis, 1787
surgical management, 1788
Sharp debridement of acute wound, 2428–2429, 2429f
Sharp injury, nerve repair and graft, 2006

Sheffield splint, 2417
Shield-tip graft, short nose, 339–340, 339f
Short nose
anatomy, 338
complications, 342
definition, 338
imaging, 338
merits and demerits, 342b
outcomes, 342
pathogenesis, 338
patient history and physical findings, 338
postoperative care, 342
septal extension graft, 338, 340f–341f
shield-tip graft, 339–340, 339f
surgical management, 338–339
approach, 339
positioning, 339
preoperative planning, 339
tongue-and-groove technique, 341–342, 341f
Short scar periareolar inferior pedicle (SPAIR) technique, 2995
closure, 2998–2999, 2999f
flap creation, 2996, 2997f
incisions, 2996, 2996f
shaping, 2996, 2997f
skin plication, 2998, 2998f
Short upper lip/transverse crease, 375, 375f
Short-scar face-lift
anatomy, 251
complications, 253
definition, 251
merits and demerits, 252b
outcomes, 252, 252f
patient history and physical findings, 251

postoperative care, 252
surgical management, 251
techniques, 251–252, 251f, 252f
Sialocele, 3083
Sialoma, 200
Siamese twins, 3094
SIEA (superficial inferior epigastric artery), 2563
Signet ring sign, 1852, 1852f
Silicone metacarpophalangeal joint arthroplasty (SMPA), 1940,
1948, 1949f, 1953, 1954f
Silicone soft elastomer intramuscular augmentation, of buttocks,
1632–1633, 1632f
Silver sulfadiazine, 2351
Simmonds/Thompson test, 2416
Simple displaced fractures
angle and ramus fractures, 911–912, 911f–912f
body fractures, 911
symphysis/parasymphysis, 910
Single injection technique, supplies for, 2316
Single pedicle technique, breast reconstruction, 1364
Single-digit sympathectomy, 2157
Single-stage flexor tendon grafting, 2066–2068, 2067f
Single-stage operation, nonunion of a mandible fracture, 929–930,
929f
Skate flap for nipple reconstruction
anatomy, 1476, 1476f
complications, 1481
definition, 1476
merits and demerits, 1477b, 1480b
outcomes, 1481
patient history and physical findings, 1476
postoperative care, 1481
surgical management

patient positioning, 1477
preoperative planning, 1477, 1477f
Skeletal deficiency, 398
Skeletal malocclusion, definition, 592
Skeleton, malar implants, 392, 392f
Skeletonization ethnic rhinoplasty, 290
Skin closure, 2891, 2891f
prune belly, 3024, 3024f
Stahl ear, 2824
Skin flap
dissection
cryptotia, 2834
prominent ears, 2838
harvest, surgical management
lateral approach, 1040
medial approach, 1040, 1041f
necrosis, 1741
transposition, cryptotia, 2834
Skin grafting
with acellular allodermal matrix, 2584, 2585f
harvesting, 2583, 2584f
placememt and securing, 2583, 2584f
recipient site preparation, 2583, 2583f
Skin grafts
anatomy, 1180
arterial and venous anatomy, 1123f
buccomandibular, 1122, 1122f
closure, with radial forearm free flap, 1075, 1075f
complications, 1182
definition, 1122, 1180
with full-thickness skin graft, 1125, 1125f
harvest
advantages, 2769

anatomy, 2769
definition, 2769
full-thickness skin grafts, 2769, 2771
merits and demerits, 2770b
natural history, 2769
postoperative care, 2771
prognosis, 2769
split-thickness skin grafts, 2769–2771, 2770f, 2771f
surgical management, 2769
lymphatic drainage, 1122
merits and demerits, 1125b, 1181b
nasal tip reconstruction, 1182
nonoperative management, 1124
outcomes, 1126–1127
patch appearance, 1126
patient history and physical findings, 1122–1124, 1180
postoperative care, 1126, 1182
preauricular, 1122, 1122f
site preparation and graft harvest, 1181, 1181f
with split-thickness skin graft, 1126, 1127f–1128f
suborbital, 1122, 1122f
surgical management, 1124
approach, 1124, 1180
patient positioning, 1124, 1180
preoperative planning, 1124, 1180
Skin laxity, 2127
Skin necrosis, 2835
Skin paddle, 1590
debulking of, 988, 988f
de-epithelization and transposition of, 1678, 1678f
elevation of, 1678
Skin pinch skin excision
anatomy, 138