Operative Technique in Plastic Surgery – Kevin C.Chung

Turbinate reduction, 329
Turbinectomy
ethnic rhinoplasty, 291
partial, 329
Turbinoplasty, nasal airway obstruction, 384, 384f
Turkish Delight, 366
Turnover flap, 1518–1519, 1519f
Two halves stabilization, 549, 550f
Two-flap palatoplasty
anatomy, 2683
bilateral complete cleft palate, 2688, 2688f
complications, 2689
definition, 2683
differential diagnosis, 2683–2684
merits and demerits, 2685b
natural history, 2683
nonoperative management, 2684
outcomes, 2689
pathogenesis, 2683
patient history and physical findings, 2683
postoperative care, 2689
surgical management, 2684
approach, 2684
patient position, 2684
preoperative planning, 2684
for unilateral complete cleft palate
greater palatine vessels isolation, 2685–2686, 2686f
markings, 2685, 2685f
nasal closure, 2687
nasal mucoperiosteum dissection, 2686–2687, 2687f
oral closure, 2687–2688
oral mucoperiosteal flaps elevation, 2685, 2685f
velar musculature dissection and reconstruction, 2687

Two-stage flexor tendon reconstruction, 2068–2069, 2068f–2069f
Two-stage operation, nonunion of mandible fracture, 930–932, 930f
Tyndall effect, 20, 33, 36
Type 1 branchial sinus/fistula, 2900–2902, 2901f
Type 2 branchial sinus/fistula, 2902, 2902f
Type I (limited maxillectomy) defect, 1013, 1013f–1014f,
1015–1016
Type II (subtotal maxillectomy) defect, 1013, 1016
Type III (total maxillectomy) defect, 1013, 1016–1019
Type IV defect (orbitomaxillectomy), 1013, 1019
U
UCL reconstruction. See Ulnar collateral ligament, of thumb
UCS. See Unilateral coronal synostosis (UCS)
Ulcer, 1710–1711, 1710f
Ulcer excision, 1708
Ulcerations, 2387
Ulcers, 2400
ULCs (upper lateral cartilages), 269, 291, 291f, 380
correction, 330, 330f
Ulnar artery perforator flap, 2122–2123
advantage, 2120
anatomy, 2120–2121
complications, 2125
definition, 2120
imaging, 2121
merits and demerits of, 2124b
nonoperative management, 2121
outcomes, 2124, 2124f
patient history, 2121
pedicled flap, 2122–2123
physical findings, 2121

postoperative care, 2124
propeller flap, 2123, 2123f–2124f
surgical management, 2121–2122, 2122f
approach, 2122
patient positioning, 2122
preoperative planning, 2122
Ulnar artery perforator flaps, hemi-tongue reconstruction, 1203,
1203f–1204f
Ulnar artery thrombosis
anatomy, 2160, 2160f
complications, 2167
definition, 2160
differential diagnosis, 2163
dissection of, 2164, 2164f
donor grafts, 2163, 2164b
flow and closure, 2166
imaging, 2162–2163
merits and demerits, 2166b
natural history, 2161
nonoperative management, 2163
outcomes, 2167
pathogenesis, 2160–2161
patient history and physical findings, 2161–2162
postoperative care, 2167
segment resection and superficial arch, 2165, 2165f
signs of
surgical management
approach, 2164, 2164f
patient positioning, 2164
preoperative planning, 2163
vein graft harvesting, 2165, 2165f
Ulnar collateral ligament, of thumb
acute reconstruction of

incision for, 1804, 1804f
suture placement and closure, 1804, 1805f
anatomy, 1802, 1802f
chronic tear reconstruction of
bone tunnel creation and tendon graft, 1807, 1807f
incision, 1805, 1806f
K-wire placement, 1807–1808, 1808f
palmaris autograft, 1808, 1808f
palmaris tendon harvest, 1806–1807, 1806f
suture anchor, 1807, 1808f
complications, 1809
definition, 1802
differential diagnosis, 1803
imaging, 1803
indications, 1803
merits and demerits, 1809b
natural history, 1803
nonoperative management, 1803
outcomes, 1809
pathogenesis, 1802, 1802f
patient history and physical findings, 1803
postoperative care, 1809
Stener lesion, 1802, 1802f
surgical management
approach, 1803
patient positioning, 1803
preoperative planning, 1803
Ulnar nerve
decompression, 1989–1990, 1990f
local anesthesia at wrist, 1758, 1758f
neurovascular bundle anatomy, 1754
schwannoma, 2300f, 2301f
Ulnar nerve injury

anatomy, 2019
complications, 2024
definition, 2019
differential diagnosis, 2020
imaging, 2020
merits and demerits, 2020b, 2024b
natural history, 2019
nonoperative management, 2020
outcome studies, 2024
pathogenesis, 2019
patient history and physical findings, 2019
postoperative care, 2024
surgical management
approach, 2020
patient positioning, 2020
preoperative planning, 2020
Ulnar nerve palsy
anterior interosseous nerve
anatomy, 2043
complications, 2047
definition, 2043
differential diagnosis, 2044
end-to-end neurorrhaphy, 2046, 2046f
imaging, 2044
internal topography, 2043, 2043f–2044f
merits and demerits, 2047
outcomes, 2047
patient history and physical findings, 2044
postoperative care, 2047
reverse end-to-side, 2046, 2046f
surgical management, 2044–2045, 2045f
low combined median and
finger clawing, 2038–2039

index finger abduction, 2037–2038
small finger abduction, 2040
thumb adduction, 2037
thumb opposition, 2036–2037
motor component identification, 2045, 2045f
Ulnar tunnel release, 1989–1990, 1989f
Ulnar tunnel syndrome
anatomy, 1986–1987, 1986f
complications, 1991
definition, 1986
differential diagnosis, 1988
imaging, 1988
merits and demerits, 1990b
nonoperative management, 1988
outcomes, 1990–1991
pathogenesis, 1987
patient history and physical findings, 1987
postoperative care, 1990
surgical management, 1988
patient positioning, 1988
preoperative planning, 1988
volar approach, 1988
ulnar tunnel release and ulnar nerve decompression, 1989–1990,
1989f, 1990f
Ultherapy, 238
Ultrasound (US)
Achilles tendon reconstruction, 2417, 2417f
cubital tunnel syndrome, 1993
lumbar and thoracic spine for epidural placement, 2327, 2327f
nerve repair and graft, 2005
reverse radial forearm flap, 2115
ulnar tunnel syndrome, 1988
Ultrasound-assisted liposuction

depiction of liposuction technique, 1357f
markings, 1357
persistent tissue removal, 1357, 1358f
Ultrasound-guided technique
adductor canal blocks, 2312f
continuous catheter technique, 2320
Deep peroneal nerve block, 2323, 2323f
femoral nerve blocks, 2311–2312, 2311f
in-plane needle insertion approach, 2316, 2318–2319
vs. nerve stimulation, 2316
out-of-plane needle insertion approaches, 2316, 2319–2320
saphenous nerve block, 2324, 2324f
superficial peroneal nerve block, 2323, 2324f
sural nerve block, 2324, 2324f
tibial nerve block, 2323
Umbilical stenosis, after abdominoplasty, 3040, 3040f
Umbilical transposition, 1592, 1604f, 1605, 1605f. See also
Abdominal panniculectomy
Umbilicoplasty
anatomy, 3037, 3037f–3038f
complications, 3040
definition, 3037
merits and demerits, 3040b
midline incision, 3038–3039, 3038f–3039f
outcomes, 3040
patient history and physical findings, 3037
postoperative care, 3040
surgical management, 3038
Umbilicus, 3037
Uncinectomy, 804f
Undiagnosed spinal stenosis, 2330
Unicoronal synostosis
fronto-orbital distraction, 447, 448f

natural history, 445
Unilateral cleft lip adhesion
completion, 2633, 2633f
incision and dissection, 2631, 2632f
markings, 2631, 2631f
suturing, 2631–2633, 2632f
Unilateral cleft lip, nasal deformity, 2715t
Unilateral cleft lip repair
anatomy, 2606, 2607f
clefting degree, 2606
complications, 2615
definition, 2606
imaging, 2606
merits and demerits, 2607b
Millard/Mohler modifications
incisions, 2609
lateral lip dissection, 2609–2610, 2610f
lip closure, 2612–2613, 2613f
markings, 2607–2609, 2608f–2609f
medial lip dissection, 2609, 2610f
mucosa closure, 2610–2611, 2611f–2612f
nasal dissection, 2611–2612, 2612f
nasal refinement, 2613–2614, 2614f
outcomes, 2615
patient history and physical findings, 2606
postoperative care, 2615
surgical management, 2606–2607
approach, 2607
patient position, 2607
preoperative planning, 2607
Unilateral complete cleft palate
two-flap palatoplasty
greater palatine vessels isolation, 2685–2686, 2686f

markings, 2685, 2685f
nasal closure, 2687
nasal mucoperiosteum dissection, 2686–2687, 2687f
oral closure, 2687–2688
oral mucoperiosteal flaps elevation, 2685, 2685f
velar musculature dissection and reconstruction, 2687
Unilateral coronal synostosis (UCS)
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
Unilateral craniofacial microsomia, 718
Unilateral hyperplasia, mandible, 714
Unilateral Karapandzic flap, 1059, 1059f
Unilateral lambdoid synostosis, 456
Unilateral nasal bone correction, 326–327
Untreated compartment syndrome, 1765, 1765f
Upper abdominal defects, 1589
Upper arm lift (brachioplasty)
anatomy, 1645, 1645f
complications, 1648
definition, 1645
imaging, 1645
outcomes, 1648
pathogenesis, 1645
patient history and physical findings, 1645
postoperative care, 1648
surgical management
approach, 1646
positioning, 1646

preoperative planning, 1645–1646
Upper blepharoplasty
anatomy, 106, 171
complications, 108, 176, 177f
definition, 106, 169–170
differential diagnosis, 172
merits and demerits, 107b, 176b
nonoperative management, 172
outcomes, 107, 176
pathogenesis, 171–172
patient history and physical findings, 106, 172, 172f
postoperative care, 107, 176
surgical management, 106–107, 172
approach, 107
positioning, 107, 107f
preoperative planning, 106–107, 106f
techniques, 107f, 107b, 172–175, 172f, 173f
Upper eyelid
anatomy of, 114, 114f, 2849f
fat grafting for periorbital rejuvenation, 162, 166
margin, position of, 3
ptosis, levator advancement technique, treatment, 123, 124f
Upper eyelid reanimation with gold weight
anatomy, 1286, 1286f
anterior lamella, 1286
blood supply, 1287
complications, 1288
definition, 1286
imaging, 1287
lower eyelid retractors, 1287
merits and demerits, 1287b
outcomes, 1288
patient history and physical findings, 1287

posterior lamella, 1286
postoperative care, 1288
surgical management
patient positioning, 1287
postseptal approach, 1288
preoperative planning, 1287
pretarsal approach, 1287, 1287f
upper eyelid retractors, 1286
Upper lateral cartilages (ULCs), 269, 291, 291f, 380, 2714
correction, 330, 330f
Upper lid reconstruction, eyelids, 2778, 2778f–2779f
Upper lip, 2606, 2607f, 2616
Upper periorbital area, filler injection into
anatomy, 23
approach, 23
complications, 25
definition, 23
merits and demerits, 24b
outcomes, 25
patient history and physical findings, 23, 23f
positioning, 23
postoperative care, 25
preoperative planning, 23
techniques, 24, 24f
Upper thigh lift
anatomy, 1649–1650, 1649f
complications, 1654
definition, 1649
pathogenesis, 1650
patient history and physical findings, 1650
postoperative care, 1654
surgical management
approach, 1650

positioning, 1650, 1650f
preoperative planning, 1650
Urethra, preparation of, 1690f, 1691
Urethral plate defect, bridging of, 3047
Urethral plate elevation, 3066, 3066f
Urinary tract, conjoined twins, 3095
Urogenital sinus mobilization, 3066, 3066f
perineal flap creation, 3068, 3068f
reconstruction, 3066, 3066f
TUM and PUM, 3068, 3068f
use, 3068–3069, 3069f
V
Vacuum-assisted closure (VAC) therapy, 2523, 2526–2527
Vagina, 3062
Vaginal agenesis, 3052
Vaginal canal caliber, 3054–3055, 3054f, 3055f
Vaginal pack, placement of, 1692, 1692f
Vaginal reconstruction
anatomy, 1681, 3052, 3053f
complications, 1685, 3061
definition, 1681, 3052
gracilis flap for (see Perineal reconstruction)
imaging, 1682, 3053
merits and demerits, 3060b
natural history, 1681–1682, 3052
nonoperative management, 3053
outcomes, 1685, 3061
pathogenesis, 1681, 3052
patient history and physical findings, 1682, 3052–3053
posterior labial artery flap for (see Vaginal reconstruction; Vulvar
reconstruction)

postoperative care, 1684–1685, 3060
surgical management, 3053–3054, 3054f
approach, 1682, 1682f
positioning, 1682
preoperative planning, 1682
Vaginal vault, creation of, 1692, 1692f
Vaginoplasty, 3053–3055, 3054f, 3055f
anterior sagittal transrectal approach, 3069–3070
high vaginal confluence, 3069
low vaginal confluence, 3069, 3069f
Valsalva maneuver, 344
Van der Woude syndrome, 2618
Vancomycin, 2471
Vascular anastomoses, 1694, 1695f
Vascular anomalies, 2275
anatomy, 2759
circular excision and purse-string closure, 2761–2762, 2761f
complications, 2763
definition, 2759
differential diagnosis, 2759
imaging, 2759
lenticular excision and linear closure, 2760b
merits and demerits, 2763b
natural history, 2759
nonoperative management, 2759
outcomes, 2763
patient history and physical findings, 2759
postoperative care, 2763
suction-assisted lipectomy, 2762–2763, 2763f
surgical management, 2759–2760
approach, 2760
patient position, 2760
preoperative planning, 2760

transverse mucosal resection and linear closure, 2762, 2762f
Vascular clamps, 2166
Vascular endothelial growth factor (VEGF), 504
Vascular lesions
anatomy, 2798
complications, 2803
definition, 2798
imaging, 2799–2800
laser treatment, 2802, 2802f
merits and demerits, 2803b
natural history, 2798
nonoperative management, 2800
outcomes, 2803
pathogenesis, 2798
patient history and physical findings, 2798–2799, 2799f
postoperative care, 2803
surgical management, 2800–2802
approach, 2801–2802, 2802b, 2802f
patient position, 2800–2801
preoperative planning, 2800
Vascular malformations, 78, 2456, 2798
Vascular malformations (VMs)
definition and classification of, 2275
fast-flow, 2275
of hand, 2275–2279
approach, 2276
complications, 2279
differential diagnosis, 2276
digits and distal palm, 2277, 2277f–2278f
imaging, 2276, 2276f
merits and demerits, 2278b
natural history, 2275
nonoperative management, 2276

outcomes, 2279
palmar incision, 2277, 2277f–2278f
pathogenesis, 2275
patient history and physical findings, 2275–2276, 2275f
postoperative care, 2279
surgical management, 2276
slow-flow, 2275
Vascular pedicle, 2514
Vascular perforators, 1557
Vascular reconstruction of lower extremity, foot, and ankle
anatomy, 2400
complications, 2406
femoropopliteal bypass, 2402–2403, 2402f
above-knee popliteal exposure, 2403, 2403f
below-knee popliteal exposure, 2403, 2404f
femoral artery identification, 2402
longitudinal incision, 2402
imaging, 2400
merits and demerits, 2405b
outcomes, 2406
patient history and physical findings, 2400
postoperative care, 2406
surgical management, 2401
for tibial-peroneal arterial occlusive disease, 2404–2405
anterior tibial artery exposure, 2404
conduit, selection of, 2404
indications, 2404
pedal artery exposure, 2405
peroneal artery exposure, 2405, 2405f
posterior tibial artery exposure, 2404–2405
Vascular supply
radial forearm free flap, 1074
scalp reconstruction with rotation flaps, 980

Vascularized autograft, 2431
Vascularized bone flaps, 928, 2510
advantage of, 2510
fibula, 2510
Vascularized bone grafts (VBGs), 1880
Vascularized bone reconstruction. See Scaphoid fracture nonunion
Vascularized fibula flap, 2424, 2435
Vascularized fibular graft, 2431
Vascularized iliac crest flap, 1038
Vascularized lymph node transfer (VLNT)
anatomy, 2557
complications, 2566
definition, 2557
differential diagnosis, 2559
donor sites, 1507, 1507f, 2560t
imaging, 2558–2559
indocyanine green appearance, 2561b
merits and demerits, 2565b
natural history, 2557–2558
nonoperative management, 2559
outcomes, 1509, 2566
pathogenesis, 2557
patient history and physical examination, 2558
postoperative care, 1509, 2565–2566
recipient sites, 1508, 1508f, 2564–2565, 2564t
surgical management
approach, 2560
patient positioning, 2560
preoperative planning, 2559–2560
Vascularized medial femoral condyle corticoperiosteal flap, 1038
Vascular/nerve supply, condyle fractures, 915
Vaseline gauze packing, 2896
VASERlipo

fat emulsification and harvest, 1627–1628
fat processing and injection, 1629
markings, 1627
power-assisted lipoplasty, 1627
Vastus lateralis, 2392–2395, 2396f
Vaughn-Jackson syndrome, 1935
VBGs (vascularized bone grafts), 1880
Veau classification, of cleft palate, 2668, 2668f
Veau clefts, 2696
Vector analysis, 158
Vectra, 305
VEGF (vascular endothelial growth factor), 504
Vein repair, 2152
Velar musculature, 2672
dissection and reconstruction, in two-flap palatoplasty, 2687
Velopharyngeal dysfunction (VPD), 2697
Velopharyngeal incompetence (VPI), 2658
Velopharyngeal insufficiency (VPI)
anatomy, 2706
complications, 2713
definition, 2706
diagnosis, 2707
differential diagnosis, 2707
dynamic sphincter pharyngoplasty
dissection, 2709, 2710f
markings, 2709, 2710f
Furlow palatoplasty/double-opposing Z-plast
dissection, 2708, 2709f
markings, 2708, 2708f
imaging, 2707
merits and demerits, 2712b
natural history, 2706
nonoperative management, 2707

outcomes, 2713
pathogenesis, 2706
patient history and physical findings, 2707
posterior pharyngeal flap
dissection, 2710–2711, 2711f
markings, 2710, 2711f
postoperative care, 2712–2713
surgical management, 2707–2708
approach, 2707
patient position, 2708
preoperative planning, 2708
Veloplasty, Z-plasty with
Venae comitantes (VCs), 1171
Venous anastomosis, 2526
Venous congestion, 2485
Venous drainage, 1515
of ear, 1129
RFFF, 1171
Venous malformations (VM), 2798–2799
Venous stasis, 2427
Venous supply, SCAIF flap, 1249
Ventral hernia
anatomy, 1563
complications, 1570–1571
definition, 1563
imaging, 1564
laparoscopic component separation, 1565, 1565f
merits and demerits, 1564b
minimally invasive component separation, 1566–1567, 1566f
open component separation, 1564–1565, 1564f
outcomes, 1568–1570, 1568f–1569f
pathogenesis, 1563
patient history and physical findings, 1563

periumbilical perforator-sparing technique, 1565–1566
posterior component separation, 1567, 1567f
postoperative care, 1568
surgical management
approach, 1564
positioning, 1564
preoperative planning, 1564
Vermilion, 1055, 1055f, 2597–2598, 2598f, 2640
abnormalities of, 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
flap, 2731
Vermilion-shifted commissuroplasty, with optional cutaneous Z-
plasty
commissuroplasty and skin closure, 2732, 2733f
design, 2731, 2732f
dissection and orbicularis repair, 2731–2732, 2732f
markings, 2731, 2731f
VERSAJET system, 2429, 2429f
Vertical elliptical wedge excision, lip pits, 2654, 2655f
Vertical mastopexy
incisions and closure, 1335–1336, 1335f
planning and markings, 1334–1335, 1334f–1335f
Vertical maxillary excess (VME), 573
Vertical rectus abdominis myocutaneous (VRAM) flap, 1215, 1528,
1657, 1657f–1658f, 1675, 1678, 1678f, 1685, 2519f–2520f
clinical anatomy, 2517f
double skin island, 1049, 1049f–1050f
lateral mandible defect, 1048
markings, 1049, 1049f
for perineal reconstruction (see Perineal reconstruction, vertical

rectus abdominis myocutaneous flap for)
for perineal reconstruction, inset of, 1679, 1679f
Vertical reduction genioplasty, 408, 408f
Vertical rhytids, 12
Vertical, superomedial pedicle reduction mammaplasty, 1342
Vessels, subcutaneous lateral brow lifting, 82
Vestibular web obliterating suture, 2614, 2614f
Video fluoroscopy, 2697
ViOptix tissue oximetry, 1555
Virginal breast hypertrophy. See Juvenile breast hypertrophy
VISI (volar intercalated segment instability) deformity, 1857, 1859
Visible cords, 18, 18f
VLNT. See Vascularized lymph node transfer (VLNT)
VM (venous malformations), 2798–2799
VME (vertical maxillary excess), 573
Voiding cystourethrography (VCUG), 3022, 3063
Volar carpal ligament, 1986, 1986f, 1989
Volar forearm
curvilinear incision, 1761, 1763, 1763f
longitudinal incisions, 1764, 1764f
split-thickness skin graft, 1765, 1765f
Volar intercalated segment instability (VISI) deformity, 1857, 1859
Volar plate arthroplasty (VPA). See Proximal interphalangeal joint
(PIPJ), of fingers
Volar retinacular cysts, 2281–2282
Volar thumb, 2105
Volar wrist ganglion, 2280–2281, 2284, 2284f
Volar wrist trauma with tendon, nerve, and arterial injuries
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
Volkmann ischemic contracture, 1765, 1765f
Vomer bone, 2659
Vomer flap, 2658
Von Langenbeck palatoplasty
anatomy, 2668, 2668f
complications, 2674
definition, 2668
differential diagnosis, 2669
elevation of oral mucoperiosteal flaps, 2670
greater palatine vessels isolation, 2671
markings, 2670, 2670f
merits and demerits, 2670b
muscle and intravelar veloplasty dissection, 2672
nasal mucosa closure, 2672, 2672f
nasal mucosa dissection, 2671
natural history, 2668–2669
nonoperative management, 2669
oral mucoperiosteal flaps elevation, 2670, 2670f
oral mucosa closure, 2673, 2673f
oral mucosa dissection, 2671
outcomes, 2673–2674
pathogenesis, 2668
patient history and physical findings, 2669

postoperative care, 2673
surgical management, 2669
approach, 2669
patient position, 2669
preoperative planning, 2669
Vone marrow aspirate concentrate, 2360–2361, 2361f
VRAM flap. See Vertical rectus abdominis myocutaneous (VRAM)
flap
Vulvar and vaginal reconstruction
anatomy, 1671
complications, 1674
definition, 1671
imaging, 1671
outcomes, 1674
pathogenesis, 1671
patient history and physical findings, 1671
postoperative care, 1674
surgical management
approach, 1672, 1672f
positioning, 1671–1672, 1672f
preoperative planning, 1671
Vulvar reconstruction
anatomy, 3052, 3053f
complications, 3061
definition, 3052
imaging, 3053
merits and demerits, 3060b
natural history, 3052
nonoperative management, 3053
outcomes, 3061
pathogenesis, 3052
patient history and physical findings, 3052–3053
postoperative care, 3060

surgical management, 3053–3054, 3054f
V-Y advancement flap, 1702, 1703f, 2099, 2099f
antia-buch flaps, 1130, 1130f, 1131f
gluteal muscles of, bilateral, 2788, 2788f
for ischial pressure injury, 2787, 2787f
nasal reconstruction
anatomy, 1183, 1184f
classic V-Y Flap, 1183–1184, 1184f
complications, 1186
definition, 1183, 1183f
extended perforator V-Y flap, 1185, 1186f
merits and demerits, 1184b
outcomes, 1186
patient history and physical findings, 1183–1184, 1183f
postoperative care, 1186
standard perforator V-Y flap, 1185, 1185f
surgical management, 1184
reconstruction with, 2419
V-Y perforator flap, 1183

W
Wagner scale, 2407, 2407f
WALANT (Wide-awake local anesthesia no tourniquet), 1754
definition, 1754
trigger finger release, 1758
WALANT (wide-awake surgery), 2056
Walt Disney eye, 1095
Wartenberg sign, 1987, 1993, 2040
Warwick-James elevator, 2676
Watson scaphoid shift test, 1851, 1852f
Wedge reconstruction
partial auriculectomy defects
anatomy, 1142, 1142f, 1165
complications, 1145, 1166
definition, 1142, 1165
full-thickness
imaging, 1142, 1165
keyhole-type cartilage excision, 1144, 1166, 1168f
merits and demerits, 1143b, 1166b
patient history and physical findings, 1142, 1165
postoperative care, 1145, 1166
surgical management, 1142–1143
variations, 1144, 1166, 1168f
wedge resection of helix, 1143, 1143f, 1166, 1167f
Wedge skin excision, Stahl ear, 2821, 2823f–2824f
White-eyed blowout fracture, 877
Whitnall tubercle, 876, 877f
Wide tip
open rhinoplasty with
anatomy, 294
complications, 296

definition, 294
imaging, 294
merits and demerits, 296b
outcomes, 296
patient history and physical findings, 294
postoperative care, 296
surgical management, 294
wide tip, correction of, 295, 295f
Wide-awake local anesthesia no tourniquet (WALANT), 1754, 2056
definition, 1754
trigger finger release, 1758
Wise pattern mastopexy, 1336–1337, 1336f, 1337f
“Witch’s chin” deformity, 757, 757f
World Health Organization groups, 2456, 2497
Wound closure
constricted ear, 2830, 2830f
cryptotia, 2834
microtia, auricular reconstruction for, 2817–2818
prominent ears, 2839
thyroglossal duct cysts, 2909, 2909f
Wound irrigation, 977
Wound preparation, 977, 2384, 2384f
W-plasty, 976, 1105, 2733
Wrist
acute perilunate dislocations (see Perilunate dislocations)
anatomy, 1889, 1889f
definition, 1754
ganglion cysts
dorsal, 2281, 2282f, 2283, 2283f
volar, 2281, 2282f, 2284, 2284f
osteoarthritis
congenital conditions, 1957
distal radius fractures, 1957

Kienbock/Preiser diseases, 1957
STT joint arthritis, 1957
surgical treatment of, 1958–1959
total wrist fusion, 1971–1973, 1972f
rheumatoid arthritis
caput ulna, 1933, 1933f–1934f
carpal tunnel syndrome, 1936
DRUJ instability, 1933
extensor tendon rupture, 1933–1935, 1934f, 1935t–1936t, 1935t
FPL rupture, 1942–1944, 1944f, 1945f
midcarpal extension, 1933
ulnar translocation of carpus, 1933
slider-crank model of, 1899–1900
Wrist arthritis
anatomy, 1905, 1905f
imaging, 1906
natural history, 1906
nonoperative management, 1906
pathogenesis, 1905–1906
patient history and physical findings, 1906
proximal row carpectomy (see Proximal row carpectomy (PRC))
radiologic staging systems of, 1906, 1907b
Wrist arthroscopy
anatomy and, 1839, 1839f, 1840t, 1842b
complications, 1849
contraindications to, 1841
definition, 1839
diagnostic, 1842
dry, 1842
4-5 portal in, 1844–1845, 1844t
imaging, 1839
indications for, 1839
merits and demerits, 1848b

midcarpal radial portal in, 1846–1848, 1846f, 1848t
midcarpal ulnar portal in, 1846–1848, 1846f, 1848t
nonoperative management, 1839
outcomes, 1849
patient history and physical findings, 1839
postoperative care, 1849
scapholunate interosseous ligament injuries
6R portal in, 1845–1846, 1846t
surgical management, 1839–1842
patient positioning, 1841, 1842f
preoperative planning, 1841, 1841f
3-4 portal in, 1843–1844, 1843f–1844f, 1844t
treatment indications for, 1840
wet, 1842
Wrist extension procedures
anatomy, 2196, 2196f–2197f
complications, 2199
definition, 2196
imaging, 2197
merits and demerits, 2198b, 2199b
outcomes, 2199
patient history and physical findings, 2196–2197
postoperative care, 2199
pronator teres, 2026, 2026f–2027f
surgical management
approach, 2198
patient positioning, 2198
preoperative planning, 2198
Wrist fusion, 2035
Wrist/fingers reconstruction. See also Neonatal brachial plexus
palsy (NBPP)
complications, 2968
FCU to ECRB tendon transfer, 2965–2966, 2965f

finger flexion, free functioning gracilis transfer for, 2966, 2966f
outcomes, 2968
postoperative care, 2967–2968
X
Xiphoid process, 1522
X-rays
cubital tunnel syndrome, 1993
peroneal nerve injury, 2411
tibial nerve, 2452
Xylocaine, 62
Y
Y-V medial canthopexy, 2868, 2868f
Z
Zancolli Lasso procedure, 2213–2214, 2214f
ZF (zygomaticofrontal) suture, 185–187, 187f
Zigzag Cairns approach, 1273, 1273f–1274f, 1276
Zimmer-Hall drill, 81
ZMC. See Zygomaticomaxillary complex (ZMC) fracture
Zone III central slip repair, 2082
Zone of injury, 2394, 2396f
Zone V extensor tendon repair, 2083, 2083f
Z-plasty, 976, 1105, 2582, 2582f. See also Furlow palatoplasty
cryptotia, 2833
cutaneous scar, 2733
double-opposing
dissection, 2708, 2709f
markings, 2708, 2708f
surgical management, 2707

with intravelar veloplasty
optional cutaneous, 2731–2732, 2731f, 2732f, 2733f
oral and nasal layers
thumb reconstruction, 2773–2774, 2773f–2774f
Z-plasty approach, 653
ZS (zygomaticosphenoid) suture, 876
ZT. See Zygomaticotemporal (ZT) nerve
Zygoma repair, 850, 850f
Zygomatic and maxillary osteotomies, 549
Zygomatic arch fractures
closed reduction and treatment
anatomy, 871, 871f
complications, 875
definition, 871
Gilles approach, 872–873
imaging, 872
Keen approach, 874, 874f
merits and demerits, 874b
nonoperative management, 872
outcomes, 875
patient history and physical findings, 871–872
percutaneous approach, 872
postoperative care, 875
surgical management, 872
osteotomy, 850, 1274
Zygomatic branches, skin-only face and neck lifting, 196
Zygomatic fractures, open correction of
alternative treatments, 881–882, 882f
anatomy, 876, 877f
complications, 883
definition, 876, 876f
imaging, 878
merits and demerits, 882b

nonoperative management, 878
outcomes, 883
patient history and physical findings, 876–877, 877f
postoperative care, 882–883
surgical management, 878
ZMC fracture, three-point fixation of, 879–881, 879f, 880f
Zygomatic sphenoid (ZS) suture, 823
Zygomaticofacial nerve, 392
anatomy, 966, 966f, 1084, 1085f
Zygomaticofrontal (ZF) suture, 185–187, 187f, 876
Zygomaticomaxillary buttress (ZMB), 876
Zygomaticomaxillary complex (ZMC) fracture, 823, 826, 871, 871f,
876–877, 876f, 881
late malpositioning of
anatomy, 884, 884f
camouflage corrections, 887b
complications, 888
correction requiring osteotomies, 887, 887f
definition, 884
imaging, 884, 885f
merits and demerits, 888b
nonoperative management, 885
outcomes, 888
patient history and physical findings, 884
postoperative care, 888
reconstruction and fixation, 888
surgical management, 885–886, 885f, 886f
open reduction internal fixation, pediatric midface fractures,
955–956
three-point fixation of, 879–881, 879f, 880f
Zygomaticosphenoid (ZS) suture, 876
Zygomaticotemporal (ZT) nerve, 70
anatomy, 966, 966f, 1084, 1085f

scalp reconstruction with rotation flaps, 980
suture, 876
Zygomaticus major muscle, anatomy, 1073, 1073f
Zygomaticus minor muscle fibers, 32