The Unfavorable Result in Plastic Surgery_ Avoidance and Treatment (2018, Thieme)

SECTION IX BURNS
1366
making skin grafts a good solution for wound reconstruction
when a donor site is available. Split-thickness skin grafts are
commonly chosen over full-thickness grafts for reconstruc­
tion. When inset as two separate aesthetic subunits, one in
the submental plane and one in the vertical plane, the cervi­
comental angle is restored, resulting in a good range of neck
movement and an aesthetically pleasing contour6 (Fig. 70.8).
When available, local regional flaps from the neck,
shoulder, and chest, such as a deltopectoral flap, may be
used for reconstruction with better color and texture match
of anterior neck contractures.7
Free flaps have also been used with great success, be­
cause they have the advantage of providing pliable tissue
from a donor site away from the burn injury with minimal
donor site morbidity. This has resulted in good neck mobil­
ity and contour without the need for prolonged postopera­
tive splinting and with a low contracture recurrence rate8
(Fig. 70.9).
can lead to debilitating functional deformities. At times,
these scar contractures need to be addressed during the
inflammatory stages of healing for improved airway access
and restoration of oral competency for adequate nutritional
intake. Furthermore, neck contractures exert an extrinsic
force to distort facial features, thus limiting ADLs. Effects
can include poor speech, drooling, and poor oral hygiene,
and the resulting physical deformity can be psychosocially
very stressful for the patient. Neck contracture should be
addressed before facial reconstruction, because this ten­
sion serves as an extrinsic force, which can severely affect
facial scar maturation. Neck contracture reconstruction in­
volves skin grafting and the use of dermal substitutes, local
flaps when available, and tissue expansion and distant or
free tissue transfer.
Contractures caused by limited scarring may be released
with z-plasties alone. Larger, more diffuse scar contractures,
however, once released or excised, result in large defects,
a
b
c
Fig. 70.8 (a) A 32-year-old man with early neck burn scar contracture after a 60% flame burn. (b) Intraoperative release of the scar with
minimal excision and platysma flap release. (c) A thick split-thickness skin graft to the anterior and lateral neck releases.

1367
Chapter 70 Burns of the Body and Extremities
Postburn Deformities of the Upper
Extremity
Upper and lower extremities suffer most from contrac­
tion deformities after injury, especially the deeper dermal
­injuries that require grafting. Immediate postoperative
splinting regimens in conjunction with scar massage and
compression (whether from elastic wraps or custom gar­
ments) are essential to minimizing such deformities. Splint­
ing and compression are often continued during the entire
maturation phase—even if it takes 2 to 3 years to complete—
to minimize subsequent reconstructions (Fig. 70.10).
Axilla
Axillary contracture is common, because it is challenging
to maintain an abducted position during the acute phase.
c
a
b
Fig. 70.10 Custom compression garments are often “easier” to pull
on than compression wraps with their customizable zippers or hook-
and-eye closures.
Fig. 70.9 (a) Severe facial scars from a flame burn. (b) Radial forearm free flap reconstruction of the lower face at age 22 years. (c) Early
postoperative result. (These images are provided courtesy of Dr. Peter Grossman.)

SECTION IX BURNS
1368
of the hand and upper extremity to minimize inflamma­
tion and maximizing the efforts of occupational therapy.
Stretches, splinting, and early return of ADLs are key to
prevention. These contractures range from a single band
to diffuse scarring deep within the joint. Isolated scars are
often addressed using a z-plasty. Where a concave surface
is desired, a five-flap z-plasty is quite useful. Larger con­
tractures may require grafting, flaps, or a combination of
these. In severe cases involving the biceps tendon, splint­
ing is often used in combination with rehabilitation until
scars mature. This is followed by surgical scar lengthening.
After secondary reconstruction, the elbow is maintained in
extension. As with most extremities and joints, early mobi­
lization and physical therapy are crucial to achieve the full
extent of the reconstruction2 (Fig. 70.11).
Heterotopic ossification affects approximately 1 to 3%
of burn patients.11 This transformation of primitive mesen­
chymal cells in soft tissue to mature lamellar bone is most
Contractures are described as bands that are isolated and
anterior or posterior. These are addressed using local flaps
followed by rigorous physical therapy. When performing
flaps in this region, the surgeon must pay close attention
to ensure that skin that bears hair or sweat glands is not
transposed to a more conspicuous area. In more significant
contractures, release of the underlying pectoralis or latis­
simus muscle may be necessary. Skin defects are often cov­
ered with split-thickness skin grafts, which increases the
risk of recurrence of contracture. In addition, limitations on
mobilization during revascularization may hinder ultimate
range of motion.2,9,10
Elbow
The elbow favors a flexed position after acute burn recon­
struction; thus a flexion contracture is most common in
this area. Early steps to prevent this include early grafting
a
b
c
d
Fig. 70.11 (a) A 22-year-old man 1 year after a burn injury with antecubital burn scar contracture. (b,c) The contracture was released using
one-stage AlloDerm (Acelity) and thin split-thickness skin grafting (both meshed 1:1). (d) Result at 6 months.

1369
Chapter 70 Burns of the Body and Extremities
Flexion contracture of the proximal interphalangeal
(PIP) joints and extension contracture of the metacarpal
phalangeal (MCP) joints (claw hand) is a complex defor­
mity involving shortening of the MCP collateral ligaments
and stronger forces of the digital flexors over the IP joints.
This deformity requires complete excision of scar tissue and
full-thickness skin grafts to the tissue defect (Fig. 70.12).
Distant tissue transfer and joint capsulotomy may be re­
quired if there is exposure of the tendon or joint. Groin and
radial forearm flaps have been described in the literature.
Tissue expansion of the extremities is problematic be­
cause of an increased risk of extrusion and nerve injury.
Small-volume expansion sessions may help ameliorate these
complications (Fig. 70.13).
Postburn Deformities of the Lower
Extremity
Knee, Ankle, Foot, and Toes
Contracture of the lower extremity and particularly of the
foot create significant functional limitations. Although
scarring involving the superficial tissue may cause minimal
functional deficits and can be treated with scar release and
local tissue rearrangement, moderate and severe contrac­
tures with tissue deficits require grafting, tissue transfer,
and/or procedures directed specifically at the joints, par­
ticularly if tendon shortening is noted or with fibrosis of
the joint capsules. Children are often more susceptible
to severe injury because of their thinner skin and greater
common in the elbow. Although heterotopic ossification was
initially believed to be worsened by early forceful stretching
after a burn, recent literature suggests this does not appear
to be a contributing factor. Controversy exists as to the tim­
ing of intervention, but in the elbow it is usually performed
by a posterior incision through which the heterotopic bone
is removed. Some authors suggest that early continuous pas­
sive motion is helpful in the postoperative phase.11
Wrist, Hand, and Fingers
Web space contractures are also known as burn syndac­
tyly. These are generally addressed with scar excision and
local tissue rearrangement or grafting. Contracture of the
first web space, particularly in adduction, limits a patient’s
grasping ability. Milder cases are often addressed using a
four-flap z-plasty to recontour the concavity. More severe
cases involving the adductor pollicis muscle and fascia may
require division of these structures followed by full-thick­
ness grafting.2,12–14
The most common and functionally limiting contrac­
tures are those of the web space, hand, and digits. The hand
should be a priority for early excision and thick skin grafting
in patients with upper extremity acute burns. Preference is
given to grafting the dominant hand. Skin grafts should be
layered longitudinally with seam lines parallel to the meta­
carpals. Mesh grafts are avoided in all but the most massive
total body surface area burn cases. Grafts in the web spaces
should be zig zag cut to prevent rounding of the dorsal web
space. Splinting and early occupational therapy are key pre­
ventive measures.
a
b
c
Fig. 70.12 A 2-year-old boy 1 year after a full-thickness burn to the volar index and middle fingers. Despite nocturnal splinting, a flexion
contracture band developed that required release and full-thickness grafting from a groin donor site. Color mismatch can be improved
when the patient is older.

SECTION IX BURNS
1370
scar. If the popliteal or posterior skin is spared, local flaps
have good results. If the popliteal region is diffusely involved,
the surgeon must be mindful of the underlying neurovascu­
lar structure during the scar excision. Scar excision is often
followed by grafting (Fig. 70.14).
Ankle mobility is hindered by dorsal contracture, which
limits plantar flexion, and contracture of the Achilles ten­
don, which limits dorsiflexion. The dorsal tissue is often
thin in this region, which can lead to exposed tendons after
excision. Grafts can be used, but in recent literature some
propensity to scar. In children this may lead to permanent
skeletal deformities. Before undertaking this complex re­
construction, the surgeon must perform a detailed assess­
ment of range of motion, complete radiographic studies,
and assess posture and gait. The dependence of the lower
limbs contributes significantly to edema and ultimate heal­
ing, and reconstruction of these deformities demands con­
sideration of these details.
The knee most commonly experiences a flexion contrac­
ture because of medial or lateral bands of diffuse popliteal
a
b
Fig. 70.13 This 40-year-old man desired removal of his skin graft scar. Slow tissue expansion allowed for local flap reconstruction.
a
b
Fig. 70.14 (a) A 9-year-old boy with symptomatic linear contracture bands on both popliteal spaces. V-Y plasty and multiple z-plasties were
used for correction. (b) The releases are stable at age 15 years.

1371
Chapter 70 Burns of the Body and Extremities
ing to preserve healthy tissue by minimizing deep débride­
ment where feasible. Recognition and preservation of viable
breast bud tissue in both males and females is paramount.
Inframammary contracture release is carried down to mus­
cle fascia and onto healthy skin. If this contracture is severe,
superior incision may be necessary, along the nipple–­areola
complex or between the breasts. A spit-thickness graft may
then be used to cover the exposed tissue. Custom “T” gar­
ments are often worn for 6 to 12 months to allow for full scar
maturation. Then breast mound reconstruction commences.
Secondary or delayed reconstruction is considered after the
patient has completed full breast and scar maturity. All re­
constructive breast options are then available for creating an
aesthetic breast mound.
Inferior outcomes have been reported using tissue ex­
panders because of the unpredictable expansion of burned
skin. Many advocate the use of a latissimus dorsi myocu­
taneous flap and an implant. Transverse rectus abdominis
muscle (TRAM) flaps are useful in older patients but are not
feasible in younger, thin women, because they have minimal
abdominal laxity18 (Fig. 70.16).
Torso
Besides the breast, the position of the umbilicus and the
symmetry of the waist all add to the aesthetics of a post­
burn anterior torso result. Larger meshed grafts are often
used on the torso with the belief that the cosmetic appear­
ance is not as important as it perhaps is on an extremity.
However, the soft tissues of the abdomen and torso are also
subject to contraction deformities. If donor site limitations
in the acute burn phase limit sheet grafting, consideration
for tissue expansion and large flap rotations are options for
restoration of symmetry.
­authors suggest various designs of local flaps. The foot has
both a horizontal and a longitudinal arch, and restoration
of both should be considered in the extent of the release
(Fig. 70.15).
Dorsal contracture of the foot leads to hyperextension
of the toes. Wearing shoes is thus difficult when the toes
are dorsally subluxed. This contracture is released using a
transverse incision along the dorsum at the metatarsopha­
langeal (MTP) joints. Next a graft is inserted and the phalan­
ges are often held in gentle flexion using Kirschner wires to
immobilize the MTP joints. Similar to the hand, a claw toe
deformity can occur with flexion contracture of the digits;
it is managed similarly to technique for the hands described
previously.15,16 After wire removal, a soft splint is inserted
into the shoe toe box to continue postoperative compression
and scar manipulation.
Postburn Deformities of the Torso
Breast
Prepubescent burns can affect breast development, because
thermal injury and the resulting burn scars inhibit normal
growth of immature breast tissue. All care must be taken
with acute surgeries to leave the nipple and breast bud at­
tached to the chest wall, even if viability is in question. Au­
thors advocate early release during the inframammary phase
of healing to prevent any growth restriction.2,17 Secondary
reconstruction should not be undertaken until completion
of development. Reconstruction is broken down into early or
initial release, in which tangential excision is used while try­
Fig. 70.15 Longitudinal and transverse arch release lines.
Fig. 70.16 A 60-year-old woman more than 30 years after a breast
tissue expansion reconstruction with saline implants, nipple recon­
structions with local flaps, and skin grafts.

SECTION IX BURNS
1372
Perineum
Contractures in the perineum restrict function and com­
plicate hygiene. Mild or moderate contracture result from
transverse scar folds between the thighs. These are ad­
dressed by use of local trapezoid flaps. The length and
width of these flaps vary based on burn severity and co­
morbidities. Larger defects often require grafting or larger
flaps. Full-thickness skin grafts are recommended to mini­
mize the contracture in this region. Perineal obliteration is
usually accompanied by inguinal and perineal contractures
and genitalia injury. Perineal obliteration (scar bands fully
covering the urethra, vagina, or rectal openings) or total
perineal contracture is formed without the fold that is pres­
ent in mild or moderate injury. Large surface area deficits
and absence of a fold in the perineum eliminates the ability
to achieve contracture release with local tissues. Success is
usually only achieved by free or pedicle flaps. Groin flaps
are useful in this situation. In the case of perineal and in­
guinal contractures, two groin flaps can be used simultane­
ously. The flap design can be single lobed or bilobed.
With a steady axial blood supply, few postoperative
complications are reported. In addition, the flap is ideal in
children, and it will tend to grow, thus minimizing contrac­
ture recurrence. Hip adduction contracture severely limits
function. In these patients, the hip usually remains in ad­
duction at rest, and thus grafts will often cause recurrent
contracture as they heal in this position.20,21
After reconstruction, a subsequent or simultaneous
procedure to create symmetry is often performed on the
contralateral unburned breast. The nipple–areolar complex
reconstruction should take place no sooner than 6 months
after the mound reconstruction. If native nipple remains, it
may benefit from surgical release and local flaps to improve
projection. Composite grafts may be used to replace absent
nipples. Full-thickness skin graft, often from the inner thigh,
can be used for areolar reconstruction; some women prefer
to undergo tattooing several months later (Fig. 70.17). Tat­
toos are problematic in grafted skin, however, and may have
limited success with scar tissue.2,17
Abdomen
Some authors report the use of modified abdominoplasty
for releasing burn scar contractures, which provides
body contouring as well as burn scar release. Appropriate
­generation of healthy skin flaps using skin excess can be
used to reconstruct regions affected by burn scars. Using
this skin excess provides match in color, texture, and thick­
ness, which can optimize the aesthetic appearance of this
burn reconstruction. Some surgeons use multiple stages for
this procedure, using tissue expansion and scar contrac­
ture release, particularly if the patient does not have ample
excess healthy abdominal skin.19 The postpartum abdo­
men is often ideal for timing of abdominal scar resection
(Fig. 70.18).
a
b
Fig. 70.17 This 11-year-old boy, 5 years after a burn, desired nipples for cosmesis to avoid “stares in the gym locker room.” The patient and
his father chose the location and color of the nipples.

1373
Chapter 70 Burns of the Body and Extremities
burn pruritus remains a significant problem for all burn
patients. Some patients experience postburn itch for life.
Fat graft transfer is a new modality that seems to have the
potential for relieving chronic itch (Fig. 70.19). Placement of
even small aliquots of fat under scars, grafts, or donor sites
may relieved chronic itch (and thus is our personal practice).
Newer Modalities for Postburn Scar
Revisions
Despite the ability to provide more sheet grafts for larger
burn surface areas, and despite the use of dermal replace­
ment technologies in addition to thin split-skin grafts, post­
a
b
c
Fig. 70.18 A 14-year-old boy 2 years after a burn. Three extra-large tissue expanders were used to create large flaps to reconstruct his an­
terior axilla and reposition the umbilicus.

SECTION IX BURNS
1374
is stiff and noncompliant. We usually fill the expander no
more than 10% of its maximum volume per session.
Large hematomas should be promptly evacuated to pre­
vent device infection. In the case of a seroma, simple percu­
taneous draining, taking care to not injure the expander, can
be performed in the clinic. If the expander becomes exposed
without being grossly infected, expander salvage can be at­
tempted in the operating room under sterile conditions. If
the expansion process is almost complete and the expander
is minimally exposed but not overtly infected, we recom­
mend continuing the expansion process without manipulat­
ing the wound or device. In the case of a gross infection with
purulent drainage, the expander should be removed and the
wound allowed to heal before replacement of the device.
Skin Grafts
Complications associated with skin grafting occur in the
acute setting or later, as the healing process evolves. Nonad­
herence of a skin graft in the acute setting most commonly
occurs secondarily to hematoma and seroma formation or
infection. Hemostasis must be achieved before placement
of the skin graft. It is our practice to use a fibrin sealant
to affix split-thickness skin grafts. It is easy to use, elimi­
nates the need for sutures or staples when placing larger
split-thickness skin grafts, and decreases dead space. This
full surface adherence therefore decreases the incidence of
hematoma and seroma formation.24,25
Complications in Postburn
Reconstruction
Tissue Expansion
Complications associated with tissue expansion range from
7 to as high as 24%. The most common complications in­
clude implant exposure, infection, tissue necrosis, seroma,
hematoma, capsule contracture, and device failure and
rupture.22 The risk of complication also increases based on
anatomic site on expansion. Tissue expanders placed in the
head and neck region, followed by the lower limbs, have
the highest rate of associated complications. The trunk has
the lowest rate of associated complications.23
To minimize the risk of complications associated with
expander placement, the surgeon should first débride all
nonviable tissue and make a pocket larger than the expander
so it does not fold on itself and to reduce tension on the over­
lying skin.23 External valves should be avoided, and the port
should be placed under normal skin and away from the
expander if possible. The port should be placed in a small
pocket and sutured in place to prevent it from flipping up­
side down. The surgeon must be meticulous when achieving
hemostasis and in performing a two-layered closure. The
expansion process begins when the wound has healed and
progresses much slower than in nonburn patients. This is
because the burn scar adjacent to the tissue being expanded
a
b
Fig. 70.19 (a) This 14-year-old girl 13 years after a burn was experiencing chronic itch and tightness in her right thigh scar. (b) Two months
after 10 cc of fat were grafted from the abdomen. Her pruritus scale decreased from 10 to 0.

1375
Chapter 70 Burns of the Body and Extremities
be used in cases of exposed vital structures to promote
granulation that may eventually be reconstructed with a
skin graft rather than free tissue transfer.
Free Flaps
The most dreaded complication after free flap reconstruc­
tion is vascular compromise leading to complete flap loss.
Free flap failure occurs in 10% of burn patients and can be
reduced by avoiding free flap reconstruction during the
first 6 weeks after burn injury. This time allows for the sys­
temic inflammatory response to subside. Early flap perfu­
sion problems in burn patients should be managed acutely
as they are in any free flap reconstruction. This includes
systemic anticoagulation and operative exploration with
arterial or venous anastomotic revision when indicated. In
the case of complete flap loss, coverage with another free
flap may be a better choice if amputation is the only other
option. In the case of incomplete flap loss, débridement of
necrotic tissue and skin grafting are often indicated.26
Conclusion
Many of the common unfavorable postburn scar problems
are related to the genetic disposition of the patient and
the severity of the initial burn. However, there are some
finesse techniques that an astute acute burn surgeon can
use to prevent the need for complex postburn reconstruc­
tion. When contractures and scars do result, prioritizing
postburn reconstructive needs and pairing these needs
with available donor sites will ensure that a successful re­
constructive plan is completed to the patient’s satisfaction.
Understanding the limits and usefulness of adjuvant skin
products such as dermal substrates and lasers will broaden
the reconstructive ladder and simplify the postsurgical
care needed to achieve cosmesis and function. The success
of current burn care is not only measured by the survival
rate, but also in the number of patients who are able to re­
turn to a full and active life.
Skin grafts can be salvaged if the hematoma or seroma
is identified and treated early. In the case of skin graft loss
where infection of the wound bed is suspected, biopsy of the
wound bed for culture should be performed and treatment
of the infection completed before reoperation.
Reconstructions that are performed in the setting of
surrounding skin grafts that have already healed should
be done with care to not disrupt the adjacent skin graft.
Blood supply to healed skin grafts comes from the wound
bed below, and any skin graft that is avulsed or lifted from
the wound bed will be lost. In addition, when working in
an area of previous skin grafting and scar, poor soft tissue
handling may lead to delayed wound healing. When per­
forming scar release, placing too small a flap or graft in the
released scar bed will result in recurrence of unstable scars
and open wounds.
Flaps
Local and Regional Flaps
Complications of performing flap coverage of a burn wound
include wound infection, seroma, hematoma, and flap ne­
crosis. Infections should be managed expectantly with an­
tibiotic therapy when appropriate, or incised and drained
in the case of gross purulent infections. Hematomas should
be promptly evacuated to prevent pressure and ischemia of
the overlying flap. Seromas can usually be drained by per­
cutaneous means in the office setting. Flap necrosis can oc­
cur secondary to excess tension of the closure, compromise
of the perforator in axial flaps, or an inadequate length-to-
width ratio in random flaps. Unlike free flaps, however, flap
loss for local and regional flaps is often incomplete when
it does occur. Débridement of necrotic tissue should be
performed; if there are no exposed vital structures, the
wound can be allowed to heal by secondary intention or
skin grafted for larger defects. In the case of exposed vital
structures after local flap failure, free flap coverage should
be considered. Alternatively, dermal skin substitutes may
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Discussion by Sigrid Blome-Eberwein
At our burn center scar treatment and reconstruction
have been an integrated part of burn care for the past
17 years. We recognize that one of the most important
steps to a successful reconstruction and reintegration
of the burn survivor of any age is the assessment of the
disability in the context of the entire person as opposed
to just “reconstructing a scar.” This means one must
consider the “sickness factor” related to hospital stays
and recovery from surgeries and anesthesia, as well as
the possibility of causing a flare-up of ­posttraumatic
stress disorder with each new intervention, as much as
the available “donor site real estate.”
I encourage surgeons to consider using the phrase
scar rehabilitation, a term coined by Dr. Matthew Do­
nelan,1 over scar excision as the optimal treatment for
scars, unless they are very small or in areas of excess
skin and the new excision scar can be hidden. Scar exci­
sion, whether serial or via expander placement, always
leaves a certain deformity in skin line orientation and
contour that is sometimes more aesthetically disturbing
than the original scar. Especially when using expand­
ers, multiple new scars are usually created, and often
there will be a new asymmetry between the two sides
of the body (Fig. 70D.1). When dealing with functional
Fig. 70D.1 (a) Arm expanders in place. (b) The same patient with a contour deformity after scar excision on the lower arm, re­
quiring further corrective surgery.
a
b

1377
Chapter 70 Burns of the Body and Extremities
impairment, of course, these unwanted effects of scar
reconstruction must be accepted.
Avoiding and Managing Unfavorable
Results in Scar Rehabilitation
Local Flaps and Z-Plasties
Scar skin is particularly vulnerable to venous stasis and
disruption of blood supply. Z-plasties need to be de­
signed in an almost 90-degree angle to avoid tip necro­
sis. Epidermolysis is common postoperatively, and the
scar should be at least 1 year old before it is rearranged
(Fig. 70D.2).
Intralesional z-plasty is used for hypertrophic scars
to rearrange the tension across the scar, and CO2 laser
treatments are then useful to improve the overall scar
appearance and feel (Fig. 70D.3).
Steroid Injections
Intralesional injections of steroids are useful in lim­
ited scar areas and decrease severe pruritus and scar
tightness. Especially in young children, underlying fat
atrophy is common, even with strictly intralesional
injection, and a blue discoloration is often visible for
months to years. The fat atrophy recovers over years in
most cases; the vascular bluish discoloration is often
permanent. Laser-assisted steroid delivery may leave a
more favorable result, but controlled long-term studies
are not available (Figs. 70D.4 and 70D.5).
Fat Grafting
I have experienced great success using fat grafting to
remodel thick adherent scars and relieve pain related to
the tethering of adherent scars over muscle and tendon.
Fig. 70D.2 Epidermolysis and tip necrosis after z-plasty for con­
tracture in a 2-year-old burn scar.
a
b
c
d
Fig. 70D.3 (a) A hypertrophic cheek scar. (b) The same patient as in (a) after intralesional z-plasty for tension rearrangement.
(c) The same patient 2 years later. The hypertrophy is decreased (additional z-plasty of neck has been performed). (d) Another
patient after neck contracture release with intralesional w-plasties. The chin scar was not touched.

SECTION IX BURNS
1378
Fig. 70D.4 Hypertrophic scars 6 months after steroid injection centrally with blue discoloration and fat atrophy.
b
Fig. 70D.5 (a) Hypertrophic scar 2 years
after a burn and scar management.
(b) Two years after steroid injection, the
patient had fat atrophy and a contour
deficit. (c) Nine years later, the fat atro­
phy has resolved and the contour deficit
autocorrected.
c
a

1379
Chapter 70 Burns of the Body and Extremities
A large series of this technique controlling for outcome
has recently been published.2 To avoid complications,
the surgeon must be careful not to overfill after scar
subcision (Fig. 70D.6).
Fractional CO2 Laser Treatment of
Burn Scars
Fractional CO2 laser treatment of hypertrophic scars is
now a well-established modality; a prospective con­
trolled study from my institution supports the large
clinical case series by Hultman and colleagues,3 Ander­
son et al,4 and others.5,6 Postlaser hyperpigmentation is
not uncommon (Fig. 70D.7).
I now treat scars as early as 2 months after wound
closure with similar effects, sometimes preventing the
extreme hypertrophy from developing (Fig. 70D.8).
Postoperative Care
It cannot be overemphasized that postoperative and
posthealing care in the form of splinting, stretching,
and other occupational and physical therapy are at
least as important for success, especially when dealing
with contracture releases, as the operative interven­
tion. We use nighttime splinting with silicone inlays
for all web space contracture releases and dynamic
splints for elbow and axillary contracture releases for
a
b
Fig. 70D.6 (a) A popliteal fossa and calf immediately after autologous fat grafting and scar subcision. (b) Three weeks later the
patient experienced epidermolysis and an open wound on the popliteal fossa.
F ig. 70D.7 Postlaser hyperpigmentation.

SECTION IX BURNS
1380
3 months. Patients who have a neck contracture release
need to wear their stiff collar for 3 to 6 months at night.
Insetting grafts in a z-plasty fashion seems to be coun­
terintuitive when healthy tissue has to be sacrificed to
achieve a nonstraight line insetting.7
Pigment Restoration
Two fairly new methods may be used in place of the
extra-thin graft reconstruction for the hypopigmented
scars mentioned in the chapter. Both dermabrasion and
spray-cell application and dermabrasion and fractional
blister grafting have been used with good success in
vitiligo.8–10 Keep in mind that dermabrasion of scars
can always cause hypertrophy.
Dermal Regeneration Templates
The use of dermal regeneration templates plus split-
thickness grafting is well established to replace full-
thickness grafting in certain indications. The resulting
skin is thinner, is more pliable, and does not adhere to
tendon or muscle like split-thickness graft alone11,12
(Fig. 70D.9). Tactile sensation, hair follicles, and oil
glands can not be restored to date with these tem­
plates. I have found that change of gloves after release,
a disinfectant wash of the wound bed, and limited
handling of the matrix combined with a vacuum-
assisted closure dressing provides the best protec­
tion from shear forces, hematoma, and infection (Fig.
70D.10).
Neck Reconstruction
In neck reconstruction, a platysma release is almost
always indicated to achieve sufficient contracture re­
lease, as described by Ninkovic and colleagues13 (Video
70D.1). Small subcutaneous bands can be released
a
b
Fig. 70D.8 (a) A hypertrophic burn scar in a teenage patient. (b) One year later, after five CO2 laser treatments.
Fig. 70D.9 Pliability of scar after use of an Integra dermal re­
generation template and skin grafting.
Fig. 70D.10 Neck collar and vacuum-assisted closure dressing
for stabilization after Integra dermal regeneration template
placement.

1381
Chapter 70 Burns of the Body and Extremities
­under local anesthesia with a braded suture as de­
scribed by Haik et al14 (Fig. 70D.11).
Burned Breast Reconstruction
In postburn breast reconstruction, often a contracture
band has formed between the axilla and upper arm and
the breast. Release of this contracture line by anterior
axillary line release with local flaps and/or a dermal
regeneration insert lets the breast fall more naturally.
Contralateral reduction and mastopexy may be another
option to correct asymmetry. Skin graft take on breast
tissue is notoriously marginal (Fig. 70D.12). This needs
to be considered to avoid complications, and a two-
stage procedure with wound bed conditioning may be
indicated.
Fig. 70D.11 (a) A patient with postburn neck contractures from subcutaneous contracture bands after multiple z-plasties. (b) Im­
mediately after subcutaneous contracture band release and CO2 laser treatment. (c) Result 8 weeks later.
a
b
c
Fig. 70D.12 Breast wound after split-thickness skin graft failure.

SECTION IX BURNS
1382
Perineal Burn Scar Reconstruction
Complications in perineal burn scar reconstruction
are common because of the location and the fact that
most burn survivors with these types of scars also
suffer from severe hand deformities that limit their
ability to perform personal hygiene. These patients
should not be discharged home immediately after re­
construction and need abduction pillows and other
splinting material in place for several weeks. The
gracilis flap is another useful local flap in this situa­
tion (Fig. 70D.13).
Pediatric Postburn Toe Contracture
Toe extension contractures in small children are
common and are probably one of the most challeng­
ing problems in burn reconstruction. I usually start
the process with web space releases, followed by scar
release and full-thickness graft insertion in addition
to scar subcision and local tissue rearrangement,
then by CO2 laser treatments. Postreconstruction
splinting is crucial to prevent recurrence. Sometimes
serial casting is required in very small children (Fig.
70D.14).
Conclusion
Burn scar reconstruction can be challenging because of
the altered elasticity and blood supply of the scarred tis­
sues. Most severe burn survivors have large body surface
area scars with limited nonscarred tissue availability.
Some reconstructive options are therefore often not avail­
able in this setting, and complications are more common.
a
b
Fig. 70D.13 (a) Severe perineal contracture. (b) Immediately after z-plasty and perineal advancement flap; an abduction pillow
was used postoperatively.
Fig. 70D.14 Immediately after web space release and contracture
release for a second toe extension contracture in a pediatric patient
and an Achauer flap for nail bed contracture of the second toe.

1383
Chapter 70 Burns of the Body and Extremities
References
1. Proceedings Of The. “Scar Wars” Meeting 7th World
congress on pediatric burns, August 29-September1,
2014
2. Jaspers ME, Brouwer KM, van Trier AJ, Groot ML, Mid­
delkoop E, van Zuijlen PP. Effectiveness of autologous
fat grafting in adherent scars: results obtained by a
comprehensive scar evaluation protocol. Plast Recon­
str Surg 2017;139(1):212–219
3. Hultman CS, Friedstat JS, Edkins RE, Cairns BA, Meyer
AA. Laser resurfacing and remodeling of hypertro­
phic burn scars: the results of a large, prospective,
before-after cohort study, with long-term follow-up.
Ann Surg 2014;260(3):519–529, discussion 529–532
4. Anderson RR, Donelan MB, Hivnor C, et al. Laser treat­
ment of traumatic scars with an emphasis on ablative
fractional laser resurfacing: consensus report. JAMA
Dermatol 2014;150(2):187–193
5. Ozog DM, Liu A, Chaffins ML, et al. Evaluation of clini­
cal results, histological architecture, and collagen
expression following treatment of mature burn scars
with a fractional carbon dioxide laser. JAMA Derma­
tol 2013;149(1):50–57
6. Qu L, Liu A, Zhou L, et al. Clinical and molecular effects
on mature burn scars after treatment with a fraction­
al CO(2) laser. Lasers Surg Med 2012;44(7):517–524
7. Anthonissen M, Daly D, Janssens T, Van den Kerck­
hove E. The effects of conservative treatments on
burn scars: A systematic review. Burns 2016;42(3):
508–518
8. Bao H, Hong W, Fu L, Wei X, Qian G, Xu A. Blister roof
grafting, cultured melanocytes transplantation and
non-cultured epidermal cell suspension transplanta­
tion in treating stable vitiligo: A mutual self-control
study. J Dermatolog Treat 2015;26(6):571–574
9. Ashique KT, Kaliyadan F. Long-Term Follow-up and
Donor Site Changes Evaluation in Suction Blister Epi­
dermal Grafting Done for Stable Vitiligo: A Retrospec­
tive Study. Indian J Dermatol 2015;60(4):369–372
10. Purschke M, Asrani FA, Sabir SA, Farinelli WA, An­
derson RR. Novel methods for generating frac­
tional
epidermal
micrografts.
Br
J
Dermatol
2015;172(4):1021–1028
11. Dantzer E, Braye FM. Reconstructive surgery using an
artificial dermis (Integra): results with 39 grafts. Br J
Plast Surg 2001;54(8):659–664
12. Schneider J, Biedermann T, Widmer D, et al. Matri­
derm versus Integra: a comparative experimental
study. Burns 2009;35(1):51–57
13. Ninkovic M, Moser-Rumer A, Ninkovic M, Spanio S,
Rainer C, Gurunluoglu R. Anterior neck reconstruc­
tion with pre-expanded free groin and scapular flaps.
Plast Reconstr Surg 2004;113(1):61–68
14. Haik J, Prat D, Kornhaber R, Tessone A. Treatment of
cervical contractures utilising a closed platysmotomy
like approach: Case report and review of the litera­
ture. Burns 2016;42(6):e93–e97

(Trang không có chữ)

INDEX
IN-1
Index
A
abdominal reconstruction. see chest
wall, abdomen reconstruction
abdominoplasty
–
–
bleeding, clotting, 468–469, 468f
–
–
burn management, 1372, 1373f
–
–
cellulitis, 465
–
–
complications, unfavorable results,
456, 471–473
–
–
dissatisfied patient, 469, 472
–
–
drain usage, 473
–
–
excess soft tissue removal,
456–459, 457–459f, 475, 476f
–
–
flap viability, 465–468, 467f, 473
–
–
fleur-de-lis, 457, 457f
–
–
hematoma, 468, 468f
–
–
infection, 69f, 98, 465, 466f, 473
–
–
ischemia, 465–468, 467f, 473
–
–
liposuction concurrent with, 459,
459f, 463, 475
–
–
markings, 460f, 475
–
–
necrosis, 465–468, 467f, 473
–
–
pain management, 473, 475–476
–
–
patient selection, 473–475, 474f
–
–
postoperative care, 476–477
–
–
pseudobursa, 463–465, 464f
–
–
rectus diastasis correction,
459–461, 459–461f, 471f
–
–
reverse, markings, 457, 458f
–
–
scar placement, quality, 461–462,
461–462f, 474–475, 476f
–
–
seroma, 463–465, 464f
–
–
trifecta of, 470–471, 471f
–
–
umbilicus, 462–463, 463f, 475
–
–
unanticipated sequelae incidence,
68, 68f
–
–
venous thromboembolism, 70, 70f,
469, 473, 475
Accreditation of Ambulatory Surgery
Facilities, Inc. (AAAASF), 65–67
acellular dermal matrix
–
–
breast augmentation, 552–555,
553–559f
breast reconstruction (implants), 646,
649f, 660–661, 661–662f
–
–
hernia repair, 1068–1073, 1069–
1073f, 1071t
Acquamid, 146
ActiveFX, 1358
ADM. see acellular dermal matrix
adolescent macromastia, 603
adverse event disclosure
–
–
apology, 75, 76
–
–
communication, 74–76
–
–
empathy, 76
–
–
follow-up, 76
–
–
immediate response, 74
–
–
investigation, 75
–
–
just culture in, 73–74
–
–
overview, 73, 76–77
–
–
principled approach to, 74–76
–
–
process improvements, 76
–
–
reporting, benefits of, 74–75
aesthetic surgery infection risk, 98
see also specific procedures
Airway Outcome Study, 354–355
alginate dressings, 118–119
alloplastic implants
–
–
asymmetry, malposition, 380f,
383, 383f, 397–398, 398f
–
–
bone erosion (remodeling), 400
–
–
chin augmentation, 385, 385–386f,
389f
–
–
complications of, 373, 393–394,
393f, 397–398
–
–
contour deformity, asymmetry,
388–389, 388–389f
–
–
cranium reconstruction, 1015–1017
–
–
dissatisfied patient, 397
–
–
extrusion, 384–385, 399
–
–
facial balance, 394
–
–
facial fractures, complications,
882, 891
–
–
facial implant types, 395–396,
395f, 395t
–
–
gluteal augmentation, 511–512
–
–
Graves’ ophthalmopathy, 375
–
–
hematoma, 392
–
–
implant materials, 377
–
–
implant shape, positioning,
immobilization, 377–378
–
–
infection, 392, 392f, 398–399, 399f
–
–
infraorbital rim augmentation,
378–379, 378–379f
–
–
lower lip muscles injury, 389–390,
390f
–
–
malar area augmentation,
379–380, 380–381f, 400
–
–
malar implant visibility, 383–384,
384f
–
–
mandibular, 385–391
–
–
masseter reattachment, 391, 391f
–
–
neoclassical canons, 376
–
–
nerve injury, 384, 385f, 391,
396–397, 397f
–
–
orthognathic surgery alternatives,
adjuncts, 374, 374–375f
–
–
patient selection, 374
–
–
pediatric facial fractures, 897
–
–
physical examination, 376
–
–
piriform aperture augmentation,
380–381, 381–382f
–
–
piriform aperture extrusion,
384–385, 399
–
–
polyethylene, 377, 395t, 396f, 397,
399
–
–
polyethylene ear framework,
808–809, 809f
–
–
preoperative assessment,
planning, 376
–
–
prevalence of, 394, 394t
–
–
pterygomasseteric sling injury,
390–391f, 391
–
–
radiology, 376

INDEX
IN-2
–
–
ramus, angle, body augmentation,
386–388, 386–388f
–
–
rejuvenation, 375–376, 375f
–
–
silicone, 377, 395t, 396–397, 396f
–
–
skeletal enhancement, 374
–
–
skeletal vs. soft tissue augmenta­
tion, 376
–
–
three-dimensional models of,
393–394
ALT flap characterization, 1067t,
1068f, 1080
American Society for Aesthetic Plastic
Surgery (ASAPS), 67
American Society of Plastic Surgeons
(ASPS), 67
amniotic band syndrome, 1135t
anastomotic stricture, 950–951, 951f,
956, 957f
angioedema, 150–151, 151–152f
angioma, tufted, 819–820, 820f, 822
Angle, Edward H., 785
animal bites, 103–104
antibody-mediated edema (angio­
edema), 150–151, 151–152f
Apert’s syndrome, 736, 737f, 1154
apostrophe lip, 413, 415f
Armour Forse, R., 44t
Arnica montana, 550t
arteriovenous malformation, 811f,
812t, 814f, 814t, 817, 818f
Aspen System (Aspen Rehabilitation),
596
attorneys, decision to seek, 52
augmentation mastopexy. see masto­
pexy, augmentation mastopexy
auricular reconstruction
–
–
adhesive retention, of prostheses,
805–806
–
–
classification of skin approach,
792f
–
–
complications in, 788
–
–
contours, revision of, 793,
793–794f
–
–
contours to reproduce, 789, 789f
–
–
implant-retained prostheses,
806–807, 806–807f
–
–
infection, 791, 794–795, 795f
–
–
intraoperative considerations,
789–791, 790–792f
–
–
overview, 788
–
–
patient selection, 789
–
–
polyethylene ear framework,
808–809, 809f
–
–
preoperative drawings, 789, 790f
–
–
preoperative planning, 789, 789f
–
–
prostheses, 803, 803f, 804–807,
804–807f
–
–
secondary cases, 797–799,
799–802f
–
–
skin necrosis, 791, 792f, 795–797,
796–798f
–
–
soft tissue irritation, 807
–
–
soft tissue remnants, 804–805,
805f
–
–
wear & tear, 805, 805f
Awad, S. S., 43t
Axhausen, Georg, 785
B
Baical skullcap root, 548t
Bak foong pill, 550t
Bellafill, 172–173, 173f
Big Five Model of Teamwork, 39, 39f
bilateral sagittal split osteotomy
–
–
intraoperative complications, 767
–
–
sensory deficit, 770, 771
–
–
vascular compromise, 768–769,
769f
biofilms, 149–150, 154f, 156f, 157,
392
biomedical ethics
–
–
children, minors, 28–29
–
–
cultural values in, 28
–
–
dissatisfied patient, 26–27 (see
also dissatisfied patient)
–
–
foundations, practical tools, 26–28
–
–
labiaplasty, 28
–
–
marketing, advertising, 29, 50
–
–
overview, 25–26, 29
–
–
patient assessment, 26–27
–
–
physician’s obligation to refuse
care, 28
–
–
refusal of care, 28
–
–
social costs/suffering, 27
–
–
valid consent/refusal, 25, 26,
31–32
bite wounds
–
–
animal, 103–104
–
–
human, 104, 1204
–
–
snake, scorpion, spider, 104
black widow spider, 104
Blair, Vilray, 785
bleeding, herbs/supplements associ­
ated with, 548–549t
blepharoplasty. see also eyelid recon­
struction
–
–
aging/baggy eyelid, 273
–
–
anatomy, 266–268, 267–269f
–
–
blepharoptosis, 285
–
–
canthopexy, canthoplasty, 271,
284, 285
–
–
complications of, 268
–
–
continuum of beauty, 286
–
–
corneal damage, 279
–
–
deep-set eyelid, 273
–
–
dryness, 281
–
–
extraocular muscle damage, 279
–
–
globe perforation, 279
–
–
hemorrhage, visual loss secondary
to, 278–279
–
–
infection, 281
–
–
lashes, loss of, 281
–
–
lower lid, 275–276, 276–278f, 285
–
–
lower lid fat resection, 281–282,
282f
–
–
lower lid malposition, 279–280,
280f, 285
–
–
medical history, 270
–
–
Occidental eyelid, 271–273
–
–
patient evaluation, 268–271,
270–272f
–
–
physical examination, 270–271,
270–272f
–
–
preoperative planning, 284, 284f
–
–
ptosis, 280–281, 281f
–
–
scarring, 281
–
–
transconjunctival, 276–278
–
–
transcutaneous lower lid, 275–
276, 276–278f, 285
–
–
treatments, stackable, 286, 286f
–
–
unfavorable results of, 268
–
–
upper eyelid, 271–274, 273–275f,
284–285
–
–
upper eyelid fat resection, 281,
285
–
–
upper eyelid malposition, 280,
280f
–
–
wound dehiscence, 279
blindness, 160–161, 164f
body contouring, post-MWL
–
–
body lifts, 482–484f, 482–486
–
–
brachioplasty, 485, 485–486f,
487–488, 488f
–
–
combination procedures, 492, 492f
–
–
complications, unfavorable out­
comes, 479–480, 485–487, 492
–
–
compression garments, 482, 495
–
–
edema, 482, 495
–
–
excision-site liposuction, 495
–
–
extremity contouring, 481–482,
481f, 485
–
–
gender differences, 496, 497f
–
–
hematoma, 485
–
–
high suprapubic scar, 491–492
–
–
infection, 482, 484
–
–
medial thigh deformity, 485–487,
486–487f
–
–
overview, 478, 479–480f
–
–
overweight patients, 494
–
–
patient selection, 480–481,
493–494
–
–
preoperative planning, 480–481

INDEX
IN-3
–
–
overview, 537
–
–
patient-centered treatment plan,
567
–
–
patient selection, 538–540,
538–540f, 552, 566–567
–
–
periareolar incision, 545
–
–
pneumothorax, 71, 71f
–
–
pocket position, 541–542, 541f,
543f, 570–572
–
–
postoperative care, 546, 567, 570
–
–
preoperative care, 544
–
–
ptosis, 550–552
–
–
quality assurance programs,
67–68, 68f
–
–
revision, 547, 552–555, 553–559f,
566
–
–
seroma, 547
–
–
silicone implants (see silicone
implants)
–
–
site change principle, 552
–
–
sizers, 567
–
–
subfascial pockets, 542
–
–
subpectoral pockets, 542, 543f, 572
–
–
suicide and, 17
–
–
surgical-site infection, 99, 101f
–
–
surgical technique, 544–546, 567
–
–
transaxillary incision, 545–546
–
–
transumbilical incision, 546
–
–
vascular supply, 597–599, 598f
breast-feeding, 604, 613
breast implant–associated anaplastic
large cell lymphoma (BI-ALCL)
–
–
characterization, 575–576,
575–576f
–
–
demographics, 578
–
–
diagnosis, 576f, 577
–
–
epidemiology, 577
–
–
etiology, 577–578
–
–
finger, wrist bone, 577
–
–
management, 578–579
–
–
pathology, cell culture, 578, 578f
–
–
presentation, 576–577, 576–577f
breast reconstruction (autologous
tissue)
–
–
abdominal donor site, 680–681
–
–
algorithm, 679, 679f, 683t
–
–
asymmetry, 667, 670–671, 673f
–
–
burn management, 1371, 1371f,
1381, 1381f
–
–
complications of, 665
–
–
DIEP flaps, 666, 667, 675, 681
–
–
dissatisfied patient, 669, 675
–
–
dog-ears, 675
–
–
fat grafting, 671–672, 671f, 675
–
–
fat necrosis, 666–667, 670
–
–
flap thrombosis, loss, 665–666,
669–670, 669f
–
–
follow-up, 683t
–
–
diplopia, 166
–
–
dry eye syndrome (xeropthalmia),
166
–
–
eyebrow ptosis, 164f, 166
–
–
eyelid ptosis, 165–166, 165f
–
–
injection site trauma, 165
–
–
lack of treatment effect, 167
–
–
lip asymmetry, 166
–
–
lower eyelid effects, 166
–
–
neck weakness, 167
–
–
patient evaluation, 165
–
–
risk management, 170–174,
172–173f
boutonnière deformities
–
–
acute, management of, 1201,
1201f
–
–
anatomy, 1187–1188f, 1188
–
–
chronic, management of, 1202,
1202t, 1203f
–
–
clinical evaluation of, 1198, 1199f
–
–
Fowler procedure and, 1194
–
–
late, 1198, 1199f, 1202, 1203f
–
–
pathogenesis, 1197–1198, 1198f
–
–
pseudo-boutonnière deformity,
1198, 1199f
–
–
relative-motion flexion splinting,
1187f, 1198–1200, 1200f, 1216
–
–
Winslow’s diamond, 1200, 1200f
brachial plexus injuries, 1289,
1293–1299. see also nerve surgery
(peripheral)
brachioplasty, 485, 485–486f,
487–488, 488f
breast augmentation. see also masto­
pexy, augmentation mastopexy
–
–
acellular dermal matrix, 552–555,
553–559f
–
–
bleeding, postoperative, 547,
548–552t
–
–
breast form, 538, 538f, 566, 583,
583f, 592–593
–
–
capsular contracture, 547–552,
554, 558f, 568–569, 569f, 581
–
–
complications, unfavorable results,
537, 546–552, 566–568
–
–
hematoma, 547
–
–
implant malposition, 550–552,
569–571, 571–573f
–
–
implant rupture, deflation, 552
–
–
implant selection, 542–544, 544f,
569–570
–
–
incision length, placement,
540–541
–
–
infection, 69f, 98, 547
–
–
informed consent, 540
–
–
inframammary incision, 544–545
–
–
litigation involving, 55, 56
–
–
outcomes, 560–564f
–
–
scarring, 488–490, 489–490f, 494,
494f
–
–
seromas, 482–483, 482–483f,
494–495
–
–
skin dehiscence, 481–482f,
481–483
–
–
skin necrosis, 482–484, 495–496
–
–
thromboembolism, 482, 484–485,
484f
–
–
truncal deformity, 490–491f,
490–492
–
–
underweight patients, 493–494
–
–
VASER ultrasound, 495
body dysmorphic disorder (BDD),
16–19, 522
bone, joint fractures
–
–
articular, 1225–1227, 1226–1227f
–
–
carpus, 1227–1228, 1228t, 1229f,
1241–1245, 1243–1244f
–
–
Chamay approach, 1225, 1226f
–
–
complex regional pain syndrome,
1238
–
–
condylar malunions, 1225, 1226f
–
–
criteria of acceptability, 1219t
–
–
distal radial (see distal radial
fractures)
–
–
humpback deformity, 1228, 1229f
–
–
infection, 1223–1224, 1224f, 1225f
–
–
ligamentous injuries concomitant,
1241, 1242f
–
–
malunion/impacted fracture dislo­
cation, 1225–1226, 1226f
–
–
malunions, 1219t, 1222, 1223f,
1233–1238, 1234–1237f, 1253
–
–
malunions, decision-making algo­
rithm, 1236f
–
–
management principles, 1218
–
–
nonunions, 1223, 1223–1224f,
1253
–
–
osteomyelitis, 1223–1224, 1224f,
1225f
–
–
phalanges, metacarpals,
1219–1223, 1219t, 1220–1221f,
1223–1224f, 1239–1241, 1240f,
1242–1243f, 1253
–
–
PIP fracture dislocations, 1240–
1241, 1240f
–
–
range of motion, 1221f, 1222
–
–
surgical options, 1219t
–
–
tenolysis, 1221–1222
–
–
treatment options, 1241
bone grafting, secondary in cleft lip/
palate, 705–709, 707–708f
botulinum toxin
–
–
allergic reactions, 165
–
–
complications of, 145, 147
–
–
difficulty swallowing (dysphagia),
167

INDEX
IN-4
–
–
scar excision, 1361
–
–
scar revision, 1373, 1374f
–
–
scarring, 1360f, 1376–1377,
1377–1378f
–
–
skin grafting, 1362–1363, 1365f,
1370f, 1374–1375
–
–
steroids, 1377, 1378f
–
–
timing, 1360–1361
–
–
tissue expansion, 1365, 1365f,
1370–1371f, 1374, 1376–1377,
1376f
–
–
toes, 1369–1371, 1370–1371f,
1382, 1382f
–
–
torso, 1371–1372, 1372f
–
–
upper extremities, 1367–1369,
1367f
–
–
wrist, hand, fingers, 1369, 1369f
–
–
Z-plasties, 1377, 1377f
burn syndactyly, 1369
C
calamine, in scar treatment, 91
calcium channel blockers, in scar
treatment, 92
camptodactyly, 1137
cancer, pathologic fracture treatment,
864t
capillary malformation, 811f, 812t,
813f, 814t, 817
capsular contracture
–
–
breast augmentation, 547–552,
554, 558f, 568–569, 569f, 581
–
–
breast reconstruction (implants),
654–655, 655f
capsulectomy, capsulotomy for
pneumothorax, 71, 71f
caput ulnae (Vaughan-Jackson)
syndrome, 1210–1211, 1210–1211f
cardiac arrhythmia incidence, 71f
carpal fractures, 1227–1228, 1228t,
1229f, 1241–1245, 1243–1244f
carpal tunnel release, 1300, 1305–
1306, 1306f
carpal tunnel syndrome, 1301, 1309,
1321
Cellfina cellulite device, 445, 445f
cheek reconstruction. see also lip
reconstruction
–
–
complications of, 991
–
–
functional units, 998, 1001
–
–
large defects, 991f, 997
–
–
local flaps for, 996–997, 997f
–
–
overview, 990, 998
–
–
principles of, 996, 1001–1003f,
1001–1004
–
–
vascularity, 1003, 1003f
–
–
outcomes, 650–651f
–
–
overview, 644
–
–
pain, chronic, 657
–
–
patient selection, 645, 658–659
–
–
pectoralis muscle release, 647,
647f
–
–
pocket creation, 647–648,
647–648f
–
–
postoperative care, 649, 662
–
–
preoperative planning, 645
–
–
radiation, 663, 663f
–
–
scarring, 655
–
–
seroma, 653
–
–
skin, nipple necrosis, 651, 651f
–
–
skin inspection, 646–647, 646f
–
–
surgical technique, 646
–
–
symmastia, 657, 657f
–
–
tissue expanders, 645–646
–
–
two-stage, 659, 659t, 660
–
–
upper pole deficiency, divots,
655–656, 656f
–
–
wound dehiscence, exposure, 654
breast reduction. see reduction
mammaplasty
Breast Reduction Assessment: Values
and Outcomes, 609
bromelain, 548t
brow lift. see forehead lift
brown recluse spider, 104
Buck-Gramcko technique, 1140, 1140f
burn management. see also facial
burns
–
–
abdominoplasty, 1372, 1373f
–
–
ankle, 1369–1371, 1370–1371f
–
–
axillary contracture, 1367–1368
–
–
breast, 1371, 1371f, 1381, 1381f
–
–
deformities, list, 1360
–
–
dermal regeneration templates,
1363, 1363–1364f, 1380, 1380f
–
–
elbow, 1368–1369, 1368f
–
–
facial (see facial burns)
–
–
fat grafting, 1361, 1361f, 1373,
1374f, 1377–1379, 1379f
–
–
flaps, 1363–1366, 1366–1367f,
1370f, 1375, 1377, 1377f
–
–
foot, 1369–1371, 1370–1371f
–
–
knee, 1369–1371, 1370–1371f
–
–
laser therapy, 1361, 1379, 1379f
–
–
lower extremity, 1369–1371,
1370–1371f
–
–
neck contractures, 1365–1366,
1366–1367f, 1380–1381, 1381f
–
–
patient selection, 1360–1361
–
–
perineum, 1372, 1382, 1382f
–
–
pigment restoration, 1380
–
–
postoperative care, 1379–1380
–
–
scar contractures, 1361–1362,
1362f
–
–
hernia/bulge, 668–669, 668f, 675
–
–
hypercoagulability, 666
–
–
implants in, 672–673, 673f
–
–
informed consent, 678
–
–
lifting, reduction techniques, 673
–
–
liposuction, 672, 672f
–
–
with lymphedema, 1116, 1116f,
1118
–
–
microanastomosis, inset, 681–682
–
–
MSFTRAM flaps, 667, 675, 681
–
–
nipple–areola complex recon­
struction, 673–674f, 673–675
–
–
overview, 665
–
–
perforasomes, 666
–
–
postoperative monitoring, 682,
683t
–
–
preoperative optimization,
677–678, 678t, 683t
–
–
radiation, 666
–
–
recipient site preparation,
681–682
–
–
secondary procedures, 682–683
–
–
SIEA flap, 667, 680–681
–
–
skin refinement, 672
–
–
timing of, 678
–
–
TRAM flaps, 666, 681
–
–
transverse upper gracilis flap, 679,
680f
–
–
venous thrombosis, 670, 677
–
–
vertical upper gracilis flap, 679,
680f
–
–
wound healing, 667–668, 675
breast reconstruction (implants)
–
–
acellular dermal matrix, 646, 649f,
660–661, 661–662f
–
–
animation deformity, 655
–
–
capsular contracture, 654–655,
655f
–
–
closure, 648–649, 649f
–
–
complications, unfavorable results,
644
–
–
delayed healing, 651, 652f
–
–
direct-to-implant, 645–646,
659–660, 659t
–
–
erythema, 651–652
–
–
implant insertion, 648, 648–649f
–
–
implant malposition, shape, size
changes, 654, 656, 656f, 657
–
–
implant rippling, 656
–
–
implant rupture, 655, 657f
–
–
incision, second-stage, 663, 663f
–
–
incisions, 645, 646f, 660, 661f
–
–
infection, 652, 653f, 662
–
–
mastectomy, nipple vs. skin-
sparing, 659t, 660
–
–
nipple malposition, 654
–
–
nipple reconstruction, 663
–
–
nitroglycerin paste, 661–662

INDEX
IN-5
–
–
pharyngeal flap procedure,
702–704, 703–704f
–
–
prosthetic rehabilitation, 707–709,
708f
–
–
regenerative/inductive maxillofacial
surgery, 925–927f, 926–927
–
–
repair, criteria for, 689
–
–
residual bony cleft reconstruction,
705–709, 707–708f
–
–
residual cleft nasal deformity/
bilateral clefts, 711, 711f
–
–
residual cleft nasal deformity
correction, 709–711, 710–712f
–
–
residual deformities, 688
–
–
results, 712, 712–716f
–
–
scars, 690
–
–
secondary bone grafting, 705–709,
707–708f
–
–
secondary lip deformities manage­
ment, 721–722
–
–
short lip, 691, 691f
–
–
sphincter pharyngoplasty, 704
–
–
tight upper lip, 692, 692f
–
–
velopharyngeal disturbances, 701
–
–
velopharyngeal function measure­
ment, 702t
–
–
velopharyngeal insufficiency, cor­
rection of, 701–711
–
–
vermilion deformities, 694
–
–
vermilion whistle deformity cor­
rection, 722–723, 722f
–
–
wound dehiscence, 689, 689f
clinodactyly, 1139, 1140f, 1147f, 1154
clitoral hood resection, 521, 525,
531f, 532, 533f
CLOVES syndrome, 816f, 817
collagenase Clostridium histolyticum,
for Dupuytren’s contracture, 1316,
1319, 1320f, 1321–1322, 1325–1327,
1330, 1336–1340, 1337–1339f
collar-button abscess, 100
combined thigh flap characterization,
1067t, 1068f
communication, WHO organizational
targets, 40t
complex regional pain syndrome
–
–
bone, joint fractures, 1238
–
–
Dupuytren’s contracture, 1321,
1326, 1330, 1340
–
–
mutilating injuries, 1258–1259
composite microvascular surgery. see
orthognathic surgery
condylar process fractures
–
–
A-line, 856, 856f
–
–
childhood, 852, 865–866, 866f
–
–
classifications, 854, 855f
–
–
complications, avoidance
algorithm, 854
–
–
mesh placement, hernia, 1068–
1073, 1069–1073f, 1071t
–
–
negative-pressure wound therapy,
1074–1075
–
–
outcomes, 1075–1077f
–
–
overview, 1063–1064
–
–
patient selection, 1064–1065
–
–
pedicled flaps, thigh/torso-based,
1067t, 1068f, 1079, 1080t
–
–
perforator pedicled flaps, 1067t,
1079–1080, 1080–1081f, 1081t
–
–
physiology, 1064
–
–
postoperative care, 1065
–
–
preoperative planning, 1064–1065
–
–
seroma, 1066
chin augmentation
–
–
alloplastic implants, 385, 385–
386f, 389f
–
–
symmetry, genioplasty and, 754,
761f, 762, 770, 778
Chinese agrimony, peony, 548t
chitosan, 118
chondroitin, 550t
chronic pain syndrome, 1313–1314,
1314f
chronic venous insufficiency,
113–114, 118f
claw hand, 1369, 1369f
cleft lip/palate. see also orthognathic
surgery
–
–
airway obstruction correction,
711, 712f
–
–
complications related to, 688, 689
–
–
free border deformities, 694
–
–
hypernasality/hyponasality, per­
sistent, 703–704, 703–705f
–
–
labial mucosal contracture,
694–695f, 695
–
–
lip repair procedure, unilateral,
719–721, 720f
–
–
lip revision, 690, 690f
–
–
long lip, 690
–
–
minimal whistling deformities,
694
–
–
mucocutaneous deformities, 694
–
–
nasoalveolar molding devices,
688–689
–
–
nasopharynx obstruction,
704–705
–
–
orbicularis oris deformities, 693,
693f
–
–
orthopedics, preoperative, 689
–
–
overview, 687, 719
–
–
palatal fistulas, 696–701, 696–
701f, 723–724
–
–
palate repair principles, 695–696
–
–
palatoplasty failures, 696–701
chemical peels
–
–
complications of, 192, 196–200,
202–203, 202–203f
–
–
contact dermatitis, 196–197
–
–
deep, 195, 195f
–
–
erythema, 196, 196f, 199f,
202–203, 202–203f
–
–
herpetic outbreak, 198–199, 198f
–
–
history of, 201–202
–
–
hyperpigmentation, hypopigmen­
tation, 197–198, 197f, 202
–
–
infection, 193, 198–199, 198f
–
–
inflammatory dermatoses, 193
–
–
isotretinoin use, 193
–
–
laryngeal edema, 200
–
–
medium-depth, 194, 195f
–
–
milia, 199
–
–
ocular complications, 200
–
–
patient selection, 193–194
–
–
phenol, cardiotoxicity with,
199–200, 203
–
–
phenol–croton oil, 202
–
–
photosensitizing drugs, 193
–
–
postinflammatory hyperpigmenta­
tion, 193
–
–
postoperative care, 195–196
–
–
pregnancy, 194
–
–
pruritus, 196
–
–
scarring, 198
–
–
skin types, darker, 193
–
–
sun exposure, occupation, 193
–
–
superficial, 194, 194f
–
–
systemic diseases, 194
–
–
technique, 194–195, 194–195f
–
–
unrealistic expectations, noncom­
pliance, 193
–
–
wound healing, abnormal, 193
chest wall, abdomen reconstruction
–
–
abdomen, zones of, 1080f, 1081t
–
–
bronchopleural fistula, 1068
–
–
chest, zones of, 1081f, 1081t
–
–
complications of, 1063, 1065,
1078–1079
–
–
disease process, 1064
–
–
Eloesser procedure, 1068, 1069f
–
–
empyema, 1066, 1068
–
–
enterotomy, enterocutaneous
fistulas, 1073–1075, 1074f
–
–
flail chest (paradoxical motion),
1066–1068
–
–
hernias, 1064, 1065, 1068–1073,
1069–1073f, 1071t, 1077f
–
–
indications, 1064
–
–
infections, 1066
–
–
intraoperative, perioperative con­
siderations, 1065
–
–
keystone flap, 1081–1082, 1082f
–
–
mediastinitis, 1066

INDEX
IN-6
–
–
alloplastic implants, 1015–1017
–
–
cranioplasty, 1015, 1015f, 1023–
1024, 1023t, 1024f
–
–
CRASSH scale, 1007t
–
–
donor vessel, 1021–1022f,
1021–1023
–
–
etiology, defect analysis, 1006
–
–
external device, simple closure,
1020, 1021f
–
–
flap protection, 1023, 1023f
–
–
flap selection, 1020t
–
–
free tissue transfer, 1012–1014,
1013–1014f, 1017, 1017f, 1022
–
–
hardware placement, 1018, 1018f
–
–
indications, 1015
–
–
infection, 1016, 1016f
–
–
intraoperative considerations,
1007
–
–
overview, 1005
–
–
patient positioning, 1020–1021,
1020t
–
–
patient selection, 1006–1007,
1007t
–
–
preoperative planning, 1005–1006
–
–
shrink-wrap phenomenon, 1017,
1017f
–
–
unfavorable results of, 1006
Crouzon’s syndrome, 736, 737f
D
dacryocystorhinostomy, 880
Danshen, 548t
débridement, process, 115–117, 140
decision making, 41t
DeepFX, 1358
deep space abscess, 100
delayed healing syndrome, 180, 180f,
183f
deoxycholic acid
–
–
complications of, 147, 167–168
–
–
risk management, 170–174,
172–173f
depression, 9, 11, 17–18
depressor anguli oris release, 411
dermal fillers
–
–
abscess, 149
–
–
biofilms, 149–150, 154f, 156f, 157,
392
–
–
bruising, 146–147, 147f
–
–
categories of, 145–146, 146t
–
–
cellulitis, 149
–
–
complications of, 145
–
–
crash kit, 164
–
–
dyspigmentation, 148, 148f
–
–
edema (see edema)
–
–
erysipelas, phlegmon, 149
–
–
erythema, 147
–
–
trust relationship, 1147, 1147f
–
–
ulnar longitudinal deficiency,
1135t
–
–
web creep, 1143, 1144f, 1150f,
1152–1153
–
–
wound healing, 1134
congenital hemangioma, 814f, 814t
consent form, 5, 11–12, 56–57. see
also informed consent
consultations, dissatisfied patient,
4–5, 11–13, 19
coral snakes, 104
CORDLESS study, 1325, 1340
corner mouth lift, 403, 403f, 406–407,
406–407f, 411
corrugator muscles, 223
corticosteroids, in scar treatment, 85,
85f, 86t, 91–92
CosmetAssure, 472–473
craniofacial clefts, 739, 745–746f,
745–748, 747t, 755–756
craniofacial surgery. see orthognathic
surgery
craniosynostosis
–
–
bleeding, 729, 731, 735–736
–
–
calvarial defects, 732–733, 737,
737f
–
–
characterization, 726–727,
726–728f, 735
–
–
complications in, 728, 736
–
–
CSF leak, 732
–
–
dural injury, 732, 732f
–
–
growing skull defects, 732
–
–
growth restriction, 733, 733f
–
–
hardware-related complications,
733
–
–
imaging, 727, 728f, 735
–
–
infection, 732, 737
–
–
lambdoid synostosis, 727, 727f,
730, 735, 736
–
–
management protocols, 735
–
–
mortality, 731
–
–
new technologies, 737–738
–
–
ocular injury, 731
–
–
polylactic, polyglycolic sheets, 738
–
–
preoperative considerations, 728
–
–
recurrence, relapse, 733, 733f
–
–
restenosis, 733, 733f
–
–
sagittal synostosis, 727, 729, 730f,
735, 736
–
–
scalp alopecia, 732, 732f
–
–
surgical treatment, 728–731,
730–731f
–
–
venous air embolism, 728–729,
731, 736–737
–
–
vision loss, 731
cranium reconstruction. see also scalp
reconstruction
–
–
complications of, 853–854
–
–
condylar neck fractures, 857
–
–
diagnostics, 854, 867
–
–
infection, 859
–
–
osteosynthesis, 858–859, 858f
–
–
retromandibular approach,
856–857f, 857
–
–
surgical approach (ORIF), 856–
857f, 856–858
–
–
treatment (ORIF), 854–856, 855f
congenital hand anomalies
–
–
adjunctive aids, 1147, 1147f
–
–
amniotic band syndrome, 1135t
–
–
anomalies associated with,
1134–1135, 1135t
–
–
axial deformities, 1139–1140,
1139–1140f, 1145, 1153–1154
–
–
Buck-Gramcko technique, 1140,
1140f
–
–
camptodactyly, 1137
–
–
clinodactyly, 1139, 1140f, 1147f,
1154
–
–
communication, 1141, 1155
–
–
complications, unfavorable results,
1133
–
–
expectations, unrealistic, 1140–
1141, 1155
–
–
functional skills development, 1134
–
–
growing hand anatomy, 1134
–
–
hypertrophic scars, 1142, 1142f
–
–
incision design, 1135–1136,
1135–1136f, 1150f
–
–
infants, anesthetics in, 1134
–
–
ischemia, 1137, 1137f, 1144–1145,
1148
–
–
joint instability, 1137–1139,
1138–1139f, 1145, 1153
–
–
keloid scars, 1142, 1142–1143f
–
–
nail deformities, 1140, 1140–
1141f, 1145, 1145f, 1154–1155
–
–
pollex abductus anomaly, 1145
–
–
polysyndactyly, 1136, 1153
–
–
radial longitudinal deficiency,
1135t
–
–
scar contracture, 1143, 1144f,
1151f, 1155
–
–
scar planning, 1135, 1135–1136f
–
–
skin flap necrosis, 1137, 1137f,
1144–1145, 1148
–
–
skin grafts, 1136, 1151–1152,
1151–1152f
–
–
surgical timing, 1133–1134, 1148
–
–
syndactyly, 1135t, 1136, 1136f,
1137, 1138f, 1142, 1148–1151,
1149–1152f
–
–
thumb mobility, 1135, 1135f
–
–
thumbs, hypoplastic, 1138–1139,
1139f

INDEX
IN-7
–
–
moisture regulating, 118–119
–
–
negative-pressure wound therapy,
120, 140
–
–
polysaccharide bead, 119
–
–
skin substitutes, 120, 121f
–
–
wet-to-dry, 117
drug overdose incidence, 71f
Dupuytren’s contracture
–
–
bowstringing, 1324, 1325f
–
–
carpal tunnel syndrome concomi­
tant, 1321
–
–
characterization, 1315
–
–
complex regional pain syndrome,
1321, 1326, 1330, 1340
–
–
complications in, 1316
–
–
digital artery preservation, 1331
–
–
digital nerve division, 1322
–
–
fasciectomy (see fasciectomy)
–
–
flare reactions, 1321, 1326, 1330
–
–
flexion deformity, 1320
–
–
flexion/joint, 1319–1321, 1320f,
1322–1324, 1323–1324f
–
–
flexor tendon injury, 1320f,
1321–1322, 1326–1327, 1338–
1339, 1339f
–
–
needle fasciectomy (see needle
fasciectomy)
–
–
neurapraxia, 1322
–
–
neurovascular injury and, 1317,
1317f, 1331, 1331f, 1339
–
–
outcomes, 1326f, 1340–1341
–
–
pathogenesis of, 1315
–
–
patient expectations, 1316, 1329
–
–
PIP joint contracture, 1319–1320,
1320f, 1322–1324, 1323–1324f,
1327, 1329, 1332–1333, 1335–
1338, 1340
–
–
recurrence, 1320–1321, 1324–
1326
–
–
screening, 1329
–
–
skin necrosis, tears, 1322, 1330f,
1331, 1332f, 1335
–
–
tension-free splinting, 1321
–
–
treatment modalities, 1315–1316,
1327
–
–
treatment selection, 1329–1330
–
–
vascular spasm, 1331
–
–
wound healing, 1317–1319,
1318–1319f
–
–
Xiaflex, 1316, 1319, 1320f,
1321–1322, 1325–1327, 1330,
1336–1340, 1337–1339f
E
ears, reconstruction of. see auricular
reconstruction
eating disorders, 17
–
–
finances, 5, 11–12
–
–
injectable treatments, avoiding,
174
–
–
malingering for secondary gain, 11
–
–
mismanagement of, 9–10
–
–
pain, ignoring, 11
–
–
patient expectations, beliefs, 8,
19–20, 51
–
–
perioral surgery, 416
–
–
reality, avoidance of, 10
–
–
reasons, discovery of, 8–9
–
–
somebody else’s patient, 12–13
–
–
support system neglect, 11
–
–
treatment plan, failure to struc­
ture, 10–11
distal radial fractures
–
–
acute, 1230–1233, 1230–1233f
–
–
intra-articular malunions, 1235
–
–
malunions, 1233–1238, 1234–
1237f
–
–
malunions, decision-making algo­
rithm, 1236f
–
–
perilunate instability, 1243–1245,
1244f
–
–
physiological volar tilt, 1233–
1234, 1234f
–
–
screws, 1232–1233, 1233f
–
–
ulnar-sided pathology, 1237–1238
–
–
volar plates, 1230–1232, 1230–
1233f, 1241
–
–
Wada’s osteotomy, 1234–1235,
1235f
documentation
–
–
communication consent, 33
–
–
digital record, 33–34
–
–
doctor–patient relationship, 33
–
–
informed consent (see informed
consent)
–
–
instructions, 6
–
–
orthognathic surgery, 762–763
–
–
patient privacy, 33, 34
–
–
photographs, 33
–
–
smart text, default entries, 33, 34
dog-ears in reduction mammaplasty,
605, 606f, 608
dolichocephaly, 727
double crush syndrome, 1312
double paracrine signaling, 120
Doumouras, A. G., 44t
dressings
–
–
advanced, 117
–
–
alginates, 118–119
–
–
foams, 119
–
–
hydrocolloids, 119
–
–
hydrofibers, 119
–
–
hydrogels, 119
–
–
interactive, 120
–
–
materials, 117–118, 118f
–
–
foreign body granulomas, 155,
155–156f
–
–
herpetic outbreak, 149
–
–
hyperpigmentation, 148
–
–
infection, 148–149
–
–
medications, herbal supplements
to avoid prior, 147
–
–
neovascularization, 147–148
–
–
nerve damage, 158–159
–
–
nodular masses, 151–157,
153–157f
–
–
paresthesia, 158–159
–
–
risk management, 170–174,
172–173f
–
–
vascular compromise, 159–163
dermal regeneration templates, 1363,
1363–1364f, 1380, 1380f
dermal substitutes, 120
dermofasciectomy, for Dupuytren’s
contracture, 1316
Devil’s claw, 548t
diabetic foot, 102–103, 102f, 124
DIEAP flap characterization, 1080,
1080f, 1081t
DIEP flap breast reconstruction, 44,
45
digital extension–flexion test,
1176–1178, 1177f
Digit Widget, 1329–1330
diphenhydramine, in scar treatment,
91
disruptive behavior
–
–
case scenarios, 58, 62–63
–
–
causes of, 58–59, 58t
–
–
communication training, 61–62
–
–
consequence of, 60
–
–
definition of, 59, 59t
–
–
identification, investigation of,
60–61
–
–
interventions, graded, 61
–
–
management of, 61–62
–
–
peer review of, 60–61
–
–
prevalence of, 59, 60
–
–
proactive measures, 61–62
–
–
solutions to, 60
–
–
trainees, 59–60
dissatisfied patient. see also litigation
–
–
abdominoplasty, 469, 472
–
–
alloplastic implants, 397
–
–
background, 8
–
–
being distant, unavailable, 10
–
–
biomedical ethics, 26–27
–
–
blaming/becoming angry, 10
–
–
consultations, 4–5, 11–13, 19
–
–
depression, postoperative, 9, 11,
17–18
–
–
feelings of inferiority, 9

INDEX
IN-8
–
–
cicatricial ectropion, 1026f,
1030–1031, 1031–1032f, 1038,
1038f, 1042, 1044
–
–
color, texture matching, 1028,
1029f
–
–
complications in, 1028
–
–
conjunctivodacryocystorhinos­
tomy, 1040, 1040f
–
–
entropion, 1026f
–
–
facial nerve paralysis, 1033, 1033f
–
–
full-thickness eyelid defect,
1042–1043, 1043f
–
–
goal of, 1025
–
–
graft, flap necrosis, 1032–1033,
1032–1033f
–
–
graft, flap thickness, 1029, 1029f
–
–
horizontal stabilization, 1025
–
–
innervation, 1025–1027
–
–
lateral canthal dystopia, 1039,
1039f, 1044
–
–
levator palpebrae superioris,
1026f, 1027
–
–
lid margin notching, 1034–1035,
1035f
–
–
lower eyelid retraction, 1036–1037,
1036f, 1043
–
–
medial canthal webbing, 1033,
1034f
–
–
pentagonal wedge resection, 1035,
1035f
–
–
posterior lamella reconstruction,
1034–1039, 1042–1043
–
–
posterior lamella repair, 1034, 1034f
–
–
postoperative concerns, 1044
–
–
ptosis, botulinum toxin for,
165–166, 165f
–
–
red eyelid margins, 1038, 1038f,
1044
–
–
retrobulbar hemorrhage,
1040–1041, 1041f, 1044
–
–
scarring, 1029–1030, 1030f, 1043
–
–
surgical considerations,
1042–1043f, 1042–1044
–
–
surgical planning, 1027–1028,
1028f, 1041–1042
–
–
sutures, 1043
–
–
tear drainage system repair, 1039,
1040f
–
–
trichiasis, 1044
–
–
upper eyelid retraction, 1037,
1037f, 1044
–
–
vertical lamellar support, 1029,
1031f
F
face and neck rejuvenation
–
–
aesthetic errors, 241
–
–
biologic principles, 1184–1185,
1184–1185f
–
–
boutonnière deformities (see bou­
tonnière deformities)
–
–
caput ulnae (Vaughan-Jackson) syn­
drome, 1210–1211, 1210–1211f
–
–
collagen response, 1185
–
–
complications, unfavorable results,
1183
–
–
dorsal soft tissue loss, 1208–1209
–
–
entire organ response, 1184, 1184f
–
–
extensor mechanism, anatomy,
1187–1188f, 1187–1190
–
–
extrinsic extensors, anatomy,
1186–1187, 1186f
–
–
forearm, 1208, 1208f
–
–
function preservation, 1184–1185,
1185f
–
–
human bite, 104, 1204
–
–
intrinsic muscles, anatomy,
1188–1189, 1199f
–
–
juncturae tendinum, anatomy,
1187
–
–
ligament stabilization, 1189–1190,
1189f
–
–
long injuries, 1205–1207, 1206f,
1217
–
–
mallet deformity (see mallet
deformity)
–
–
outcomes, 1207
–
–
relative-motion concept, 1196–
1197, 1197f, 1215
–
–
relative-motion flexion splinting,
1187f, 1198–1200, 1200f, 1205,
1206f, 1215–1217
–
–
sagittal band rupture, 1202–1204,
1205f, 1216–1217
–
–
scar planning, 1185
–
–
Stack splint, 1191–1192, 1191f
–
–
swan neck deformity, 1188–1190,
1189–1190f, 1192, 1193f,
1209–1210
–
–
thumb injuries, 1207, 1208f
–
–
Winslow’s diamond, anatomy,
1187–1188f, 1188
–
–
zones of injury, 1190, 1190f
external pressure, in scar treatment,
85, 85f
eyelid reconstruction. see also blepha­
roplasty
–
–
anatomy, 1025–1027, 1026–1027f
–
–
anterior lamellar repair, 1028–1030,
1030f, 1042
–
–
apposition to globe, 1025, 1026f
–
–
canalicular obstructions, 1040,
1040f
–
–
capsulopalpebral fascia, 1026f,
1027
ectropion
–
–
eyelid reconstruction, 1026f,
1030–1031, 1031–1032f, 1038,
1038f, 1042, 1044
–
–
facial burns, 1347–1348, 1348f,
1356
–
–
facial fractures, 882–883
–
–
laser facial resurfacing, 181,
189–190, 189f
–
–
mandible, maxilla reconstruction,
985–986
edema
–
–
antibody-mediated (angioedema),
150–151, 151–152f
–
–
body contouring, post-MWL, 482,
495
–
–
fat grafting, 207, 207f
–
–
laryngeal, in chemical peels, 200
–
–
malar, 157–158, 157–159f
–
–
in mutilating injuries, 1247, 1248f
–
–
non–antibody-mediated (delayed),
151, 152f
–
–
prevention, treatment of, 156f,
157, 171–172
–
–
short-term posttraumatic, 150
education. see training and education
elbow
–
–
burn management, 1368–1369,
1368f
–
–
mutilating injuries, 1257
–
–
reconstruction in nerve surgery,
1298
elective medicine, 27–28
electrolarynx, 960
electronic health records (EHRs),
33–34, 42
electronic medical records (EMRs),
33, 34
Eloesser procedure, 1068, 1069f
Embrace device, in scar prevention,
84–85, 84f
Enhanced Recovery After Surgery
(ERAS), 42–43
enophthalmos
–
–
facial fractures, 881, 881–882f,
883, 884f, 890–891, 890f
–
–
pediatric facial fractures, 897–898,
898f
Enterobacteriaceae, 103, 118, 149
enterotomy, enterocutaneous fistulas,
1073–1075, 1074f
epiphora, in facial fractures, 879–880
epithelioid hemangioendothelioma,
820, 821f
ethics. see biomedical ethics
extension block splinting, 1241
extensor tendon repair
–
–
anatomy, 1185–1190, 1186–1189f

INDEX
IN-9
–
–
sensory nerve damage, 884
–
–
septal complications, 886
–
–
soft tissue injuries, 876, 890
–
–
soft tissue secondary abnormal­
ity, 880
–
–
telecanthus, 879
–
–
treatment approach, 875
–
–
zygomaticomaxillary, 876,
883–884, 884f
facial reanimation
–
–
accurate muscle positioning, 1058,
1059f
–
–
beneficial errors, 1054, 1055f
–
–
bilateral facial paralysis, 1054,
1054f
–
–
buccal–zygomatic muscle com­
plex, 1045
–
–
communication errors, 1048, 1057
–
–
complications, unfavorable results
in, 1047, 1054–1056
–
–
cross-face nerve graft, 1045–1047,
1046f, 1057–1058, 1057–1058f
–
–
facial nerve–based, long-term pa­
ralysis, 1049–1053, 1050–1053f
–
–
free gracilis muscle transfer, 1046f,
1047, 1058, 1059f
–
–
history taking errors, 1048
–
–
lower lip depressor deformity,
1054
–
–
muscle tension, 1060–1062, 1061f
–
–
non–facial donor nerve,
1052–1053f, 1053
–
–
paralysis, symptoms of, 1045
–
–
patient selection, 1047–1048
–
–
physical examination errors,
1048–1049, 1049f, 1056
–
–
preoperative planning, 1047–1048
–
–
reconstructed side bulk reduction,
1060, 1060f
–
–
reconstructive considerations,
1045–1047, 1046f
–
–
strong motor input creation, 1060,
1060f
–
–
surgical errors, 1049–1053
facial reconstruction. see maxillofacial
reconstruction
fasciectomy
–
–
digital artery preservation, 1331
–
–
for Dupuytren’s contracture,
1315–1316
–
–
neurovascular injury and, 1317,
1317f, 1331, 1331f
–
–
open palm, 1315–1316,
1330–1333, 1331–1333f
–
–
patient selection, 1330–1331,
1330f
–
–
radical, 1331
–
–
recurrence, 1324
–
–
microstomia, 1348, 1356, 1357f
–
–
neck contractures, 1348, 1356,
1357f
–
–
nose, 1349–1350, 1358
–
–
outcomes, 1353
–
–
tissue expansion, 1351
–
–
tissue rearrangement, 1351
–
–
treatment generally, 1345–1346,
1346–1347f, 1355–1356, 1355f
facial fractures
–
–
aesthetic deformities, 885–886,
885f
–
–
airflow obstruction, 884–885
–
–
alloplastic materials-related com­
plications, 882, 891
–
–
complications, unfavorable results,
876
–
–
contour irregularity, 877, 878f
–
–
CSF leakage, 887
–
–
diplopia, 881
–
–
ectropion, 882–883
–
–
enophthalmos, 881, 881–882f,
883, 884f, 890–891, 890f
–
–
epicanthal folds secondary abnor­
mality, 880
–
–
epiphora, 879–880
–
–
facial projection loss, 887
–
–
frontal sinus, 876–879, 878f, 891,
891f
–
–
hypoglobus, 881, 881–882f,
890–891, 890f
–
–
infection, 875–876, 889–890
–
–
lacrimal apparatus damage,
879–880
–
–
lagophthalmos, 882–883
–
–
lateral canthal dystopia, 883, 884f
–
–
Le Fort, 876, 886–887
–
–
malar flattening, 883
–
–
malocclusion, 886
–
–
malunion, nonunion, 876–877,
890, 890f
–
–
masticatory dysfunction, 884
–
–
maxillary sinusitis, 887
–
–
meningeal tears, injury, 878, 878f
–
–
mucocele, mucopyocele, 878–879,
878–879f
–
–
nasal bone, 876, 884–886, 885f
–
–
nasal projection loss, 880
–
–
nasal septal deviation, 886–887
–
–
naso-orbitoethmoid, 876,
879–880, 891–892, 891f
–
–
nerve damage, 884, 887
–
–
ocular injury, 880–881
–
–
orbital, 876, 880–883, 881–882f,
890–891, 890f
–
–
panfacial, 876, 887
–
–
pediatric (see pediatric facial
fractures)
–
–
anatomy, 160f
–
–
cheek dissection errors, 244–245,
244–245f
–
–
complications of, 240
–
–
deflation, 251, 251f
–
–
digastric muscles, prominent,
257–258, 258f
–
–
earlobe reduction, 259–260, 259f
–
–
facial atrophy, 254, 254–255f
–
–
facial nerve injury, 245, 245–246f,
248
–
–
4 Rs of, 171
–
–
hairline distortion, 243–244, 243f
–
–
hematoma, 245–247
–
–
hemostasis, 247
–
–
incision planning, 241, 242f
–
–
infection, 69f, 247, 247f
–
–
lamellar dissections, 253, 253f
–
–
laxity, improving, 250
–
–
mouth, under-rejuvenated,
260–261, 261f
–
–
neck, under-rejuvenated, 254–259
–
–
patient comfort, 247
–
–
pixie ear deformity, 241, 242f
–
–
platysma banding recurrence, 250
–
–
results, limited longevity of, 241
–
–
secondary facelifts, 252–254,
253–254f, 261–264, 262–263f
–
–
seroma, 247
–
–
submandibular glands, prominent,
256–257, 256–257f
–
–
subplatysmal fat excess, 254–256
–
–
technical errors, 241, 242f
–
–
tragoplasty, 258–259, 259–260f
–
–
transillumination, 244–245, 244f
–
–
undercorrection, 241, 250–251
–
–
unfavorable results of, 240
–
–
vertical skin redraping, 248–249,
248–250f
face transplantation, 937–938
facial burns. see also burn manage­
ment
–
–
alopecia, 1347
–
–
anal verge, 1350–1351, 1350f
–
–
complications in, 1345
–
–
ectropion, 1347–1348, 1348f,
1356
–
–
eyelids, 1349, 1349f, 1356
–
–
fat grafting, 1351–1352,
1356–1358, 1357f
–
–
forehead, scalp, 1348–1349, 1349f,
1356–1358, 1357f
–
–
graft appearance, 1346–1347
–
–
graft complications, 1348–1351
–
–
laser facial resurfacing, 1352–
1353, 1358–1359
–
–
lips, 1350–1351, 1350f, 1357f,
1358

INDEX
IN-10
–
–
digital extension–flexion test,
1176–1178, 1177f
–
–
epitendinous suture, 1167–1168,
1168f
–
–
failed repair options, 1171
–
–
failed repair reconstruction,
1171–1173, 1172f
–
–
fixation, temporary, 1175
–
–
flexor digitorum superficialis only,
1180
–
–
grafting, 1172, 1180
–
–
grasp, 1166
–
–
healing, biology of, 1159–1160,
1160f
–
–
incisions, tendon retrieval,
1162–1165, 1163–1164f, 1175
–
–
indications, 1179
–
–
little fingers, repair in, 1180–1181
–
–
local injuries/multiple tissues,
1179–1180
–
–
mechanism of injury, 1161
–
–
multiple flexor tendon defects, 1180
–
–
multiple tendon lacerations, proxi­
mal palm/carpal tunnel, 1180
–
–
outcomes, 1181, 1181t
–
–
overview, 1157
–
–
pathologies, collateral, 1161–1162
–
–
patient examination, 1162
–
–
postoperative rehabilitation,
1169–1170, 1178, 1179f
–
–
preoperative planning, 1161–1162
–
–
profundus tendon repair, 1175
–
–
pulley venting, 1168–1169, 1169f,
1175–1176, 1177f
–
–
repair technique, 1165–1169,
1166–1169f, 1174–1178,
1176–1177f
–
–
rupture, 1170–1171, 1180
–
–
soft tissue defect/scar, 1180
–
–
strands, number of, 1166–1167,
1167f
–
–
surgeon-related factors, 1162
–
–
suture, core, 1165–1166,
1166–1167f
–
–
suture/knot bypes, 1167, 1167f
–
–
suture tensile strength, 1160–1161
–
–
tenolysis, repeated, 1181
–
–
timing of repair, 1161, 1161f,
1174–1175
–
–
unfavorable results, 1158t,
1178–1179
–
–
wide-awake, 1162, 1163f
flexor tenosynovitis, 100
floor-of-mouth defects, 944–945,
945–946f
foam dressings, 119
follicular unit extraction (FUE), 418
fatigue, WHO organizational targets,
41t
felon, 100
female aesthetic genital surgery
–
–
central wedge labiaplasty,
521, 523–525, 524–525f, 528f,
530–531f, 530–532
–
–
clitoral hood resection, 521, 525,
531f, 532, 533f
–
–
combined procedures, 533
–
–
complications of, 521
–
–
deepithelialization labiaplasty,
521, 525
–
–
edge-trim labiaplasty, 523, 523f,
530
–
–
goals of, 527
–
–
labia majora augmentation, 521,
523
–
–
labia majora resection, 521–523,
528–530, 528–530f
–
–
labia minora reduction, 521,
523–525, 524–525f, 528f,
530–531f, 530–532
–
–
mons pubis lift, 521, 522, 527–528
–
–
patient selection, 522
–
–
perineoplasty, 521, 525–526, 525f,
532–533
–
–
preoperative planning, 522
–
–
reconstruction, 533–534, 533f
–
–
vaginoplasty, 521, 526, 532–533
–
–
wedge resection labiaplasty,
523–525, 524f
feverfew, 548t
filler crash kit, 164
fingers. see also hand
–
–
burn management, 1369, 1369f
–
–
claw hand, 1369, 1369f
–
–
fractures, 1219–1223, 1219t,
1220–1221f, 1223–1224f, 1239–
1241, 1240f, 1242–1243f
–
–
multiple-finger amputation, 1273,
1274f
–
–
mutilating injuries, 1256
–
–
replantation, open book technique,
1280–1281, 1280–1281f
–
–
single-finger amputation, 1273
fish oil, 550t
flail chest (paradoxical motion),
1066–1068
flexor tendon surgery
–
–
active flexion, assessment, 1181
–
–
adhesions, 1171
–
–
anatomy, 1158–1159, 1159–1160f
–
–
anesthesia, 1162, 1163f
–
–
diagnosis, treatment delays, 1161,
1161f
–
–
digital amputation, replantation,
1180
–
–
skin flap necrosis, 1331, 1332f
–
–
vascular spasm, 1331
–
–
wound healing, 1317–1318,
1318–1319f
fat grafting
–
–
aesthetic misjudgments, 216–218,
217f
–
–
aspiration of excess, 219f, 220–221
–
–
blindness, 212–213, 213f
–
–
botulinum toxin, 209
–
–
in breast reconstruction (see
breast reconstruction (autologous
tissue))
–
–
burn management, 1361, 1361f,
1373, 1374f, 1377–1379, 1379f
–
–
central retinal artery occlusion
management, 213
–
–
complications of, 205, 216
–
–
contamination, avoiding, 210
–
–
death, 214
–
–
donor site complications, 209,
209f, 216
–
–
dynamic deformities, 218,
218–219f
–
–
edema, 207, 207f
–
–
embolization, post-injection,
212–213
–
–
facial burns, 1351–1352,
1356–1358, 1357f
–
–
facial identity loss, 218–219, 220f
–
–
fat migration, 209
–
–
foreign body introduction, avoid­
ing, 210, 210f
–
–
frozen fat, 209
–
–
infection, 209–210, 210f, 409
–
–
insufficient volume, 205–206
–
–
irregularities, lumps, 207–209,
208f
–
–
lip lifting, 402–408, 403–408f,
411, 416
–
–
lower eyelids, removal of fat
grafted to, 221–222
–
–
minimal aliquot placement, 206,
207f
–
–
muscle injury, 211, 211f
–
–
nerve injuries, 207f, 210–211, 211f
–
–
preoperative planning, 219–220
–
–
pure fat, obtaining, 206
–
–
resorption, 206
–
–
salivary gland injury, 211–212,
212f
–
–
skin necrosis, 214, 214f
–
–
stroke, 212–214, 213f
–
–
trauma, reducing, 206
–
–
variable take, 216
–
–
viability, preserving, 206, 206f
–
–
weight gain, overgrowth with,
216, 217f, 220–221

INDEX
IN-11
–
–
nipple–areola complex, 628–629,
628f, 632–633, 633f
–
–
patient selection, 624–625
–
–
preoperative planning, 624–625
–
–
pseudogynecomastia, 624
–
–
puffy areola, 638
–
–
rashes, skin sensitivity, 638, 638f
–
–
recurrence, 631–632, 631–632f
–
–
scarring, 629, 632, 635, 636–637f,
636–638
–
–
seroma, 629–631, 631f
–
–
skin envelope retailoring, 627–
628, 627f
–
–
skin slough, 632–634, 633–634f
–
–
staging of, 624t
–
–
surface irregularity, 629
–
–
types of, 623–624, 624t
–
–
volume reduction, 625–628
–
–
volume reduction, incomplete, 629
H
hair collar sign, 817
hair transplantation
–
–
alopecia, 428–429, 429f
–
–
clumpy, pluggy appearance, 426,
426–427f
–
–
complications of, 424
–
–
donor site harvesting, 418–419
–
–
dressing, 419, 422f
–
–
grafts, oversized, 426, 426–427f
–
–
growth, poor, 429
–
–
hairline issues, 424, 425f
–
–
infiltration, formula, 419
–
–
outcomes, 419–421, 423–424f
–
–
overview, 418
–
–
preoperative planning, 418,
430–431, 431f
–
–
scarring, 428–429, 428–429f
–
–
stick and place technique, 419,
420–422f
–
–
technique, 418–420, 419–424f
hand. see also fingers; thumbs
–
–
anomalies, congenital (see
congenital hand anomalies)
–
–
burn management, 1369, 1369f
–
–
cellulitis, 100
–
–
fractures, 1219–1223, 1219t,
1220–1221f, 1223–1224f, 1239–
1241, 1240f, 1242–1243f, 1253
–
–
metacarpal hand amputation,
1273–1274, 1274f
–
–
mutilating injuries, 1256
–
–
osteomyelitis, 1254–1255, 1254f
–
–
reconstruction in nerve surgery,
1298–1299
hand replantation
–
–
arterial insufficiency, 1269
–
–
fat graft survival, 501, 503f,
506–507, 509f
–
–
fat necrosis, 508, 508–509f
–
–
fat preparation, 503–504, 504f
–
–
fat transfer, 504, 505f, 518–519
–
–
flank shape potential, 501, 502f
–
–
implant selection, 518
–
–
infection, 508–510, 510f
–
–
liposuction, 503
–
–
markings, 501–503
–
–
mortality, 510–511
–
–
outcomes, 513–514f, 520, 520f
–
–
overview, 499–500
–
–
patient selection, 500–501, 517,
517–518f
–
–
pearls, 515
–
–
pitfalls in, 500, 515
–
–
postoperative care, 506, 519
–
–
prophylaxis treatment, 517
–
–
seroma, 511
–
–
surgical planning, 501–503,
502–503f, 517–519, 519f
–
–
trunk/buttock shapes, 501, 502f
–
–
wound dehiscence, 511, 516, 518,
519f
gluteal augmentation/fillers, 512–513
gluteal augmentation/silicone im­
plants, 511–512
Goldenhar syndrome, 763
granuloma, pyogenic, 812t, 813f, 814t
Graves’ ophthalmopathy, 375
greater arc injuries, 1245
Grogan, E. L., 43t
group A streptococci, 99
Guīlinggāo, 550t
gunshot injury, 859, 860f, 1289
gynecomastia
–
–
areola depression, 632, 632f
–
–
asymmetry, 629
–
–
Benelli (purse-string) technique,
635, 635–636f
–
–
bruising, swelling, 638–639,
638–639f
–
–
characterization, 623–624, 623f,
630
–
–
complications of, 624, 629, 630
–
–
depressions (dynamic), 639–641,
640f
–
–
depressions (static), 641–642,
641–642f
–
–
direct excision, 625, 625f, 627
–
–
gland excision, insufficient, 635,
635f
–
–
hematoma, 629, 638–639,
638–639f
–
–
infection, 629, 634–635, 635f
–
–
liposuction, 626–627, 626f
–
–
loose skin, 637, 637f
follicular unit transplantation (FUT),
418
forearm, 1208, 1208f, 1257
forehead lift
–
–
complications of, 224, 227,
238–239
–
–
endoscopic technique, 225–238,
226–235f
–
–
eyebrows, aging and, 223
–
–
lateral-temporal approach,
236–237, 237f
–
–
muscle anatomy, physiology, 223
–
–
open coronal approach, 229
–
–
open technique, 224–225,
224–225f
–
–
outcomes, 236
–
–
preoperative considerations, 229
Fournier’s gangrene, differential
diagnosis, 102
fractional carbon dioxide laser ther­
apy, burns, 1352–1353, 1358–1359,
1379, 1379f
Fritillaria bulbs, 550t
frontalis muscles, 223
frontal sinus fractures, 876–879, 878f,
891, 891f
frozen/woody neck management,
952–954, 954f
funnel tongue, 947–948, 948f
G
garlic, 548t
gas gangrene, 102
genioplasty
–
–
aesthetic outcomes, 778
–
–
chin symmetry, 754, 761f, 762,
770, 778
–
–
intraoperative complications, 767
–
–
osseous, neurologic deficits, 771
–
–
sensory deficit, 771
–
–
treatment planning, 763, 778
genital surgery. see female aesthetic
genital surgery
geum japonicum, 548t
Gillies, Harold, 785
ginger, 548t
ginkgo, 548t
glossectomy. see oral and pharyngeal
reconstruction
glucosamine, 550t
gluteal augmentation/fat transfer
–
–
abscess, 510, 510f
–
–
asymmetry, 507–508, 507f
–
–
complications of, 500, 516–517
–
–
contour abnormalities, 508
–
–
cysts, 508, 508–509f
–
–
fat embolism, 510

INDEX
IN-12
–
–
human bites, 104
–
–
hyperglycemia and, 94–95, 98
–
–
hypoxia and, 94, 95
–
–
incidence, 68f, 69, 69f
–
–
intraoperative, 98
–
–
malnutrition and, 95
–
–
marine exposure, 102
–
–
necrotizing fasciitis, 102, 108, 109f
–
–
nicotine and, 95, 124
–
–
obesity and, 95, 124
–
–
osteomyelitis, 103, 103f
–
–
postoperative, 98
–
–
preoperative, 95–98, 96–97t
–
–
prevention of, 124
–
–
pulsatile lavage treatment of, 98
–
–
reconstruction of, 105–106f,
105–107, 109–110, 109–110t, 109f
–
–
risk factors for, 94–98, 96t
–
–
septic arthritis, 103
–
–
snake, scorpion, spider bites, 104
–
–
soft tissue, 99–102
–
–
soft tissue flap treatment of,
105–106f, 105–107, 109–110,
109–110t, 109f
–
–
surgical-site, diagnosis/manage­
ment of, 99, 100, 101f, 124
–
–
surgical-site, risk factors, 94–98,
96t
–
–
vacuum-assisted wound closure,
98
–
–
viral, 187, 187f, 198–199, 198f
–
–
wound classification, 96t
–
–
wound healing and, 83
inferior turbinectomy, 371
inflammatory nodules, 153, 155–157,
156f
informed consent
–
–
consent form, 5, 11–12, 56–57
–
–
described, 31–32
–
–
ethics of, 25, 26
–
–
in litigation, 51, 56–57
–
–
patient-centered standards, 56
–
–
professional standard rule, 56
–
–
valid consent/refusal, 25, 26,
31–32
infraorbital rim augmentation,
378–379, 378–379f
initial consultation mistakes, 3–4, 12,
18–20, 27
injectables. see botulinum toxin;
deoxycholic acid; dermal fillers
Integra dermal matrix, 120
interferon therapy, in scar treatment,
91
intraoral vertical ramus osteotomy,
767, 770
Ivy, Robert, 785
–
–
management principles, 36
–
–
organizational culture, adaptation,
36–38, 37t, 38f
–
–
people-focused interventions,
38–44, 43–44t, 43f
–
–
plastic surgery setting, 44–45
–
–
policies and procedures in, 44
–
–
preoccupation with failure, 37
–
–
relational coordination, 44–45
–
–
simplification, standardization in,
42
HIPAA, 33
histamine, in scar treatment, 91
honey, 118
Hull, L., 44t
human bites, 104, 1204
hyaluronic acid
–
–
characterization, 145–146, 146t
–
–
complications associated with,
149–154, 159f, 171–172
–
–
in gluteal augmentation, 512
–
–
high-molecular-weight, 154
–
–
low-molecular-weight, 154
hydrocolloid dressings, 119
hydrofiber dressings, 119
hydrogels, 119
hypernasality/hyponasality, persis­
tent, 703–704, 703–705f
hypertelorism, 739, 748–751, 750f,
756–758, 757f
hypoglobus in facial fractures, 881,
881–882f, 890–891, 890f
I
immune-mediated delayed nodules,
153–154
implant reconstruction. see breast
reconstruction (implants)
implants. see breast augmentation
infantile hemangioma, 811f, 812t,
814f, 814t, 816f, 820–821, 821f
infection. see also under specific
procedures
–
–
ablation of, 108–109, 109f
–
–
absolute bacterial burden, 115
–
–
animal bites, 103–104
–
–
antibiotic prophylaxis, 95, 97t,
110, 110t, 126
–
–
antibiotics, for bioburden, 115
–
–
bacterial, 186–187, 198, 547
–
–
diabetic foot, 102–103, 102f, 124
–
–
diagnosis, management, 99
–
–
evaluation algorithm, 101f
–
–
fungal (yeast), 187–188, 188f, 199,
199f
–
–
gas gangrene, 102
–
–
gram-negative bacilli, 99
–
–
cold intolerance, 1269
–
–
complications, unfavorable results,
1266
–
–
contraindications, 1267, 1267–
1268f
–
–
distal, 1270
–
–
major proximal, 1272
–
–
multiple-digit, 1272, 1272f
–
–
nonunion, malunion, 1269
–
–
open book technique, 1280–1281,
1280–1281f
–
–
preparation, 1268
–
–
principles, 1267, 1280–1281,
1280–1281f
–
–
replant loss, 1269
–
–
ring avulsion injuries, 1270
–
–
sensory recovery, 1269
–
–
tendon repair, restricted, 1269
–
–
transmetacarpal, 1270–1272,
1271f
–
–
treatment selection, 1268, 1268f
–
–
venous insufficiency, 1269
harlequin deformity, 727
Haynes, A. B., 43t
head and neck cancer infection risk,
98
hemangioendothelioma, epithelioid,
820, 821f
hemangioma
–
–
congenital, 814f, 814t
–
–
infantile, 811f, 812t, 814f, 814t,
816f, 820–821, 821f
hematoma incidence, 68–69, 68f. see
also under specific procedures
hemifacial microsomia, 739–744,
740–742f, 743t, 753–755, 753t
hemihamate osteochondral arthro­
plasty, 1241
hernias, 1064, 1065, 1068–1073,
1069–1073f, 1071t, 1077f
Hicks, C. W., 43t, 44t
hidradenitis suppurativa, 100
high reliability organizations (HROs)
–
–
active failures, 38
–
–
automation in, 33–34, 42
–
–
Big Five Model of Teamwork, 39,
39f
–
–
clinical microsystems, 37–38, 37f
–
–
commitment to resilience, 37
–
–
defenses-in-depth, 38
–
–
deference to expertise, 37
–
–
human factors applications,
39–44, 40–41t, 40f, 42–43f, 43–44t
–
–
human factors study principles,
38–39, 39f
–
–
intervention effectiveness hierar­
chy, 42, 42f
–
–
latent conditions, 38

INDEX
IN-13
–
–
safety precautions, 186
–
–
scarring, 177, 179–180, 180f, 182,
183f, 190, 190f
–
–
synechia, 189, 189f
–
–
wound care, 178
latissimus dorsi flap characterization,
1067t, 1068f
Lean concepts, 42
Lee, B. T., 44
Le Fort fractures, 876, 886–887
Le Fort I osteotomy
–
–
aesthetic outcomes, 778
–
–
airway complications, 766, 777
–
–
asymmetry correction, 754
–
–
fixation failure, 774, 775f
–
–
fractures, unfavorable, 772
–
–
historical background, 785
–
–
intraoperative complications, 767
–
–
neurologic deficits, 770
–
–
transverse width correction, 764,
765f, 779
–
–
vascular compromise, 768–769,
769f
lesser arc injuries, 1245
Lindemann, August, 785
liposuction
–
–
in breast reconstruction (see
breast reconstruction (autologous
tissue))
–
–
complications, unfavorable results,
435, 452
–
–
deformities, progression of, 436
–
–
dose-response curve, 433, 433f,
436
–
–
under extraction, 436
–
–
foam, 447
–
–
gluteal augmentation/fat transfer
(see gluteal augmentation/fat
transfer)
–
–
gynecomastia, 626–627, 626f
–
–
infection data, 69f
–
–
lymphedema, 1115t
–
–
pneumothorax, 71, 71f
–
–
postoperative care, 446–447, 446f
–
–
repeat, difficulties inherent in,
433f, 435–436
–
–
repeat, reasons for, 434–435, 434f
–
–
revision vs. secondary, 434
–
–
SAFELipo (see SAFELipo)
–
–
technologies, 433–434, 450–451
–
–
thermal injury, 436
–
–
unanticipated sequelae incidence,
68f
–
–
VASER system, 452–454, 452–454f
lip reconstruction. see also cheek
reconstruction; perioral surgery
–
–
aesthetic subunits, 991
L
labiaplasty
–
–
central wedge, 521, 523–525, 524–
525f, 528f, 530–531f, 530–532
–
–
deepithelialization, 521, 525
–
–
edge-trim, 523, 523f, 530
–
–
labia majora augmentation, 521,
523
–
–
labia majora resection, 521–523,
528–530, 528–530f
–
–
labia minora reduction, 521, 523–
525, 524–525f, 528f, 530–531f,
530–532
–
–
wedge resection, 523–525, 524f
lacrimal apparatus damage, facial
fractures, 879–880
lagophthalmos in facial fractures,
882–883
laser facial resurfacing
–
–
ablative, side effects/complications
of, 177
–
–
acne, 188–189
–
–
anesthesia, 183
–
–
antibiotic prophylactic, therapeu­
tic dosing, 187, 187t
–
–
characterization, 176
–
–
complications, 178–183, 179–
180f, 185
–
–
delayed healing syndrome, 180,
180f, 183f
–
–
dyschromia, 179
–
–
ectropion, 181, 189–190, 189f
–
–
erythema, 178, 181f, 189
–
–
facial burns, 1352–1353, 1358–
1359
–
–
facioplasty combined with,
190–191, 191f
–
–
fractionated, 176, 178
–
–
herpetic outbreak, 179, 179f
–
–
hyperpigmentation, 179, 179f
–
–
hyperpigmentation, hypopigmen­
tation, 179, 179f, 182, 183, 186,
188
–
–
hypersensitivity, 188–189
–
–
infection, 178–179, 179f, 181f,
182, 186–188, 187–188f, 187t
–
–
intraoperative considerations,
177–178
–
–
isotretinoin use, 177, 179
–
–
laser fluence, 177–178
–
–
milia, 188–189
–
–
nonablative, 176
–
–
patient selection, 177, 185–186
–
–
post-resurfacing care, 186
–
–
preoperative planning, 177, 183f,
185–186
J
Japanese honeysuckle, 550t
jaw fractures
–
–
anatomy, 850
–
–
angle, 851f, 852
–
–
atrophic, 851f, 852, 863–865,
864–865f
–
–
bony resection, reconstruction,
861–863, 862f
–
–
childhood, 852, 865–866, 866f
–
–
closed reduction, 866
–
–
comminuted, 851f, 852, 859–860,
860f, 867
–
–
condylar head, 851f, 852
–
–
condylar neck, 857
–
–
condylar process, 851f, 852–859,
855–858f, 867
–
–
débridement, 872, 872f
–
–
gunshot injury, 859, 860f
–
–
Le Fort I, 851–852, 851f
–
–
mandibular, 852, 853, 854f, 862f,
869–873, 870–872f
–
–
maxillary, 851–852, 851f, 868–869
–
–
maxillomandibular fixation,
869–872, 870–871f
–
–
microvascular procedures, 863
–
–
open reduction/internal fixation
(ORIF), 850–851, 853–856, 855f,
864–866, 864f
–
–
oronasal fistula, 853, 853f
–
–
parasymphyseal, 851f
–
–
pathologic, 851f, 852, 860–863,
862f, 864t, 867
–
–
prosthodontics, 873
–
–
reconstruction, goals of, 850
–
–
sagittal, 851f, 852–853, 853f
–
–
sandwich technique, 862
–
–
therapeutic principles, 850–851
–
–
types of, 850, 851f
Juvéderm, 153f, 172f
juvenile gigantomastia, 603
K
Kangen-karyu, 550t
Kaposiform hemangioendothelioma,
812t, 814f, 814t, 820, 821f
Kasabach-Merritt phenomenon, 820f,
821, 822f
Kazanjian, V. H., 785
keystone flap, 1081–1082, 1082f
Klippel-Trénaunay syndrome, 816f,
817
knowledge, skills, attitudes (KSAs),
38–39, 43–44t, 43f
Kybella, 167

INDEX
IN-14
–
–
indications, 1115t
–
–
lymphocele, 1120–1121
–
–
lymphovenous bypass, 1114,
1115t, 1120f, 1121, 1122–1127,
1123–1126f
–
–
outcomes, 1115t, 1118 1120f,
1121, 1127–1128, 1127f
–
–
overview, 1113
–
–
patient selection, 1114–1116,
1115t, 1122–1124, 1123f
–
–
preoperative planning, 1114–
1116, 1115t, 1122–1124, 1123f
–
–
reductive surgery, 1113–1114
–
–
seroma, 1118, 1119f, 1120
–
–
surgical recommendations by
stage, 1115t
–
–
surgical technique, 1116–1117f,
1116–1118, 1124–1126f, 1124–
1127
–
–
vascularized lymph node transfer,
1114, 1115t, 1118, 1122–1124,
1123f
lymphovenous bypass, 1114, 1115t,
1120f, 1121, 1122–1127, 1123–1126f
M
Macrolane, 512
Maintenance of Certification (MOC),
473
malar area augmentation (implants),
379–380, 380–381f, 400
malar edema, 157–158, 157–159f
malar flattening, 883
malar implant visibility (implants),
383–384, 384f
mallet deformity
–
–
clinical assessment, 1192–1193,
1192–1193f
–
–
Fowler procedure, 1194
–
–
fracture treatment, 1195–1196,
1196f
–
–
K-wire immobilization, 1193,
1194f, 1216
–
–
late/chronic, 1193–1194, 1194f
–
–
management, acute, 1192–1193,
1192–1193f
–
–
outcomes, 1197t
–
–
overview, 1190–1191f, 1190–1192
–
–
relative-motion flexion splinting,
1187f, 1215–1216
–
–
Stack splint, 1191–1192, 1191f
–
–
surgical treatment, 1194–1195,
1195f
–
–
tenodermatodesis, 1194, 1194f
managerial leadership, 40t
mandible, maxilla reconstruction
–
–
arterial failure, 982–983, 983f
–
–
flap harvesting, 1109
–
–
foot region, 1097t, 1102, 1102f
–
–
free flap loss, 1104–1105, 1105f,
1110–1111, 1111–1112f
–
–
functional, coverage requirements,
1098, 1101f
–
–
infectious wounds, 1094–1095,
1099f
–
–
knee region, 1096t, 1098, 1109
–
–
local flap complications,
1103–1104, 1103–1104f
–
–
lymphatic wounds, 1094–1095
–
–
MESS scoring system, 1089–1090,
1089t
–
–
negative-pressure wound therapy,
1086, 1109
–
–
NISSSA scoring system, 1090t
–
–
oncologic defects, 1090–1093f,
1090–1092
–
–
orthoplastic approach, 1107
–
–
osteomyelitis, 1094–1095, 1095f,
1099f
–
–
patient selection, 1086, 1108
–
–
perforator, propeller flaps, 1110
–
–
plantar forefoot region, 1097t
–
–
postoperative considerations, 1110
–
–
postoperative dressing, 1110
–
–
preoperative planning, 1086,
1108–1109
–
–
by region, 1096–1097t
–
–
scoring systems, 1089–1090,
1089–1090t, 1108
–
–
surgical technique, 1086–1088,
1087–1088f, 1109
–
–
team, 1107–1108
–
–
thigh region, 1096–1098, 1096t,
1099f
–
–
thrombotic complications, 1087
–
–
tibial region, 1096t, 1098,
1100–1101f
–
–
timing of closure, 1086
–
–
trauma, 1088–1089
–
–
vascular wounds, 1094–1095
lymphatic malformations, 811f, 812t,
814f, 814t, 822
lymphedema
–
–
breast reconstruction with, 1116,
1116f, 1118
–
–
Charles procedure, 1122–1124
–
–
chyle leak, 1120–1121
–
–
complex decongestive therapy,
1122
–
–
complications, 1115t, 1118–1120,
1119t
–
–
congenital, 1122–1123, 1123f
–
–
counseling, 1114–1116, 1115t
–
–
donor site numbness, 1118–1119
–
–
flap harvesting, 1118, 1119f
–
–
anal verge, 1350–1351, 1350f
–
–
asymmetry, botulinum toxin and,
166
–
–
bony foundation, 991, 992f
–
–
complications of, 991
–
–
facial burns, 1350–1351, 1350f,
1357f, 1358
–
–
free tissue transfer, 999–1000
–
–
functional units, 998
–
–
goals of, 992–993, 992–993f
–
–
large defects, 999–1000
–
–
lifting, 402–408, 403–408f
–
–
lip function, 992
–
–
lower lip ptosis, 414–415
–
–
microstomia, 993, 993f
–
–
overview, 990, 998
–
–
paranasal upper lip lift, 410f, 411
–
–
preoperative planning, 993–994,
994f
–
–
scar planning, 994, 994f, 1001
–
–
skin color, 991, 991f, 999
–
–
skin grafts, 998–999, 998f
–
–
surgical technique, 994–996,
995–996f
–
–
upper lip, 993, 994, 999–1000,
999–1000f
–
–
vermilion advancement, 403–404,
407, 407f
–
–
vermilion whistle deformity cor­
rection, 722–723, 722f
liquorice/licorice, 548t
litigation. see also dissatisfied patient;
medical malpractice
–
–
avoiding, 10, 17, 31, 49–50
–
–
empathy without admission, 51
–
–
informed consent (see informed
consent)
–
–
legal guidance, seeking, 52, 61
–
–
marketing, advertising in, 51, 55
–
–
medical records in, 34
–
–
patient dismissal, 52
–
–
patient expectations management,
8, 19–20, 51
–
–
refunds, 51–52
–
–
revision procedures, 52
–
–
standard of care, 50, 54
–
–
unfavorable result management, 51
–
–
warranties, 32, 50–51
lower extremity reconstruction
–
–
Achilles tendon region, 1097t
–
–
amputation vs. salvage, 1089–
1090t, 1089–1092, 1091f, 1108
–
–
closure, 1109–1110
–
–
complications of, 1085, 1102–
1105
–
–
Cook Doppler monitoring, 1110
–
–
diabetic wounds, 1094–1095,
1094f

INDEX
IN-15
–
–
evolution of, 914–916, 915–916f
–
–
face transplantation, 937–938
–
–
free flap methods, limitations of,
914–916, 915–916f
–
–
midface defects surgery, 918–919,
919–920f
–
–
orofacial, prefabricated grafts in,
918
–
–
overview, 914, 930
–
–
prefabricated grafts, 916–918,
917–918f
–
–
regenerative, inductive surgery,
919–925
–
–
revisions, secondary, 936,
936–937f, 938
–
–
soft tissue volume, 934, 938
–
–
structural buttresses, 932–933
–
–
surgical planning, 930, 937
–
–
timing, 934, 935f, 938
–
–
tissue requirements, 933, 938
maxillofacial surgery. see maxillo­
facial reconstruction; orthognathic
surgery
maxillofacial surgery, regenerative/
inductive. see regenerative/inductive
maxillofacial surgery
Mayfield’s perilunate injury classifica­
tion, 1245
medialized external corner lip lift
(MECLL), 411, 414
medical errors. see adverse event
disclosure
medical malpractice. see also litiga­
tion
–
–
elements of proof, 54
–
–
informed consent (see informed
consent)
–
–
jurors’ bias, 54–55
–
–
liability, 49
–
–
multiple procedures cases, 55
–
–
promises unkept, 55–56
–
–
public perception, 55
MESS scoring system, 1089–1090,
1089t
metacarpals
–
–
fractures, 1219–1223, 1219t,
1220–1221f, 1223–1224f, 1239–
1241, 1240f, 1242–1243f, 1253
–
–
hand amputation, 1273–1274,
1274f
–
–
hand replantation, 1270–1272,
1271f
methicillin-resistant Staphylococcus
aureus (MRSA), 95, 99–100, 103, 118,
187, 364
microsurgery
–
–
anastomosis, 135, 135t, 140, 141f
–
–
anticoagulants, 136–137
–
–
implant malposition, 596–597
–
–
ischemia, 599, 599f
–
–
necrosis, 599, 599f
–
–
overview, 581, 600–601
–
–
parenchymal elasticity, 583, 583f
–
–
patient examination, 582–585,
582–585f, 583t
–
–
patient selection, 582
–
–
preoperative planning, 582–585,
582–585f, 583t, 593–595,
594–595f
–
–
pseudoptosis, 582f, 594, 599–600
–
–
ptosis, 582f, 583t, 594
–
–
revision mastopexy manage­
ment, 583f, 585–588, 586–587f,
596–600, 598–600f
–
–
scarring, 599, 637
–
–
secondary procedures, 596
–
–
staged procedure, 595–596
–
–
tissue-related complications,
597–600
–
–
unfavorable results in, 582, 593,
593t
–
–
vascular supply, 597–599, 598f
–
–
vertical excess, 594
–
–
wrinkling, rippling, 597
mastopexy, reduction, 68f, 69f, 71, 71f
matrix of mistakes
–
–
chance, 7
–
–
consultations, 4–5, 11–13, 19
–
–
documentation, instructions, 6
–
–
finances, 5, 11–12
–
–
follow-up, 6–7
–
–
initial consultation, 3–4, 12,
18–20, 27
–
–
intuition, presentiments, 4
–
–
iron man (woman) delusion, 7
–
–
operating for wrong reasons, 4
–
–
overview, 3
–
–
patient management, 6
–
–
patient selection, 4, 32, 32f
–
–
physical examination, 3–4, 12
–
–
poorly informed patient, 5
–
–
poorly planned/performed opera­
tion, 5–6
–
–
surgeon’s reputation, 5, 6
maxillary osteotomy, hemorrhage in,
768
maxillofacial distraction surgery. see
orthognathic surgery
maxillofacial reconstruction
–
–
aesthetic units, 930–932, 931f, 937
–
–
bone, soft tissue support, 934, 938
–
–
bone–muscle crosstalk, 914
–
–
complications of, 914
–
–
concept surgery, 918, 925–927,
925–927f
–
–
defect boundaries, 937–938
–
–
asymmetry, 987–988
–
–
autologous bone grafts, 969–970
–
–
bone nonunion, 986–987
–
–
carotid blowout, 984
–
–
complications of, 972, 981, 982t,
986–988, 988f
–
–
diplopia, 986
–
–
donor site complications, 978–
980, 982t
–
–
ectropion, 985–986
–
–
fistula management, 976–978,
979f, 986, 987
–
–
flap compromise management,
972–973, 973f, 982–984, 983f, 985f
–
–
flap loss management, 974–975,
974–975f
–
–
hardware failure, 976, 977–978f
–
–
herald bleed, 976
–
–
infections, 976
–
–
malocclusion, 987–988, 988f
–
–
microvascular free flaps, 970
–
–
partial free flap failure, 984, 985f
–
–
plate exposure, 984–985
–
–
PMMC pedicled flap, 971, 971f
–
–
postoperative care, 971–972
–
–
reconstruction plating, 987
–
–
second free flap, post-failure, 984
–
–
soft tissue free flaps, 970–971,
971f
–
–
techniques, 969
–
–
TMJ fibrosis, 976
–
–
trismus, 976
–
–
venous failure, 983, 983f
–
–
wound separation, 976, 976–977f
mandibular distraction, hemifacial
microsomia, 739–744, 740–742f,
743t, 753–755, 753t
Mangled Extremity Severity Score
(MESS) scoring system, 1089–1090,
1089t
marine exposure, 102
marionette folds excision, 404, 404f,
407–409, 408f
marionette folds migration, 414, 415f
marketing, advertising, 29, 50, 51, 55
massive weight loss. see body con­
touring, post-MWL
mastopexy, augmentation mastopexy.
see also breast augmentation
–
–
asymmetry, 599
–
–
augmentation mastopexy revision
management, 588–591, 588–591f,
596–600, 598–600f
–
–
breast footprint, 585
–
–
breast form, 538, 538f, 566, 583,
583f, 592–593
–
–
implant-based complications, 593,
596

INDEX
IN-16
neck burn management, 1365–1366,
1366–1367f, 1380–1381, 1381f
necrotizing fasciitis, 102, 108, 109f
needle fasciectomy
–
–
characterization, 1316, 1327
–
–
flexor tendon injury, 1321
–
–
outcomes, 1335–1337
–
–
patient selection, 1333, 1335
–
–
recurrence, 1324
–
–
technique, 1333–1335, 1334f ,
1336f
–
–
wound healing, 1318–1319
negative-pressure wound therapy
–
–
chest wall, abdomen reconstruc­
tion, 1074–1075
–
–
lower extremity reconstruction,
1086, 1109
–
–
microsurgery, 140
–
–
wound management, 120
neoplastic transformation, chronic
wounds in, 114
nerve decompression surgery
–
–
carpal tunnel release, 1300,
1305–1306, 1306f
–
–
carpal tunnel syndrome, 1301,
1309
–
–
chronic pain syndrome,
1313–1314, 1314f
–
–
clinical assessment, 1300–1302,
1301f
–
–
comorbidities, 1312
–
–
complications of, 1301, 1309,
1312, 1312f
–
–
compression syndromes, 1300,
1302
–
–
direct nerve injury, 1302–1303,
1303f
–
–
indications, 1311
–
–
injury severity, 1310–1311, 1311f
–
–
medial antebrachial cutaneous
nerve injury, 1304, 1304f
–
–
median nerve laceration, 1305,
1305f
–
–
median release, incomplete, 1306
–
–
neural tumor, 1308, 1308f
–
–
palmar cutaneous branch/median
nerve injury, 1303, 1304f, 1309
–
–
pathology, synchronous, 1302
–
–
posterior interosseous nerve com­
pression, 1306, 1307–1308f
–
–
postoperative care, 1309
–
–
preoperative planning, 1300–1302,
1301f
–
–
pronator/anterior interosseous
nerve compression, 1306, 1307f
–
–
recurrent branch/median nerve
injury, 1303, 1304f
–
–
surgeon expertise in, 1312
–
–
malunion, 1253
–
–
nerve gap closure, 1258
–
–
nerve injuries, 1251–1252, 1251f,
1264
–
–
nerve repair complications,
1258–1259
–
–
neuroma, 1258, 1258f
–
–
nonunion, 1253
–
–
osteomyelitis, 1254–1255, 1254f
–
–
outcomes, 1259–1262, 1265,
1265f
–
–
patient history, incomplete, 1250,
1251f
–
–
prehension, minimum digits re­
quired for, 1260–1261, 1260f
–
–
psychological impacts, 1259, 1265
–
–
recipient vessel preservation,
1260, 1260f
–
–
rehabilitation complications, 1259
–
–
repair prioritization, 1252
–
–
replantation complications, 1254
–
–
revascularization complications,
1255
–
–
scar formation in, 1247–1249,
1248–1249f
–
–
severity, underestimation of,
1249–1250, 1250f
–
–
skeletal repair, 1264
–
–
soft tissue coverage, 1255,
1259–1260, 1259f
–
–
spare parts, discarding, 1250
–
–
stiff hand, 1257–1258, 1257f
–
–
tendon injuries, missing, 1251
–
–
tendon repair complications,
1257–1258, 1257f, 1264
–
–
treatment, delayed, 1249
–
–
Volkmann ischemic contracture,
1255, 1255f
–
–
wound care in functional outcome,
1261, 1262f, 1264
–
–
wound healing, delayed, 1252–1253
–
–
wound healing in, 1247–1249,
1248–1249f
MWL. see body contouring, post-
MWL
Mycobacterium marinum, 102
myocardial infarction incidence, 71f
N
nasal airway obstruction (postopera­
tive). see rhinoplasty (secondary)
nasal bone fractures, 876, 884–886,
885f
nasolabial folds excision, 404, 404f,
407–409, 408f
naso-orbitoethmoid fractures, 876,
879–880, 891–892, 891f
–
–
clot formation, 134, 140
–
–
complications, postoperative, 136
–
–
complications associated with,
131, 132
–
–
contraindications, 132
–
–
design, planning, 132–133, 133f,
139–140, 139f
–
–
flap inset, 135, 135f
–
–
flap monitoring, salvage, 136, 136f
–
–
free tissue transfer, 140
–
–
indications, 131–132
–
–
negative-pressure wound therapy,
140
–
–
patient factors, 132
–
–
patient selection, 132
–
–
pedicle selection, 134, 134f
–
–
recipient vessel, 134
–
–
rehabilitation, 137, 137f
–
–
skin island, myocutaneous flap,
140–141, 141f
microsurgical toe-to-hand transfers.
see toe-to-hand transfer (microsurgi­
cal)
midface rotation advancement,
755–756
M22 laser therapy, facial burns,
1352–1353, 1358–1359
Möbius syndrome, 1054, 1060
mons pubis lift, 521, 522, 527–528
mTOR inhibitors, vascular anomalies,
821
mucocele, mucopyocele, 878–879,
878–879f, 896
MULTICORD study, 1336
mutilating injuries
–
–
amputations, 1253–1254,
1253–1254f, 1264
–
–
complex regional pain syndrome,
1258–1259
–
–
complications of, 1249
–
–
contractures, 1259–1260, 1259f
–
–
diagnosis, missed, 1249,
1263–1264
–
–
donor site selection, 1256
–
–
edema in, 1247, 1248f
–
–
finger/hand/wrist, 1256
–
–
flap complications, 1264
–
–
flap selection, secondary proce­
dures, 1261, 1261f
–
–
flap selection/coverage, 1255–1257,
1256f
–
–
forearm/elbow/shoulder, 1257
–
–
fractures/dislocations, missing,
1251
–
–
infection, 1252
–
–
ischemia–reperfusion injury, 1255
–
–
life-threatening injuries, missed,
1249, 1250, 1251f

INDEX
IN-17
–
–
voice reconstruction background,
959
–
–
voice tube, 960–967, 961–964f
orbicularis oculi muscle, 223,
266–267, 267f
orbital fractures, 876, 880–883,
881–882f, 890–891, 890f
orbital hypertelorism, 739, 748–751,
750f
orofacial, craniofacial deformities
–
–
complications of, 739
–
–
craniofacial clefts, 739, 745–746f,
745–748, 747t, 755–756
–
–
hemifacial microsomia, 739–744,
740–742f, 743t, 753–755, 753t
–
–
hypertelorism, 739, 748–751, 750f,
756–758, 757f
orthognathic surgery. see also cleft
lip/palate
–
–
aesthetic outcomes, 777–778
–
–
airway complications, 766, 767f,
777
–
–
apertognathia, 766
–
–
communication errors, 760–762,
761f, 786
–
–
complications, rare, 775, 775f
–
–
complications, unfavorable out­
comes, 760, 766
–
–
dental injury, 773, 773f
–
–
dentoskeletal instability, relapse,
778–780
–
–
diagnostic errors, 762–763
–
–
distraction, indications for, 786
–
–
distraction osteogenesis in,
923–925, 923–925f
–
–
early relapse, 774, 774–775f
–
–
fixation failure, 774, 775f
–
–
functional outcomes, 777
–
–
hemorrhage, 766–768, 769f
–
–
historical background, 784–785
–
–
infection, 771, 772f
–
–
malocclusion, 774, 774f
–
–
mobilization, inadequate, 774
–
–
neurologic complications,
770–771, 770–771f
–
–
nomenclature, 784
–
–
operative complications, 766–767
–
–
operative orthodontic manage­
ment, 776–777, 776f
–
–
oronasal lacerations, fistulas, 773
–
–
osteotomies, unfavorable,
772–773, 773f
–
–
outcomes, 777–780, 781f
–
–
overview, 759–760
–
–
postoperative care, 779
–
–
preoperative planning, 760–764
–
–
preoperative stage, 761f, 764–766
–
–
principles, 779, 786
–
–
inflammatory, 153, 155–157, 156f
–
–
noninflammatory, 151–152,
153–154f
noninflammatory nodules, 151–152,
153–154f
nontechnical skills (NTS), 43–44,
43–44t
NSAIDs, in scar treatment, 91
Nurok, M., 44t
O
obesity-related breast hypertrophy,
603
Obwegeser, Hugo, 785
occlusal splinting, 901, 901f
oil of wintergreen, 548t
operating room (OR). see high reli­
ability organizations (HROs)
oral and pharyngeal reconstruction
–
–
anastomotic stricture, 950–951,
951f, 956, 957f
–
–
aspiration, 948, 949f
–
–
complications of, 944
–
–
electrolarynx, 960
–
–
failed reconstruction manage­
ment, 957, 957f
–
–
flap insetting, 949–950, 950f
–
–
flap selection, 944, 949–955
–
–
floor-of-mouth defects, 944–945,
945–946f
–
–
frozen/woody neck management,
952–954, 954f
–
–
funnel tongue, 947–948, 948f
–
–
ileocolon flap, 960–962, 961f
–
–
mediastinal tracheostomy avoid­
ance, 954–955, 954–955f
–
–
medical evaluation, 943–944
–
–
motor reinnervation, 948–949
–
–
neck wound infection, 956, 960
–
–
oral diet resumption, 952
–
–
overview, 943
–
–
partial/hemiglossectomy defects,
945–947, 946–947f
–
–
perforator compression, kinking,
950, 950f
–
–
pharyngocutaneous fistulas,
951–952, 952f, 956, 960
–
–
postlaryngopharyngectomy
defects, 949
–
–
preoperative planning, 943–944
–
–
rapid awakening protocol,
955–956
–
–
speech physiology, 959
–
–
total/subtotal glossectomy defects,
947, 948f
–
–
tracheoesophageal puncture, 960
–
–
tracheostoma problems, 952, 953f
–
–
timing of, 1311–1312
–
–
ulnar motor branch injury,
1305–1306, 1306f
–
–
ulnar nerve kinking, 1305, 1305f
–
–
variables and technologies in,
1313, 1313f
Nerve Injury, Ischemia, Soft Tissue,
Skeletal Injury/Shock/Age (NISSSA)
scoring system, 1090t
nerve surgery (peripheral)
–
–
axonotmesis, 1287t, 1288
–
–
brachial plexus injuries, 1289,
1293–1299
–
–
bread loafing technique, 1286
–
–
complications, early postoperative,
1297, 1298f
–
–
complications, intraoperative,
1296–1297, 1296–1297f
–
–
electrodiagnostic studies, 1289,
1296–1297, 1296–1297f
–
–
gunshot wounds, 1289
–
–
hand reconstruction in, 1298–
1299
–
–
injury classification, 1287–1289,
1287t
–
–
nerve grafts, 1290, 1290f
–
–
nerve substitutes, 1291
–
–
nerve transfers, 1291
–
–
neurapraxia, 1287–1288, 1287t
–
–
neuroma, 1291–1292
–
–
neurotmesis, 1287t, 1288
–
–
pain management, 1292
–
–
patient selection, 1282–1286,
1283–1285f
–
–
presentation, evaluation,
1294–1296, 1295–1296f
–
–
prognosis, recovery, 1287t
–
–
rehabilitation, 1292–1293
–
–
shoulder deformity reconstruc­
tion, 1298, 1298f
–
–
surgical considerations,
1289–1291, 1290f
–
–
timing, 1286–1287
–
–
wrist reconstruction in, 1298–
1299
neurotoxin. see botulinum toxin
Nguyen, N., 45t
Nicksa, G. A., 45t
nifedipine, in scar treatment, 92
nipple–areolar complex congestion,
605–606, 608–609, 609f, 617, 618f,
620f
NISSSA scoring system, 1090t
nodules
–
–
foreign body granulomas, 155,
155–156f
–
–
immune-mediated delayed,
153–154, 157

INDEX
IN-18
–
–
apostrophe lip, 413, 415f
–
–
benefits of, 402, 410
–
–
collateral distortion, 412–415
–
–
complications of, 404
–
–
corner mouth lift, 403, 403f,
406–407, 406–407f, 411
–
–
cutaneous resurfacing, 411
–
–
depressor anguli oris (DAO) re­
lease, 411
–
–
dissatisfied patient, 416
–
–
fat transfer, 411, 416
–
–
infection, 408f, 409
–
–
labial–alar/alar base descent,
412–413f, 412–414
–
–
lip lifting, 402–408, 403–408f
–
–
lower lip ptosis, 414–415
–
–
marionette folds excision, 404,
404f, 407–409, 408f
–
–
marionette folds migration, 414,
415f
–
–
medialized external corner lip lift,
411, 414
–
–
nasolabial folds excision, 404,
404f, 407–409, 408f
–
–
paranasal upper lip lift, 410f, 411
–
–
patient selection, 404
–
–
preoperative planning, 410–411
–
–
scarring, 404f, 407f, 408–409,
408–409f, 410–411f, 411–412, 416
–
–
vermilion advancement, 403–404,
407, 407f
–
–
V-Y–plasties, 411, 415–416
peripheral nerve surgery. see nerve
surgery (peripheral)
Pfeiffer’s syndrome, 736
PHACES, 816, 816f
phalanges, metacarpals fractures,
1219–1223, 1219t, 1220–1221f,
1223–1224f, 1239–1241, 1240f,
1242–1243f, 1253
pharyngeal reconstruction. see oral
and pharyngeal reconstruction
pharyngocutaneous fistulas, 951–952,
952f, 956, 960
Pichler, Hans, 785
PIN syndrome, 1306, 1307–1308f
PIP fracture dislocations, 1240–1241,
1240f
PIP joint contracture, 1319–1320,
1320f, 1322–1324, 1323–1324f, 1327,
1329, 1332–1333, 1335–1338, 1340
piriform aperture augmentation
(implants), 380–381, 381–382f
piriform aperture extrusion (im­
plants), 384–385, 399
plagiocephaly, 727
PLLA (poly-L-lactic acid), 146
pneumonia incidence, 71f
–
–
CSF rhinorrhea, 894
–
–
distribution, 894
–
–
dural tears in, 896
–
–
enophthalmos, 897–898, 898f
–
–
entrapment, 897
–
–
epidemiology, 893–894
–
–
evaluation, management prin­
ciples, 894
–
–
facial growth, 893
–
–
frontal sinus, extending to orbital
roof, 912–913, 912f
–
–
growth disturbance, 899, 899f,
901–902, 902f
–
–
infection, 895
–
–
injuries associated with, 894
–
–
intracranial injury, 894
–
–
malocclusion, 901, 901f
–
–
malunion, nonunion, 895
–
–
mandible, dentition, 893, 900–902f,
900–904
–
–
medial orbital, muscle entrap­
ment, 910–911, 911f
–
–
mucocele, 896
–
–
nasal bones, septum, 893,
898–900, 899f, 909–910, 910f
–
–
occlusal splinting, 901, 901f
–
–
open book, 898
–
–
orbital apex syndrome, 894–895
–
–
orbital floor, complications of,
897–898, 898f
–
–
osteomyelitis, 895
–
–
paranasal sinuses, 893
–
–
posttraumatic growing skull, 896
–
–
residual deformity, 899–900
–
–
rigid fixation sequelae, 895–896
–
–
septal hematoma, 899–900f, 900
–
–
soft tissue laceration, 895
–
–
superior orbital fissure, 894–895
–
–
supero-orbital, 896
–
–
telecanthus, 896
–
–
TMJ ankylosis, 902–904, 902f
–
–
tooth loss, root injury, 900–901,
900f
–
–
unfavorable results, 895
–
–
white-eyed blowout, 897
perforator compression, kinking, 950,
950f
performance-based cultures, 37t
perilunate fracture dislocation, 1245
perilunate instability, 1243–1245,
1244f
perineoplasty, 521, 525–526, 525f,
532–533
perineum burn management, 1372,
1382, 1382f
perioral surgery. see also lip recon­
struction
–
–
aesthetic disharmony, 408–409,
408f, 415–416
–
–
records, documentation, 762–763
–
–
simulation, 762–763
–
–
smile arc, 778
–
–
TMJ dysfunction, 777
–
–
treatment planning, 763–764,
765f, 779, 786
–
–
vascular compromise, 768–770,
769f
–
–
virtual surgical planning, 779
osteomyelitis
–
–
bite wounds, 103, 103f
–
–
bone, joint fractures, 1223–1224,
1224f, 1225f
–
–
in jaw fractures, 861, 862f
–
–
lower extremity, 1094–1095,
1095f, 1099f
–
–
mutilating injuries, 1254–1255,
1254f
–
–
in pediatric facial fractures, 895
outpatient surgery safety
–
–
accreditation, licensure, 65–67
–
–
compliance management program,
67
–
–
data collection, analysis, 67–70f,
67–71
–
–
Internet based quality assurance
program, 67
–
–
never events, 65, 66
P
Paige, J. T., 43t, 45t
palatal fistulas, 696–701, 696–701f,
723–724
paradoxical motion (flail chest),
1066–1068
paralysis, facial. see facial reanimation
paranasal upper lip lift, 410f, 411
paronychia, 100
partial/hemiglossectomy defects,
945–947, 946–947f
patient dissatisfaction. see dissatisfied
patient
patient selection mistakes, 4, 32, 32f
PDL therapy, facial burns, 1352–1353,
1358–1359
pectoralis major flap characterization,
1067t, 1068f
pediatric facial fractures
–
–
alloplastic implants, 897
–
–
bilateral subcondylar, medially
displaced condyles, 908–909, 909f
–
–
case studies, 908–913, 909–912f
–
–
cervical spine injury, 895
–
–
C-formed, 898
–
–
circummandibular wiring, 901,
901f
–
–
complications, 894, 895, 908

INDEX
IN-19
–
–
tobacco use, 603
–
–
upper breast border as landmark,
619–621, 621f
–
–
vascular supply, 617, 618f
–
–
venous thromboembolism, 604
–
–
vertical incision cinching,
614–616, 615f
–
–
Wise pattern, 619, 619f
–
–
wound healing, 607–608, 608f,
614–616, 615f
regenerative/inductive maxillofacial
surgery
–
–
aging face, 927–929, 928–929f
–
–
bone transport, 921–923, 922f
–
–
cleft lip/palate, 925–927f, 926–927
–
–
concept surgery, 918, 925–927,
925–927f
–
–
distraction osteogenesis, histogen­
esis, 921, 922f
–
–
distraction osteogenesis in,
923–925, 923–925f
–
–
gingiva attachment, 921
–
–
inner mucosal lining restitution,
921
–
–
masticatory load resistance, 921
–
–
neomucosa anti-inflammatory
response, 921
–
–
osseomucosal unit induction, 919,
921f
–
–
principles, 919
relative-motion concept, 1196–1197,
1197f, 1215
relative-motion flexion splinting,
1187f, 1197, 1198–1200, 1200f, 1205,
1206f, 1215–1217
residual alveolar clefts, secondary
bone grafting, 705–709, 707–708f
residual cleft nasal deformity correc­
tion, 709–711, 710–712f
restorative plastic surgery, principles,
914
reticular hemangioma, diffuse, 816f
revision mastopexy management,
583f, 585–588, 586–587f, 596–600,
598–600f
revision rhinoplasty. see rhinoplasty
(secondary)
rhinoplasty (primary)
–
–
airways, impacts on, 328
–
–
alar cartilages, 301, 301–302f,
307f, 324t, 327
–
–
anatomic variants, 289–293, 290–
292f, 303, 324–326, 324t, 325f
–
–
BDD symptoms and, 17
–
–
breathing difficulties evaluation,
333
–
–
cartilaginous middle third,
296–297, 298f
rapid awakening protocol, 955–956
reconstruction. see also microsurgery
records. see documentation
rectus abdominis flap characteriza­
tion, 1067t, 1068f, 1079
rectus femoris flap characterization,
1067t, 1068f
recurrent compression syndrome,
1302
red chili pepper, 548t
reduction mammaplasty
–
–
age, increasing, 603
–
–
antibiotic prophylaxis, 604
–
–
asymmetry, 608
–
–
blood loss, 604–605
–
–
breast contour, 606, 616, 616f
–
–
breast-feeding, 604, 613
–
–
cancer screening, 613–614
–
–
comorbidities, 603
–
–
complications of, 602, 607–610
–
–
dermal flaps, slings, 616–617, 617f
–
–
dog-ears, 605, 606f, 608
–
–
epidermal inclusion cyst, 608
–
–
hematomas, 607, 607f
–
–
infection, 609, 610f
–
–
inframammary fold as landmark,
619–621, 621f
–
–
juvenile population, 603, 613, 613f
–
–
liposuction areas, infiltrating,
617–619
–
–
low-molecular-weight heparin
(LMWH), 604
–
–
macromastia, recurrent, 609, 610f
–
–
necrosis, 607, 608f, 619, 620f
–
–
new pedicle involvement, 619,
620f
–
–
nipple–areolar complex conges­
tion, 605–606, 608–609, 609f, 617,
618f, 620f
–
–
obesity, 603
–
–
oncologic history, 603
–
–
oncoplastic reduction, 604
–
–
overview, 602
–
–
parenchyma removal, 616, 617f
–
–
pathology, atypical, 610, 614
–
–
patient selection, 602–604, 613
–
–
perfusion information, obtaining,
606
–
–
preoperative considerations,
602–604, 613–614
–
–
principles of, 614
–
–
psychological disturbances, 604
–
–
readmission, reasons for, 611
–
–
repeat reduction, 619, 620f
–
–
scarring, 605, 605f, 607–608, 608f,
610f
–
–
seromas, 607, 607f
–
–
surgical drains, 607, 619
pneumothorax incidence, 71, 71f
pollex abductus anomaly, 1145
polyacrylamide hydrogel, in gluteal
augmentation, 512
poly-L-lactic acid, 512, 895–896
polymethylmethacrylate (PMMA), 146
polysaccharide bead dressings, 119
polysyndactyly, 1136, 1153
poncitrin, 550t
post–bariatric-surgery deformities.
see body contouring, post-MWL
power-based cultures, 37t
prepayment, advantages of, 5
pressure garment therapy, 85, 85f, 91
procerus muscle, 223
profundus tendon repair, 1175
propranolol, infantile hemangioma
regimen, 821
protein kinase C inhibitors, in scar
treatment, 92
Pseudomonas aeruginosa, 103, 118,
149, 791
psychological aspects
–
–
body dysmorphic disorder, 16–19,
522
–
–
body image dissatisfaction, 15–16
–
–
cosmetic surgery popularity,
14–15
–
–
depression, 9, 11, 17–18
–
–
eating disorders, 17
–
–
overview, 14
–
–
patient assessment, 18–20
–
–
physical attractiveness, 15, 27
–
–
postoperative issues, 20
–
–
psychiatric history, status, 19
–
–
psychopathology, formal, 16
–
–
psychosocial status, post-proce­
dure, 18
–
–
self-performed procedures, 16
–
–
suicide, 17
psychopathology screening, 18–20
Pucher, P. H., 45t
pulmonary embolism incidence, 70,
70–71f
pyogenic granuloma, 812t, 813f, 814t
Q
quadriga effect, 1196–1197, 1215
R
Radiesse, 146, 148f, 153f, 172–173,
172–173f
ramus, angle, body augmentation
(implants), 386–388, 386–388f
rapamycin, infantile hemangioma,
821

INDEX
IN-20
–
–
severe deformity, 343
–
–
soft tissue problems, 354f,
362–363f, 363
–
–
splinting, 342
–
–
supratip deformity, 335, 335f, 339
–
–
surgical technique, 288, 336–341,
336–342f, 358, 358–360f
–
–
telangiectasia, 334
–
–
tip, 306, 307f
–
–
tip graft, 339–340, 340f
–
–
tip refinement, 339, 340f,
345–348, 345–348f
–
–
turbinates, 358, 365–371, 366f,
369–370f
–
–
valves, 302, 352–354, 352–354f,
356f, 357
risk managers, 52
Robertson, E., 44t
robotic surgery, 42
rules-based cultures, 37t
Russ, S., 43t
S
SAFELipo
–
–
ancillary procedures, 445–446,
445f
–
–
anesthesia, 439
–
–
contraindications, 437
–
–
fat grafting, shifting, 445, 445f
–
–
fat separation, aspiration, equal­
ization, 441–443, 442–444f
–
–
foam, 447
–
–
indications, 437
–
–
markings, 438f, 439
–
–
overview, 436–437, 450
–
–
patient evaluation, 437–438
–
–
patient positioning, 439–441,
439–441f
–
–
postoperative care, 446–447, 446f
–
–
preoperative planning, prepara­
tion, 438, 438–439f
–
–
process, 437
–
–
results, outcomes, 447, 448–450f
–
–
shark bites, 439–440, 440f
–
–
surgical technique, 439–446
–
–
windshield wiper effect, 443, 444f
safety culture, 40t
sagittal band rupture, 1202–1204,
1205f, 1216–1217
sagittal split osteotomy
–
–
fractures, unfavorable, 771f, 772,
773f
–
–
hemorrhage in, 769, 769f
–
–
neurologic deficits, 770–771,
770–771f
saw palmetto, 548t
SCAAR FX, 1358
–
–
bone work, 305, 305f
–
–
breathing difficulties evaluation,
333
–
–
cartilaginous vaults, 353, 353f
–
–
circulatory problems, 362–363
–
–
columellar strut, 339
–
–
common deformities in, 332, 356
–
–
completion, 343
–
–
complications, avoiding, 257t,
355–361, 356f, 358–361f
–
–
composite skin cartilage graft,
348–350, 349–350f
–
–
conchal cartilage graft harvesting,
337
–
–
costal cartilage graft harvesting,
338, 344, 344f
–
–
deconstruct/reconstruct surgical
technique, 343–350, 344–350f
–
–
dorsal deficiency correction, 337,
337f, 338–339, 339f
–
–
empty nose syndrome, 363
–
–
footplates, 340
–
–
goal of, 303
–
–
graft problems, 361–362
–
–
hanging columella, 335, 335f, 340
–
–
iatrogenic airway obstruction,
360f, 361, 362f
–
–
incision, 336
–
–
infection, 364
–
–
inferior turbinectomy, 371
–
–
intermediate level of complexity,
343
–
–
inverted-V deformity, 334, 335f,
338, 338f, 352, 353f
–
–
lateral crura, 339, 346–348, 347f,
353–354, 354f
–
–
nasal bone asymmetry, irregu­
larity, 334, 334f, 344–345, 345f,
348–350, 349–350f, 353f, 363
–
–
nasal bone osteotomy, 334f, 337
–
–
nostril length, 341
–
–
outcomes, 315–320, 364
–
–
packing, 342
–
–
patient evaluation, 303, 332–335,
334–335f
–
–
physical examination, 332–335,
334–335f
–
–
postoperative follow-up, 342, 350
–
–
preoperative planning, 335–336
–
–
radix, 334, 334f, 336–337, 336f
–
–
residual dorsal hump removal, 337
–
–
rhinitis, 363
–
–
rib cartilage usage, 308–309, 308f
–
–
septal collapse, 363
–
–
septoplasty, complications of,
365–371, 366f, 369–370f
–
–
septum, septal perforation, 357,
362
–
–
challenges in, 323, 329
–
–
complications, avoiding, 257t,
355–359, 356f, 358–360f
–
–
complications of, 289, 303–309
–
–
deformity, patterns of, 324
–
–
dorsal contour revision, 305,
305–306f
–
–
dorsal plateau revision, 304–305,
304–305f
–
–
dorsum, 294–295f, 295–296, 326,
326t
–
–
healing forces, 323–324
–
–
individual bone manipulation,
296, 297f, 305, 305f
–
–
infection, 97–98
–
–
instruments, 293, 293–294f
–
–
lateral crura malposition, 289,
290f, 302f
–
–
lip lift concurrent with, 405
–
–
low radix, 291, 291f, 299, 305,
305f, 326, 326t
–
–
narrow middle vault, 290f, 291,
324t, 326–327
–
–
nasal bones length, shape, 291,
292f
–
–
nasal imbalance, 324
–
–
nose dissection, 294–295, 295f
–
–
osteotomy, osteoplasty, 294f, 296,
305, 305f
–
–
outcomes, 309–320
–
–
patient assessment, 293, 303
–
–
postoperative distortion, 323–324
–
–
preoperative planning, 293, 324t,
326t, 328–329, 330f
–
–
principles of, 288, 288f, 322–323
–
–
proper proportions identification,
291–293
–
–
restructure vs. camouflage, 304
–
–
rib cartilage usage, 308–309, 308f
–
–
septum, 296–297, 298f, 301–302,
304
–
–
skeletal collapse, 324
–
–
skin thickness, 290, 302–303, 302f
–
–
soft tissue collapse, 324
–
–
structural layers, 324
–
–
structural revision technique, 320
–
–
tip, 288f, 299–301, 299–301f
–
–
tip projection, 324t, 327
–
–
tip revision, 306–308, 307–308f
–
–
turbinates, 301–302
–
–
valves, 301–302
rhinoplasty (secondary)
–
–
Airway Outcome Study, 354–355
–
–
alar base abnormalities, 341,
348–350, 349–350f
–
–
alar rim correction, 340
–
–
anatomic variants, 289, 352–354,
352–354f