Phẫu Thuật Tạo Hình (Tập 1): Nguyên Lý Cơ Bản – Neligan (2018)

Plastic
Fourth Edition
Surgery
Principles
Volume One

Content Strategist: Belinda Kuhn
Content Development Specialists: Louise Cook, Sam Crowe, Alexandra Mortimer
e-products, Content Development Specialist: Kim Benson
Project Managers: Anne Collett, Andrew Riley, Julie Taylor
Designer: Miles Hitchen
Illustration Managers: Karen Giacomucci, Amy Faith Heyden
Marketing Manager: Melissa Fogarty
Video Liaison: Will Schmitt

Volume Editor
Geoffrey C. Gurtner
MD, FACS
Johnson and Johnson Distinguished
Professor of Surgery and Vice Chairman,
Department of Surgery (Plastic Surgery)
Stanford University
Stanford, CA, USA
For additional online figures, videos and video lectures visit Expertconsult.com
Plastic
Surgery
Fourth Edition
Editor-in-Chief
Peter C. Neligan
MB, FRCS(I), FRCSC, FACS
Professor of Surgery
Department of Surgery, Division of Plastic Surgery
University of Washington
Seattle, WA, USA
London, New York, Oxford, Philadelphia, St Louis, Sydney 2018
Volume One
Principles
Multimedia Editor
Daniel Z. Liu
MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at
Midwestern Regional Medical Center
Zion, IL, USA

© 2018, Elsevier Inc. All rights reserved.
First edition 1990
Second edition 2006
Third edition 2013
Fourth edition 2018
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without permis-
sion in writing from the publisher. Details on how to seek permission, further information about the Publisher’s
permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the
Copyright Licensing Agency, can be found at our website:
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered,
to verify the recommended dose or formula, the method and duration of administration, and contraindications.
It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate
safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products’ liability, negligence, or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
Volume 1 ISBN: 978-0-323-35694-7
Volume 1 Ebook ISBN: 978-0-323-35695-4
6 volume set ISBN: 978-0-323-35630-5
Printed in Canada
Last digit is the print number:  9  8  7  6  5  4  3  2  1
The
publisher’s
policy is to use
paper manufactured
from sustainable forests

Video Contents
Chapter 11: Asian facial cosmetic surgery
1.1: Medial epicanthoplasty
11.2: Eyelidplasty: Non-incisional method
11.3: Rhinoplasty
11.4: Subclinical ptosis correction (total)
11.5: Secondary rhinoplasty: Septal extension graft and costal
cartilage strut fixed with K-wire
Kyung S. Koh, Jong Woo Choi, and Clyde H. Ishii
Chapter 12: Neck rejuvenation
12.1: Anterior lipectomy
James E. Zins, Colin M. Morrison, and C. J. Langevin
Chapter 13: Structural fat grafting
13.1: Structural fat grafting of the face
Sydney R. Coleman and Alesia P. Saboeiro
Chapter 14: Skeletal augmentation
14.1: Chin implant
Michael J. Yarumchuk
© Mesa J, Havlik R, Mackay D, Buchman S, Losee J, eds. Atlas of
Operative Craniofacial Surgery, CRC Press, 2019.
14.2: Mandibular angle implant
14.3: Midface skeletal augmentation and rejuvenation
Michael J. Yarumchuk
© Michael J. Yaremchuk
Chapter 16: Open technique rhinoplasty
16.1: Open technique rhinoplasty
Allen L. Van Beek
Chapter 20: Otoplasty and ear reduction
20.1: Setback otoplasty
Leila Kasrai
Chapter 23: Abdominoplasty procedures
23.1: Abdominoplasty
Dirk F. Richter and Alexander Stoff
Chapter 24: Lipoabdominoplasty
24.1: Lipoabdominoplasty (including secondary lipo)
Osvaldo Saldanha, Sérgio Fernando Dantas de Azevedo,
Osvaldo Ribeiro Saldanha Filho, Cristianna Bonnetto Saldanha, and
Luis Humberto Uribe Morelli
Chapter 26.2: Buttock augmentation: Buttock
augmentation with implants
26.2.1: Buttock augmentation
Terrence W. Bruner, Jose Abel De la Peña Salcedo,
Constantino G. Mendieta, and Thomas L. Roberts III
Chapter 27: Upper limb contouring
27.1: Brachioplasty
27.2: Upper limb contouring
Joseph F. Capella, Matthew J. Trovato, and Scott Woehrle
Volume One:
Chapter 15: Skin graft
15.1: Harvesting a split-thickness skin graft
Dennis P. Orgill
Chapter 34: Robotics in plastic surgery
34.1: Robotic microsurgery
34.2: Robotic rectus abdominis muscle flap harvest
34.3: Trans-oral robotic surgery
34.4: Robotic latissimus dorsi muscle harvest
34.5: Robotic lymphovenous bypass
Jesse C. Selber
Volume Two:
Chapter 6.2: Facelift: Principles of and surgical
approaches to facelift
6.2.1: Parotid masseteric fascia
6.2.2: Anterior incision
6.2.3: Posterior incision
6.2.4: Facelift skin flap
6.2.5: Facial fat injection
Richard J. Warren
6.2.6: Anthropometry, cephalometry, and orthognathic surgery
Jonathon S. Jacobs, Jordan M. S. Jacobs, and Daniel I. Taub
Chapter 6.3: Facelift: Platysma-SMAS plication
6.3.1: Platysma-SMAS plication
Dai M. Davies and Miles G. Berry
Chapter 6.4: Facelift: Facial rejuvenation with loop
sutures – the MACS lift and its derivatives
6.4.1: Loop sutures MACS facelift
Patrick L. Tonnard
From Aston SJ, Steinbrech DS, Walden JL, eds. Aesthetic Plastic
Surgery, Saunders Elsevier; 2009; with permission from Elsevier
Chapter 6.7: Facelift: SMAS with skin attached – the
“high SMAS” technique
6.7.1: The high SMAS technique with septal reset
Fritz E. Barton Jr.
© Fritz E. Barton Jr.
Chapter 6.8: Facelift: Subperiosteal midface lift
6.8.1: Subperiosteal midface lift: Endoscopic temporo-midface
Oscar M. Ramirez
Chapter 9: Blepharoplasty
9.1: Periorbital rejuvenation
Julius Few Jr. and Marco Ellis
© Julius Few Jr.

xiii
Video Contents
Chapter 26: Velopharyngeal dysfunction
26.1: Velopharyngeal incompetence – 1
26.2: Velopharyngeal incompetence – 2
26.3: Velopharyngeal incompetence – 3
Richard E. Kirschner and Adriane L. Baylis
Chapter 27: Secondary deformities of the cleft lip,
nose, and palate
27.1: Abbé flap
27.2: Alveolar bone grafting
27.3: Complete takedown
27.4: Definitive rhinoplasty
Evan M. Feldman, John C. Koshy, Larry H. Hollier Jr., and
Samuel Stal
27.5: Thick lip and buccal sulcus deformities
Evan M. Feldman and John C. Koshy
Chapter 36: Pierre Robin Sequence
36.1: Mandibular distraction
Arun K. Gosain and Chad A. Purnell
Chapter 39: Vascular anomalies
39.1: Lip hemangioma
Arin K. Greene
Chapter 43: Reconstruction of urogenital defects:
Congenital
43.1: First-stage hypospadias repair with free inner preputial
graft
43.2: Second-stage hypospadias repair with tunica vaginalis
flap
Mohan S. Gundeti and Michael C. Large
Volume Four:
Chapter 2: Management of lower extremity trauma
2.1: Anterolateral thigh flap harvest
Michel Saint-Cyr
Chapter 3: Lymphatic reconstruction of the
extremities
3.1: End-to-side lymphovenous bypass technique
© Cheng M-H, Chang D, Patel K. Principles and Practice of
Lymphedema Surgery, Elsevier; 2015.
3.2: Recipient site preparation for vascularized lymph node
transfer – axilla
© Cheng M-H, Chang D, Patel K. Principles and Practice of
Lymphedema Surgery, Elsevier; 2015.
3.3: Indocyanine green lymphography
David W. Chang
3.4: Charles procedure
Peter C. Neligan
Chapter 6: Diagnosis and treatment of painful
neuroma and nerve compression in the lower
extremity
6.1: Diagnosis and treatment of painful neuroma and of nerve
compression in the lower extremity 1
6.2: Diagnosis and treatment of painful neuroma and of nerve
compression in the lower extremity 2
Chapter 28: Post-bariatric reconstruction
28.1: Post-bariatric reconstruction – bodylift procedure
J. Peter Rubin and Jonathan W. Toy
© J. Peter Rubin
Volume Three:
Chapter 6: Aesthetic nasal reconstruction
6.1: The three-stage folded forehead flap for cover and lining
6.2: First-stage transfer and intermediate operation
Frederick J. Menick
Chapter 7: Auricular construction
7.1: Total auricular construction
Akira Yamada
Chapter 8: Acquired cranial and facial bone
deformities
8.1: Removal of venous malformation enveloping intraconal
optic nerve
Renee M. Burke, Robert J. Morin, and S. Anthony Wolfe
Chapter 13: Facial paralysis
13.1: Facial paralysis
Eyal Gur
13.2: Facial paralysis
13.3: Cross facial nerve graft
13.4: Gracilis harvest
Peter C. Neligan
Chapter 14: Pharyngeal and esophageal
reconstruction
14.1: Reconstruction of pharyngoesophageal defects with the
anterolateral thigh flap
Peirong Yu
Chapter 15: Tumors of the facial skeleton: Fibrous
dysplasia
15.1: Surgical approaches to the facial skeleton
Yu-Ray Chen, You-Wei Cheong, and Alberto Córdova-Aguilar
Chapter 17: Local flaps for facial coverage
17.1: Facial artery perforator flap
17.2: Local flaps for facial coverage
Peter C. Neligan
Chapter 21.2: Rotation advancement cheiloplasty
21.2.1: Repair of unilateral cleft lip
Philip Kuo-Ting Chen, M. Samuel Noordhoff, Frank Chun-Shin,
Chang, and Fuan Chiang Chan
21.2.2: Unilateral cleft lip repair – anatomic subunit
approximation technique
David M. Fisher
Chapter 24: Alveolar clefts
24.1: Unilateral cleft alveolar bone graft
24.2: Mobilized premaxilla after vomer osteotomy prior to
setback and splint application
Richard A. Hopper and Gerhard S. Mundinger

xiv
Video Contents
6.3: Diagnosis and treatment of painful neuroma and of nerve
compression in the lower extremity 3
A. Lee Dellon
Chapter 7: Skeletal reconstruction
7.1: Medial femoral condyle/medial geniculate artery
osteocutaneous free flap dissection for scaphoid nonunion
Stephen J. Kovach III and L. Scott Levin
Chapter 10: Reconstruction of the chest
10.1: Sternal rigid fixation
David H. Song and Michelle C. Roughton
Chapter 12: Abdominal wall reconstruction
12.1: Component separation innovation
Peter C. Neligan
Chapter 13: Reconstruction of male genital defects
13.1: Complete and partial penile reconstruction
Stan Monstrey, Peter Ceulemans, Nathalie Roche,
Philippe Houtmeyers, Nicolas Lumen, and Piet Hoebeke
Volume Five:
Chapter 6: Mastopexy options and techniques
6.1: Circumareolar mastopexy
Kenneth C. Shestak
Chapter 7: One- and two-stage considerations for
augmentation mastopexy
7.1: Preoperative markings for a single-stage augmentation
mastopexy
W. Grant Stevens
Chapter 10: Reduction mammaplasty with short scar
techniques
10.1: SPAIR technique
Dennis C. Hammond
Chapter 11: Gynecomastia surgery
11.1: Ultrasound-assisted liposuction
Charles M. Malata
Chapter 15: One- and two-stage prosthetic
reconstruction in nipple-sparing mastectomy
15.1: Pectoralis muscle elevation
15.2: Acellular dermal matrix
15.3: Sizer
Amy S. Colwell
Chapter 16: Skin-sparing mastectomy: Planned
two-stage and direct-to-implant breast
reconstruction
16.1: Mastectomy and expander insertion: First stage
16.2: Mastectomy and expander insertion: Second stage
Maurizio B. Nava, Giuseppe Catanuto, Angela Pennati,
Valentina Visintini Cividin, and Andrea Spano
Chapter 19: Latissimus dorsi flap breast
reconstruction
19.1: Latissimus dorsi flap technique
Scott L. Spear†
19.2: Markings
19.3: Intraoperative skin paddles
19.4: Tendon division
19.5: Transposition and skin paddles
19.6: Inset and better skin paddle explanation
Neil A. Fine and Michael S. Gart
Chapter 20.2: The deep inferior epigastric artery
perforator (DIEAP) flap
20.2.1: The Deep Inferior Epigastric Artery Perforator (DIEAP)
flap breast reconstruction
Phillip N. Blondeel and Robert J. Allen, Sr
Chapter 21.2: Gluteal free flaps for breast
reconstruction
21.2.1: Superior Gluteal Artery Perforator (SGAP) flap
21.2.2: Inferior Gluteal Artery Perforator (IGAP) flap
Peter C. Neligan
Chapter 21.3: Medial thigh flaps for breast
reconstruction
21.3.1: Transverse Upper Gracilis (TUG) flap 1
Peter C. Neligan
21.3.2: Transverse Upper Gracilis (TUG) flap 2
Venkat V. Ramakrishnan
Chapter 23.2: Partial breast reconstruction using
reduction and mastopexy techniques
23.2.1: Partial breast reconstruction using reduction
mammoplasty
Maurice Y. Nahabedian
23.2.2: Partial breast reconstruction with a latissimus dorsi flap
Neil A. Fine
23.2.3: Partial breast reconstruction with a pedicle TRAM
Maurice Y. Nahabedian
Volume Six:
Chapter 1: Anatomy and biomechanics of the hand
1.1: The extensor tendon compartments
1.2: The contribution of the interosseous and lumbrical
muscles to the lateral bands
1.3: Extrinsic flexors and surrounding vasculonervous
elements, from superficial to deep
1.4: The lumbrical plus deformity
1.5: The sensory and motor branches of the median nerve in
the hand
James Chang, Vincent R. Hentz, Robert A. Chase, and
Anais Legrand
Chapter 2: Examination of the upper extremity
2.1: Flexor profundus test in a normal long finger
2.2: Flexor sublimis test in a normal long finger
2.3: Extensor pollicis longus test in a normal person
2.4: Test for the Extensor Digitorum Communis (EDC) muscle
in a normal hand
2.5: Test for assessing thenar muscle function
2.6: The “cross fingers” sign
2.7: Static Two-Point Discrimination Test (s-2PD Test)
2.8: Moving 2PD Test (m-2PD Test) performed on the radial or
ulnar aspect of the finger

xv
Video Contents
2.9: Semmes–Weinstein monofilament test: The patient should
sense the pressure produced by bending the filament
2.10: Allen’s test in a normal person
2.11: Digital Allen’s test
2.12: Scaphoid shift test
2.13: Dynamic tenodesis effect in a normal hand
2.14: The milking test of the fingers and thumb in a normal
hand
2.15: Eichhoff test
2.16: Adson test
2.17: Roos test
Ryosuke Kakinoki
Chapter 3: Diagnostic imaging of the hand and
wrist
3.1: Scaphoid lunate dislocation
Alphonsus K. Chong and David M. K. Tan
3.2: Right wrist positive midcarpal catch up clunk
Alphonsus K. Chong
Chapter 4: Anesthesia for upper extremity surgery
4.1: Supraclavicular block
Subhro K. Sen
Chapter 5: Principles of internal fixation as applied
to the hand and wrist
5.1: Dynamic compression plating and lag screw technique
Christopher Cox
5.2: Headless compression screw
5.3: Locking vs. non-locking plates
Jeffrey Yao and Jason R. Kang
Chapter 7: Hand fractures and joint injuries
7.1: Bennett reduction
7.2: Hemi-Hamate arthroplasty
Warren C. Hammert
Chapter 9: Flexor tendon injury and reconstruction
9.1: Zone II flexor tendon repair
9.2: Incision and feed tendon forward
9.3: Distal tendon exposure
9.4: Six-strand M-tang repair
9.5: Extension–flexion test – wide awake
Jin Bo Tang
Chapter 10: Extensor tendon injuries
10.1: Sagittal band reconstruction
10.2: Setting the tension in extensor indicis transfer
Kai Megerle
Chapter 11: Replantation and revascularization
11.1: Hand replantation
James Chang
Chapter 12: Reconstructive surgery of the mutilated
hand
12.1: Debridement technique
James Chang
Chapter 13: Thumb reconstruction: Non-
microsurgical techniques
13.1: Osteoplastic thumb reconstruction
13.2: First Dorsal Metacarpal Artery (FDMA) flap
Jeffrey B. Friedrich
Chapter 14: Thumb reconstruction: Microsurgical
techniques
14.1: Trimmed great toe
14.2: Second toe for index finger
14.3: Combined second and third toe for metacarpal hand
Nidal F. Al Deek
Chapter 19: Rheumatologic conditions of the hand
and wrist
19.1: Extensor tendon rupture and end–side tendon transfer
James Chang
19.2: Silicone metacarpophalangeal arthroplasty
Kevin C. Chung and Evan Kowalski
Chapter 20: Osteoarthritis in the hand and wrist
20.1: Ligament reconstruction tendon interposition arthroplasty
of the thumb carpometacarpal joint
James W. Fletcher
Chapter 21: The stiff hand and the spastic hand
21.1: Flexor pronator slide
David T. Netscher
Chapter 22: Ischemia of the hand
22.1: Radial artery sympathectomy
Hee Chang Ahn and Neil F. Jones
22.2: Interposition arterial graft and sympathectomy
Hee Chang Ahn
Chapter 24: Nerve entrapment syndromes
24.1: The manual muscle testing algorithm
24.2: Scratch collapse test – carpal tunnel
Elisabet Hagert
24.3: Injection technique for carpal tunnel surgery
24.4: Wide awake carpal tunnel surgery
Donald Lalonde
24.5: Clinical exam and surgical technique – lacertus
syndrome
Elisabet Hagert
24.6: Injection technique for cubital tunnel surgery
24.7: Wide awake cubital tunnel surgery
Donald Lalonde
24.8: Clinical exam and surgical technique – radial tunnel
syndrome
24.9: Clinical exam and surgical technique – lateral
intermuscular syndrome
24.10: Clinical exam and surgical technique – axillary nerve
entrapment
Elisabet Hagert
24.11: Carpal tunnel and cubital tunnel releases in the same
patient in one procedure with field sterility: Part 1 – local
anesthetic injection for carpal tunnel
24.12: Carpal tunnel and cubital tunnel releases in the same
patient in one procedure with field sterility: Part 2 – local
anesthetic injection for cubital tunnel
Donald Lalonde and Michael Bezuhly
Chapter 25: Congenital hand I: Embryology,
classification, and principles
25.1: Pediatric trigger thumb release
James Chang

xvi
Video Contents
Chapter 27: Congenital hand III: Thumb hypoplasia
27.1: Thumb hypoplasia
Joseph Upton III and Amir Taghinia
Chapter 30: Growth considerations in pediatric
upper extremity trauma and reconstruction
30.1: Epiphyseal transplant harvesting technique
Marco Innocenti and Carla Baldrighi
Chapter 31: Vascular anomalies of the upper
extremity
31.1: Excision of venous malformation
Joseph Upton III and Amir Taghinia
Chapter 32: Peripheral nerve injuries of the upper
extremity
32.1: Suture repair of the cut digital nerve
32.2: Suture repair of the median nerve
Simon Farnebo and Johan Thorfinn
Chapter 35: Free-functioning muscle transfer in the
upper extremity
35.1: Gracilis functional muscle harvest
Gregory H. Borschel
Chapter 36: Brachial plexus injuries: Adult and
pediatric
36.1: Pediatric: shoulder correct and biceps-to-triceps transfer
with preserving intact brachialis
36.2: Adult: results of one-stage surgery for C5 rupture, C6–T1
root avulsion 10 years after
36.3: Nerve transfer results 1
36.4: Nerve transfer results 2
36.5: Nerve transfer results 3
36.6: Nerve transfer results 4
36.7: Nerve transfer results 5
David Chwei-Chin Chuang
Chapter 37: Restoration of upper extremity function
in tetraplegia
37.1: The single-stage grip and release procedure
37.2: Postoperative results after single-stage grip release
procedure in OCu3–5 patients
Carina Reinholdt and Catherine Curtin
Chapter 38: Upper extremity vascularized composite
allotransplantation
38.1: Upper extremity composite tissue allotransplantation
W. P. Andrew Lee and Vijay S. Gorantla
Chapter 39: Hand therapy
39.1: Goniometric measurement
39.2: Threshold testing
Christine B. Novak and Rebecca L. Neiduski

Lecture Video Contents
Volume One:
Chapter 1: Plastic surgery and innovation in medicine
Plastic surgery and innovation in medicine
Peter C. Neligan
Chapter 7: Digital imaging in plastic surgery
Digital imaging in plastic surgery
Daniel Z. Liu
Chapter 15: Skin graft
Skin graft
Peter C. Neligan
Chapter 19: Repair and grafting of peripheral nerve
Nerve injury and repair
Kirsty Usher Boyd, Andrew Yee, and Susan E. Mackinnon
Chapter 20: Reconstructive fat grafting
Reconstructive fat grafting
J. Peter Rubin
Chapter 21: Vascular territories
Vascular territories
Steven F. Morris
Chapter 22: Flap classification and applications
Flap classification and applications
Joon Pio Hong
Chapter 23: Flap pathophysiology and pharmacology
Flap pathophysiology and pharmacology
Cho Y. Pang and Peter C. Neligan
Chapter 24: Principles and techniques of
microvascular surgery
Principles and techniques of microvascular surgery
Fu-Chan Wei, Nidal F. Al Deek, and
Sherilyn Keng Lin Tay
Chapter 25: Principles and applications of tissue
expansion
Principles and applications of tissue expansion
Ivo Alexander Pestana, Louis C. Argenta, and
Malcolm W. Marks
Chapter 26: Principles of radiation
Therapeutic radiation: principles, effects, and complications
Gabrielle M. Kane
Chapter 28: Benign and malignant nonmelanocytic
tumors of the skin and soft tissue
Benign and malignant nonmelanocytic tumors of the skin and soft
tissue
Rei Ogawa
Chapter 31: Facial prosthetics in plastic surgery
Facial prosthetics in plastic surgery
Gordon H. Wilkes
Volume Two:
Chapter 4: Skincare and nonsurgical skin
rejuvenation
Skincare and nonsurgical skin rejuvenation
Leslie Baumann and Edmund Weisberg
Chapter 5.2: Injectables and resurfacing techniques:
Soft-tissue fillers
Soft-tissue fillers
Trevor M. Born, Lisa E. Airan, and Daniel Suissa
Chapter 5.3: Injectables and resurfacing techniques:
Botulinum toxin (BoNT-A)
Botulinum toxin
Michael A. C. Kane
Chapter 5.4: Injectables and resurfacing techniques:
Laser resurfacing
Laser resurfacing
Steven R. Cohen, Ahmad N. Saad, Tracy Leong,
and E. Victor Ross
Chapter 5.5: Injectables and resurfacing techniques:
Chemical peels
Chemical peels
Suzan Obagi
Chapter 6.1: Facelift: Facial anatomy and aging
Anatomy of the aging face
Bryan Mendelson and Chin-Ho Wong
Chapter 6.2: Facelift: Principles of and surgical
approaches to facelift
Principles of and surgical approaches to facelift
Richard J. Warren
Chapter 6.3: Facelift: Platysma-SMAS plication
Platysma-SMAS plication
Miles G. Berry

xviii
Lecture Video Contents
Chapter 6.4: Facelift: Facial rejuvenation with loop
sutures – the MACS lift and its derivatives
Facial rejuvenation with loop sutures – the MACS lift and its
derivatives
Mark Laurence Jewell
Chapter 6.5: Facelift: Lateral SMASectomy facelift
Lateral SMASectomy facelift
Daniel C. Baker and Steven M. Levine
Chapter 6.6: Facelift: The extended SMAS technique
in facial rejuvenation
The extended SMAS technique in facelift
James M. Stuzin
Chapter 6.7: Facelift: SMAS with skin attached – the
“high SMAS” technique
SMAS with skin attached – the high SMAS technique
Fritz E. Barton Jr.
Chapter 6.8: Facelift: Subperiosteal midface lift
Subperiosteal midface lift
Alan Yan and Michael J. Yaremchuk
Chapter 6.9: Facelift: Male facelift
Male facelift
Timothy J. Marten and Dino Elyassnia
Chapter 6.10: Facelift: Secondary deformities and
the secondary facelift
Secondary deformities and the secondary facelift
Timothy J. Marten and Dino Elyassnia
Chapter 7: Forehead rejuvenation
Forehead rejuvenation
Richard J. Warren
Chapter 8: Endoscopic brow lifting
Endoscopic brow lift
Renato Saltz and Alyssa Lolofie
Chapter 9: Blepharoplasty
Blepharoplasty
Julius Few Jr. and Marco Ellis
Chapter 11: Asian facial cosmetic surgery
Asian facial cosmetic surgery
Clyde H. Ishii
Chapter 12: Neck rejuvenation
Neck rejuvenation
James E. Zins, Joshua T. Waltzman, and Rafael A. Couto
Chapter 13: Structural fat grafting
Structural fat grafting
Sydney R. Coleman and Alesia P. Saboeiro
Chapter 15: Nasal analysis and anatomy
Nasal analysis and anatomy
Rod J. Rohrich
Chapter 19: Secondary rhinoplasty
Secondary rhinoplasty
Ronald P. Gruber, Simeon H. Wall Jr., David L. Kaufman,
and David M. Kahn
Chapter 21: Hair restoration
Hair restoration
Jack Fisher
Chapter 22.1: Liposuction: A comprehensive review
of techniques and safety
Liposuction
Phillip J. Stephan, Phillip Dauwe, and Jeffrey Kenkel
Chapter 22.2: Correction of liposuction deformities
with the SAFE liposuction technique
SAFE liposuction technique
Simeon H. Wall Jr. and Paul N. Afrooz
Chapter 23: Abdominoplasty procedures
Abdominoplasty
Dirk F. Richter and Nina Schwaiger
Chapter 25.2: Circumferential approaches to truncal
contouring: Belt lipectomy
Belt lipectomy
Al S. Aly, Khalid Al-Zahrani, and Albert Cram
Chapter 25.3: Circumferential approaches to truncal
contouring: The lower lipo-bodylift
Circumferential lower bodylift
Dirk F. Richter and Nina Schwaiger
Chapter 25.4: Circumferential approaches to truncal
contouring: Autologous buttocks augmentation with
purse string gluteoplasty
Purse string gluteoplasty
Joseph P. Hunstad and Nicholas A. Flugstad
Chapter 25.5: Circumferential approaches to truncal
contouring: Lower bodylift with autologous gluteal
flaps for augmentation and preservation of gluteal
contour
Lower bodylift with gluteal flaps
Robert F. Centeno and Jazmina M. Gonzalez
Chapter 26.3: Buttock augmentation: Buttock
shaping with fat grafting and liposuction
Buttock shaping with fat grafting and liposuction
Constantino G. Mendieta, Thomas L. Roberts III,
and Terrence W. Bruner
Chapter 27: Upper limb contouring
Upper limb contouring
Joseph F. Capella, Matthew J. Trovato, and Scott Woehrle
Chapter 30: Aesthetic genital surgery
Aesthetic genital surgery
Gary J. Alter

xix
Lecture Video Contents
Volume Three:
Chapter 10.3: Midface reconstruction: The M. D.
Anderson approach
Midfacial reconstruction: The M. D. Anderson approach
Matthew M. Hanasono and Roman Skoracki
Chapter 12: Lip reconstruction
Lip reconstruction
Peter C. Neligan and Lawrence J. Gottlieb
Chapter 14: Pharyngeal and esophageal
reconstruction
Pharyngoesophageal reconstruction
Peirong Yu
Chapter 15: Tumors of the facial skeleton: Fibrous
dysplasia
Fibrous dysplasia
Alberto Córdova-Aguilar and Yu-Ray Chen
Chapter 17: Local flaps for facial coverage
Local flaps for facial coverage
David W. Mathes
Chapter 19: Facial transplant
Facial transplant
Michael Sosin and Eduardo D. Rodriguez
Chapter 32: Nonsyndromic craniosynostosis
Nonsyndromic craniosynostosis
Patrick A. Gerety, Jesse A. Taylor, and Scott P. Bartlett
Chapter 36: Pierre Robin Sequence
Pierre Robin sequence
Chad A. Purnell and Arun K. Gosain
Chapter 39: Vascular anomalies
Vascular anomalies
Arin K. Greene and John B. Mulliken
Volume Four:
Chapter 2: Management of lower extremity trauma
Management of lower extremity trauma
Yoo Joon Sur, Shannon M. Colohan, and Michel Saint-Cyr
Chapter 15: Surgery for gender identity disorder
Surgery for gender identity disorder
Loren S. Schechter
Chapter 16: Pressure sores
Pressure sores
Robert Kwon, Juan L. Rendon, and Jeffrey E. Janis
Chapter 17: Perineal reconstruction
Perineal reconstruction
Hakim K. Said and Otway Louie
Volume Five:
Chapter 5: Breast augmentation with autologous fat
grafting
Breast augmentation with autologous fat grafting
E. Delay
Chapter 6: Mastopexy options and techniques
Mastopexy
Robert Cohen
Chapter 9: Reduction mammaplasty with inverted-T
techniques
Reduction mammaplasty with inverted-T techniques
Maurice Y. Nahabedian
Chapter 15: One- and two-stage prosthetic
reconstruction in nipple-sparing mastectomy
Prosthetic reconstruction in nipple-sparing mastectomy
Amy S. Colwell
Chapter 20.1: Abdominally based free flaps:
Introduction
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 20.2: The deep inferior epigastric artery
perforator (DIEAP) flap
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 20.3: The superficial inferior epigastric
artery (SIEA) flap
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 20.4: The free TRAM flap
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 25: Radiation therapy considerations in the
setting of breast reconstruction
Radiation therapy in breast reconstruction
Steven Kronowitz
Volume Six:
Chapter 7: Hand fractures and joint injuries
Hand fractures and joint injuries
Joseph S. Khouri and Warren C. Hammert
Chapter 13: Thumb reconstruction: Non-
microsurgical techniques
Thumb reconstruction
Nicholas B. Vedder and Jeffrey B. Friedrich
Chapter 21: The stiff hand and the spastic hand
The stiff hand
David T. Netscher, Kenneth W. Donohue, and Dang T. Pham

xx
Lecture Video Contents
Chapter 24: Nerve entrapment syndromes
Tips and pearls on common nerve compressions
Elisabet Hagert and Donald Lalonde
Chapter 30: Growth considerations in pediatric
upper extremity trauma and reconstruction
Growth considerations in pediatric upper extremity trauma and
reconstruction
Marco Innocenti and Carla Baldrighi
Chapter 33: Nerve transfers
Nerve injury and repair
Kirsty Usher Boyd, Andrew Yee, and Susan E. Mackinnon
Chapter 37: Restoration of upper extremity function
in tetraplegia
Restoration of upper extremity function in tetraplegia
Carina Reinholdt and Catherine Curtin

Preface to the Fourth Edition
When I wrote the preface to the 3rd edition of this book, I
remarked how honored and unexpectedly surprised I was to
be the Editor of this great series. This time ‘round, I’m equally
grateful to carry this series forward. When Elsevier called me
and suggested it was time to prepare the 4th edition, my
initial reaction was that this was way too soon. What could
possibly have changed in Plastic Surgery since the 3rd edition
was launched in 2012? As it transpires, there have been many
developments and I hope we have captured them in this
edition.
We have an extraordinary specialty. A recent article by
Chadra, Agarwal and Agarwal entitled “Redefining Plastic
Surgery” appeared in Plastic and Reconstructive Surgery—Global
Open. In it they gave the following definition: “Plastic surgery
is a specialized branch of surgery, which deals with deformi-
ties, defects and abnormalities of the organs of perception,
organs of action and the organs guarding the external pas-
sages, besides innovation, implantation, replantation and
transplantation of tissues, and aims at restoring and improv-
ing their form, function and the esthetic appearances.” This is
an all-encompassing but very apt definition and captures the
enormous scope of the specialty.1
In the 3rd edition, I introduced volume editors for each of
the areas of the specialty because the truth is that one person
can no longer be an expert in all areas of this diverse specialty,
and I’m certainly not. I think this worked well because the
volume editors not only had the expertise to present their area
of subspecialty in the best light, but they were tuned in to
what was new and who was doing it. We have continued this
model in this new edition. Four of the seven volume editors
from the previous edition have again helped to bring the latest
and the best to this edition: Drs Gurtner, Song, Rodriguez,
Losee, and Chang have revised and updated their respective
volumes with some chapters remaining, some extensively
revised, some added, and some deleted. Dr. Peter Rubin has
replaced Dr. Rick Warren to compile the Aesthetic volume
(Vol. 2). Dr. Warren did a wonderful job in corralling this
somewhat disparate, yet vitally important, part of our spe-
cialty into the Aesthetic volume in the 3rd edition but felt that
the task of doing it again, though a labor of love, was more
than he wanted to take on. Similarly, Dr. Jim Grotting who did
a masterful job in the last edition on the Breast volume,
decided that doing a major revision should be undertaken by
someone with a fresh perspective and Dr. Maurice Nahabe-
dian stepped into that breach. I hope you will like the changes
you see in both of these volumes.
Dr. Allen Van Beek was the video editor for the last edition
and he compiled an impressive array of movies to comple-
ment the text. This time around, we wanted to go a step
further and though we’ve considerably expanded the list of
videos accompanying the text (there are over 170), we also
added the idea of lectures accompanying selected chapters.
What we’ve done here is to take selected key chapters and
include the images from that chapter, photos and artwork,
and create a narrated presentation that is available online;
there are annotations in the text to alert the reader that this is
available. Dr. Daniel Liu, who has taken over from Dr. Van
Beek as multimedia editor (rather than video editor) has done
an amazing job in making all of this happen. There are over
70 presentations of various key chapters online, making it as
easy as possible for you, the reader, to get as much knowledge
as you can, in the easiest way possible from this edition. Many
of these presentations have been done by the authors of the
chapters; the rest have been compiled by Dr. Liu and myself
from the content of the individual chapters. I hope you find
them useful.
The reader may wonder how this all works. To plan this
edition, the Elsevier team, headed by Belinda Kuhn, and I,
convened a face-to-face meeting in San Francisco. The volume
editors, as well as the London based editorial team, were
present. We went through the 3rd edition, volume by volume,
chapter by chapter, over an entire weekend. We decided what
needed to stay, what needed to be added, what needed to be
revised, and what needed to be changed. We also decided
who should write the various chapters, keeping many exist-
ing authors, replacing others, and adding some new ones; we
did this so as to really reflect the changes occurring within the
specialty. We also decided on practical changes that needed to
be made. As an example, you will notice that we have omitted
the complete index for the 6 Volume set from Volumes 2-6
and highlighted only the table of contents for that particular
volume. The complete index is of course available in Volume
1 and fully searchable online. This allowed us to save several
hundred pages per volume, reducing production costs and
diverting those dollars to the production of the enhanced online
content.
In my travels around the world since the 3rd edition was
published, I’ve been struck by what an impact this publication
has had on the specialty and, more particularly, on training.
Everywhere I go, I’m told how the text is an important part
of didactic teaching and a font of knowledge. It is gratifying
to see that the 3rd edition has been translated into Portuguese,
Spanish, and Chinese. This is enormously encouraging. I
hope this 4th edition continues to contribute to the specialty,
remains a resource for practicing surgeons, and continues to
prepare our trainees for their future careers in Plastic Surgery.
Peter C. Neligan
Seattle, WA
September, 2017
1 Chandra R, Agarwal R, Agarwal D. Redefining Plastic Surgery. Plast
Reconstr Surg Glob Open. 2016;4(5):e706.

List of Editors
Editor-in-Chief
Peter C. Neligan, MB, FRCS(I), FRCSC, FACS
Professor of Surgery
Department of Surgery, Division of Plastic Surgery
University of Washington
Seattle, WA, USA
Volume 1: Principles
Geoffrey C. Gurtner, MD, FACS
Johnson and Johnson Distinguished Professor of
Surgery and Vice Chairman,
Department of Surgery (Plastic Surgery)
Stanford University
Stanford, CA, USA
Volume 2: Aesthetic
J. Peter Rubin, MD, FACS
UPMC Professor of Plastic Surgery
Chair, Department of Plastic Surgery
Professor of Bioengineering
University of Pittsburgh
Pittsburgh, PA, USA
Volume 3: Craniofacial, Head and Neck Surgery
Eduardo D. Rodriguez, MD, DDS
Helen L. Kimmel Professor of Reconstructive
Plastic Surgery
Chair, Hansjörg Wyss Department of Plastic
Surgery
NYU School of Medicine
NYU Langone Medical Center
New York, NY, USA
Volume 3: Pediatric Plastic Surgery
Joseph E. Losee, MD
Ross H. Musgrave Professor of Pediatric Plastic
Surgery
Department of Plastic Surgery
University of Pittsburgh Medical Center;
Chief Division of Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh
Pittsburgh, PA, USA
Volume 4: Lower Extremity, Trunk, and Burns
David H. Song, MD, MBA, FACS
Regional Chief, MedStar Health
Plastic and Reconstructive Surgery
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC, USA
Volume 5: Breast
Maurice Y. Nahabedian, MD, FACS
Professor and Chief
Section of Plastic Surgery
MedStar Washington Hospital Center
Washington, DC, USA;
Vice Chairman
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington, DC, USA
Volume 6: Hand and Upper Extremity
James Chang, MD
Johnson & Johnson Distinguished
Professor and Chief
Division of Plastic and Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Multimedia editor
Daniel Z. Liu, MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at Midwest-
ern Regional Medical Center
Zion, IL, USA

List of Contributors
VOLUME ONE
Hatem Abou-Sayed, MD, MBA
Vice President
Physician Engagement
Interpreta, Inc.
San Diego, CA, USA
Paul N. Afrooz, MD
Resident
Plastic and Reconstructive Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Claudia R. Albornoz, MD, MSc
Research Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Nidal F. Al Deek, MD
Doctor of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taipei, Taiwan
Amy K. Alderman, MD, MPH
Private Practice
Atlanta, GA, USA
Louis C. Argenta, MD
Professor of Plastic and Reconstructive Surgery
Department of Plastic Surgery
Wake Forest Medical Center
Winston Salem, NC, USA
Stephan Ariyan, MD, MBA
Emeritus Frank F. Kanthak Professor of Surgery,
Plastic Surgery, Surgical Oncology,
Otolaryngology
Yale University School of Medicine;
Associate Chief
Department of Surgery;
Founding Director, Melanoma Program
Smilow Cancer Hospital, Yale Cancer Center
New Haven, CT, USA
Tomer Avraham, MD
Attending Plastic Surgeon
Mount Sinai Health System
Tufts University School of Medicine
New York, NY, USA
Aaron Berger, MD, PhD
Clinical Assistant Professor
Division of Plastic Surgery
Florida International University School of
Medicine
Miami, FL, USA
Kirsty Usher Boyd, MD, FRCSC
Assistant Professor Surgery (Plastics)
Division of Plastic and Reconstructive Surgery
University of Ottawa
Ottawa, Ontario, Canada
Charles E. Butler, MD, FACS
Professor and Chairman
Department of Plastic Surgery
Charles B. Barker Endowed Chair in Surgery
The University of Texas MD Anderson Cancer
Center
Houston, TX, USA
Peter E. M. Butler, MD, FRCSI, FRCS,
FRCS(Plast)
Professor
Plastic and Reconstructive Surgery
University College and Royal Free London
London, UK
Yilin Cao, MD, PhD
Professor
Shanghai Ninth People’s Hospital
Shanghai Jiao Tong University School of
Medicine
Shanghai, China
Franklyn P. Cladis, MD, FAAP
Associate Professor of Anesthesiology
Department of Anesthesiology
The Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, PA, USA
Mark B. Constantian, MD
Private Practice
Surgery (Plastic Surgery)
St. Joseph Hospital
Nashua, NH, USA
Daniel A. Cuzzone, MD
Plastic Surgery Fellow
Hanjörg Wyss Department of Plastic Surgery
New York University Medical Center
New York, NY, USA
Gurleen Dhami, MD
Chief Resident
Department of Radiation Oncology
University of Washington
Seattle, WA, USA
Gayle Gordillo, MD
Associate Professor
Plastic Surgery
The Ohio State University
Columbus, OH, USA
Geoffrey C. Gurtner, MD, FACS
Johnson and Johnson Distinguished Professor
of Surgery and Vice Chairman,
Department of Surgery (Plastic Surgery)
Stanford University
Stanford, CA, USA
Phillip C. Haeck, MD
Surgeon
Plastic Surgery
The Polyclinic
Seattle, WA, USA
The late Bruce Halperin†, MD
Formerly Adjunct Associate Professor of
Anesthesia
Department of Anesthesia
Stanford University
Stanford, CA, USA
Daniel E. Heath
Lecturer
School of Chemical and Biomedical Engineering
University of Melbourne
Parkville, Victoria, Australia
Joon Pio Hong, MD, PhD, MMM
Professor
Plastic Surgery
Asan Medical Center, University of Ulsan
Seoul, South Korea
Michael S. Hu, MD, MPH, MS
Postdoctoral Fellow
Division of Plastic Surgery
Department of Surgery
Stanford University School of Medicine
Stanford, CA, USA
C. Scott Hultman, MD, MBA
Professor and Chief
Division of Plastic and Reconstructive Surgery
University of North Carolina
Chapel Hill, NC, USA
Amir E. Ibrahim
Division of Plastic Surgery
Department of Surgery
American University of Beirut Medical Center
Beirut, Lebanon
Leila Jazayeri, MD
Microsurgery Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
The editors would like to acknowledge and offer grateful thanks for the input of all previous editions’ contributors, without whom this new edition would
not have been possible.

xxiv
List of Contributors
Brian Jeffers
Student
Bioengineering
University of California Berkeley
Berkeley, CA USA
Lynn Jeffers, MD, FACS
Private Practice
Oxnard, CA, USA
Mohammed M. Al Kahtani, MD, FRCSC
Clinical Fellow
Division of Plastic Surgery
Department of Surgery
University of Alberta
Edmonton, Alberta, Canada
Gabrielle M. Kane, MB, BCh, EdD, FRCPC
Associate Professor
Radiation Oncology
University of Washington
Seattle, WA, USA
Raghu P. Kataru, PhD
Senior Research Scientist
Memorial Sloan-Kettering Cancer Center
New York, NY, USA
Carolyn L. Kerrigan, MD, MSc, MHCDS
Professor of Surgery
Surgery
Dartmouth–Hitchcock Medical Center
Lebanon, NH, USA
Timothy W. King, MD, PhD, FAAP, FACS
Associate Professor with Tenure
Departments of Surgery and Biomedical
Engineering;
Director of Research, Division of Plastic Surgery
University of Alabama at Birmingham (UAB)
Craniofacial and Pediatric Plastic Surgery
Children’s of Alabama – Plastic Surgery;
Chief, Plastic Surgery Section
Birmingham VA Hospital
Birmingham, AL, USA
Brian M. Kinney, MD, FACS, MSME
Clinical Assistant Professor of Plastic Surgery
University of Southern California
School of Medicine
Los Angeles, CA, USA
W. P. Andrew Lee, MD
The Milton T. Edgerton MD, Professor and
Chairman
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Sherilyn Keng Lin Tay, MBChB, MSc,
FRCS(Plast)
Consultant Plastic Surgeon
Canniesburn Plastic Surgery Unit
Glasgow Royal Infirmary
Glasgow, UK
Daniel Z. Liu, MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at
Midwestern Regional Medical Center
Zion, IL, USA
Wei Liu, MD, PhD
Professor
Plastic and Reconstructive Surgery
Shanghai Ninth People’s Hospital
Shanghai Jiao Tong University School of
Medicine
Shanghai, China
Michael T. Longaker, MD, MBA, FACS
Deane P. and Louise Mitchell Professor and Vice
Chair
Department of Surgery
Stanford University
Stanford, CA, USA
H. Peter Lorenz, MD
Service Chief and Professor, Plastic Surgery
Lucile Packard Children’s Hospital
Stanford University School of Medicine
Stanford, CA, USA
Susan E. Mackinnon, MD
Sydney M. Shoenberg Jr. and Robert H.
Shoenberg Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Malcolm W. Marks, MD
Professor and Chairman
Department of Plastic Surgery
Wake Forest University School of Medicine
Winston-Salem, NC, USA
Diego Marre, MD
Fellow
O’Brien Institute
Department of Plastic and Reconstructive
Surgery
St. Vincent’s Hospital
Melbourne, Australia
David W. Mathes, MD
Professor and Chief of the Division of Plastic
and Reconstructive Surgery
University of Colorado
Aurora, CO, USA
Evan Matros MD, MMSc
Plastic Surgeon
Memorial Sloan-Kettering Cancer Center
New York, NY, USA
Isabella C. Mazzola, MD
Attending Plastic Surgeon
Klinik für Plastische und Ästhetische Chirurgie
Klinikum Landkreis Erding
Erding, Germany
Riccardo F. Mazzola, MD
Plastic Surgeon
Department of Specialistic Surgical Sciences
Fondazione Ospedale Maggiore Policlinico, Ca’
Granda IRCCS
Milano, Italy
Lindsay D. McHutchion, MS, BSc
Anaplastologist
Institute for Reconstructive Sciences in Medicine
Edmonton, Alberta, Canada
Babak J. Mehrara, MD, FACS
Associate Member, Associate Professor of
Surgery (Plastic)
Memorial Sloan Kettering Cancer Center
Weil Cornell University Medical Center
New York, NY, USA
Steven F. Morris, MD, MSc, FRCSC
Professor of Surgery
Department of Surgery
Dalhousie University
Halifax, Nova Scotia, Canada
Wayne A. Morrison, MBBS, MD, FRACS
Professorial Fellow
O’Brien Institute
Department of Surgery, University of Melbourne
Department of Plastic and Reconstructive
Surgery, St. Vincent’s Hospital
Melbourne, Australia
Peter C. Neligan, MB, FRCS(I), FRCSC,
FACS
Professor of Surgery
Department of Surgery, Division of Plastic
Surgery
University of Washington
Seattle, WA, USA
Andrea J. O’Connor, BE(Hons), PhD
Associate Professor
Department of Chemical and Biomolecular
Engineering
University of Melbourne
Parkville, Victoria, Australia
Rei Ogawa, MD, PhD, FACS
Professor and Chief
Department of Plastic
Reconstructive and Aesthetic Surgery
Nippon Medical School
Tokyo, Japan
Dennis P. Orgill, MD, PhD
Professor of Surgery
Harvard Medical School
Medical Director, Wound Care Center;
Vice Chairman for Quality Improvement
Department of Surgery
Brigham and Women’s Hospital
Boston, MA, USA

xxv
List of Contributors
Cho Y. Pang, PhD
Senior Scientist
Research Institute
The Hospital for Sick Children;
Professor
Departments of Surgery/Physiology
University of Toronto
Toronto, Ontario, Canada
Ivo Alexander Pestana, MD, FACS
Associate Professor
Plastic and Reconstructive Surgery
Wake Forest University
Winston Salem, NC, USA
Giorgio Pietramaggior, MD, PhD
Swiss Nerve Institute
Clinique de La Source
Lausanne, Switzerland
Andrea L. Pusic, MD, MHS, FACS
Associate Professor
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Russell R. Reid, MD, PhD
Associate Professor
Surgery/Section of Plastic and Reconstructive
Surgery
University of Chicago Medicine
Chicago, IL, USA
Neal R. Reisman, MD, JD
Chief
Plastic Surgery
Baylor St. Luke’s Medical Center
Houston, TX, USA
Joseph M. Rosen, MD
Professor of Surgery
Plastic Surgery
Dartmouth–Hitchcock Medical Center
Lebanon, NH, USA
Sashwati Roy, MS, PhD
Associate Professor
Surgery, Center for Regenerative Medicine and
Cell based Therapies
The Ohio State University
Columbus, OH, USA
J. Peter Rubin, MD, FACS
UPMC Professor of Plastic Surgery
Chair, Department of Plastic Surgery
Professor of Bioengineering
University of Pittsburgh
Pittsburgh, PA, USA
Karim A. Sarhane, MD
Department of Surgery
University of Toledo Medical Center
Toledo, OH, USA
David B. Sarwer, PhD
Associate Professor of Psychology
Departments of Psychiatry and Surgery
University of Pennsylvania School of Medicine
Philadelphia, PA, USA
Saja S. Scherer-Pietramaggiori, MD
Plastic and Reconstructive Surgeon
Plastic Surgery
University Hospital Lausanne
Lausanne, Vaud, Switzerland
Iris A. Seitz, MD, PhD
Director of Research and International
Collaboration
University Plastic Surgery
Rosalind Franklin University;
Clinical Instructor of Surgery
Chicago Medical School
Chicago, IL, USA
Jesse C. Selber, MD, MPH, FACS
Associate Professor, Director of Clinical
Research
Department of Plastic Surgery
MD Anderson Cancer Center
Houston, TX, USA
Chandan K. Sen, PhD
Professor and Director
Center for Regenerative Medicine and Cell-
Based Therapies
The Ohio State University Wexner Medical
Center
Columbus, OH, USA
Wesley N. Sivak, MD, PhD
Resident in Plastic Surgery
Department of Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA
M. Lucy Sudekum
Research Assistant
Thayer School of Engineering at Dartmouth
College
Hanover, NH, USA
G. Ian Taylor, AO, MBBS, MD, MD(Hon
Bordeaux), FRACS, FRCS(Eng), FRCS(Hon
Edinburgh), FRCSI(Hon), FRSC(Hon
Canada), FACS(Hon)
Professor
Department of Plastic Surgery
Royal Melbourne Hospital;
Professor
Department of Anatomy
University of Melbourne
Melbourne, Victoria, Australia
Chad M. Teven, MD
Resident
Section of Plastic and Reconstructive Surgery
University of Chicago
Chicago, IL, USA
Ruth Tevlin, MB BAO BCh, MRCSI, MD
Resident in Surgery
Department of Plastic and Reconstructive
Surgery
Stanford University School of Medicine
Stanford, CA, USA
E. Dale Collins Vidal, MD, MS
Chief
Section of Plastic Surgery
Dartmouth–Hitchcock Medical Center
Lebanon, NH, USA
Derrick C. Wan, MD
Associate Professor
Division of Plastic Surgery
Department of Surgery
Director of Maxillofacial Surgery
Lucile Packard Children’s Hospital
Stanford University School of Medicine
Stanford, CA, USA
Renata V. Weber, MD
Assistant Professor Surgery (Plastics)
Division of Plastic and Reconstructive Surgery
Albert Einstein College of Medicine
Bronx, NY, USA
Fu-Chan Wei, MD
Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
Gordon H. Wilkes, BScMed, MD
Clinical Professor of Surgery
Department of Surgery University of Alberta
Institute for Reconstructive Sciences in Medicine
Misericordia Hospital
Edmonton, Alberta, Canada
Johan F. Wolfaardt, BDS,
MDent(Prosthodontics), PhD
Professor
Division of Otolaryngology – Head and Neck
Surgery
Department of Surgery
Faculty of Medicine and Dentistry;
Director of Clinics and International Relations
Institute for Reconstructive Sciences in Medicine
University of Alberta
Covenant Health Group
Alberta Health Services
Alberta, Canada
Kiryu K. Yap, MBBS, BMedSc
Junior Surgical Trainee & PhD Candidate
O’Brien Institute
Department of Surgery, University of Melbourne
Department of Plastic and Reconstructive
Surgery, St. Vincent’s Hospital
Melbourne, Australia
Andrew Yee
Research Assistant
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Elizabeth R. Zielins, MD
Postdoctoral Research Fellow
Surgery
Stanford University School of Medicine
Stanford, CA, USA

xxvi
List of Contributors
VOLUME TWO
Paul N. Afrooz, MD
Resident
Plastic and Reconstructive Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Jamil Ahmad, MD, FRCSC
Director of Research and Education
The Plastic Surgery Clinic
Mississauga;
Assistant Professor
Surgery
University of Toronto
Toronto, Ontario, Canada
Lisa E. Airan, MD
Aesthetic Dermatologist NYC
Private Practice;
Associate Clinical Professor Department of
Dermatology
Mount Sinai School of Medicine
New York, NY, USA
Gary J. Alter, MD
Assistant Clinical Professor
Division of Plastic Surgery
University of California
Los Angeles, CA, USA
Al S. Aly, MD
Professor of Plastic Surgery
Aesthetic and Plastic Surgery Institute University
of California Irvine
Orange, CA, USA
Khalid Al-Zahrani, MD, SSC-PLAST
Assistant Professor
Consultant Plastic Surgeon
King Khalid University Hospital
King Saud University
Riyadh, Saudi Arabia
Bryan Armijo, MD
Plastic Surgery Chief Resident
Department of Plastic and Reconstructive
Surgery
Case Western Reserve/University Hospitals
Cleveland, OH, USA
Daniel C. Baker, MD
Professor of Surgery
Institute of Reconstructive Plastic Surgery
New York University Medical Center
Department of Plastic Surgery
New York, NY, USA
Fritz E. Barton Jr., MD
Clinical Professor
Department of Plastic Surgery
UT Southwestern Medical Center
Dallas, TX, USA
Leslie Baumann, MD
CEO
Baumann Cosmetic and Research Institute
Miami, FL, USA
Miles G. Berry, MS, FRCS(Plast)
Consultant Plastic and Aesthetic Surgeon
Institute of Cosmetic and Reconstructive
Surgery
London, UK
Trevor M. Born, MD
Division of Plastic Surgery
Lenox Hill/Manhattan Eye Ear and Throat
Hospital North Shore-LIJ Hospital
New York, NY, USA;
Clinical Lecturer
Division of Plastic Surgery
University of Toronto Western Division
Toronto, Ontario, Canada
Terrence W. Bruner, MD, MBA
Private Practice
Greenville, SC, USA
Andrés F. Cánchica, MD
Chief Resident of Plastic Surgery
Plastic Surgery Service Dr. Osvaldo Saldanha
São Paulo, Brazil
Joseph F. Capella, MD
Chief Post-bariatric Body Contouring
Division of Plastic Surgery
Hackensack University Medical Center
Hackensack, NJ, USA
Robert F. Centeno, MD, MBA
Medical Director
St. Croix Plastic Surgery and MediSpa;
Chief Medical Quality Officer
Governor Juan F. Luis Hospital and Medical
Center
Christiansted, Saint Croix, United States Virgin
Islands
Ernest S. Chiu, MD, FACS
Associate Professor of Plastic Surgery
Department of Plastic Surgery
New York University
New York, NY, USA
Jong Woo Choi, MD, PhD, MMM
Associate Professor
Department of Plastic and Reconstructive
Surgery
Seoul Asan Medical Center
Seoul, South Korea
Steven R. Cohen, MD
Senior Clinical Research Fellow, Clinical
Professor
Plastic Surgery
University of California
San Diego, CA;
Director
Craniofacial Surgery
Rady Children’s Hospital, Private Practice,
FACES+ Plastic Surgery, Skin and Laser Center
La Jolla, CA, USA
Sydney R. Coleman, MD
Assistant Clinical Professor
Plastic Surgery
New York University Medical Center
New York;
Assistant Clinical Professor
Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Mark B. Constantian, MD
Private Practice
Surgery (Plastic Surgery)
St. Joseph Hospital
Nashua, NH, USA;
Adjunct Clinical Professor
Surgery (Plastic Surgery)
University of Wisconsin School of Medicine
Madison, WI, USA;
Visiting Professor
Plastic Surgery
University of Virginia Health System
Charlottesville, VA, USA
Rafael A. Couto, MD
Plastic Surgery Resident
Department of Plastic Surgery
Cleveland Clinic
Cleveland, OH, USA
Albert Cram, MD
Professor Emeritus
University of Iowa
Iowa City Plastic Surgery
Coralville, IO, USA
Phillip Dauwe, MD
Department of Plastic Surgery
University of Texas Southwestern Medical
School
Dallas, TX, USA
Dai M. Davies, FRCS
Consultant and Institute Director
Institute of Cosmetic and Reconstructive
Surgery
London, UK
Jose Abel De la Peña Salcedo, MD, FACS
Plastic Surgeon
Director
Instituto de Cirugia Plastica S.C.
Huixquilucan
Estado de Mexico, Mexico
Barry DiBernardo, MD, FACS
Clinical Associate Professor, Plastic Surgery
Rutgers, New Jersey Medical School
Director New Jersey Plastic Surgery
Montclair, NJ, USA
Felmont F. Eaves III, MD, FACS
Professor of Surgery, Emory University
Medical Director, Emory Aesthetic Center
Medical Director, EAC Ambulatory Surgery
Center
Atlanta, GA, USA

xxvii
List of Contributors
Marco Ellis, MD
Director of Craniofacial Surgery
Northwestern Specialists in Plastic Surgery;
Adjunct Assistant Professor
University of Illinois Chicago Medical Center
Chicago, IL, USA
Dino Elyassnia, MD
Associate Plastic Surgeon
Marten Clinic of Plastic Surgery
San Francisco, CA, USA
Julius Few Jr., MD
Director
The Few Institute for Aesthetic Plastic Surgery;
Clinical Professor
Plastic Surgery
University of Chicago Pritzker School of
Medicine
Chicago, IL, USA
Osvaldo Ribeiro Saldanha Filho, MD
Professor of Plastic Surgery
Plastic Surgery Service Dr. Osvaldo Saldanha
São Paulo, Brazil
Jack Fisher, MD
Associate Clinical Professor
Plastic Surgery
Vanderbilt University
Nashville, TN, USA
Nicholas A. Flugstad, MD
Flugstad Plastic Surgery
Bellevue, WA, USA
James D. Frame, MBBS, FRCS, FRCSEd,
FRCS(Plast)
Professor of Aesthetic Plastic Surgery
Anglia Ruskin University
Chelmsford, UK
Jazmina M. Gonzalez, MD
Bitar Cosmetic Surgery Institute
Fairfax, VA, USA
Richard J. Greco, MD
CEO
The Georgia Institute For Plastic Surgery
Savannah, GA, USA
Ronald P. Gruber, MD
Adjunct Associate Clinical Professor
Division of Plastic and Reconstructive Surgery
Stanford University
Stanford, CA
Clinical Association Professor
Division of Plastic and Reconstructive Surgery
University of California San Francisco
San Francisco, CA, USA
Bahman Guyuron, MD, FCVS
Editor in Chief, Aesthetic Plastic Surgery Journal
Emeritus Professor of Plastic Surgery
Case School of Medicine
Cleveland, OH, USA
Joseph P. Hunstad, MD, FACS
Associate Consulting Professor
Division of Plastic Surgery
The University of North Carolina at Chapel Hill;
Private Practice
Huntersville/Charlotte, NC, USA
Clyde H. Ishii, MD, FACS
Assistant Clinical Professor of Surgery
John A. Burns School of Medicine;
Chief, Department of Plastic Surgery
Shriners Hospital
Honolulu Unit
Honolulu, HI, USA
Nicole J. Jarrett, MD
Department of Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA
Elizabeth B. Jelks, MD
Private Practice
Jelks Medical
New York, NY, USA
Glenn W. Jelks, MD
Associate Professor
Department of Ophthalmology
Department of Plastic Surgery
New York University School of Medicine
New York, NY, USA
Mark Laurence Jewell, MD
Assistant Clinical Professor Plastic Surgery
Oregon Health Science University
Portland, OR, USA
David M. Kahn, MD
Clinical Associate Professor of Plastic Surgery
Department of Surgery
Stanford University School of Medicine
Stanford, CA, USA
Michael A. C. Kane, BS, MD
Attending Surgeon
Plastic Surgery
Manhattan Eye, Ear, and Throat Hospital
New York, NY, USA
David L. Kaufman, MD, FACS
Private Practice Plastic Surgery
Aesthetic Artistry Surgical and Medical Center
Folsom, CA, USA
Jeffrey Kenkel, MD
Professor and Chairman
Department of Plastic Surgery
UT Southwestern Medical Center
Dallas, TX, USA
Kyung S. Koh, MD, PhD
Professor of Plastic Surgery
Asan Medical Center, University of Ulsan School
of Medicine
Seoul, South Korea
Tracy Leong, MD
Dermatology
Rady Children’s Hospital - San Diego;
Sharp Memorial Hospital;
University California San Diego Medical Center
San Diego;
Private Practice, FACES+ Plastic Surgery, Skin
and Laser Center
La Jolla, CA, USA
Steven M. Levine, MD
Assistant Professor of Surgery (Plastic)
Hofstra Medical School, Northwell Health,
New York, NY, USA
Michelle B. Locke, MBChB, MD
Senior Lecturer in Surgery
Department of Surgery
University of Auckland Faculty of Medicine and
Health Sciences;
South Auckland Clinical Campus
Middlemore Hospital
Auckland, New Zealand
Alyssa Lolofie
University of Utah
Salt Lake City, UT, USA
Timothy J. Marten, MD, FACS
Founder and Director
Marten Clinic of Plastic Surgery
San Francisco, CA, USA
Bryan Mendelson, FRCSE, FRACS, FACS
The Centre for Facial Plastic Surgery
Toorak, Victoria, Australia
Constantino G. Mendieta, MD, FACS
Private Practice
Miami, FL, USA
Drew B. Metcalfe, MD
Division of Plastic and Reconstructive Surgery
Emory University
Atlanta, GA, USA
Gabriele C. Miotto, MD
Emory School of Medicine
Atlanta, GA, USA
Foad Nahai, MD
Professor of Surgery
Division of Plastic and Reconstructive Surgery
Department of Surgery
Emory University School of Medicine
Emory Aesthetic Center at Paces
Atlanta, Georgia, USA
Suzan Obagi, MD
Associate Professor of Dermatology
Dermatology
University of Pittsburgh;
Associate Professor of Plastic Surgery
Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA

xxviii
List of Contributors
Sabina Aparecida Alvarez de Paiva, MD
Resident of Plastic Surgery
Plastic Surgery Service Dr. Ewaldo Bolivar de
Souza Pinto
São Paulo, Brazil
Galen Perdikis, MD
Assistant Professor of Surgery
Division of Plastic Surgery
Emory University School of Medicine
Atlanta, GA, USA
Jason Posner, MD, FACS
Private Practice
Boca Raton, FL, USA
Dirk F. Richter, MD, PhD
Clinical Professor of Plastic Surgery
University of Bonn
Director and Chief
Dreifaltigkeits-Hospital
Wesseling, Germany
Thomas L. Roberts III, FACS
Plastic Surgery Center of the Carolinas
Spartanburg, SC, USA
Jocelyn Celeste Ledezma Rodriguez, MD
Private Practice
Guadalajara, Jalisco, Mexico
Rod J. Rohrich, MD
Clinical Professor and Founding Chair
Department of Plastic Surgery
Distinguished Teaching Professor
University of Texas Southwestern Medical Center
Founding Partner
Dallas Plastic Surgery Institute
Dallas, TX, USA
E. Victor Ross, MD
Director of Laser and Cosmetic Dermatology
Scripps Clinic
San Diego, CA, USA
J. Peter Rubin, MD, FACS
Chief
Plastic and Reconstructive Surgery
University of Pittsburgh Medical Center;
Associate Professor
Department of Surgery
University of Pittsburgh
Pittsburgh, PA, USA
Ahmad N. Saad, MD
Private Practice
FACES+ Plastic Surgery
Skin and Laser Center
La Jolla, CA, USA
Alesia P. Saboeiro, MD
Attending Physician
Private Practice
New York, NY, USA
Cristianna Bonnetto Saldanha, MD
Plastic Surgery Service Dr. Osvaldo Saldanha
São Paulo, Brazil
Osvaldo Saldanha, MD, PhD
Director of Plastic Surgery Service Dr. Osvaldo
Saldanha;
Professor of Plastic Surgery Department
Universidade Metropolitana de Santos
- UNIMES
São Paulo, Brazil
Renato Saltz, MD, FACS
Saltz Plastic Surgery
President
International Society of Aesthetic Plastic Surgery
Adjunct Professor of Surgery
University of Utah
Past-President, American Society for Aesthetic
Plastic Surgery
Salt Lake City and Park City, UT, USA
Paulo Rodamilans Sanjuan MD
Chief Resident of Plastic Surgery
Plastic Surgery Service Dr. Ewaldo Boliar de
Souza Pinto
São Paulo, Brazil
Nina Schwaiger, MD
Senior Specialist in Plastic and Aesthetic
Surgery
Department of Plastic Surgery
Dreifaltigkeits-Hospital Wesseling
Wesseling, Germany
Douglas S. Steinbrech, MD, FACS
Gotham Plastic Surgery
New York, NY, USA
Phillip J. Stephan, MD
Clinical Faculty
Plastic Surgery
UT Southwestern Medical School;
Plastic Surgeon
Texoma Plastic Surgery
Wichita Falls, TX, USA
David Gonzalez Sosa, MD
Plastic and Reconstructive Surgery
Hospital Quirónsalud Torrevieja
Alicante, Spain
James M. Stuzin, MD
Associate Professor of Surgery
(Plastic) Voluntary
University of Miami Leonard M. Miller School of
Medicine
Miami, FL, USA
Daniel Suissa, MD, MSc
Clinical Instructor
Section of Plastic and Reconstructive Surgery
Yale University
New Haven, CT, USA
Charles H. Thorne, MD
Associate Professor of Plastic Surgery
Department of Plastic Surgery
NYU School of Medicine
New York, NY, USA
Ali Totonchi, MD
Assistant Professor
Plastic Surgery
Case Western Reserve University;
Medical Director Craniofacial Deformity Clinic
Plastic Surgery
MetroHealth Medical center
Cleveland, OH, USA
Jonathan W. Toy, MD, FRCSC
Program Director, Plastic Surgery Residency
Program Assistant Clinical Professor
University of Alberta
Edmonton, Alberta, Canada
Matthew J. Trovato, MD
Dallas Plastic Surgery Institute
Dallas, TX, USA
Simeon H. Wall Jr., MD, FACS
Director
The Wall Center for Plastic Surgery;
Assistant Clinical Professor
Plastic Surgery
LSU Health Sciences Center at Shreveport
Shreveport, LA, USA
Joshua T. Waltzman, MD, MBA
Private Practice
Waltzman Plastic and Reconstructive Surgery
Long Beach, CA, USA
Richard J. Warren, MD, FRCSC
Clinical Professor
Division of Plastic Surgery
University of British Columbia
Vancouver, British Columbia, Canada
Edmund Weisberg, MS, MBE
University of Pennsylvania
Philadelphia, PA, USA
Scott Woehrle, MS BS
Physician Assistant
Department of Plastic Surgery
Jospeh Capella Plastic Surgery
Ramsey, NJ, USA
Chin-Ho Wong, MBBS, MRCS, MMed(Surg),
FAMS(Plast Surg)
W Aesthetic Plastic Surgery
Mt Elizabeth Novena Specialist Center
Singapore
Alan Yan, MD
Former Fellow
Adult Reconstructive and Aesthetic
Craniomaxillofacial Surgery
Division of Plastic and Reconstructive Surgery
Massachusetts General Hospital
Boston, MA, USA

xxix
List of Contributors
Michael J. Yaremchuk, MD
Chief of Craniofacial Surgery
Massachusetts General Hospital;
Clinical Professor of Surgery
Harvard Medical School;
Program Director
Harvard Plastic Surgery Residency Program
Boston, MA, USA
James E. Zins, MD
Chairman
Department of Plastic Surgery
Dermatology and Plastic Surgery Institute
Cleveland Clinic
Cleveland, OH, USA
VOLUME THREE
Neta Adler, MD
Senior Surgeon
Department of Plastic and Reconstructive
Surgery
Hadassah University Hospital
Jerusalem, Israel
Ahmed M. Afifi, MD
Assistant Professor of Plastic Surgery
Department of Surgery
University of Wisconsin
Madison, WI, USA;
Associate Professor
Department of Plastic Surgery
Cairo University
Cairo, Egypt
Marta Alvarado, DDS, MS
Department of Orthodontics
Facultad de Odontología
Universidad de San Carlos de Guatemala
Guatemala
Eric Arnaud, MD
Pediatric Neurosurgeon and Co-Director
Unité de Chirurgie Craniofaciale
Hôpital Necker Enfants Malades
Paris, France
Stephen B. Baker, MD, DDS
Associate Professor and Program Director
Co-Director Inova Hospital for Children
Craniofacial Clinic
Department of Plastic Surgery
Georgetown University Hospital
Georgetown, WA, USA
Scott P. Bartlett, MD
Professor of Surgery
Surgery
University of Pennsylvania;
Chief Division of Plastic Surgery
Surgery
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Bruce S. Bauer, MD
Chief
Division of Plastic Surgery
NorthShore University HealthSystem
Highland Park;
Clinical Professor of Surgery
Department of Surgery
University of Chicago Pritzker School of
Medicine
Chicago, IL, USA
Adriane L. Baylis, PhD
Speech Scientist
Section of Plastic and Reconstructive Surgery
Nationwide Children’s Hospital
Columbus, OH, USA
Mike Bentz, MD, FAAP, FACS
Interim Chairman
Department of Surgery
University of Wisconsin;
Chairman Division of Plastic Surgery
Department of Surgery
University of Wisconsin
Madison, WI, USA
Craig Birgfeld, MD, FACS
Associate Professor, Pediatric Plastic and
Craniofacial Surgery
Seattle Children’s Hospital
Seattle, WA, USA
William R. Boysen, MD
Resident Physician, Urology
University of Chicago Medicine
Chicago, IL, USA
James P. Bradley, MD
Professor and Chief
Section of Plastic and Reconstructive Surgery
Temple University
Philadelphia, PA, USA
Edward P. Buchanan, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Michael R. Bykowski, MD, MS
Plastic Surgery Resident
Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Edward J. Caterson, MD, PhD
Director of Craniofacial Surgery
Division of Plastic Surgery
Brigham and Women’s Hospital
Boston, MA, USA
Rodney K. Chan, MD
Chief Plastic and Reconstructive Surgery
Clinical Division and Burn Center
United States Army Institute of Surgical
Research
Joint Base San Antonio, TX, USA
Edward I. Chang, MD
Assistant Professor
Department of Plastic Surgery
The University of Texas M. D. Anderson Cancer
Center
Houston, TX, USA
Constance M. Chen, MD, MPH
Director of Microsurgery
Plastic and Reconstructive Surgery
New York Eye and Ear Infirmary of Mt Sinai;
Clinical Assistant Professor
Plastic and Reconstructive Surgery
Weil Medical College of Cornell University;
Clinical Assistant Professor
Plastic and Reconstructive Surgery
Tulane University School of Medicine
New York, NY, USA
Yu-Ray Chen, MD
Professor of Surgery
Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taoyuan City, Taiwan
Philip Kuo-Ting Chen, MD
Professor
Craniofacial Center
Chang Gung Memorial Hospital
Taoyuan City, Taiwan
Ming-Huei Cheng, MD, MBA
Professor
Division of Reconstructive Microsurgery
Department of Plastic and Reconstructive
Surgery
Chang Gung Memorial Hospital
Taoyuan City, Taiwan
Gerson R. Chinchilla, DDS MS
Director
Department of Orthodontics
Facultad de Odontología
Universidad de San Carlos de Guatemala
Guatemala
Peter G. Cordeiro, MD
Chief
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center;
Professor of Surgery
Surgery
Weil Medical College of Cornell University
New York, NY, USA
Alberto Córdova-Aguilar, MD, MPH
Attending Plastic Surgeon
Surgery
Faculty of Medicine Ricardo Palma University
Lima, Peru
Edward H. Davidson, MA(Cantab), MBBS
Resident Plastic Surgeon
Department of Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA

xxx
List of Contributors
Sara R. Dickie, MD
Clinician Educator
Surgery
University of Chicago Hospital Pritzker School of
Medicine;
Attending Surgeon
Section of Plastic and Reconstructive Surgery
NorthShore University HealthSystem
Northbrook, IL, USA
Risal S. Djohan, MD
Microsurgery Fellowship Program Director
Plastic Surgery
Cleveland Clinic;
Surgery ASC Quality Improvement Officer
Plastic Surgery
Cleveland Clinic
Cleveland, OH, USA
Amir H. Dorafshar, MBChB, FACS, FAAP
Associate Professor
Plastic and Reconstructive Surgery
Johns Hopkins Medical Institute;
Assistant Professor
Plastic Surgery
R Adams Cowley Shock Trauma Center
Baltimore, MD, USA
Jeffrey A. Fearon, MD
Director
The Craniofacial Center
Dallas, TX, USA
Alexander L. Figueroa, DMD
Craniofacial Orthodontist
Rush Craniofacial Center
Rush University Medical Center
Chicago, IL, USA
Alvaro A. Figueroa, DDS, MS
Co-Director
Rush Craniofacial Center
Rush University Medical Center
Chicago, IL, USA
David M. Fisher, MB, BCh, FRCSC, FACS
Medical Director Cleft Lip and Palate Program
Plastic Surgery
Hospital for Sick Children;
Associate Professor
Surgery
University of Toronto
Toronto, Ontario, Canada
Roberto L. Flores, MD
Associate Professor of Plastic Surgery
Director of Cleft Lip and Palate
Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Andrew Foreman, B. Physio, BMBS(Hons),
PhD, FRACS
Consultant Surgeon, Department of
Otolaryngology - Head and Neck Surgery
University of Adelaide,
Royal Adelaide Hospital,
Adelaide, SA, Australia
Patrick A. Gerety, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Indiana University and Riley Hospital for
Children
Philadelphia, PA, USA
Jesse A. Goldstein, MD
Chief Resident
Department of Plastic Surgery
Georgetown University Hospital
Washington, DC, USA
Arun K. Gosain, MD
Chief
Division of Plastic Surgery
Ann and Robert H. Lurie Children’s Hospital of
Chicago
Chicago, IL, USA
Lawrence J. Gottlieb, MD
Professor of Surgery
Department of Surgery
Section of Plastic and Reconstructive Surgery
University of Chicago
Chicago, IL, USA
Arin K. Greene, MD, MMSc
Department of Plastic and Oral Surgery
Boston Children’s Hospital;
Associate Professor of Surgery
Harvard Medical School
Boston, MA, USA
Patrick J. Gullane, MD, FRCS
Wharton Chair in Head and Neck Surgery
Professor of Surgery, Department of
Otolaryngology - Head and Neck Surgery
University of Toronto
Toronto, Ontario, Canada
Mohan S. Gundeti, MB, MCh, FEBU,
FRCS(Urol), FEAPU
Associate Professor of Urology in Surgery and
Pediatrics, Director Pediatric Urology, Director
Centre for Pediatric Robotics and Minimal
Invasive Surgery
University of Chicago and Pritzker Medical
School Comer Children’s Hospital
Chicago, IL, USA
Eyal Gur, MD
Professor of Surgery, Chief
Department of Plastic and Reconstructive
Surgery
The Tel Aviv Sourasky Medical Center
Tel Aviv, Israel
Bahman Guyuron, MD, FCVS
Editor in Chief, Aesthetic Plastic Surgery
Journal;
Emeritus Professor of Plastic Surgery
Case School of Medicine
Cleveland, OH, USA
Matthew M. Hanasono, MD
Associate Professor
Department of Plastic Surgery
The University of Texas MD Anderson Cancer
Center
Houston, TX, USA
Toshinobu Harada, PhD
Professor in Engineering
Department of Systems Engineering
Faculty of Systems Engineering
Wakayama University
Wakayama, Japan
Jill A. Helms, DDS, PhD
Professor
Surgery
Stanford University
Stanford, CA, USA
David L. Hirsch, MD, DDS
Director of Oral Oncology and Reconstruction
Lenox Hill Hospital/Northwell Health
New York, NY, USA
Jung-Ju Huang, MD
Associate Professor
Division of Microsurgery
Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
William Y. Hoffman, MD
Professor and Chief
Division of Plastic and Reconstructive Surgery
UCSF
San Francisco, CA, USA
Larry H. Hollier Jr., MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Richard A. Hopper, MD, MS
Chief
Division of Craniofacial Plastic Surgery
Seattle Children’s Hospital;
Surgical Director
Craniofacial Center
Seattle Children’s Hospital;
Associate Professor
Department of Surgery
University of Washington
Seattle, WA, USA
Gazi Hussain, MBBS, FRACS
Clinical Senior Lecturer
Macquarie University
Sydney, Australia
Oksana Jackson, MD
Assistant Professor
Plastic Surgery
Perelman School of Medicine at the University
of Pennsylvania;
Assistant Professor
Plastic Surgery
The Children’s Hospital of Philadelphia
Philadelphia, PA, USA

xxxi
List of Contributors
Syril James, MD
Clinic Marcel Sembat
Boulogne-Billancourt
Paris, France
Leila Jazayeri, MD
Microsurgery Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Sahil Kapur, MD
Assistant Professor
Department of Plastic Surgery
University of Texas - MD Anderson Cancer
Center
Houston, TX, USA
Henry K. Kawamoto Jr., MD, DDS
Clinical Professor
Surgery Division of Plastic Surgery
UCLA
Los Angeles, CA, USA
David Y. Khechoyan, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Richard E. Kirschner, MD
Section Chief
Plastic and Reconstructive Surgery
Nationwide Children’s Hospital;
Senior Vice Chair
Plastic Surgery
The Ohio State University Medical College
Columbus, OH, USA
John C. Koshy, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Michael C. Large, MD
Urologic Oncologist
Urology of Indiana
Greenwood, IN, USA
Edward I. Lee, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Jamie P. Levine, MD
Chief of Microsurgery
Associate Professor
Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Jingtao Li, DDS, PhD
Consultant Surgeon
Oral and Maxillofacial Surgery
West China Hospital of Stomatology
Chengdu, Sichuan, People’s Republic of China
Lawrence Lin, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Joseph E. Losee, MD
Ross H. Musgrave Professor of Pediatric Plastic
Surgery
Department of Plastic Surgery
University of Pittsburgh Medical Center;
Chief, Division of Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh
Pittsburgh, PA, USA
David W. Low, MD
Professor of Surgery
Division of Plastic Surgery
Perelman School of Medicine at the University
of Pennsylvania;
Clinical Associate
Department of Surgery
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Ralph T. Manktelow, MD, FRCSC
Professor of Surgery,
The University of Toronto,
Toronto, Ontario, Canada
Paul N. Manson, MD
Distinguished Service Professor
Plastic Surgery
Johns Hopkins University
Baltimore, MD, USA
David W. Mathes, MD
Professor and Chief of the Division of Plastic
and Reconstructive Surgery
Surgery Division of Plastic and Reconstructive
Surgery
University of Colorado
Aurora, CO, USA
Frederick J. Menick, MD
Private Practitioner
Tucson, AZ, USA
Fernando Molina, MD
Director
Craniofacial Anomalies Foundation A.C.
Mexico City;
Professor of Plastic Reconstructive and
Aesthetic Surgery
Medical School
Universidad La Salle
Mexico City, Distrito Federal, Mexico
Laura A. Monson, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Reid V. Mueller, MD
Associate Professor
Plastic Surgery
Oregon Health and Science University
Portland, OR, USA
John B. Mulliken, MD
Professor
Department of Plastic and Oral Surgery
Boston Children’s Hospital
Harvard Medical School
Boston, MA, USA
Gerhard S. Mundinger, MD
Assistant Professor
Craniofacial, Plastic, and Reconstructive Surgery
Louisiana State University Health Sciences
Center
Children’s Hospital of New Orleans
New Orleans, LA, USA
Blake D. Murphy, BSc, PhD, MD
Craniofacial Fellow
Plastic Surgery
Nicklaus Children’s Hospital
Miami, FL, USA
Peter C. Neligan, MB, FRCS(I), FRCSC,
FACS
Professor of Surgery
Department of Surgery, Division of Plastic
Surgery
University of Washington
Seattle, WA, USA
M. Samuel Noordhoff, MD, FACS
Emeritus Professor in Surgery
Chang Gung University
Taoyuan City, Taiwan
Giovanna Paternoster, MD
Unité de chirurgie crânio-faciale du departement
de neurochirurgie
Hôpital Necker Enfants Malades
Paris, France
Jason Pomerantz, MD
Assistant Professor
Surgery
University of California San Francisco;
Surgical Director
Craniofacial Center
University of California San Francisco
San Francisco, CA, USA
Julian J. Pribaz, MD
Professor of Surgery
University of South Florida, Morsani College of
Medicine
Tampa General Hospital
Tampa, FL, USA
Chad A. Purnell, MD
Division of Plastic Surgery
Lurie Children’s Hospital of Northwestern
Feinberg School of Medicine
Chicago, IL, USA
Russell R. Reid, MD, PhD
Associate Professor
Surgery/Section of Plastic and Reconstructive
Surgery
University of Chicago Medicine
Chicago, IL, USA
Eduardo D. Rodriguez, MD, DDS
Helen L. Kimmel Professor of Reconstructive
Plastic Surgery
Chair, Hansjörg Wyss Department of Plastic
Surgery
NYU School of Medicine
NYU Langone Medical Center
New York, NY, USA

xxxii
List of Contributors
Craig Rowin, MD
Craniofacial Fellow
Plastic Surgery
Nicklaus Children’s Hospital
Miami, FL, USA
Ruston J. Sanchez, MD
Plastic and Reconstructive Surgery Resident
University of Wisconsin
Madison, WI, USA
Lindsay A. Schuster, DMD, MS
Director Cleft-Craniofacial Orthodontics
Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh of UMPC;
Clinical Assistant Professor of Plastic Surgery
Department of Plastic Surgery
University of Pittsburgh School of Medicine
Pittsburgh, PA, USA
Jeremiah Un Chang See, MD
Plastic Surgeon
Department of Plastic and Reconstructive
Surgery
Penang General Hospital
Georgetown, Penang, Malaysia
Pradip R. Shetye, DDS, BDS, MDS
Assistant Professor (Orthodontics)
Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Roman Skoracki, MD
Plastic Surgery
The Ohio State University
Columbus, OH, USA
Mark B. Slidell, MD, MPH
Assistant Professor of Surgery
Department of Surgery
Section of Pediatric Surgery
University of Chicago Medicine Biological
Sciences
Chicago, IL, USA
Michael Sosin, MD
Research Fellow
Department of Plastic Surgery Institute of
Reconstructive Plastic Surgery
NYU Langone Medical Center
New York, NY, USA;
Research Fellow
Division of Plastic Reconstructive and
Maxillofacial Surgery
R Adams Cowley Shock Trauma Center
University of Maryland Medical Center
Baltimore, MD, USA;
Resident
Department of Surgery
Medstar Georgetown University Hospital
Washington, DC, USA
Youssef Tahiri, MD, MSc, FRCSC, FAAP,
FACS
Associate Professor
Pediatric Plastic & Craniofacial Surgery
Cedars Sinai Medical Center
Los Angeles, CA, USA
Peter J. Taub, MD
Professor
Surgery Pediatrics Dentistry and Medical
Education
Surgery Division of Plastic and Reconstructive
Surgery
Icahn School of Medicine at Mount Sinai
New York, NY, USA
Jesse A. Taylor, MD
Mary Downs Endowed Chair of Pediatric
Craniofacial Treatment and Research;
Director, Penn Craniofacial Fellowship;
Co-Director, CHOP Cleft Team
Plastic, Reconstructive, and Craniofacial Surgery
The University of Pennsylvania and
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Kathryn S. Torok, MD
Assistant Professor
Pediatric Rheumatology
University of Pittsburgh
Pittsburgh, PA, USA
Ali Totonchi, MD
Assistant Professor
Plastic Surgery
Case Western Reserve University;
Medical Director Craniofacial Deformity Clinic
Plastic Surgery
MetroHealth Medical Center
Cleveland, OH, USA
Kris Wilson, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
S. Anthony Wolfe, MD
Plastic Surgery
Miami Children’s Hospital
Miami, FL, USA
Akira Yamada, MD, PhD
Professor of Plastic Surgery
World Craniofacial Foundation
Dallas, TX, USA;
Clinical Assistant Professor
Plastic Surgery
Case Western Reserve University
Cleveland, OH, USA
Peirong Yu, MD
Professor
Plastic Surgery
M. D. Anderson Cancer Center;
Adjunct Professor
Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Ronald M. Zuker, MD, FRCSC, FACS,
FRCSEd(Hon)
Professor of Surgery
Department of Surgery
University of Toronto;
Staff Plastic and Reconstructive Surgeon
Department of Surgery
SickKids Hospital
Toronto, Ontario, Canada
VOLUME FOUR
Christopher E. Attinger, MD
Professor, Interim Chairman
Department of Plastic Surgery
Center for Wound Healing
Medstar Georgetown University Hospital
Washington, DC, USA
Lorenzo Borghese, MD
Plastic Surgeon
Chief of International Missions
Ospedale Pediatrico Bambino Gesù
Rome, Italy
Charles E. Butler, MD, FACS
Professor and Chairman
Department of Plastic Surgery
Charles B. Barker Endowed Chair in Surgery
The University of Texas M. D. Anderson Cancer
Center
Houston, TX, USA
David W. Chang, MD
Professor of Surgery
University of Chicago
Chicago, IL, USA
Karel Claes, MD
Department of Plastic and Reconstructive
Surgery
Ghent University Hospital
Ghent, Belgium
Mark W. Clemens II, MD, FACS
Associate Professor
Plastic Surgery
MD Anderson Cancer Center,
Houston, TX, USA
Shannon M. Colohan, MD, MSc
Assistant Professor of Surgery
University of Washington
Seattle, WA, USA
Peter G. Cordeiro, MD
Chief
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Salvatore D’Arpa, MD, PhD
Department of Plastic and Reconstructive
Surgery
Ghent University Hospital
Ghent, Belgium

xxxiii
List of Contributors
Michael V. DeFazio, MD
Department Plastic Surgery
MedStar Georgetown University Hospital
Washington, DC, USA
A. Lee Dellon, MD, PhD
Professor of Plastic Surgery
Professor of Neurosurgery
Johns Hopkins University
Baltimore, MD, USA
Sara R. Dickie, MD
Clinical Associate of Surgery
University of Chicago Hospitals
Pritzker School of Medicine
Chicago, IL, USA
Ivica Ducic, MD, PhD
Clinical Professor of Surgery
GWU Washington Nerve Institute
McLean, VA, USA
Gregory A. Dumanian, MD
Stuteville Professor of Surgery
Division of Plastic Surgery
Northwestern Feinberg School of Medicine
Chicago, IL, USA
John M. Felder III, MD
Fellow in Hand Surgery
Plastic Surgery
Washington University in Saint Louis
St. Louis, MO, USA
Goetz A. Giessler, MD, PhD
Professor Director
Plastic-Reconstructive, Aesthetic and Hand
Surgery
Gesundheit Nordhessen
Kassel, Germany
Kevin D. Han, MD
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington, DC, USA
Piet Hoebeke
Department of Urology
Ghent University Hospital
Ghent, Belgium
Joon Pio Hong, MD, PhD, MMM
Professor of Plastic Surgery
Asan Medical Center, University of Ulsan
Seoul, South Korea
Michael A. Howard, MD
Clinical Assistant Professor of Surgery
Plastic Surgery
NorthShore University HealthSystem/University
of Chicago
Chicago, IL, USA
Jeffrey E. Janis, MD, FACS
Professor of Plastic Surgery, Neurosurgery,
Neurology, and Surgery;
Executive Vice Chairman, Department of Plastic
Surgery;
Chief of Plastic Surgery, University Hospitals
Ohio State University Wexner Medical Center
Columbus, OH, USA
Leila Jazayeri, MD
Microsurgery Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Grant M. Kleiber, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Stephen J. Kovach III, MD
Assistant Professor
Division of Plastic Surgery
University of Pennsylvania
Philadelphia, PA, USA
Robert Kwon, MD
Southwest Hand and Microsurgery
3108 Midway Road, Suite 103
Plano, TX, USA
Raphael C. Lee, MS, MD, ScD, FACS,
FAIMBE
Paul and Allene Russell Professor
Plastic Surgery, Dermatology, Anatomy and
Organismal Biology, Molecular Medicine
University of Chicago
Chicago, IL, USA
L. Scott Levin, MD, FACS
Chairman of Orthopedic Surgery
Department of Orthopaedic Surgery
University of Pennsylvania School of Medicine
Philadelphia, PA, USA
Otway Louie, MD
Associate Professor
Surgery
University of Washington Medical Center
Seattle, WA, USA
Nicolas Lumen, MD, PhD
Head of Clinic
Urology
Ghent University Hospital
Ghent, Belgium
Alessandro Masellis, MD
Plastic Surgeon
Euro-Mediterranean Council for Burns and Fire
Disasters
Palermo, Italy
Michele Masellis, MD
Former Chief of Department of Plastic and
Reconstructive Surgery and Burn Therapy
Department of Plastic and Reconstructive
Surgery and Burn Therapy - ARNAS Ospedale
Civico e Benfratelli
Palermo, Italy
Stephen M. Milner, MB BS, BDS
Professor of Plastic Surgery
Surgery
Johns Hopkins School of Medicine
Baltimore, MD, USA
Arash Momeni, MD
Fellow, Reconstructive Microsurgery
Division of Plastic Surgery
University of Pennsylvania Health System
Philadelphia, PA, USA
Stan Monstrey, MD, PhD
Department of Plastic and Reconstructive
Surgery
Ghent University Hospital
Ghent, Belgium
Venkateshwaran N, MBBS, MS, DNB, MCh,
MRCS(Intercollegiate)
Consultant Plastic Surgeon
Jupiter Hospital
Thane, India
Rajiv P. Parikh, MD, MPHS
Resident Physician
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Mônica Sarto Piccolo, MD, MSc, PhD
Director
Pronto Socorro para Queimaduras
Goiânia, Goiás, Brazil
Nelson Sarto Piccolo, MD
Chief
Division of Plastic Surgery
Pronto Socorro para Queimaduras
Goiânia, Goiás, Brazil
Maria Thereza Sarto Piccolo, MD, PhD
Scientific Director
Pronto Socorro para Queimaduras
Goiânia, Goiás, Brazil
Vinita Puri, MS, MCh
Professor and Head
Department of Plastic, Reconstructive Surgery
and Burns
Seth G S Medical College and KEM Hospital
Mumbai, Maharashtra, India
Andrea L. Pusic, MD, MHS, FACS
Associate Professor
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA

xxxiv
List of Contributors
Vinay Rawlani, MD
Division of Plastic Surgery
Northwestern Feinberg School of Medicine
Chicago, IL, USA
Juan L. Rendon, MD, PhD
Clinical Instructor Housestaff
Department of Plastic Surgery
The Ohio State University Wexner Medical
Center
Columbus, OH, USA
Michelle C. Roughton, MD
Assistant Professor
Division of Plastic and Reconstructive Surgery
University of North Carolina at Chapel Hill
Chapel Hill, NC, USA
Hakim K. Said, MD, FACS
Associate Professor
Division of Plastic surgery
University of Washington
Seattle, WA, USA
Michel Saint-Cyr, MD, FRSC(C)
Professor
Plastic Surgery
Mayo Clinic
Rochester, MN, USA
Michael Sauerbier, MD, PhD
Professor, Chair
Department for Plastic, Hand, and
Reconstructive Surgery
Academic Hospital Goethe University Frankfurt
am Main
Frankfurt am Main, Germany
Loren S. Schechter, MD
Associate Professor and Chief
Division of Plastic Surgery
Chicago Medical School
Morton Grove, IL, USA
David H. Song, MD, MBA, FACS
Regional Chief, MedStar Health
Plastic and Reconstructive Surgery
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC, USA
Yoo Joon Sur, MD, PhD
Associate Professor
Department of Orthopedic Surgery
The Catholic University of Korea, College of
Medicine
Seoul, Korea
Chad M. Teven, MD
Resident
Section of Plastic and Reconstructive Surgery
University of Chicago
Chicago, IL, USA
VOLUME FIVE
Jamil Ahmad, MD, FRCSC
Director of Research and Education
The Plastic Surgery Clinic
Mississauga, Ontario, Canada;
Assistant Professor of Surgery
University of Toronto
Toronto, Ontario, Canada
Robert J. Allen Sr., MD
Clinical Professor of Plastic Surgery
Department of Plastic Surgery
New York University Medical Center
Charleston, NC, USA
Ryan E. Austin, MD, FRCSC
Plastic Surgeon
The Plastic Surgery Clinic
Mississauga, ON, Canada
Brett Beber, BA, MD, FRCSC
Plastic and Reconstructive Surgeon
Lecturer, Department of Surgery
University of Toronto
Toronto, Ontario, Canada
Philip N. Blondeel, MD
Professor of Plastic Surgery
Department of Plastic Surgery
University Hospital Ghent
Ghent, Belgium
Benjamin J. Brown, MD
Gulf Coast Plastic Surgery
Pensacola, FL, USA
Mitchell H. Brown, MD, MEd, FRCSC
Plastic and Reconstructive Surgeon
Associate Professor, Department of Surgery
University of Toronto
Toronto, Ontario, Canada
M. Bradley Calobrace, MD, FACS
Plastic Surgeon
Calobrace and Mizuguchi Plastic Surgery Center
Departments of Surgery, Divisions of Plastic
Surgery
Clinical Faculty, University of Louisville and
University of Kentucky
Louisville, KY, USA
Grant W. Carlson, MD
Wadley R. Glenn Professor of Surgery
Emory University
Atlanta, GA, USA
Bernard W. Chang, MD
Chief of Plastic and Reconstructive Surgery
Mercy Medical Center
Baltimore, MD, USA
Mark W. Clemens II, MD, FACS
Assistant Professor Plastic Surgery
M. D. Anderson Cancer Center
Houston, TX, USA
Robert Cohen MD, FACS
Medical Director
Plastic Surgery
Scottsdale Center for Plastic Surgery
Paradise Valley, AZ and;
Santa Monica, CA, USA
Amy S. Colwell, MD
Associate Professor
Harvard Medical School
Massachusetts General Hospital
Boston, MA, USA
Edward H. Davidson, MA(Cantab), MB, BS
Resident Plastic Surgeon
Department of Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Emmanuel Delay, MD, PhD
Unité de Chirurgie Plastique et Reconstructrice
Centre Léon Bérard
Lyon, France
Francesco M. Egro, MB ChB, MSc, MRCS
Department of Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Neil A. Fine, MD
President
Northwestern Specialists in Plastic Surgery;
Associate Professor (Clinical) Surgery/Plastics
Northwestern University Fienberg School of
Medicine
Chicago, IL, USA
Jaime Flores, MD
Plastic and Reconstructive Microvascular
Surgeon
Miami, FL, USA
Joshua Fosnot, MD
Assistant Professor of Surgery
Division of Plastic Surgery
The Perelman School of Medicine
University of Pennsylvania Health System
Philadelphia, PA, USA
Allen Gabriel, MD
Clinical Associate Professor
Department of Plastic Surgery
Loma Linda University Medical Center
Loma Linda, CA, USA
Michael S. Gart, MD
Resident Physician
Division of Plastic Surgery
Northwestern University Feinberg School of
Medicine
Chicago, IL, USA
Matthew D. Goodwin, MD
Plastic Surgeon
Plastic Reconstructive and Cosmetic Surgery
Boca Raton Regional Hospital
Boca Raton, FL, USA

xxxv
List of Contributors
Samia Guerid, MD
Cabinet
50 rue de la République
Lyon, France
Moustapha Hamdi, MD, PhD
Professor of Plastic and Reconstructive Surgery
Brussels University Hospital
Vrij Universitaire Brussels
Brussels, Belgium
Alexandra M. Hart, MD
Emory Division of Plastic and Reconstructive
Surgery
Emory University School of Medicine
Atlanta, GA, USA
Emily C. Hartmann, MD, MS
Aesthetic Surgery Fellow
Plastic and Reconstructive Surgery
University of Southern California
Los Angeles, CA, USA
Nima Khavanin, MD
Resident Physician
Department of Plastic and Reconstructive
Surgery
Johns Hopkins Hospital
Baltimore, MD, USA
John Y. S. Kim, MD
Professor and Clinical Director
Department of Surgery
Division of Plastic Surgery
Northwestern University Feinberg School of
Medicine
Chicago, IL, USA
Steven Kronowitz, MD
Owner, Kronowitz Plastics
PLLC;
University of Texas, M. D. Anderson Medical
Center
Houston, TX, USA
John V. Larson, MD
Resident Physician
Division of Plastic and Reconstructive Surgery
Keck School of Medicine of USC
University of Southern California
Los Angeles, CA, USA
Z-Hye Lee, MD
Resident
Department of Plastic Surgery
New York University Medical Center
New York, NY, USA
Frank Lista, MD, FRCSC
Medical Director
The Plastic Surgery Clinic
Mississauga, Ontario, Canada;
Assistant Professor Surgery
University of Toronto
Toronto, Ontario, Canada
Albert Losken, MD, FACS
Professor of plastic surgery and Program
Director
Emory Division of Plastic and Reconstructive
Surgery
Emory University School of Medicine
Atlanta, GA, USA
Charles M. Malata, BSc(HB), MB ChB,
LRCP, MRCS, FRCS(Glasg), FRCS(Plast)
Professor of Academic Plastic Surgery
Postgraduate Medical Institute
Faculty of Health Sciences
Anglia Ruskin University
Cambridge and Chelmsford, UK;
Consultant Plastic and Reconstructive Surgeon
Department of Plastic and Reconstructive
Surgery
Cambridge Breast Unit at Addenbrooke’s
Hospital
Cambridge University Hospitals NHS
Foundation Trust
Cambridge, UK
Jaume Masià, MD, PhD
Chief and Professor of Plastic Surgery
Sant Pau University Hospital
Barcelona, Spain
G. Patrick Maxwell, MD, FACS
Clinical Professor of Surgery
Department of Plastic Surgery
Loma Linda University Medical Center
Loma Linda, CA, USA
James L. Mayo, MD
Microsurgery Fellow
Plastic Surgery
New York University
New York, NY, USA
Roberto N. Miranda, MD
Professor
Department of Hematopathology
Division of Pathology and Laboratory Medicine
MD Anderson Cancer Center
Houston, TX, USA
Colin M. Morrison, MSc (Hons) FRCSI
(Plast)
Consultant Plastic Surgeon
St. Vincent’s University Hospital
Dublin, Ireland
Maurice Y. Nahabedian, MD, FACS
Professor and Chief
Section of Plastic Surgery
MedStar Washington Hospital Center
Washington DC, USA;
Vice Chairman
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington DC, USA
James D. Namnoum, MD
Clinical Professor of Plastic Surgery
Atlanta Plastic Surgery
Emory University School of Medicine
Atlanta, GA, USA
Maria E. Nelson, MD
Assistant Professor of Clinical Surgery
Department of Surgery, Division of Upper GI/
General Surgery, Section of Surgical Oncology
Keck School of Medicine
University of Southern California
Los Angeles, CA, USA
Julie Park, MD
Associate Professor of Surgery
Section of Plastic Surgery
University of Chicago
Chicago, IL, USA
Ketan M. Patel, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Keck Medical Center of USC
University of Southern California
Los Angeles, CA, USA
Nakul Gamanlal Patel, BSc(Hons),
MBBS(Lond), FRCS(Plast)
Senior Microsurgery Fellow
St. Andrew’s Centre for Plastic Surgery
Broomfield Hospital
Chelmsford, UK
Gemma Pons, MD, PhD
Head
Microsurgery Unit
Plastic Surgery
Hospital de Sant Pau
Barcelona, Spain
Julian J. Pribaz, MD
Professor of Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Venkat V. Ramakrishnan, MS, FRCS,
FRACS(Plast Surg)
Consultant Plastic Surgeon
St. Andrew’s Centre for Plastic Surgery
Broomfield Hospital
Chelmsford, UK
Elena Rodríguez-Bauzà, MD
Plastic Surgery Department
Hospital Santa Creu i Sant Pau
Barcelona, Spain
Michael R. Schwartz, MD
Board Certified Plastic Surgeon
Private Practice
Westlake Village, CA, USA
Stephen F. Sener, MD
Professor of Surgery, Clinical Scholar
Chief of Breast, Endocrine, and Soft Tissue
Surgery
Department of Surgery, Keck School of
Medicine of USC
Chief of Surgery and Associate Medical Director
Perioperative Services
LAC+USC (LA County) Hospital
Los Angeles, CA, USA

xxxvi
List of Contributors
Joseph M. Serletti, MD, FACS
The Henry Royster–William Maul Measey
Professor of Surgery and Chief
Division of Plastic Surgery
University of Pennsylvania Health System
Philadelphia, PA, USA
Deana S. Shenaq, MD
Chief Resident
Department of Surgery - Plastic Surgery
The University of Chicago Hospitals
Chicago, IL, USA
Kenneth C. Shestak, MD
Professor, Department of Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Ron B. Somogyi, MD MSc FRCSC
Plastic and Reconstructive Surgeon
Assistant Professor, Department of Surgery
University of Toronto
Toronto, ON, Canada
David H. Song, MD, MBA, FACS
Regional Chief, MedStar Health
Plastic and Reconstructive Surgery
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC, USA
The late Scott L. Spear†, MD
Formerly Professor of Plastic Surgery
Division of Plastic Surgery
Georgetown University
Washington, MD, USA
Michelle A. Spring, MD, FACS
Program Director
Glacier View Plastic Surgery
Kalispell Regional Medical Center
Kalispell, MT, USA
W. Grant Stevens, MD, FACS
Clinical Professor of Surgery
Marina Plastic Surgery Associates;
Keck School of Medicine of USC
Los Angeles, CA, USA
Elizabeth Stirling Craig, MD
Plastic Surgeon and Assistant Professor
Department of Plastic Surgery
University of Texas
MD Anderson Cancer Center
Houston, TX, USA
Simon G. Talbot, MD
Assistant Professor of Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Jana Van Thielen, MD
Plastic Surgery Department
Brussels University Hospital
Vrij Universitaire Brussel (VUB)
Brussels, Belgium
Henry Wilson, MD, FACS
Attending Plastic Surgeon
Private Practice
Plastic Surgery Associates
Lynchburg, VA, USA
Kai Yuen Wong, MA, MB BChir, MRCS,
FHEA, FRSPH
Specialist Registrar in Plastic Surgery
Department of Plastic and Reconstructive
Surgery
Cambridge University Hospitals NHS
Foundation Trust
Cambridge, UK
VOLUME SIX
Hee Chang Ahn, MD, PhD
Professor
Department of Plastic and Reconstructive
Surgery
Hanyang University Hospital School of Medicine
Seoul, South Korea
Nidal F. Al Deek, MD
Surgeon
Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taipei, Taiwan
Kodi K. Azari, MD, FACS
Reconstructive Transplantation Section Chief
Professor
Department of Orthopedic Surgery
UCLA Medical Center
Santa Monica, CA, USA
Carla Baldrighi, MD
Staff Surgeon
Pediatric Surgery Meyer Children’s Hospital
Pediatric Hand and Reconstructive Microsurgery
Unit
Azienda Ospedaliera Universitaria Careggi
Florence, Italy
Gregory H. Borschel, MD, FAAP, FACS
Assistant Professor
University of Toronto Division of Plastic and
Reconstructive Surgery;
Assistant Professor
Institute of Biomaterials and Biomedical
Engineering;
Associate Scientist
The SickKids Research Institute
The Hospital for Sick Children
Toronto, Ontario, Canada
Kirsty Usher Boyd, MD, FRCSC
Assistant Professor
Division of Plastic Surgery, University of Ottawa
Ottawa, Ontario, Canada
Gerald Brandacher, MD
Scientific Director
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Lesley Butler, MPH
Clinical Research Coordinator
Charles E. Seay, Jr. Hand Center
Texas Scottish Rite Hospital for Children
Dallas, TX, USA
Ryan P. Calfee, MD
Associate Professor
Department of Orthopedic Surgery
Washington University School of Medicine
St. Louis, MO, USA
Brian T. Carlsen, MD
Associate Professor
Departments of Plastic Surgery and Orthopedic
Surgery
Mayo Clinic
Rochester, MN, USA
David W. Chang, MD
Professor
Division of Plastic and Reconstructive Surgery
The University of Chicago Medicine
Chicago, IL, USA
James Chang, MD
Johnson & Johnson Distinguished Professor
and Chief
Division of Plastic and Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Robert A. Chase, MD
Holman Professor of Surgery – Emeritus
Stanford University Medical Center
Stanford, CA, USA
Alphonsus K. S. Chong, MBBS, MRCS,
MMed(Orth), FAMS (Hand Surg)
Senior Consultant
Department of Hand and Reconstructive
Microsurgery
National University Health System
Singapore;
Assistant Professor
Department of Orthopedic Surgery
Yong Loo Lin School of Medicine
National University of Singapore
Singapore
David Chwei-Chin Chuang, MD
Senior Consultant, Ex-President, Professor
Department of Plastic Surgery
Chang Gung University Hospital
Tao-Yuan, Taiwan
Kevin C. Chung, MD, MS
Chief of Hand Surgery
Michigan Medicine
Charles B G De Nancrede Professor, Assistant
Dean for Faculty Affairs
University of Michigan Medical School
Ann Arbor, Michigan, USA
Christopher Cox, MD
Attending Surgeon
Kaiser Permanente
Walnut Creek, CA, USA

xxxvii
List of Contributors
Catherine Curtin, MD
Associate Professor
Department of Surgery Division of Plastic
Surgery
Stanford University
Stanford, CA, USA
Lars B. Dahlin, MD, PhD
Professor and Consultant
Department of Clinical Sciences, Malmö – Hand
Surgery
University of Lund
Malmö, Sweden
Kenneth W. Donohue, MD
Hand Surgery Fellow
Division of Plastic Surgery
Department of Orthopedic Surgery
Baylor College of Medicine
Houston, TX, USA
Gregory A. Dumanian, MD, FACS
Stuteville Professor of Surgery
Division of Plastic Surgery
Northwestern Feinberg School of Medicine
Chicago, IL, USA
William W. Dzwierzynski, MD
Professor and Program Director
Department of Plastic Surgery
Medical College of Wisconsin
Milwaukee, WI, USA
Simon Farnebo, MD, PhD
Associate Professor and Consultant Hand
Surgeon
Department of Plastic Surgery, Hand Surgery
and Burns
Institution of Clinical and Experimental
Medicine, University of Linköping
Linköping, Sweden
Ida K. Fox, MD
Assistant Professor of Plastic Surgery
Department of Surgery
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Paige M. Fox, MD, PhD
Assistant Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Jeffrey B. Friedrich, MD
Professor of Surgery and Orthopedics
Department of Surgery, Division of Plastic
Surgery
University of Washington
Seattle, WA, USA
Steven C. Haase, MD, FACS
Associate Professor
Department of Surgery, Section of Plastic
Surgery
University of Michigan Health
Ann Arbor, MI, USA
Elisabet Hagert, MD, PhD
Associate Professor
Department of Clinical Science and Education
Karolinska Institute;
Chief Hand Surgeon
Hand Foot Surgery Center
Stockholm, Sweden
Warren C. Hammert, MD
Professor of Orthopedic and Plastic Surgery
Chief, Division of Hand Surgery
Department of Orthopedics and Rehabilitation
University of Rochester
Rochester, NY, USA
Isaac Harvey, MD
Clinical Fellow
Department of Pediatric Plastic and
Reconstructive Surgery
Hospital for SickKids
Toronto, Ontario, Canada
Vincent R. Hentz, MD
Emeritus Professor of Surgery and Orthopedic
Surgery (by courtesy)
Stanford University
Stanford, CA, USA
Jonay Hill, MD
Clinical Assistant Professor
Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA, USA
Steven E. R. Hovius, MD, PhD
Former Head, Department of Plastic,
Reconstructive and Hand Surgery
Erasmus MC
University Medical Center
Rotterdam, the Netherlands;
Xpert Clinic, Hand and Wrist Center
The Netherlands
Jerry I. Huang, MD
Associate Professor
Department of Orthopedics and Sports
Medicine
University of Washington;
Program Director
University of Washington Hand Fellowship
University of Washington
Seattle, WA, USA
Marco Innocenti, MD
Associate Professor of Plastic Surgery,
University of Florence;
Director, Reconstructive Microsurgery
Department of Oncology
Careggi University Hospital
Florence, Italy
Neil F. Jones, MD, FRCS
Professor and Chief of Hand Surgery
University of California Medical Center;
Professor of Orthopedic Surgery;
Professor of Plastic and Reconstructive Surgery
University of California Irvine
Irvine, CA, USA
Ryosuke Kakinoki, MD, PhD
Professor of Hand Surgery and Microsurgery,
Reconstructive, and Orthopedic Surgery
Department of Orthopedic Surgery
Faculty of Medicine
Kindai University
Osakasayama, Osaka, Japan
Jason R. Kang, MD
Chief Resident
Department of Orthopedic Surgery
Stanford Hospital & Clinics
Redwood City, CA, USA
Joseph S. Khouri, MD
Resident
Division of Plastic Surgery, Department of
Surgery
University of Rochester
Rochester, NY, USA
Todd Kuiken, MD, PhD
Professor
Departments of PM&R, BME, and Surgery
Northwestern University;
Director, Neural Engineering Center for Artificial
Limbs
Rehabilitation Institute of Chicago
Chicago, IL, USA
Donald Lalonde, BSC, MD, MSc, FRCSC
Professor of Surgery
Division of Plastic and Reconstructive Surgery
Saint John Campus of Dalhousie University
Saint John, New Brunswick, Canada
W. P. Andrew Lee, MD
The Milton T. Edgerton MD, Professor and
Chairman
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Anais Legrand, MD
Postdoctoral Research Fellow
Plastic and Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Terry Light, MD
Professor
Department of Orthopedic Surgery
Loyola University Medical Center
Maywood, IL, USA
Jin Xi Lim, MBBS, MRCS
Senior Resident
Department of Hand and Reconstructive
Microsurgery
National University Health System
Singapore
Joseph Lopez, MD, MBA
Resident, Plastic and Reconstructive Surgery
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA

xxxviii
List of Contributors
Susan E. Mackinnon, MD
Sydney M. Shoenberg, Jr. and Robert H.
Shoenberg Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Brian Mailey, MD
Assistant Professor of Surgery
Institute for Plastic Surgery
Southern Illinois University
Springfield, IL, USA
Steven J. McCabe, MD, MSc, FRCS(C)
Director of Hand and Upper Extremity Program
University of Toronto
Toronto Western Hospital
Toronto, Ontario, Canada
Kai Megerle, MD, PhD
Assistant Professor
Clinic for Plastic Surgery and Hand Surgery
Technical University of Munich
Munich, Germany
Amy M. Moore, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Department of Surgery
Washington University School of Medicine
St. Louis, MO, USA
Steven L. Moran, MD
Professor and Chair of Plastic Surgery
Division of Plastic Surgery, Division of Hand and
Microsurgery;
Professor of Orthopedics
Rochester, MN, USA
Rebecca L. Neiduski, PhD, OTR/L, CHT
Dean of the School of Health Sciences
Professor of Health Sciences
Elon University
Elon, NC, USA
David T. Netscher, MD
Program Director, Hand Surgery Fellowship;
Clinical Professor, Division of Plastic Surgery
and Department of Orthopedic Surgery
Baylor College of Medicine;
Adjunct Professor of Clinical Surgery (Plastic
Surgery)
Weill Medical College
Cornell University
Houston, TX, USA
Michael W. Neumeister, MD
Professor and Chairman
Division of Plastic Surgery
Springfield Illinois University School of Medicine
Springfield, IL, USA
Shelley Noland, MD
Assistant Professor
Division of Plastic Surgery
Mayo Clinic Arizona
Phoenix, AZ, USA
Christine B. Novak, PT, PhD
Associate Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
University of Toronto
Toronto, Ontario, Canada
Scott Oates, MD
Deputy Department Chair;
Professor
Department of Plastic Surgery, Division of
Surgery
The University of Texas MD Anderson Cancer
Center
Houston, TX, USA
Kerby Oberg, MD, PhD
Associate Professor
Department of Pathology and Human Anatomy
Loma Linda University School of Medicine
Loma Linda, CA, USA
Scott Oishi, MD
Director, Charles E. Seay, Jr. Hand Center
Texas Scottish Rite Hospital for Children;
Professor, Department of Plastic Surgery and
Department of Orthopedic Surgery
University of Texas Southwestern Medical Center
Dallas, TX, USA
William C. Pederson, MD, FACS
President and Fellowship Director
The Hand Center of San Antonio;
Adjunct Professor of Surgery
The University of Texas Health Science Center at
San Antonio
San Antonio, TX, USA
Dang T. Pham, MD
General Surgery Resident
Department of Surgery
Houston Methodist Hospital
Houston, TX, USA
Karl-Josef Prommersberger, MD, PhD
Chair, Professor of Orthopedic Surgery
Clinic for Hand Surgery
Bad Neustadt/Saale, Germany
Carina Reinholdt, MD, PhD
Senior Consultant in Hand Surgery
Center for Advanced Reconstruction of
Extremities
Sahlgrenska University Hospital/ Mölndal
Mölndal, Sweden;
Assistant Professor
Department of Orthopedics
Institute for Clinical Sciences
Sahlgrenska Academy
Goteborg, Sweden
Justin M. Sacks, MD, MBA, FACS
Director, Oncological Reconstruction;
Assistant Professor
Department of Plastic and Reconstructive
Surgery
Johns Hopkins School of Medicine
Baltimore, MD, USA
Douglas M. Sammer, MD
Associate Professor of Plastic and Orthopedic
Surgery
Chief of Plastic Surgery at Parkland Memorial
Hospital
Program Director Hand Surgery Fellowship
University of Texas Southwestern Medical Center
Dallas, TX, USA
Subhro K. Sen, MD
Clinical Associate Professor
Plastic and Reconstructive Surgery
Robert A. Chase Hand and Upper Limb Center
Stanford University School of Medicine
Stanford, CA, USA
Pundrique R. Sharma, MBBS, PhD and
FRCS (Plast)
Consultant Plastic Surgeon
Department for Plastic and Reconstructive
Surgery
Alder Hey Children’s Hospital
Liverpool, UK
Randolph Sherman, MD, FACS
Vice Chair
Department of Surgery
Cedars-Sinai Medical Center
Los Angeles, CA, USA
Jaimie T. Shores, MD
Clinical Director, Hand/Arm Transplant Program
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Vanila M. Singh, MD, MACM
Clinical Associate Professor
Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA, USA
Jason M. Souza, MD, LCDR, MC, USN
Staff Plastic Surgeon, United States Navy
Walter Reed National Military Medical Center
Bethesda, MD, USA
Amir Taghinia, MD, MPH
Attending Surgeon
Department of Plastic and Oral Surgery
Boston Children’s Hospital;
Assistant Professor of Surgery
Harvard Medical School
Boston, MA, USA
David M. K. Tan, MBBS
Senior Consultant
Department of Hand and Reconstructive
Microsurgery
National University Health System
Singapore;
Assistant Professor
Department of Orthopedic Surgery
Yong Loo Lin School of Medicine
National University Singapore
Singapore

xxxix
List of Contributors
Jin Bo Tang, MD
Professor and Chair
Department of Hand Surgery;
Chair, The Hand Surgery Research Center
Affiliated Hospital of Nantong University
Nantong, The People’s Republic of China
Johan Thorfinn, MD, PhD
Senior Consultant of Plastic Surgery, Burn Unit;
Co-Director
Department of Plastic Surgery, Hand Surgery
and Burns
Linköping University Hospital
Linköping, Sweden
Michael Tonkin, MBBS, MD, FRACS(Orth),
FRCS(Ed Orth)
Professor of Hand Surgery
Department of Hand Surgery and Peripheral
Nerve Surgery
Royal North Shore Hospital
The Children’s Hospital at Westmead
University of Sydney Medical School
Sydney, New South Wales, Australia
Joseph Upton III, MD
Staff Surgeon
Department of Plastic and Oral Surgery
Boston Children’s Hospital;
Professor of Surgery
Harvard Medical School
Boston, MA, USA
Francisco Valero-Cuevas, PhD
Director
Brain-Body Dynamics Laboratory;
Professor of Biomedical Engineering;
Professor of Biokinesiology and Physical
Therapy;
(By courtesy) Professor of Computer Science
and Aerospace and Mechanical Engineering
The University of Southern California
Los Angeles, CA, USA
Christianne A. van Nieuwenhoven, MD, PhD
Plastic Surgeon/Hand Surgeon
Plastic and Reconstructive Surgery
Erasmus Medical Centre
Rotterdam, the Netherlands
Nicholas B. Vedder, MD
Professor of Surgery and Orthopedics
Chief of Plastic Surgery Vice Chair
Department of Surgery
University of Washington
Seattle, WA, USA
Andrew J. Watt, MD
Attending Hand and Microvascular Surgeon;
Associate Program Director, Buncke Clinic Hand
and Microsurgery Fellowship;
Adjunct Clinical Faculty, Stanford University
Division of Plastic and Reconstructive Surgery
The Buncke Clinic
San Francisco, CA, USA
Fu-Chan Wei, MD
Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
Julie Colantoni Woodside, MD
Orthopedic Surgeon
OrthoCarolina
Gastonia, NC, USA
Jeffrey Yao, MD
Associate Professor
Department of Orthopedic Surgery
Stanford Hospital & Clinics
Redwood City, CA, USA

Acknowledgments
My wife, Gabrielle Kane, has always been my rock. She not
only encourages me in my work but gives constructive criti-
cism bolstered by her medical expertise as well as by her
knowledge and training in education. I can never repay her.
The editorial team at Elsevier have made this series possible.
Belinda Kuhn leads the group of Alexandra Mortimer, Louise
Cook, and the newest addition to the team, Sam Crowe. The
Elsevier production team has also been vital in moving this
project along. The volume editors, Geoff Gurtner, Peter Rubin,
Ed Rodriguez, Joe Losee, David Song, Mo Nahabedian, Jim
Chang, and Dan Liu have shaped and refined this edition,
making vital changes to keep the series relevant and up-to-
date. My colleagues in the University of Washington, headed
by Nick Vedder, have provided continued encouragement
and support. Finally, and most importantly, the residents and
fellows who pass through our program keep us on our toes
and ensure that we give them the best possible solutions to
their questions.
Peter C. Neligan, MB, FRCS(I), FRCSC, FACS
I want to thank my wife Kathryn for her unfailing good cheer
and support on the nights and weekends I worked on this
volume. I would also like to thank my sons, Cole, Pierce and
Jack, for their limitless curiosity and energy, which continu-
ally challenge my view of the world. I am grateful to my
assistant, Theresa Carlomagno, for her skill in helping me
juggle too many things. And I need to acknowledge the
Elsevier staff, especially Sam Crowe, for his patience in
dealing with me.
Geoffrey C. Gurtner, MD, FACS

Dedicated to future plastic surgeons. Take up the torch
and lead us forward!

1 
Plastic surgery and innovation in medicine
Peter C. Neligan
SYNOPSIS
■ There is a major difference between research and innovation, though
the two are often interrelated.
■ Most advances in surgery come from innovation rather than basic
research.
■ Surgical innovation is one of the defining features of plastic surgery.
■ Surgical innovation is made safe by defining principles.
■ A detailed knowledge of anatomy is a major factor on which these
principles are based.
■ A balance between out-of-the-box thinking and conservative
deliberation is the perfect milieu to effect change yet keep perspective.
Introduction
There was a time when a general surgeon took care of every-
thing; from fractures to furuncles, skin grafts to sigmoidosco-
pies, cysts to cancers. Since that time, everything has become
specialized. Even in our specialty, the era of subspecialization
has already arrived. Despite this, in some ways plastic sur-
geons are the last general surgeons. We are not confined to an
organ or system. Nor are we linked to a disease, and this
separates us from almost every other medical specialty. With
some exceptions, plastic surgery operations are not always the
same. We regularly perform operations that we’ve never done
in precisely the same way before and will likely never do in
exactly the same way again. We almost always have com-
pleted some elements of the surgery before, or we may add
elements from another sphere of surgery to create a new
approach to a problem. The adoption of endoscopic techniques
is an example of this.
Sometimes this innovation is born of necessity, the chal-
lenge of solving a unique problem for which there is no
standard or well-accepted solution. Sometimes it is born of
the will to do something better, to solve a problem in such a
way that is better than what has been done before. The time
of greatest surgical innovation in most specialties is in times
of war and natural disaster when we are presented with
problems in such overwhelming numbers that we have to
come up with some solution that enables us to deal with such
large numbers. While this is acceptable in these unique situ-
ations, the concept of innovation at other times is sometimes
shocking to non-medical people. To the uninitiated it may
seem cavalier, even dangerous. However, these innovations
are based on principles that we learn in our training and that
we apply in our practice. That is the magic of plastic surgery
and what many people have called the art of plastic surgery.
It is in many ways similar to the musician who tries a new
way of interpreting a song or a painter who uses new materi-
als to paint a picture, though my personal view is that plastic
surgery is more a craft than an art. Of course this type of surgi-
cal innovation raises ethical issues and it is something with
which many institutions are struggling, not merely in the
domain of plastic surgery but in the field of surgery in general.1
In 2008, a position statement of the Society of University
Surgeons (SUS) recommended the creation of institutional
surgical innovation committees (SICs) to ensure appropriate
oversight of surgical innovations. It is surprising that several
years later, only 23% of surgery departments had SICs in place
and many department chairs were unaware of the position
statement.2 Many institutions already have processes and
protocols in place to oversee and regulate innovation.3 When
is innovation in surgery ethical and when is it not? This has
already been the source of much discussion in the literature.4–6
How far can we safely push the envelope? That particular
discussion is beyond the scope of this chapter. In order to
push the frontiers of surgery it is important to strike a balance
between necessary oversight of research practices and a sup-
portive environment where research can flourish.
Innovation and research
What is the difference between innovation and research?
Wikipedia () defines
  Access video lecture content for this chapter online at expertconsult.com

2
CHAPTER 1 • Plastic surgery and innovation in medicine
Some of these problems are generated from within our
own practices, some come from our interaction with other
specialties. We develop solutions and frequently allow those
other specialties to run with the ball while we go on to some-
thing else. The facility to adapt is important in all spheres. For
example, this ability to adapt, change and incorporate new
ideas is what has made English such a dominant language. It
is the reason that Apple Inc. has become an industry leader.
This is the essence of innovation. There are numerous examples
in biology that underline how the power of adaption is the
power of survival. For plastic surgery the same holds true and
while some fear the demise of the specialty, I would argue that
while we continue to adapt and develop, there will always be
a place for plastic surgery.
Vascularized composite
allotransplantation
In research we work with models; models of disease, models
of a procedure. Animal models provide a means by which we
can study the process we are interested in addressing in our
patients. Occasionally, in order to solve a problem, we move
to models that are perhaps less relevant to our everyday clini-
cal practice. For example, most people don’t realize that the
first kidney transplant was performed by Dr. Joseph Murray
(Fig. 1.1), a plastic surgeon at the Peter Bent Brigham Hospital
in Boston,10 now the Brigham and Women’s Hospital. People
are generally intrigued by this snippet of information. What
was a plastic surgeon doing transplanting kidneys? How
could this be? His practice as a plastic surgeon raised ques-
tions in his mind surrounding transplantation. His experience
treating burn patients sent back from the war during World
War II gave him wide exposure to skin grafting and raised
issues of immune rejection that he would later find ways to
address. In trying to work out the immunology of skin grafts,
he moved to a single organ model, the kidney, in order to
answer the question he had originally conceived. This
research as follows: “Research comprises ‘creative work
undertaken on a systematic basis in order to increase the stock
of knowledge, including knowledge of humans, culture and
society, and the use of this stock of knowledge to devise new
applications.’” The definition of innovation is much different:
() “The term ‘inno-
vation’ can be defined as something original and more effec-
tive and, as a consequence, new, that ‘breaks into’ the market
or society.” It may refer to an incremental emergent change or
radical and revolutionary changes in thinking, products,
processes, or organizations.” Though we would like to think
that innovation comes from research, this is not always the
case. It’s not just in medicine that this happens. For example,
innovations in the computer industry are often simple changes
introduced to facilitate a task, only to sometimes completely
change how things are done. For instance, Apple recently
redesigned laptop batteries to completely fill the irregular
space available and thereby prolong battery life. They have
also revolutionized how we listen to music, and how we even
purchase it. New changes happen all the time; they are some-
times incremental and sometimes game-changing.
Most of the surgical innovations we see are not the result
of research and, historically, most of the major advances in
surgery have been the result of innovation rather than basic
research. In fact, not infrequently, an innovation, often con-
ceived on the fly, is subsequently subjected to more rigorous
study. A surgeon may design a new operation or, for example,
a new flap. This may be a variation on an old procedure or
sometimes something completely new. As I have already said,
it may have been forced on the surgeon because of the circum-
stances of the case. There may be no other way to solve the
problem. When it works, the surgeon decides to design a
study to explain why the procedure worked or to describe the
blood supply of the flap. Though one could argue that this is
not the ideal way to do things, it certainly happens7,8 and is
merely a reflection of the dynamic nature of surgical innova-
tion. Innovation may be planned or, in the case of this example
and as happens probably more frequently, may be made on
the fly. Research may be innovative. A researcher may design
a novel experiment to probe a theory, an approach to the
problem that has not been explored before. This is also inno-
vation and is more commonly how research and innovation
are linked. An innovative idea is subjected to the scientific
method that research demands. What makes an innovator? It
has been said that the characteristics that most major innova-
tors have in common include: 1) the ability to recognize an
idea, 2) persistence in developing the strategy and 3) commit-
ment to the project, and final completion of a response to the
problem or problems in question.9
Innovation and plastic surgery
The history of plastic surgery, at least the history of modern
plastic surgery, is one of constant development. We regularly
devise new ways of dealing with a particular problem. We
develop a technique, perfect it and then either lose it to some
other group, or give it away. There are numerous examples of
this, from cleft surgery to microsurgery, from hand surgery to
craniofacial surgery. While some see this as a major problem,
I would argue that it is the lifeblood of plastic surgery. We are
constantly developing new solutions to diverse problems.
Fig. 1.1  Dr. Joseph Murray.

3
Collaboration
(s)he practices or how (s)he does a particular operation. Every
now and again the innovation is radical. The development of
craniofacial surgery is an example of radical innovation. Paul
Tessier (Fig. 1.2) was the first to describe a combined intra- and
extracranial approach for the correction of hypertelorism,13,14
breaking the previously held taboo of exposing the intracranial
environment to the upper aerodigestive tract. Going against
the surgical mainstream demands unimaginable courage. It
takes pioneers like Dr. Tessier to have the courage of their
convictions, or the obstinacy to push the envelope beyond the
general comfort level. Apart from spawning the specialty of
craniofacial surgery, Dr. Tessier’s advances led to advances in
related fields. An interesting footnote is that we now rarely see
cases of hypertelorbitism, presumably because they are
detected in utero and the fetuses aborted.
One of the related fields that Dr. Tessier’s work influenced
is that of skull base surgery. The craniofacial principles devel-
oped by Dr. Tessier literally opened this field. Tumors that
were previously considered inoperable and inaccessible
became treatable. That progress led to further innovations. So,
continuing with the example of skull base surgery, the radical
resections and approaches that were developed in the 1970s
and 80s15,16 created complications such as meningitis, brain
abscesses and problems related to delayed wound healing.
Smaller defects could be closed with local flaps such as peri-
cranial flaps, or galeafrontalis flaps.17 However, larger defects
remained a problem until free flaps were used to close these
defects.18,19 Then the incidence of all of the complications, the
brain abscesses, meningitis and wound healing problems,
were dramatically reduced and the surgery became safer. So
microvascular surgery made skull base tumor surgery safer.
More recently in this field we have seen innovations in the
surgical approaches to the skull base facilitate the develop-
ment of endoscopic skull base surgery. Large resections are
culminated in the first successful kidney transplant performed
from one twin to another by Dr. Murray at the Peter Bent
Brigham Hospital in Boston in 1954. Having helped develop
the specialty of transplantation, he went on to perform the
world’s first successful allograft in 1959 and the world’s first
cadaveric renal transplant in 1962. Dr. Murray ultimately
returned to his roots, the practice of plastic surgery, and was
awarded the Nobel Prize in Physiology or Medicine in 1990
for his contribution to the science of transplantation.
Now, that wheel has turned full circle and plastic surgery is,
once again, in the mainstream of transplant innovation (see
Chapter 32). Hand and face transplants have become a reality.
The first hand transplant was performed in 199811 and the first
face transplant in 2005.12 While these procedures are still not in
the mainstream of practice, it is interesting that there are
20 institutions designated as VCA (vascularized composite
allograft) transplant centers in the US and three of them have
established their programs as standard of care rather than
submitting them under an institutional review board (IRB)
protocol. This has been accepted by UNOS (United Network
for Organ Sharing), the private, non-profit organization that
manages the US organ transplant system under contract with
the federal government. VCA is designed to address those
reconstructions that we cannot realistically achieve with con-
ventional reconstructive techniques. Because immunosup-
pression to prevent rejection is such an onerous undertaking
for the patient, VCA is currently restricted to major transplants.
However, at some stage we will figure out a better and safer
way to prevent rejection and then VCA will include transplan-
tation of functioning eyelids, noses, ears, tongue and other
specialized organs, all the areas that we currently can’t effec-
tively reconstruct with conventional techniques. While total
nasal reconstruction, as an example, has attained a high level
of sophistication, the truth is that elegant total nasal recon-
structions are achieved by only a small number of expert sur-
geons utilizing very complex techniques in a series of operations
over a period of months or years. The concept of a surgeon
being able to transplant a nose in a single stage and achieve an
elegant result is very attractive. The same is true for many other
body parts, such as ears, tongue, genitalia, etc. In fact, penile
transplantations have already become a reality. Obviously
many obstacles remain before we will see this range of trans-
plants in practice. VCA is a perfect example of how an innova-
tive technical advance engenders increased research activity.
The barrier to successful transplantation is not a technical one,
it is an immunologic one and current interest in VCA has
spawned a new wave of research activity in the field of immu-
nology. This demands a collaborative and multidisciplinary
approach, something that, again, plastic surgeons do well.
Collaboration
Plastic surgeons cannot lay claim to being the only innovators
in medicine. Medicine is full of innovators. Yet it is true that
the nature of the plastic surgeon’s work, more than many other
specialties, demands innovation. And that is what most plastic
surgeons do every day of the week. Because so much of what
we do, particularly in reconstructive surgery, is in collabora-
tion with other specialties, innovation in those areas of practice
often lead to innovations in our field. Most of the innovations
we see are incremental. A surgeon incrementally changes how
Fig. 1.2  Dr. Paul Tessier. (Courtesy of Barry M Jones.)

4
CHAPTER 1 • Plastic surgery and innovation in medicine
Fig. 1.3  The Editor and Dr. Joe McCarthy at the launch of Plastic Surgery, 3rd
edition.
Fig. 1.4  Sir Harold Gillies.
now feasible through an endoscopic approach. This develop-
ment has had a large impact on these patients because exten-
sive open approaches, with the associated risks of scarring
and deformity, are no longer necessary. However, with these
large endoscopic resections, we are seeing the re-emergence
of problems such as meningitis and abscess because of the
difficulty in reconstructing these defects endoscopically.20 This
has led to the development of new reconstructive techniques
and approaches in order to address these complications.21–23
This is an excellent example of how a multidisciplinary
approach can advance a field. An innovation in one area
can create a problem in another area that forces further
innovation.
Similarly, an innovation in another specialty can change the
way we practice in ours. An example is the introduction of
bone lengthening procedures by Dr. Gavril Ilizarov.24 This was
revolutionary in the 1960s. That technology was adapted by
Dr. Joseph McCarthy (Fig. 1.3) and applied to the craniofacial
skeleton.25–27 This innovation has changed the way many
craniofacial deformities are treated. Dr. McCarthy, inciden-
tally, edited the first edition of Plastic Surgery.
Progress in surgery, regardless of specialty, demands a
balance between innovators and conservatives. Innovators
push the envelope and work best when they are paired
with conservatives who rein them in to a degree. Thus, a
balance between out-of-the-box thinking and conservative
deliberation is the perfect milieu to effect change yet keep
perspective.
Drivers of innovation
As already mentioned, innovation is also forced in times of
upheaval and change. The classic examples are war and
natural disasters. More surgical advances are made in wartime
than in peacetime. This is because specific problems are seen
in unprecedented numbers and demand a solution. In this
sort of environment it becomes reasonable to break the rules.
One has to, simply, cope. Out of this generally comes a change
in practice. Most of the advances in how we manage major
trauma have come from the arena of war. The MASH units of
the Korean conflict taught us that initiating treatment early, in
the field, saves lives. The ultimate progression of that concept
has been the development of robotic surgery, bringing high
level expertise to the field so that skilled intervention can be
effected at the earliest possible opportunity. The fact that this
can be achieved using robotic technology makes it feasible for
a highly skilled surgeon located in some central site to treat
multiple injuries in separate locations.
The types of injury seen in war also lead to changes in
practice. Plastic surgery, as we know it today, was born during
the First World War. Sir Harold Gillies (Fig. 1.4) developed
techniques for facial reconstruction initially at Aldershot and
later at the Queen’s Hospital in Sidcup, Kent. (It later became
Queen Mary’s Hospital.) His innovative solutions for some of
the injuries he saw led to the development of modern plastic
surgery. During the Second World War, the Plastic Surgery
Unit at the Queen Victoria Hospital in East Grinstead, headed
by Sir Archibald McIndoe (Gillies’ cousin) (Fig. 1.5) became
famous for treating severely burned airmen. This surgery
was so experimental that McIndoe’s patients formed a
club known as the Guinea Pig Club. The club was initially
formed as a drinking club and its membership was made up
of injured airmen in the hospital as well as the surgeons and

5
Principles of innovation
Fig. 1.5  Sir Archibald McIndoe. (Courtesy of Blond McIndoe Research Foundation,
registered charity no. 1106240.)
anesthesiologists who treated them. Airmen had to have gone
through a minimum of 10 surgical procedures before being
eligible for membership in the club. By the end of the war the
club had 649 members. The club itself was socially innovative
because McIndoe conceived it as a way of integrating injured
airmen back into society. He convinced some of the local
families in East Grinstead to accept his patients as guests and
other residents to treat them as normally as possible. It was
very successful and East Grinstead became known as “the
town that doesn’t stare”.
Innovation and development in other spheres has also
changed the face of plastic surgery and brought further recon-
structive challenges to surgeons. For example, the develop-
ment of effective body armor has led to an increase in the
types of injuries we see in the unprotected areas such as the
limbs and the head and neck. It is not that these injuries didn’t
occur before. It is simply that before the military had effective
body armor, soldiers were dying of their injuries and we did
not have to deal with their devastating facial or extremity
injuries. Limb amputations are surprisingly common. In the
US it is estimated that there are 10 000 new upper limb ampu-
tees every year. This has led to the development of innovative
prosthetics as well as novel techniques to power these pros-
thetics. Use of myoelectric technology has led to innovations
in the surgical approach to amputations and amputation
stumps.24,25 It is likely that VCA (Ch. 32)) will change the
reconstructive landscape for these devastating injuries and we
are already seeing that in the upper limb.
Principles of innovation
I mentioned that innovations are based on principles. What
are those principles and on what are they based? Obviously
the specific principles will depend on the area under study.
The principles on which innovation are based will be different
for plastic surgeons as compared to gastrointestinal surgeons,
for example. Central to everything and what I consider the
core of plastic surgery is a detailed knowledge of anatomy. As
a specialty and in general, plastic surgeons have a more
detailed knowledge of anatomy than any other specialty. Of
course the cardiac surgeon knows the heart better than anyone
and the orthopedist knows his bones better than anyone but
neither of these specialties are likely to be in each other’s
domain very often. Yet the plastic surgeon is frequently asked
to cover exposed fractures or to provide vascularized cover
for an infected sternotomy wound. Neither of these tasks is
possible without a detailed knowledge of the anatomy of the
region. Regardless of the area of subspecialty practice one is
in, whether it is cosmetic surgery or hand surgery, a detailed
knowledge of anatomy is the most important core under-
standing that is required to do the job well.
To drill down and define what is the single element of
anatomic knowledge that is most vital to us, the answer
would have to be vascular anatomy. Because so much of what
we do involves the rearrangement of tissue, either locally,
regionally or from afar, we have to know what keeps that
tissue alive and we have to preserve that element. It is inter-
esting to look at the advances that have been made in plastic
surgery over the past 50 years. Many of them are directly
related to a better knowledge of vascular anatomy. The most
tangible of these is the development of flap surgery. We have
come from an era when all flaps were random, to the present
time when we know not only which blood vessel is supplying
our flap but how much of that tissue is being perfused by that
blood vessel. Innovations in imaging technology allow us the
luxury of a roadmap to the vascular anatomy of our planned
reconstruction using CT and/or MRI technology.26–28 Even
better, we have a surgical GPS that allows us to visualize
perfusion in real time using indocyanine green.29 Technical
advances allow us to transfer the tissue and perform a micro-
vascular anastomosis to restore its blood supply. However it
goes beyond that. We can also restore function, sometimes
using microsurgical techniques, other times, once again, uti-
lizing our knowledge of anatomy, by robbing Peter to pay
Paul. Tendon transfers, for example, have long been a tech-
nique for restoring function to a compromised limb.30–32 More
recently, nerve transfers have been utilized and are proving
to be a valuable addition to our reconstructive armamentar-
ium.32 These are all examples of innovation, describing a new
solution to an otherwise insoluble problem.
We have also combined our knowledge of vascular anatomy
with our knowledge of genetic engineering. Using genetic
engineering we can program cells to perform certain tasks. We
can suppress certain functions, stimulate others; in other
words we can manipulate cells. This is a very powerful science
and has potential applications across all of medicine. The
process of transfection, whereby DNA or RNA is introduced
into cells to modify gene expression, is widely used in
molecular research. Geoff Gurtner, Editor of this volume of
Plastic Surgery introduced us to the concept of “biologic
brachytherapy”.33 Using techniques of viral transfection, he
has been able to design flaps that not only close a surgical
defect but introduce a therapeutic element to the reconstruc-
tion by having the flap produce peptides appropriate to the
disease entity being treated, producing probiotics for infected
wounds, or antiangiogenic peptides for oncologic reconstruc-
tions. This innovative approach combines the best of plastic
surgery with the best of genetic engineering to provide a new
and better solution to an existing clinical problem. Biologic
brachytherapy represents the melding of anatomic knowledge

6
CHAPTER 1 • Plastic surgery and innovation in medicine
vacuum to the breast caused swelling and enlargement. This
was somewhat of a transitory enlargement but, nevertheless,
an enlargement. Several other innovations led to a rethinking
of what was happening with the Brava system and ultimately
led to a very innovative approach to breast reconstruction that
is still in the initial stage of skeptical interest but that may well
become an established technique. This association of ideas is
often how innovation works. What were these different ideas?
Each in its own right is a major innovation.
The first is fat grafting. This is an old idea and one with
a checkered history. Dermal fat grafts have long been an
accepted method of correcting small contour defects. Attempts
at engrafting larger fat deposits have generally been unsuc-
cessful. The concept of fat injection as a means of engrafting
fat is another idea that was greeted with skepticism until
Coleman and others showed us that it does work when the
fat is deposited in small aliquots with a fine cannula.37,42,43 This
technique is now widely practiced in both aesthetic and
reconstructive arenas and has become an invaluable addition
to our armamentarium.
The second innovation is tissue expansion. Though tissue
expansion has been around for a long time, we have thought
of it in terms of internal expansion, i.e. expansion produced
by the implantation of an expanding device. The suction
system used by the Brava bra introduces us to the concept of
external expansion, i.e. expansion caused by external forces,
the application of a vacuum to the skin.
The third innovation is that of vacuum-assisted closure, the
VAC system. This is an idea so simple that we all wish we
had thought of it. However, as with many things in medicine,
it is not as simple as it first appears. Not only, it appears,
does the VAC mechanically remove debris and exudate from
the wound, but it also promotes angiogenesis and cell
proliferation.44–46
Putting all these concepts together, Khouri has developed
a system for both breast reconstruction as well as breast
augmentation, which uses the Brava system, married to the
structural fat-grafting concept, whereby the external expan-
sion induced by the Brava vacuum produces edema, angio-
genesis and cell proliferation that permits larger volumes of
fat to be deposited in a favorable matrix, thereby increasing
graft take and fat retention. To date, the results of this approach
are remarkable. Undoubtedly there are many unanswered
questions and here, once again, we have an example of an
innovation that has already found clinical application but that
requires extensive research to elucidate the mechanism of the
clinical picture we are seeing.
Fat grafting, as well as providing a clinical solution to
many problems, both aesthetic and reconstructive, has also
engaged our curiosity in another area – that of stem cell
research. This again represents an association of ideas from
disparate fields. Many of the changes we see as a result of fat
grafting are not readily explained by the injection of fat alone.
As an example, it has been reported that many of the skin
changes associated with irradiation seem to be reversed when
fat is injected into, for example, a breast defect resulting from
lumpectomy and irradiation.47 Why should this be? The
answer, stem cells, may be a simplistic solution to explain
something we don’t understand. The answer may also be our
introduction into a whole new area of development for plastic
surgery. Of course, as we’ve seen before, not only does this
innovation (fat grafting) solve a clinical problem, it raises
with tissue engineering principles and is a very exciting
development.
The concept of flap prefabrication is another imaginative
way of providing a better solution to a clinical problem.34
Using these techniques, the most appropriate reconstructive
construct can be assembled prior to the definitive reconstruc-
tion. While flap prefabrication is an elegant approach to a
complex problem, it demands a high level of expertise, imagi-
nation and an innovative outlook. It also demands multiple
stages and increased time to complete the reconstruction.
In some disease states, such a delay may not be feasible.
Engineering body parts is yet another approach that is cur-
rently being developed. Wayne Morrison (Fig. 1.6), working
in the Bernard O’Brien Institute in Melbourne, has been able
to grow functioning cardiac muscle35 as well as functioning
islet cells.36 He continues to work on various matrix types
to produce vascularized tissue chambers in which different
cell types can be grown and vascularized. The ultimate aim
is to produce clinically viable engineered organ parts.37 This
introduces the concept of “spare-parts” surgery, something
that, while still not a reality, is no longer the stuff of science
fiction.
The concept of making new tissue constructs is not new
and is the basis, for example, of bone distraction and tissue
expansion. Tissue expansion has been around since the 1980s.
In fact, like many things in medicine, it was originally
described long before that,38 but was only popularized in the
1980s.39 It has become one of the standard ways to reconstruct
a breast following mastectomy and, of course, it has multiple
other uses. When first introduced by Radovan, like many
innovations, it was considered with a great deal of skepticism.
Unfortunately Radovan did not live to see his idea become
widely accepted.
Innovation also involves the application of established
techniques in new areas. Bone distraction is an example that
was cited already. Devised by Ilizarov for the treatment of long
bones, the technique has been adapted to the craniofacial
skeleton. The applications of bone distraction in plastic surgery
are more recent. Popularized by McCarthy,40 bone distraction
has changed the practice of craniofacial surgery, minimizing
the extent of surgery required to treat certain conditions while
improving outcomes. Such developments occur all the time
and sometimes there is a disconnect between the development
of the original idea and its ultimate application. An example
of this is the Brava bra. This was first developed as a means of
achieving breast augmentation non-surgically.41 Applying a
Fig. 1.6  Dr. Wayne Morrison.

7
Documentation, data gathering and regulation
about innovation itself? How can we ensure that innovation
is as safe as possible and conducted in some sort of organized
fashion and with some form of structure? Do we need such
organization and such structure? As I mentioned at the outset,
a discussion on the ethics of innovation is beyond the scope
of this chapter. However, there are some things that are useful
to consider.
Documentation, data gathering
and regulation
It is important to document change. If one asks a surgeon how
many procedures (s)he has done, the answer is usually a gross
exaggeration. Similarly we tend to underestimate our compli-
cations. We’re not good at remembering stuff though we think
we are. It is surprising when one starts to keep a database how
sobering it is to see the actual numbers. It’s also surprising
how much information one can glean and this information is
vital if we are to change and improve. Innovation implies
change and in times of change it is imperative to document
results. How else can one evaluate the effects of the innova-
tion? So documentation and data gathering are important
aspects of innovation.
The difficulty with innovation arises in that gray zone
between innovation and research. Small changes are easy to
effect, large changes more difficult! Most institutions regulate
change through the institutional review board (IRB). Regula-
tion is necessary yet it is also restrictive. The IRB process varies
from institution to institution but, in general, is getting more
and more stringent. This can have a significant effect on the
development of medicine as a whole. It is widely believed, for
example, that the reason the first heart transplant did not occur
in the United States was because of the stringent regulations
governing experimental surgery in the US as compared to
South Africa where Dr. Christiaan Barnard, an American-
trained cardiac surgeon, performed this operation. Institutions
also grapple with the dilemma of allowing some degree of
innovation, yet controlling quality and risk exposure. The
latter is an important consideration for institutions and indi-
viduals alike. Apart from protecting the individual and the
institution, regulation also introduces and enforces an element
of objectivity. When one is involved in developing a theory, an
operation, or some sort of change, it is very easy to lose objec-
tivity and that is a serious issue. Regulation enforces objectivity
and the difficulty lies in the balance between creativity and
objectivity. Just as one can become obsessed with creativity
and freedom of expression, however, one can also become
obsessed with objectivity and regulation. Finding a balance
between the two is sometimes difficult. Added to that is the
conflict of interest that is sometimes introduced to the process
when a commercial value is associated with the innovation,
and particularly when a significant sum may already have
been invested in developing it. That introduces the ethics of
practice and this subject is covered in Chapter 4.
So we have seen that innovation is an important part of
medicine. It is separate from research though often stimulates
research. It is as difficult to regulate as it is to define and, at
least in some instances, may be stifled by regulation. From all
of the innovations I have touched on in this chapter we can
see that innovation is vital to the development of medicine in
general and to the evolution of plastic surgery in particular.
numerous questions and opens the door to new areas of
research and quite likely to even newer innovations.
External influences and innovation
In order to achieve some of our surgical results we rely not
only on our own expertise as surgeons, we also rely on our
tools, our instruments and devices. Microsurgery could not
have developed without the development of the operating
microscope and appropriate instrumentation. One of the
biggest barriers to the development of modern microsurgery
was the inability to swage an ultrafine suture to a sufficiently
small needle. Similarly, the manufacture of implants of any
kind demand an expertise that we, as surgeons, do not have.
Bioengineers, chemists, physicists and all manner of experts
are required to help bring our ideas into clinical practice.
None of these developments are possible without the partner-
ship of industry. Of course this is a double-edged sword as it
introduces other interests and possible conflicts. Nevertheless,
it is a vital part of the development of any specialty.
I’ve already mentioned how microsuture development led
to the development of reconstructive microsurgery. Once it
was possible to do microanastomoses, it became possible to
replant amputated digits. The new technology spurred the
advance of flap surgery and our interest in vascular anatomy
was again renewed. This inspired the likes of Mathes and
Nahai to elucidate and classify the blood supply of muscles
and others to describe new myocutaneous flaps. Ian Taylor
started his classic cadaver injection studies that led to the
development of the angiosome theory. Later, Isao Koshima
and others described perforator flaps and that development
and innovation is ongoing.
Craniofacial surgery is another subspecialty area that could
not have developed without the help of industry. When
Joseph Gruss recognized the importance of internal fixation
for the craniofacial skeleton in the early 1980s he was using
wires to painstakingly piece together comminuted fractures.
This led him and others to the recognition of the concept of
facial buttresses and to the development of plating systems
for the face. This approach is now standard of care but could
not have happened without the expertise of the engineers and
implant biologists who worked with surgeons to develop the
plating systems and instrumentation that make it all possible.
Once again, this is an ongoing process.
Every aspect of plastic surgery has undergone such change
and development. In cosmetic surgery we have also seen
these changes evolve. In each area, surgeons have developed
a better understanding of anatomy and function and devel-
oped, with industry, ways to improve and develop the field.
Endoscopic techniques were adapted from other areas of
practice and applied to the face, and minimally invasive
techniques led to the development of barbed sutures and
suspension systems. Implant biology has brought us various
injectable fillers and broadened the scope of cosmetic surgery
in a way that was once unimaginable.
So innovation is a natural consequence of practice. In every
sphere people strive to improve things, surgeons to do better
operations, anesthesiologists to improve pain control, indus-
try to provide better materials and instruments. These innova-
tions occur in all specialties and, as we have seen, innovation
in one specialty can influence how another develops. What

8
CHAPTER 1 • Plastic surgery and innovation in medicine
1. Angelos P. Surgical ethics and the challenge of surgical innovation.
Am J Surg. 2014;208:881–885. Surgical ethics as a specific discipline is
relatively new to many. Surgical ethics focuses on the ethical issues that
are particularly important to the care of surgical patients. Informed
consent for surgical procedures, the level of responsibility that surgeons
feel for their patients’ outcomes, and the management of surgical
innovation are specific issues that are important in surgical ethics and
are different from other areas of medicine. The future of surgical progress
is dependent on surgical innovation, yet the nature of surgical
innovation raises specific concerns that challenge the professionalism of
surgeons.
4. McCulloch P, Altman DG, Campbell WB, et al. No surgical
innovation without evaluation: the IDEAL recommendations.
Lancet. 2009;374:1105–1112. This paper acknowledges the complexity of
interventions that surgery comprises, depending on operator, team,
setting and other variations. The authors propose recommendations for
surgical assessment based on a 5-stage description of development of the
surgical process. They also encourage use of prospective databases and
registries as well as reporting outcomes whether good or adverse.
Protocols for such studies should be registered and randomized trials
should be used wherever possible. They also propose design styles as an
alternative to randomized controlled trials which may be impractical in
certain situations
18. Neligan PC, Boyd JB. Reconstruction of the cranial base defect.
Clin Plast Surg. 1995;22:71–77.
20. Harvey RJ, Smith JE, Wise SK, et al. Intracranial complications
before and after endoscopic skull base reconstruction. Am J Rhinol.
2008;22:516–521.
21. Horiguchi K, Murai H, Hasegawa Y, et al. Endoscopic endonasal
skull base reconstruction using a nasal septal flap: surgical results
and comparison with previous reconstructions. Neurosurg Rev.
2010;33:235–241.
24. Hijjawi JB, Kuiken TA, Lipschutz RD, et al. Improved myoelectric
prosthesis control accomplished using multiple nerve transfers.
Plast Reconstr Surg. 2006;118:1573–1578.
27. Mathes DW, Neligan PC. Preoperative imaging techniques for
perforator selection in abdomen-based microsurgical breast
reconstruction. Clin Plast Surg. 2010;37:581–591. This paper cites
the disadvantages of abdominal based perforator flaps as
difficulty with the dissection making the procedure longer
because of the necessity to find the perforators as well as
define their intramuscular course. Imaging techniques
provide us with a road map pre-operatively giving us this
informatin and thereby making the oprocedures quicker and
safer.
32. Tung TH, Mackinnon SE. Nerve transfers: indications, techniques,
and outcomes. J Hand Surg Am. 2010;35:332–341.
34. Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head
and neck: a 10-year experience. Plast Reconstr Surg. 1999;103:
808–820. Tissue neovascularized by implanting a vascular pedicle can be
transferred as a “prefabricated flap” based on the blood flow through the
implanted pedicle. This technique potentially allows any defined tissue
volume to be transferred to any specified recipient site, greatly expanding
the armamentarium of reconstructive options. During the past 10 years,
17 flaps were prefabricated and 15 flaps were transferred successfully in
12 patients. Tissue expanders were used as an aid in 11 flaps. Seven flaps
were prefabricated at a distant site and later transferred using
microsurgical techniques. Ten flaps were prefabricated near the recipient
site by either transposition of a local vascular pedicle or the
microvascular transfer of a distant vascular pedicle. The prefabricated
flaps were subsequently transferred as island pedicle flaps. These local
vascular pedicles can be re-used to transfer additional neovascularized
tissues. Common pedicles used for neovascularization included the
descending branch of the lateral femoral circumflex, superficial temporal,
radial, and thoracodorsal pedicles. Most flaps developed transient venous
congestion that resolved in 36 to 48 hours. Venous congestion could be
reduced by incorporating a native superficial vein into the design of the
flap or by extending the prefabrication time from 6 weeks to several
months. Placing a Gore-Tex sleeve around the proximal pedicle allowed
for much easier pedicle dissection at the time of transfer. Prefabricated
flaps allow the transfer of moderate-sized units of thin tissue to recipient
sites throughout the body. They have been particularly useful in patients
recovering from extensive burn injury on whom thin donor sites are
limited.
47. Rigotti G, Marchi A, Galiè M, et al. Clinical treatment of
radiotherapy tissue damage by lipoaspirate transplant: a healing
process mediated by adipose-derived adult stem cells. Plast
Reconstr Surg. 2007;119:1409–1422, discussion 1423–1424. There has
been a lot of discussion about the contribution of stem cells to restoration
of tissue vascularization and organ function. This study aimed to assess
the presence of adipose derived stem cells which were in the lipo-aspirate
and to assess the clijnical effectiveness of lipoaspirate transplantation in
the treatment of radiation induced tissue injury. The authors followed 22
patients with significant radiation effects for 31 months after lipoaspirate
injection. Clinical outcomes led to an improvement of symptoms and they
concluded that this is a low invasive therapeutic approach for resolving
the late side effects of radiotherapy.
Access the complete reference list online at

8.e1
References
References
1. Angelos P. Surgical ethics and the challenge of surgical innovation.
Am J Surg. 2014;208:881–885. Surgical ethics as a specific discipline is
relatively new to many. Surgical ethics focuses on the ethical issues that
are particularly important to the care of surgical patients. Informed
consent for surgical procedures, the level of responsibility that surgeons
feel for their patients’ outcomes, and the management of surgical
innovation are specific issues that are important in surgical ethics and are
different from other areas of medicine. The future of surgical progress is
dependent on surgical innovation, yet the nature of surgical innovation
raises specific concerns that challenge the professionalism of surgeons.
2. McNair LA, Biffl WL. Assessing awareness and implementation of
a recommendation for surgical innovation committees: a survey of
academic institutions. Ann Surg. 2015;262:941–948.
3. Neumann U, Hagen A, Schönermark M. Procedures and criteria
for the regulation of innovative non-medicinal technologies into
the benefit catalogue of solidly financed health care insurances.
GMS Health Technol Assess. 2008;3:Doc13.
4. McCulloch P, Altman DG, Campbell WB, et al. No surgical
innovation without evaluation: the IDEAL recommendations.
Lancet. 2009;374:1105–1112. This paper acknowledges the complexity of
interventions that surgery comprises, depending on operator, team,
setting and other variations. The authors propose recommendations for
surgical assessment based on a 5-stage description of development of the
surgical process. They also encourage use of prospective databases and
registries as well as reporting outcomes whether good or adverse.
Protocols for such studies should be registered and randomized trials
should be used wherever possible. They also propose design styles as an
alternative to randomized controlled trials which may be impractical in
certain situations
5. Ergina PL, Cook JA, Blazeby JM, et al. Challenges in evaluating
surgical innovation. Lancet. 2009;374:1097–1104.
6. Barkun JS, Aronson JK, Feldman LS, et al. Evaluation and stages of
surgical innovations. Lancet. 2009;374:1089–1096.
7. Neligan P, Gullane PJ, Vesely M, Murray D. The internal
mammary artery perforator flap: new variation on an old theme.
Plast Reconstr Surg. 2007;119:891–893.
8. Vesely M, Murray DJ, Novak CB, et al. The internal mammary
artery perforator flap: an anatomical study and a case report. Ann
Plast Surg. 2007;58:156–161.
9. Toledo-Pereyra L. Surgical innovator. J Invest Surg. 2011;24:4–7.
10. Guild WR, Harrison JH, Merrill JP, Murray J. Successful
homotransplantation of the kidney in an identical twin. Trans Am
Clin Climatol Assoc. 1955–1956;67:167–173.
11. Dubernard JM, Owen E, Herzberg G, et al. Human hand allograft:
report on first 6 months. Lancet. 1999;353:1315–1320.
12. Devauchelle B, Badet L, Lengelé B, et al. First human face
allograft: early report. Lancet. 2006;368:203–209.
13. Tessier P. Experiences in the treatment of orbital hypertelorism.
Plast Reconstr Surg. 1974;53:1–18.
14. Tessier P, Guiot G, Derome P. Orbital hypertelorism. II. Definite
treatment of orbital hypertelorism (OR.H.) by craniofacial or by
extracranial osteotomies. Scand J Plast Reconstr Surg. 1973;7:39–58.
15. Westbury G, Wilson JS, Richardson A. Combined craniofacial
resection for malignant disease. Am J Surg. 1975;130:463–469.
16. Hardy J, Vezina JL. Transsphenoidal neurosurgery of intracranial
neoplasm. Adv Neurol. 1976;15:261–273.
17. Jackson IT. Advances in craniofacial tumor surgery. World J Surg.
1989;13:440–453.
18. Neligan PC, Boyd JB. Reconstruction of the cranial base defect.
Clin Plast Surg. 1995;22:71–77.
19. Neligan PC, Mulholland S, Irish J, et al. Flap selection in cranial
base reconstruction. Plast Reconstr Surg. 1996;98:1159–1166.
20. Harvey RJ, Smith JE, Wise SK, et al. Intracranial complications
before and after endoscopic skull base reconstruction. Am J Rhinol.
2008;22:516–521.
21. Horiguchi K, Murai H, Hasegawa Y, et al. Endoscopic endonasal
skull base reconstruction using a nasal septal flap: surgical results
and comparison with previous reconstructions. Neurosurg Rev.
2010;33:235–241.
22. Hackman T, Chicoine MR, Uppaluri R. Novel application of the
palatal island flap for endoscopic skull base reconstruction.
Laryngoscope. 2009;119:1463–1466.
23. El-Banhawy OA, Halaka AN, Altuwaijri MA, et al. Long-term
outcome of endonasal endoscopic skull base reconstruction with
nasal turbinate graft. Skull Base. 2008;18:297–308.
24. Hijjawi JB, Kuiken TA, Lipschutz RD, et al. Improved myoelectric
prosthesis control accomplished using multiple nerve transfers.
Plast Reconstr Surg. 2006;118:1573–1578.
25. Kuiken TA, Miller LA, Lipschutz RD, et al. Targeted reinnervation
for enhanced prosthetic arm function in a woman with a proximal
amputation: a case study. Lancet. 2007;369:371–380.
26. Masia J, Kosutic D, Clavero JA, et al. Preoperative computed
tomographic angiogram for deep inferior epigastric artery
perforator flap breast reconstruction. J Reconstr Microsurg.
2010;26:21–28.
27. Mathes DW, Neligan PC. Preoperative imaging techniques for
perforator selection in abdomen-based microsurgical breast
reconstruction. Clin Plast Surg. 2010;37:581–591. This paper cites
the disadvantages of abdominal based perforator flaps as
difficulty with the dissection making the procedure longer
because of the necessity to find the perforators as well as
define their intramuscular course. Imaging techniques
provide us with a road map pre-operatively giving us this
informatin and thereby making the oprocedures quicker and
safer.
28. Masia J, Kosutic D, Cervelli D, et al. In search of the ideal method
in perforator mapping: noncontrast magnetic resonance imaging.
J Reconstr Microsurg. 2010;26:29–35.
29. Pestana IA, Coan B, Erdmann D, et al. Early experience with
fluorescent angiography in free-tissue transfer reconstruction. Plast
Reconstr Surg. 2009;123:1239–1244.
30. Sammer DM, Chung KC. Tendon transfers: part I. Principles of
transfer and transfers for radial nerve palsy. Plast Reconstr Surg.
2009;123:169e–177e.
31. Sammer DM, Chung KC. Tendon transfers: Part II. Transfers for
ulnar nerve palsy and median nerve palsy. Plast Reconstr Surg.
2009;124:212e–221e.
32. Tung TH, Mackinnon SE. Nerve transfers: indications, techniques,
and outcomes. J Hand Surg Am. 2010;35:332–341.
33. Michaels JT, Dobryansky M, Galiano RD, et al. Ex vivo
transduction of microvascular free flaps for localized peptide
delivery. Ann Plast Surg. 2004;52:581–584.
34. Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head and
neck: a 10-year experience. Plast Reconstr Surg. 1999;103:808–820.
Tissue neovascularized by implanting a vascular pedicle can be
transferred as a “prefabricated flap” based on the blood flow through the
implanted pedicle. This technique potentially allows any defined tissue
volume to be transferred to any specified recipient site, greatly expanding
the armamentarium of reconstructive options. During the past 10 years,
17 flaps were prefabricated and 15 flaps were transferred successfully in
12 patients. Tissue expanders were used as an aid in 11 flaps. Seven flaps
were prefabricated at a distant site and later transferred using
microsurgical techniques. Ten flaps were prefabricated near the recipient
site by either transposition of a local vascular pedicle or the
microvascular transfer of a distant vascular pedicle. The prefabricated
flaps were subsequently transferred as island pedicle flaps. These local
vascular pedicles can be re-used to transfer additional neovascularized
tissues. Common pedicles used for neovascularization included the
descending branch of the lateral femoral circumflex, superficial temporal,
radial, and thoracodorsal pedicles. Most flaps developed transient venous
congestion that resolved in 36 to 48 hours. Venous congestion could be
reduced by incorporating a native superficial vein into the design of the
flap or by extending the prefabrication time from 6 weeks to several
months. Placing a Gore-Tex sleeve around the proximal pedicle allowed
for much easier pedicle dissection at the time of transfer. Prefabricated
flaps allow the transfer of moderate-sized units of thin tissue to recipient
sites throughout the body. They have been particularly useful in patients

8.e2
CHAPTER 1 • Plastic surgery and innovation in medicine
recovering from extensive burn injury on whom thin donor sites are
limited.
35. Stubbs SL, Crook JM, Morrison WA, Newcomb AE. Toward
clinical application of stem cells for cardiac regeneration. Heart
Lung Circ. 2011;20:173–179.
36. Hussey AJ, Winardi M, Wilson J, et al. Pancreatic islet
transplantation using vascularised chambers containing nerve
growth factor ameliorates hyperglycaemia in diabetic mice. Cells
Tissues Organs. 2010;191:382–393.
37. Coleman WP 3rd. Autologous fat transplantation. Plast Reconstr
Surg. 1991;88:736.
38. Neumann C. The expansion of an area of skin by the progressive
distension of a subcutaneous balloon. Plast Reconstr Surg.
1957;19:124–130.
39. Radovan C. Breast reconstruction after mastectomy using the
temporary expander. Plast Reconstr Surg. 1982;69:195–208.
40. McCarthy JG, Schreiber J, Karp N, et al. Lengthening the human
mandible by gradual distraction. Plast Reconstr Surg. 1992;89:1–8,
discussion 9–10.
41. Smith CJ, Khouri RK, Baker TJ. Initial experience with the Brava
nonsurgical system of breast enhancement. Plast Reconstr Surg.
2002;110:1593–1595, author reply 1595–1598.
42. Coleman SR. Long-term survival of fat transplants: controlled
demonstrations. Aesthetic Plast Surg. 1995;19:421–425.
43. Coleman SR. Structural fat grafting. Aesthet Surg J. 1998;18:386,
388.
44. Greene AK, Puder M, Roy R, et al. Microdeformational wound
therapy: effects on angiogenesis and matrix metalloproteinases in
chronic wounds of 3 debilitated patients. Ann Plast Surg.
2006;56:418–422.
45. Chen SZ, Li J, Li XY, Xu LS. Effects of vacuum-assisted closure on
wound microcirculation: an experimental study. Asian J Surg.
2005;28:211–217.
46. Saxena V, Hwang CW, Huang S, et al. Vacuum-assisted closure:
microdeformations of wounds and cell proliferation. Plast Reconstr
Surg. 2004;114:1086–1096, discussion 1097–1098.
47. Rigotti G, Marchi A, Galiè M, et al. Clinical treatment of
radiotherapy tissue damage by lipoaspirate transplant: a healing
process mediated by adipose-derived adult stem cells. Plast
Reconstr Surg. 2007;119:1409–1422, discussion 1423–1424. There has
been a lot of discussion about the contribution of stem cells to restoration
of tissue vascularization and organ function. This study aimed to assess
the presence of adipose derived stem cells which were in the lipo-aspirate
and to assess the clijnical effectiveness of lipoaspirate transplantation in
the treatment of radiation induced tissue injury. The authors followed 22
patients with significant radiation effects for 31 months after lipoaspirate
injection. Clinical outcomes led to an improvement of symptoms and they
concluded that this is a low invasive therapeutic approach for resolving
the late side effects of radiotherapy.

2 
History of reconstructive and
aesthetic surgery
Riccardo F. Mazzola and Isabella C. Mazzola
SYNOPSIS
■ Closure of wounds represents one of the first gestures of reparative
surgery.
■ History shows that almost every possible local flap has been
described in the past and that the ingenuity of plastic surgeons was
unlimited.
■ The lesson drawn from history reveals that the so-called new flaps are
variations of what has already been published.
■ We have to be humble and recognize that “nothing is new under the
sun.”
Historical definition of plastic surgery
In 1597, the Bolognese Gaspare Tagliacozzi (1545–1597), con-
sidered the founder of plastic surgery, gave the following
definition of our discipline: plastic surgery is the art devoted
to “restore what Nature has given and chance has taken away.
The main purpose of this procedure is not the restoration of
the original beauty of the face, but rather the rehabilitation of
the part in question”,1 in other terms repair of congenital or
acquired defects, restoration of an appearance as close as
possible to normality, but also improvement of functional
impairment. The term “plastic” comes from the Greek
πλαστικóς (plasticós), moldable.
Origin of plastic surgery
The distant past – the wound as a problem
The ancient origin of plastic surgery relates to the healing of
wounds. Management of wounds caused by stones, weapons,
arrows, and animal bites goes back millions of years, when
primitive humans had to face four major problems: (1) closing
posttraumatic defects; (2) bleeding; (3) infection; and (4) pain.
Attempts to transform a defect that heals slowly by secondary
intention into one healing quicker by primary intention may
well account for the first example of a reparative procedure.
However, this must have been quite complex without
appropriate tools, in the presence of hemorrhage and without
anesthesia. There is no documentation of stitching of wounds
among primitive people.2 We may extrapolate from what was
reported in ancient Hindu medicine, where wound edges
were sewn with simple means like fibers or strips of tendon,
or pinned together using insect mandibles. Later, bronze pins
were used (Fig. 2.1).
In Ancient Egypt
We are well informed about Egyptian surgery thanks to the
Edwin Smith papyrus, the most ancient medical text. The
papyrus is a later transcription (about 1650 BC) of an original
manuscript dating from the Old Kingdom (between 3000 and
2500 BC). It describes 48 surgical cases, including wounds,
fractures, dislocations, sores, and tumors, and suggests their
potential management. Fresh wounds were treated conserva-
tively with the application of grease and honey using linen
and swabs. Adhesive strips of cloth, stitches or a combination
of clamp and stitches were advocated to bring together
the margins of the wound. A surgical knife was never men-
tioned, as wounds already existed in the cases presented.2
Treatment of nasal fractures is accurately explained. First,
clots should be removed from the inside of the nostrils, then
the bony fragments repositioned; two stiff rolls of linen were
applied externally “by which the nose is held fast” and finally
“two plugs of linen saturated with grease placed into the
nostrils.”3
In Mesopotamia
Mesopotamia is the region between the rivers Tigris and
Euphrates (now approximately Iraq), cradle of the Sumerian
civilization. Medicine was well developed, although strongly
influenced by astrology and divination. During excavations
of the Nineveh palace, a great library containing more than

10
CHAPTER 2 • History of reconstructive and aesthetic surgery
adventurer Nicolò Manuzzi (1639–1717) wrote a manuscript
about the Moghul empire in which an account of forehead
rhinoplasty is supplied. Regrettably the manuscript, kept in
the Marciana Library in Venice, was not published until 1907.7
Information on the forehead flap in nasal reconstruction only
reached the western world at the end of the 18th century,
thanks to a letter signed BL, addressed to Mr. Urban, editor
of the Gentleman’s Magazine, and published in October 1794
(Fig. 2.2).8
A friend of mine has transmitted to me, from the East
Indies, the following very curious and, in Europe, I believe
unknown chirurgical operation, which has long been practiced
in India with success; namely, affixing a new nose on a
man’s face.
There follows the accurate description of the two-step proce-
dure carried out on Cowasjee, a bullock driver of the English
Fig. 2.1  Bronze pin to approximate wound margins. (Reproduced from Rodius J.
De Acia Dissertatio. Padua: Frambotto; 1639.)
Fig. 2.2  Indian forehead flap nasal reconstruction. (Reproduced from BL. Letter to
the editor. Gentleman’s Magazine. 1794;64:891–892.)
30 000 clay tablets with cuneiform inscriptions was discov-
ered, 800 of them of a medical nature. They were written
about 600 BC, although the text dates from around 2000 BC. A
few of them deal with wound healing or congenital anomalies.
“If a man is sick with a blow on the cheek, pound together
turpentine, tamarisk, daisy, flour of Inninnu […] mix in milk
and beer in a small copper pan; spread on skin and he shall
recover.”4 Another tablet suggests the use of a dressing with
oil for an open wound.
Monsters (congenital malformations) had a key role in
predicting future events and in determining their course.
“When a woman gives birth to an infant […] whose nostrils
are absent, the country will be in affliction, and the house of
the man ruined; that has no tongue the house of the man will
be ruined; that has no lips affliction will strike the land and
the house of the man will be destroyed.”5 Interestingly, surgery
is never mentioned in clay tablets, although surgery was
certainly performed. In the King Hammurabi Code,2 dating
from about 1700 BC, surgical malpractice was recognized with
precise laws: “If a physician carried out a major operation on
a seignior with a bronze lancet and has caused the seignior’s
death or he opened the eye socket of a seignior and has
destroyed the seignior eye, they shall cut off his hand.” “If a
physician carried out a major operation on a commoner’s
slave with a bronze lancet and has caused [his] death, he shall
make good slave for slave.”
In India
In the Samhita, a Sanskrit text on surgery attributed to Sush-
ruta and possibly dating 600 BC, the description of several
reconstructive procedures related to the face are discussed. In
particular, management of eyelid anomalies like entropion,
trichiasis, or ingrown eyelashes and repair of the nose is
reported. Certain Indian populations had the habit of cutting
the nose of adulterers, thieves and prisoners of war as a sign
of humiliation. In an attempt to improve this terrible disfig-
urement, surgeons invented different solutions over the
centuries.
Repair of the nose was carried out by the Koomas, a low
caste of priests, or, according to others, a guild of potters.
Local flaps, outlined in the cheek, were used, and accurate
description of blunt (yantra) and sharp (sastra) instruments to
perform nasal reconstruction was supplied.6
When was the forehead skin used? There is no mention
of it. In the second half of the 17th century, the Venetian

11
Plastic surgery after the decline of the Roman Empire
army, who fell under the disfavor of Tippoo Sultan, and had
his nose amputated. It demonstrated the high level of surgery
reached by the Indians in performing an operation, without
anesthesia, in a very similar way to what we do nowadays.
In Greece
Greek medicine was influenced by Hippocrates, the greatest
physician of his time. Historians consider that Hippocrates
was born in the island of Kos around the year 460 BC, and
probably trained in medicine at the Asklepieion of Kos. In
ancient Greece and Rome, the Asklepieion (Latin: aesculapīum)
was a healing temple, sacred to Asklepios, the Greek god of
medicine. Hippocrates rejected the views of his time that
illness was due to supernatural influence, possession of evil
spirits, or disfavor of the gods. He based his medical practice
on the direct observation of disease and on an analysis of the
human body, introducing scientific methods into medicine.
Hippocrates taught and practiced medicine throughout his
life, traveling in various Greek regions. He established the
Great School of Medicine on the isle of Kos. He probably died
in Larissa (Greece) at the age of 83 or 90.
About 70 medical treatises, assembled during the Alexan-
drian era (third century AD), were attributed to Hippocrates.
They form the so-called Corpus Hippocraticum. Whether Hip-
pocrates himself is the author of the Corpus and these works
are authentic has been the matter of great dispute and contro-
versy.9 The Corpus contains manuals, lectures, research, philo-
sophical thoughts, and essays on different topics of medicine,
without any logical order and even with significant contradic-
tions among them. The works of Hippocrates were true best-
sellers, reprinted numerous times over the centuries. The first
printed edition of the Opera omnia (Complete Works) was issued
in Latin in Rome in 1525, and in Greek in Venice in 1526 by
the Aldine Press.
The surgical knowledge of Hippocrates was vast. He used
cauterization for the management of raw surfaces, reduced
malunited fractures, and practiced cranial trephination to
evacuate hematomas.
In Rome
In Rome, surgery was well developed, at least judging from
the rather sophisticated bronze instruments discovered in
Pompei and now kept at Naples National Museum. Many
were stored in traveling kits to be used by surgeons for emer-
gency or in the battlefields.
The two most representative figures of Roman medicine
were Celsus and Galen.
Aulus Cornelius Celsus (25 BC–50 AD) was probably not a
physician, but a writer from a noble family and the author, in
about 30 AD, of De Medicina (On Medicine) in eight volumes.
In book seven, chapter nine, vessel ligature and lithotomy as
well as lip closure (cleft lip or lip tumor) by means of flaps
are reported. It is explained how “defects of the ears, lips and
nose can be cured” (curta in auribus, labrisque ac naribus,
quomodo sarciri et curare possint), followed by a description of
wound closure by advancement flap.10 “The defect should be
converted into a square (in quadratum redigere). Then, from the
inner angles transverse incisions are made (lineas transversas
incidere), so that the part on one side is fully divided from that
on the opposite side.” “After that, the tissues which have been
Fig. 2.3  Lip repair according to Celsus. (Reproduced from Nélaton C, Ombredanne
L. Les Autoplasties. Paris: Steinheil; 1907.)
undermined, are brought together” (in unum adducere). “If this
is not possible two additional semilunar incisions are made at
some distance from the original (ultra lineas, quas ante fecimus,
alias duas lunatas et ad piagam conversas immittere), but only
sectioning the outer skin. […] These latter incisions enable the
parts to be easily brought together without using any trac-
tion” (Fig. 2.3). Celsus holds a key role in the history of plastic
surgery, as he is considered the earliest writer on this particu-
lar topic. He introduced the four cardinal signs of acute
inflammation, “redness and swelling with heat and pain”
(rubor et tumor, cum calore et dolore). A copy of Celsus’s manu-
script was discovered in Milan in 1443, and printed for the
first time in 1478 in Florence.11 De Medicina went through more
than 50 editions.
Claudius Galen (c. 129–201 AD) was born in Pergamon
(Turkey), studied medicine at the Asklepieion (see above) in
his native city and moved to Rome. He wrote about head
traumas, techniques of trephination for evacuating hemato-
mas and various types of bandaging. An excellent anatomist,
he described more than 300 muscles, the seven pairs of cranial
nerves and contributed to neurology, demonstrating that
nerves arise from the brain or spinal cord. He observed that
section of the laryngeal nerve resulted in dysphonia. For
management of wounds he used sutures and cautery. Numer-
ous works of Galen were lost, but 82 survived. Originally
written in Greek, many were translated into Arabic and Latin.
Galen’s Opera was first printed in Latin in Venice in 1490 and
in Greek in Venice in 1525 by the Aldine Press.
Plastic surgery after the decline of the
Roman Empire
Byzantine surgery
Oribasius (325–403 AD) wrote a collection of medical texts
entitled Synagogae Medicae in which reconstructive procedures
for cheek, nose, ears, and eyebrow defects are described.12

12
CHAPTER 2 • History of reconstructive and aesthetic surgery
Fig. 2.4  Mondino in the chair supervising a cadaver dissection. (Reproduced from
Ketham J. Fasciculo de Medicina. Venice: Gregorio de’ Gregorii; 1493.)
Paulus of Aegina (625–690 AD), surgeon and obstetrician, was
the author of a medical encyclopedia (Epitome) in seven
volumes. In book 6, which deals with surgery, a description
of tracheotomy, tonsillectomy, ectropion, upper eyelid retrac-
tion and lip repair is supplied.13,14 “Defects [Greek, colobomata]
of the lips and ears are treated in this way. First the skin is
freed on the underside. Then the edges of the wound are
brought together and the callosity is removed. Finally, stitches
holding the margins into position are applied.” This technique
closely resembles that of Celsus.
The Middle Ages
Arabian surgery
Arabian medical writers came from different nations, such as
Persia, Syria, and Spain. Their only common denominator
was the language. The most representative figure was Abū-l-
Qāsim or Albucasis (c. 936–1013 AD), whose famous treatise,
Al Tasrif (On Surgery), was translated into Latin and first
published in 1500. It included more than 200 illustrations of
surgical instruments, such as tongue depressor, tooth extrac-
tor, hooks, and cauteries, most invented by Albucasis himself,
with an explanation of their use.15 Like most Arabian surgeons,
Albucasis was a proponent of cautery, for different clinical
applications and the management of wounds and cleft lip. He
was the first to use a syringe with a piston.
The rise of the universities
The founding of the universities is one of the most important
events in the Middle Age and a key factor in the development
of modern culture. Originally, universitas denoted an aggrega-
tion of masters (magistri), students, or both, and the primary
goal was teaching philosophy and theology. Lessons were
practiced in the house of the masters or in small rooms. Stu-
dents sat on the floor, whereas the professor was in the chair.
The oldest university, at least in Europe, was Bologna, estab-
lished in 1088, followed by Paris, Oxford, and Montpellier. In
Bologna medicine was taught and cadaver dissection was
accepted, thus significantly contributing to the development
of the study of anatomy. Mondino de’ Luzzi (1270–1326) was
the first anatomist to lecture directly in front of the cadaver
(Fig. 2.4). As anatomists were also surgeons, such as Henry of
Mondeville (1260–1320) or Guy of Chauliac (1300–1368),
surgery was part of the teaching program of anatomy.
The discovery of printing
The invention of printing around 1440 by Gutenberg spread
medical knowledge and considerably enlarged the libraries of
universities and monasteries.
The first printed textbook on surgery was La Ciroxia (On
Surgery), by William of Saliceto (1210–1277), issued in Venice
in 1474. This text has particular relevance in the history of
surgery, because it reintroduced the use of the surgical knife
to replace cautery, strongly advocated by Arabian surgeons.
The first printed textbook on anatomy was Anatomia by
Mondino de’ Luzzi, issued in Padua about 1476, which
remained the reference text for numerous years. The printed
works of Hippocrates, Galen, Celsus and Arabian writers
played a key role in educating medical students.
The Renaissance
Renaissance surgery
The most celebrated surgeon of the Renaissance was the
Frenchman Ambroise Paré (1510–1590) (Fig. 2.5). A humble
but very talented barber-surgeon, Paré amassed considerable
experience from his tireless work in the battlefields. At that
time, gunshot wounds were considered poisoned and bar-
barically cauterized either with red-hot iron, or with boiling
oil poured directly into the wound. On the contrary, Paré used
simple dressings and soothing ointment made of egg yolk, oil
of roses and turpentine with great benefit for the soldiers. The
conclusion was that less invasive methods were far superior
to the traditional ones. In 1545 he published his observation
in La Méthode de traicter les playes… (The Method of Treating
Wounds…). Paré’s works were collected in a single folio
volume, “Les Oeuvres”, first published at Paris in 1575 and
dedicated to Henry II, King of France.16 Paré’s contributions
to plastic surgery were significant. He showed the first image
of a cleft lip suture in medical literature (Fig. 2.6). To facilitate
healing avoiding potential wound breakdown and reducing
the risk of unpleasant wide scar formation on the face, he
applied adhesive and fastened the wound margins (Fig. 2.7).

13
Plastic surgery after the decline of the Roman Empire
He described and illustrated a vast number of congenital
malformations, some real and others the result of fantasy, the
so-called monstrosities.
The year 1583 marks a great breakthrough in ophthalmol-
ogy and eyelid surgery with “Ophthalmodouleia, das ist Augen-
dienst” (Ophthalmodouleia, or the Service of the Eyes) by
Georg Bartisch (1535–1607), oculist to the Elector August of
Saxony.17 The book constitutes the first comprehensive treatise
on the care and management of the diseases of eye and adnexa
and is embellished by dozens of detailed anatomical images
of the eye, eyelids and brain, as well as of surgical instru-
ments. Besides this, it includes the first clinical illustration of
blepharochalasis and baggy eyelid (Fig. 2.8) and the report of
an original technique for surgical excision of the overhanging
skin fold above the tarsus for correcting blepharochalasis,
using a curved clamp in the form of a guillotine (Fig. 2.9).
The beginning of plastic surgery is usually associated with
De Curtorum Chirurgia per Insitionem (On the Surgery of Injuries
by Grafting),1,18 published in Venice in 1597, by Gaspare Taglia-
cozzi (1544–1599), Professor of Surgery at Bologna University,
in which the procedure for nasal reconstruction is shown
step by step and skillfully illustrated. The instruments neces-
sary for the operation are presented first, followed by the
indications, flap outlining on the arm, flap inset, the bandage
necessary to secure the arm into position, resection of the
vascular pedicle, final result, as well as the different clinical
Fig. 2.5  Portrait of Ambroise Paré (1510–1590).
Fig. 2.6  Cleft lip repair. (Reproduced from Paré A. Les Oeuvres. Paris: Buon;
1575.)
applications of the technique for lip and ear defects (Fig. 2.10).
The book was well received and reprinted in a pocket edition
at Frankfurt the following year, directed specifically at mili-
tary surgeons who were often confronted with the problems
of nasal repair in the battlefields.
But when did nasal reconstruction start in the western
world and from whom did Tagliacozzi learn the technique?
The operation was performed by members of the Branca
family from Catania (Sicily). Gustavo (early 15th century)
used skin taken from the cheek. His son, Antonio, made
considerable improvements to the operation. He selected the
arm as the donor site, to avoid further scars on the face. About
1460, at Antonio’s death, the Branca method, which was kept
as a family secret and passed on by word of mouth, was
discontinued in Sicily. It was resumed by Vincenzo Vianeo in
Calabria (southern Italy). His sons Pietro (about 1510–1571)
and Paolo (about 1505–1560) established a flourishing clinic
for rhinoplasty in Tropea (Calabria). Evidence of their recon-
structive work comes from the Bolognese army surgeon
Leonardo Fioravanti (1517–1588), who assisted in Vianeo’s
operations and issued a detailed report in Il Tesoro della Vita
Humana (Treasure of Human Life) issued in Venice in 1570.19
I moved to Tropea where at that time there were two brothers
Pietro and Paolo, who made a nose for anyone who had lost his
by some accident […]. I went every day to the house of these