Phẫu Thuật Tạo Hình (Tập 4): Chi Dưới, Thân Mình Và Bỏng – Neligan (Ấn bản 4)

Plastic
Surgery
Lower Extremity, Trunk, and Burns
Fourth Edition
Volume Four

Content Strategist: Belinda Kuhn
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Volume Editor
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
For additional online figures, videos and video lectures visit Expertconsult.com
Plastic
Surgery
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 Four
Lower Extremity, Trunk, and Burns
Multimedia Editor
Daniel Z. Liu
MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at
Midwestern Regional Medical Center
Zion, IL, USA
Fourth Edition

© 2018, Elsevier Inc. All rights reserved.
First edition 1990
Second edition 2006
Third edition 2013
Fourth edition 2018
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Volume 4, Video clip 3.1 End-to-side lymphovenous bypass technique, and 3.2 Recipient site preparation for
vascularized lymph node transfer-axilla, © Principles and Practice of Lymphedema Surgery, 1st Edition, Elsevier,
2015.
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
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It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
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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

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’d like to thank all the authors for their commitment to produc­
ing this volume, my colleagues and residents at the University
of Chicago Medical Center, MedStar Health and Georgetown
University School of Medicine who work tirelessly to advance
Plastic Surgery; my parents who first inspired me to seek
knowledge; and most importantly my wife Janie and my
daughters Olivia, Ava, and Ella without whom this and all
work loses meaning and significance for me.
David H. Song, MD, MBA, FACS
Acknowledgments

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

SECTION I • Lower Extremity Surgery
1 
Comprehensive lower extremity anatomy
Grant M. Kleiber and Rajiv P. Parikh
SYNOPSIS
■ Reconstructive surgery of the lower extremity is dependent on a
comprehensive understanding of structural and functional anatomy in
order to accurately analyze defects and develop tailored solutions that
preserve and restore normal form and function.
■ The reconstructive surgeon may be called upon to treat specific tissue
defects of the lower extremity, or to harvest tissue for transfer from the
many potential donor sites in the lower extremity.
■ This chapter aims to provide a comprehensive review of the 3D
anatomy of the lower extremity in order to facilitate operative and
clinical decision-making by the reconstructive surgeon.
■ A detailed description is given of each region of the lower extremity
with respect to skeletal support, musculofascial anatomy, vascular
supply, lymphatic drainage, neuroanatomy, and skin and soft-tissue
elements.
■ A broad overview of the available soft-tissue donor sites from each
region, donor sites for bone grafts, anatomic basis of common lower
extremity flaps, and common points of nerve injury and entrapment are
included to provide a clinically relevant discussion of the anatomy of
the lower extremity as a framework for common challenges in
reconstructive surgery.
Embryology
The first recognizable sign of lower limb growth in the human
embryo occurs during the third week of life. The initial limb
development begins along the ventrolateral surface. Slow
outgrowth of the apical epidermal ridge continues into the
fifth week when a small, flattened foot plate develops. The
foot plate begins development straight with no dorsiflexion
and the plantar surface pointed toward the head. Skeletogen­
esis occurs in the tibial/fibular region while the foot plate
rotates externally. By the sixth week, digital rays appear and
external notching occurs. From the sixth to the eighth week
chondrification progresses throughout the future bony struc­
tures and the lower limb elongates.
The transition from the embryonic to the fetal period occurs
during the eighth week. At this point, the phalanges, metatar­
sals, tarsals, malleoli, tibia, fibula, and femur are all present.
The first signs of detectable ossification begin in the foot,
specifically in the distal phalanges and metatarsal shaft. The
intervening proximal and middle phalanges follow. Tarsal
bones begin ossification in the fifth month, first with the talus
and the cuboid. Ossification of the remaining regions of the
lower extremity continues throughout gestation.
The lower extremity vascular anatomy of the embryo
differs from the adult primarily by the development and
transient presence of the sciatic artery.1 This artery arises from
the umbilical artery and is separate from the femoral artery
as it courses inferiorly along the posterior surface of the thigh,
knee, and leg, and is a major contributor to lower extremity
vascular supply in early fetal development. The femoral
artery passes along the anterior side of the thigh and branches
into the primitive posterior tibial, anterior tibial, and peroneal
arteries. As the fetus grows, the femoral artery increases in
size and the sciatic artery becomes attenuated. In normal
development the sciatic artery involutes during the eighth
week of gestation and its remnants contribute to the formation
of the inferior gluteal, deep femoral, popliteal, and peroneal
vessels (Fig. 1.1). However, in 0.01–0.05% of the population a
sciatic artery persists throughout fetal development and into
adulthood.2 A persistent sciatic artery can lead to aneurysm
formation, thrombosis, and embolization. Although it is a rare
anomaly, failure to recognize a persistent sciatic artery can
lead to incorrect assumptions of vascular anatomy.
The gluteal region
Gluteal skeletal structure
The pelvis consists of the paired hip bones and the midline
sacrum, articulating together at the two sacroiliac joints. The
hip bones are formed by the fusion of the ilium, pubis, and
ischium. These three bony regions of the pelvis coalesce to

2
SECTION I
CHAPTER 1 • Comprehensive lower extremity anatomy
internal and external rotators on the hip joint serve to stabilize
and position the torso during the complex process of
ambulation.
Clinical correlation – iliac crest bone graft
The iliac crest serves as a versatile source of autogenous bone
graft for reconstructing a variety of defects. Bone grafts can
be cortical, cancellous, or corticocancellous in composition.
Cortical bone is structurally stable with osteoconductive
properties and ideally suited for structural defects requiring
immediate mechanical stability. Cancellous bone is osteoin­
ductive, osteogenic, and osteoconductive, undergoes rapid
form the acetabulum. The large thick bony prominences of the
pelvis serve as attachments for the muscles of the hip and
thigh (Fig. 1.2). These prominences also become clinically
relevant in contributing to the formation of pressure ulcers,
most commonly over the ischial tuberosity, sacral prominence,
and greater trochanter. Dense ligaments reinforce the pelvis
and distribute the numerous opposing forces acting on it. The
sacrospinous ligament runs from the sacrum to the ischial
spine, bounding the greater sciatic foramen. The sacrotuber­
ous ligament attaches the sacrum to the ischial tuberosity and
encloses the lesser sciatic foramen. Running from the anterior
superior iliac spine (ASIS) to the pubic tubercle is the inguinal
ligament. The actions of the multiple flexors, extensors, and
Fig. 1.1  Vascular development of the lower extremity.
B
A
C
D
E
External iliac
Medial sacral
Medial sacral
Umbilical
Obliterated umbilical
Femoral
Femoral
Femoral
Popliteal
Popliteal
Popliteal
Perforating
Popliteal
Posterior tibial
Posterior tibial
Profunda femoris
Superior gluteal
Internal iliac
External iliac
Inferior epigastric
Internal pudendal
Left common iliac
Right common iliac
Profunda femoris
Posterior tibial
Posterior tibial
Lateral plantar
Lateral plantar
Medial plantar
Medial plantar
Dorsalis pedis
Ramus perforans tarsi
Ramus communicans inferior
Ramus communicans superior
Ramus communicans medius
Ramus perforans cruris
Lateral calcaneal branch
Medial calcaneal branch
Fibular
Fibular
Posterior superficial fibular
Anterior tibial
Anterior tibial
Anterior tibial
Superficial posterior tibial
Common iliac
Ischiadic
Ischiadic
Ischiadic
Ischiadic
Aorta
Aorta

3
The gluteal region
commonly harvested from the iliac tubercle, 3–4 cm posterior
and parallel to the ASIS to maximize available bone and
minimize risk to the lateral femoral cutaneous nerve. The iliac
crest lies deep to a musculofascial layer from the external
oblique and the iliacus muscle. The ilioinguinal nerve runs
along the medial surface of the iliacus muscle and is at risk
during harvest from the anterior crest. The anterior iliac crest
remodeling and vascularization and is ideally suited for non-
unions and bony fusion. Cancellous bone can be obtained
between the inner and outer table of the ilium. The anterior
and posterior iliac crest are common donor sites for cancellous
and corticocancellous bone grafts, with 13 cm3 and 30 cm3
average graft volumes available from the anterior and poste­
rior crest, respectively3 (Fig. 1.3). Anteriorly, bone graft is most
Fig. 1.2  Bony attachments of
buttock and thigh muscles.
(From: Netter;
.com. © Elsevier Inc. All rights
reserved.)
Posterior View
Gluteus medius m.
Gluteus minimus m.
Tensor fasciae latae m.
Sartorius m.
Rectus femoris m.
Obturator externus m.
Gluteus medius m.
Quadratus femoris m.
Iliopsoas m.
Gluteus maximus m.
Vastus lateralis m.
Adductor magnus m.
Adductor brevis m.
Vastus intermedius m.
Biceps femoris m.
(short head)
Adductor magnus m.
Vastus lateralis m.
Plantaris m.
Gastrocnemius m.
(lateral head)
Popliteus m.
Popliteus m.
Semimembranosus m.
Gastrocnemius m.
(medial head)
Adductor magnus m.
Adductor longus m.
Vastus medialis m.
Pectineus m.
Semimembranosus m.
Biceps femoris (long head)
and semitendinosus mm.
Adductor magnus m.
Obturator internus m.
Gluteus
maximus m.
Superior
gemellus m.
Inferior
gemellus m.
Quadratus
femoris m.
Note: Width of zone of attachments to posterior
aspect of femur (linea aspera) is greatly exaggerated
Anterior View
Iliacus m.
Sartorius m.
Rectus femoris m.
Obturator internus
and superior
and inferior
gemellus mm.
Piriformis m.
Gluteus
minimus m.
Vastus
lateralis m.
Iliopsoas m.
Vastus medialis m.
Vastus
intermedius m.
Articularis genus m.
Iliotibial tract
Biceps femoris m.
Adductor magnus m.
Sartorius m.
Gracilis m.
Semitendinosus m.
Origins
Insertions
Quadratus
femoris m.
Adductor
magnus m.
Obturator
externus m.
Gracilis m.
Piriformis m.
Pectineus m.
Adductor longus m.
Adductor brevis m.
Pes
anserinus
Rectus femoris,
vastus lateralis,
vastus intermedius,
and vastus medialis
via patellar ligament
Origin of psoas major m. from sides of
vertebral bodies, intervertebral discs,
and transverse processes (T12–L4)
Intertrochanteric line
A
B

4
SECTION I
CHAPTER 1 • Comprehensive lower extremity anatomy
medius it thickens and forms the gluteal aponeurosis. This is
attached to the lateral border of the iliac crest superiorly, and
splits anteriorly to enclose the tensor fasciae latae and poste­
riorly to enclose the gluteus maximus.
Muscles of the buttocks
The gluteus maximus is the largest muscle in the body and
lies most superficially in the gluteal region, originating from
the posterior gluteal line of the ilium and the dorsal portion
of the sacrum (Fig. 1.4). The superficial fibers coalesce into a
thick tendinous expansion that contributes to the iliotibial
band of the fascia lata, while the deep fibers insert on the
gluteal tuberosity of the femur. The gluteus maximus acts as
a hip extensor when the hip is in a flexed position. In a stand­
ing position, the gluteus maximus dorsally rotates the pelvis
and torso, maintaining stability. The vascular supply is pri­
marily derived from the inferior gluteal vessels, which supply
the inferior two-thirds of the muscle. The superior gluteal
vessels supply the superior portion, and the first perforator
branch of the profunda femoris contributes to the vascular
supply of the muscle laterally. For ease of description,
the Mathes–Nahai classification system is used when discuss­
ing muscle vascularity (Table 1.1).6 The gluteus maximus has
a type III vascular supply, with two dominant pedicles from
the superior and inferior gluteal arteries. Innervation to the
gluteus maximus is provided by the inferior gluteal nerve.
Underneath the gluteus maximus lie three bursae: the tro­
chanteric, gluteofemoral, and ischiofemoral, which allow
frictionless movement over its underlying structures.
The gluteus medius, situated immediately deep to the
gluteus maximus, arises from the outer surface of the iliac
wing and inserts on the greater trochanter of the femur. It is
innervated by the superior gluteal nerve and functions to
abduct the hip and medially rotate the femur. Blood supply
to this muscle is from the deep branch of the superior gluteal
artery (SGA) and from the trochanteric connection.
The gluteus minimus lies deep to the gluteus medius and
arises from the outer surface of the ilium. Its fibers join the
aponeurosis of the gluteus medius to insert on the greater
trochanter, and the two muscles function together to
abduct the hip. The gluteus minimus is innervated by the
superior gluteal nerve and receives blood supply from the
SGA and trochanteric connection. Several small muscles arise
from the medial pelvis and insert on the greater trochanter of
the femur, functioning collectively to rotate the hip externally.
provides twice the volume of packed cancellous bone com­
pared to the distal radius or olecranon. Alternatively, tricorti­
cal bone grafts can be harvested from the inner and outer table
of the anterior ilium, and corticocancellous bone grafts can be
harvested to include either the inner or outer table. Posteriorly,
the bone is thickest and best harvested in the area superior to
a line connecting the posterior superior iliac spine (PSIS) and
the apex of the sacroiliac joint. Harvesting from an area
approximately 4 cm distal to the PSIS prevents violation of
the sacroiliac joint.4 Unicortical and corticocancellous bone
grafts can be obtained from the outer table of the posterior
ilium and additional cancellous bone harvested from the
inner table of the ilium. The iliac crest can also provide vas­
cularized bone for a variety of composite soft-tissue and bone
defects. Corticocancellous, vascularized bone can be obtained
from the outer cortex of the ilium on the lateral half of the iliac
crest, supplied by the ascending branch of the lateral femoral
circumflex system.5 The inner cortex of the ilium, supplied
through nutrient branches off the deep circumflex iliac artery,
is another common source of vascularized iliac bone.
Gluteal fascial anatomy
The fascial system of the gluteal region and the lower extrem­
ity contains various permutations of a nearly continuous
superficial fascial and a deep fascial layer. The superficial
system is located in the subcutaneous fat. The deep fascial
layer is thicker and frequently can be seen as a dual-layered
fibrous band. It usually lies directly over the underlying limb
musculature and its proper fascia. The superficial fascia of the
gluteal region is contiguous with that over the lower back and
continues inferiorly into the proximal thigh. The deep fascia
covering the gluteal muscles varies in thickness. Over the
maximus it is thin, but over the anterior two-thirds of the
Fig. 1.3  Harvest sites for iliac crest bone graft. ASIS, anterior superior iliac spine;
PSIS, posterior superior iliac spine. (From: Ebraheim NA, Elgafy H, Xu R. Bone-graft
harvesting from iliac and fibular donor sites: techniques and complications. J Am
Acad Orthop Surg. 2001;9(3):210–218.)
ASIS
PSIS
Iliac tubercle
Table 1.1  Mathes–Nahai classification system for muscle
vascular supply
Muscle vascular
supply type
Description
I
Single vascular pedicle
II
Dominant vascular pedicle and one or more
minor pedicles
III
Two dominant pedicles
IV
Segmental vascular pedicles
V
Single dominant vascular pedicle and
secondary segmental pedicles

5
The gluteal region
Fig. 1.4  Muscles of hip and thigh: posterior views. (From: Netter; © Elsevier Inc. All rights reserved.)
Superficial dissection
Deeper dissection
Iliac crest
Gluteal aponeurosis over
Gluteus medius muscle
Gluteus minimus muscle
Gluteus maximus muscle
Piriformis muscle
Sciatic nerve
Sacrospinous ligament
Superior gemellus muscle
Obturator internus muscle
Inferior gemellus muscle
Sacrotuberous ligament
Quadratus femoris muscle
Ischial tuberosity
Semitendinosus muscle
Greater trochanter
Biceps femoris muscle (long head)
Adductor minimus part of
Adductor magnus muscle
Semimembranosus muscle
Iliotibial tract
Gracilis muscle
Biceps femoris muscle
Short head
Long head
Semimembranosus muscle
Semitendinosus muscle
Popliteal vessels and tibial nerve
Common fibular (peroneal) nerve
Plantaris muscle
Sartorius muscle
Popliteus muscle
Tendinous arch of
Soleus muscle
Plantaris tendon (cut)
Gastrocnemius muscle
Medial head
Lateral head
A
B

6
SECTION I
CHAPTER 1 • Comprehensive lower extremity anatomy
buttocks, while the posterior cutaneous nerve continues to
descend down the posterior thigh deep to the fascia lata,
sending segmental cutaneous branches to the skin of the
posterior thigh. The gluteal muscles are innervated by the
superior and inferior gluteal nerves. The superior gluteal
nerve runs with the SGA and divides into superior and infe­
rior branches, which course respectively with the superior
and inferior branches of the deep SGA, supplying the gluteus
medius and minimus. The inferior branch runs laterally to
also innervate the tensor fascia latae. The inferior gluteal
nerve runs with the IGA, exiting the pelvis below the pirifor­
mis and entering the gluteus maximus.
The thigh
The thigh region is generally defined as the cylindrical proxi­
mal portion of the lower extremity that extends from the
infragluteal crease and the inguinal ligament distally to the
tibiofemoral joint. The thigh aids in trunk support and posi­
tioning of the knee in space, serving a critical role in ambula­
tion. The muscles of the thigh are some of the largest in the
body and often have redundant or overlapping function.
Similarly, the corresponding fasciocutaneous coverage in the
thigh is relatively redundant. Thorough knowledge of thigh
anatomy is key for taking advantage of these redundancies
and utilizing the thigh as a generous source of donor tissue
for local, regional, and distant reconstructive surgical options.
Thigh skeletal structure
The femur is the longest bone in the body and the predomi­
nant bone in the thigh region. The femoral head articulates
with the pelvic acetabulum to form the only true ball-and-
socket joint in the body, allowing for stability under load as
well as smooth multiplanar movement. Two bony promi­
nences emanate from the femoral neck at about 90° from each
other – the greater and lesser trochanters. These femoral
prominences primarily serve as insertion sites for hip actors
(Fig. 1.2). The action of multiple flexors, extensors, and inter­
nal and external rotators on the hip joint serves to stabilize
and position the torso during the complex process of
ambulation.
The vascular supply of the femoral bone arises from mul­
tiple sources. The femoral head and neck are encircled by an
arterial anastomosis between the medial and lateral circum­
flex arteries with lesser contribution by the superior and
inferior gluteal vessels. The femoral shaft has multiple nutri­
ent foramina supplied by branches from the second perforat­
ing artery from the profunda femoris. These foramina usually
run along the linea aspera on the posterior surface of the
femur in the middle one-third of the femoral shaft. Periosteal
vascularity along the femur receives vascular input from
either the perforating branches of the profunda or directly
from the profunda femoris. The distal metaphyseal region of
the femur also has multiple vascular foramina that are derived
from the genicular arterial system.
Clinical correlation – medial femoral condyle flap
The arterial anatomy of the distal femur, specifically the
medial femoral condyle (MFC) and supracondylar region, has
clinical significance as it is the anatomical basis for the MFC
These muscles include piriformis, superior and inferior
gemellus, quadratus femoris, obturator internus, and obtura­
tor externus.
Gluteal vasculature
The SGA is the last branch of the posterior trunk of the internal
iliac artery. It exits the pelvis through the greater sciatic
foramen superior to the piriformis, dividing into two branches
(Fig. 1.5). The deep branch runs deep to the gluteus medius,
dividing into superior and inferior branches. The superior
branch travels laterally to the anterior superior iliac spine and
connects with the ascending branch of the lateral circumflex
femoral and the deep circumflex iliac. The inferior branch
supplies the gluteus medius and minimus, and later joins
with the lateral circumflex femoral. The superficial branch of
the SGA pierces the gluteus maximus, connecting intramus­
cularly with branches of the inferior gluteal artery (IGA), and
sending musculocutaneous perforators to the overlying skin.
The IGA branches from the anterior trunk of the internal iliac
and exits the pelvis through the greater sciatic foramen below
the piriformis. It runs deep to the gluteus maximus, supplying
it and its overlying skin with musculocutaneous perforators.
The descending branch of the IGA continues down the poste­
rior thigh, between the semitendinosus and the biceps femoris,
running with the posterior cutaneous nerve and connecting
with the perforating branches to supply the skin.7
Clinical correlation – SGAP and IGAP flaps
Perforating branches from the SGA and IGA can be used to
perfuse free and pedicled flaps to reconstruct a variety of
soft-tissue defects. There is considerable variability in size,
location, and branching pattern of perforators in the gluteal
region. Generally, the superior gluteal region is perfused by
perforators from the SGA and the inferior gluteal region is
perfused by perforators from the IGA. SGA perforators can
be reliably found medial and adjacent to a line drawn from
the PSIS to the greater trochanter and range in number from
5 to 11. The mean size of SGA perforators is 0.6 mm; however,
there is always a perforator greater than 0.8 mm in diameter
and, on average, at least 4 perforators per side greater than
0.8 mm.8 Perforator lengths for pedicle use vary from 4 cm to
10 cm and are dependent on the extent of dissection to the
source vessel. The thickness and size of subcutaneous tissue
that can be reliably perfused by SGA perforators follows the
perforasome theory.9 Flaps harvested on the superficial fascial
plane can be “ultra-thin”, with thickness ranging from 5 mm
to 11 mm and an average flap size of 125 cm.2,10 IGA perfora­
tors range in number from 4 to 12 perforators each side, with
a mean diameter of 0.4–0.6 mm, and perforator lengths vary
from 4 cm to 14 cm.8,11 Perforators from the IGA can perfuse
an average of 175 cm2 of subcutaneous tissue, with thickness
ranging from 1 cm to 6 cm depending on indication and
patient body habitus.11
Gluteal innervation
The posterior cutaneous nerve of the thigh exits the pelvis
with the inferior gluteal vessels (Fig. 1.5). Several branches
will curl around the inferior border of the gluteus maximus
and run superiorly to innervate the overlying skin of the

7
The thigh
Fig. 1.5  Arteries and nerves of thigh: deep dissection (posterior view). (From: Netter; © Elsevier Inc. All rights reserved.)
Superior clunial nerves
Gluteus maximus muscle (cut)
Medial clunial nerves
Inferior gluteal artery and nerve
Pudendal nerve
Nerve to obturator internus
(and superior gemellus)
Posterior femoral
cutaneous nerve
Sacrotuberous ligament
Ischial tuberosity
Inferior clunial nerves (cut)
Adductor magnus muscle
Gracilis muscle
Sciatic nerve
Muscular branches of sciatic nerve
Semitendinosus muscle (retracted)
Semimembranosus muscle
Sciatic nerve
Articular branch
Adductor hiatus
Popliteal vein and artery
Superior medial genicular artery
Medial epicondyle of femur
Tibial nerve
Gastrocnemius muscle (medial head)
Medial sural cutaneous nerve
Small saphenous vein
Iliac crest
Gluteal aponeurosis and
gluteus medius muscle (cut)
Superior gluteal artery and nerve
Gluteus minimus muscle
Tensor fasciae latae muscle
Piriformis muscle
Gluteus medius muscle (cut)
Superior gemellus muscle
Greater trochanter of femur
Obturator internus muscle
Inferior gemellus muscle
Gluteus maximus muscle (cut)
Quadratus femoris muscle
Medial circumflex femoral
artery
Vastus lateralis muscle
and iliotibial tract
Adductor minimus part of
adductor magnus muscle
1st perforating artery (from
profunda femoris artery)
Adductor magnus muscle
2nd and 3rd perforating arteries
(from profunda femoris artery)
4th perforating artery (from
profunda femoris artery)
Long head (retracted)
Short head
Superior lateral genicular artery
Common fibular (peroneal) nerve
Plantaris muscle
Gastrocnemius muscle (lateral head)
Lateral sural cutaneous nerve
Deep dissection
Biceps femoris
muscle

8
SECTION I
CHAPTER 1 • Comprehensive lower extremity anatomy
perforators to the MFC. Paired venae comitantes provide
venous drainage for the MFC flap, often converging to form
the short descending genicular vein.
Thigh fascial composition
The thigh has a superficial and deep fascial system. The
superficial fascia lies within the subcutaneous fat of the thigh
encircling the entire structure. Superficial vessels and nerves
pass along and pierce this fascia as they travel to the skin. The
thickness of the fascia varies throughout the thigh but thickens
proximally in the inguinal region. At the inguinal ligament
the superficial fascia fuses with the deep thigh fascia.
The deep fascia is a tough, well-vascularized fibrous tissue
that lies beneath the superficial fascia and the subcutaneous
fat. This fibrous structure encircles and constrains the thigh
musculature in a near-complete sheath. There is varying ter­
minology used to describe the deep fascia of the thigh, and
this is often a source of confusion. The deep fascia of the thigh
is also called investing fascia or the fascia lata. For simplicity
and consistency, it will be referred to as the deep fascia in this
text. The deep fascia of the thigh attaches posteriorly to the
sacrum and coccyx, anteriorly to the inguinal ligament, and
laterally to the iliac crest. At the inguinal ligament, where the
superficial fascia joins the deep fascia, there is an opening in
both fascial layers called the fossa ovalis. The great saphenous
vein, superficial branches of the femoral artery, and lymphat­
ics pass through this opening between the deep and the
superficial layers of the thigh (Fig. 1.7). This opening is
covered by a membranous layer of the superficial fascia called
the cribriform fascia. A thickening of the fibrous tissues is
present on the lateral aspect of the deep fascia and is termed
the iliotibial band or tract (Fig. 1.8). The iliotibial band is
proximally attached to the tensor fascia latae muscle, and
together this myofascial unit aids in maintaining knee
extension.
Septa pass from the deep fascial sheath to the bones under­
neath, confining the functional muscle groups within osteo­
fascial compartments. In addition to separating musculature,
fascial planes also provide pathways for vessel perforators to
travel from deeper vasculature to the overlying skin. There
are three functional compartments of the thigh: anterior,
posterior, and medial. The anterior compartment contains the
knee extensor muscles; the posterior compartment comprises
knee flexors; and the medial compartment retains the hip
adductors (Fig. 1.9). The medial and lateral intermuscular
septa travel from the fascia lata to attach to the femur on the
linea aspera along its posterior aspect. These septa then divide
the anterior compartment from the posterior compartments
and partition the thigh musculature according to knee func­
tion. Only the anterior and posterior compartments have defi­
nite fascial boundaries. The medial (adductor) compartment
is not a true anatomical compartment as it has no defined
intermuscular septa separating it. The muscles of the
adductor compartment – gracilis, pectineus, adductor longus,
adductor brevis, and adductor magnus – form a functional
compartment in the proximal aspect of the thigh.
Thigh musculature
The three compartments of the thigh are a well-organized way
to approach the thigh musculature (Table 1.2). There are 17
vascularized corticoperiosteal flap (Fig. 1.6). This flap can be
harvested as a corticoperiosteal free or pedicled flap with or
without cancellous bone and provides an excellent option for
transfer of vascularized bone in the treatment of recalcitrant
fracture nonunions.12 The vascular supply to the MFC is
derived from the descending genicular artery (DGA) and/or
the superior medial genicular artery. The DGA, the longer and
larger of the two vessels, is a medial branch off the superficial
femoral artery and originates just proximal to the adductor
hiatus, approximately 14 cm proximal to the knee joint. The
DGA is the dominant vessel to the MFC 90% of the time, has
a mean pedicle length of 8 cm, and has a proximal diameter
of at least 1.5 mm, suitable for microsurgical anastomosis.13,14
The superior medial genicular artery, a branch off the popliteal
artery, has a smaller vessel diameter of 0.8 mm and pedicle
length of 5 cm, and therefore is less utilized when harvesting
a flap.13 The osteoarticular branch of the DGA provides
periosteal perfusion, and there are numerous intraosseous
Descending genicular
artery
Superomedial genicular
artery
Medial collateral ligament
Adductor magnus tendon
Fig. 1.6  The medial femoral periosteal bone flap. (From: Netter;
© Elsevier Inc. All rights reserved.)

9
The thigh
muscle inserts on the proximal, medial surface of the tibia.
The sartorius inserts in this region above the gracilis, which
then inserts above the semitendinosus (Fig. 1.11). This three-
muscle insertion point forms the pes anserinus. The superficial
location of the sartorius muscle and its proximity to the
femoral triangle make it an ideal flap for muscle transposition
coverage over proximal thigh wounds with vessel or pros­
thetic graft exposure. The vascular anatomy of the sartorius
muscle is traditionally described as a type IV, segmental
pattern. Six to eight muscular branches enter the sartorius
along the length of the muscle from different source vessels.
The proximal third is supplied by branches from the superfi­
cial circumflex iliac and the lateral circumflex femoral arteries.
The middle third receives multiple branches from the
superficial femoral artery. The distal third of the muscle is
supplied by muscular branches of the descending genicular
and superomedial genicular arteries (Fig. 1.12).15 A recent
anatomic study has challenged this purely segmental classifi­
cation, demonstrating two dominant vascular pedicles.16 This
renewed anatomic understanding of the sartorius muscle
suggests that it may be based on a single pedicle, and therefore
have a larger arc of rotation for wound coverage.
muscles that course through the region of the thigh. The
anterior thigh compartment contains the sartorius, articularis
genu, and quadriceps femoris comprising the rectus femoris,
vastus lateralis, intermedius, and medialis. These muscles are
the primary knee extensors. All of the anterior compartment
muscles share a single articular function, with the exception
of the sartorius and the rectus femoris, which cross both the
hip joint and the knee joint. The sartorius muscle is the most
superficial muscle of the thigh. It obliquely crosses the anterior
thigh from superolateral to medial inferior. The proximal end
of the sartorius makes up one of the three limbs of the femoral
triangle: the medial border of the sartorius makes up the
lateral side, the medial border of the adductor longus makes
up the medial side, and the inguinal ligament makes up the
superior limb (Fig. 1.10). The femoral triangle denotes the
region where the femoral artery, nerve, and vein are tran­
siently uncovered superficially by muscle in the proximal
thigh. Here, all three structures radiate multiple branches in
multiple directions to supply the vasculature and innervation
to the groin region, lower abdomen, and proximal thigh. As
the femoral artery, vein, and nerve descend distally in the
thigh, they dive under the adductor longus and then proceed
to the adductor canal. At the distal end of the sartorius, the
Fig. 1.7  Surface anatomy: superficial veins and
nerves. (From: Netter; ©
Elsevier Inc. All rights reserved.)
Inguinal lig.
(Poupart)
Superficial
circumflex iliac v.
Lateral cutaneous n.
of thigh
Saphenous opening
(fossa ovalis)
Anterior femoral
cutaneous nn.
of thigh (from
femoral n.)
Superficial epigastric v.
Femoral v.
Superficial external
pudendal v.
Great saphenous v.
Cutaneous branches
of obturator n.
Infrapatellar branch
of saphenous n.
Saphenous n. (terminal
branch of femoral n.)
Great saphenous v.
Branches of lateral
sural cutaneous
n. (from common
fibular [peroneal] n.)
Superficial fibular
(peroneal) n.
Small saphenous v. and
lateral dorsal cutaneous
n. (from sural n.)
Dorsal metatarsal vv.
Dorsal digital
nn. and vv.
Dorsal venous arch
Dorsal digital n. and v. of
medial side of great toe
Dorsal digital branch of
deep fibular (peroneal) n.
Medial cluneal
nn. (from dorsal
rami of S1, 2, 3)
Branches of posterior
cutaneous n. of thigh
Cutaneous branch
of obturator n.
Great saphenous v.
Small saphenous v.
Branches of saphenous n.
Medial calcaneal
branches of tibial n.
Plantar cutaneous branches
of medial plantar n.
Superior
cluneal nn.
(from dorsal
rami of L1, 2, 3)
Inferior cluneal nn.
(from posterior
cutaneous n. of thigh)
Branches of
lateral cutaneous
n. of thigh
Lateral sural cutaneous n.
(from common
fibular [peroneal] n.)
Plantar cutaneous branches
of lateral plantar n.
Medial sural cutaneous n.
(from tibial n.)
Sural n.
Lateral calcaneal
branches of sural n.
Anterior view
Posterior view
A
B
Text continued on p. 16

10
SECTION I
CHAPTER 1 • Comprehensive lower extremity anatomy
Fig. 1.8  Muscles of hip and thigh: lateral view.
Iliac crest
External oblique
muscle
Anterior superior
iliac spine
Sartorius muscle
Tensor fasciae latae muscle
Rectus femoris muscle
Gluteal aponeurosis
over gluteus medius muscle
Gluteus maximus muscle
Vastus lateralis muscle
Iliotibial tract
Biceps femoris muscle
Long head
Short head
Semimembranosus muscle
Fibular collateral ligament
Plantaris muscle
Gastrocnemius muscle (lateral head)
Head of fibula
Fibularis (peroneus) longus muscle
Lateral condyle of tibia
and Gerdy’s tubercle
Lateral patellar retinaculum
Patella
Extensor digitorum longus muscle
Patellar ligament
Tibialis anterior muscle

11
The thigh
Fig. 1.9  Thigh: serial cross-sections. (From: Netter; © Elsevier Inc. All rights reserved.)
Thigh: Serial Cross-Sections
Sartorius muscle
Deep artery and vein of thigh
Pectineus muscle
lliopsoas muscle
Rectus femoris muscle
Vastus medialis muscle
Lateral cutaneous nerve of thigh
Vastus intermedius muscle
Femur
Vastus lateralis muscle
Tensor fasciae latae muscle
lliotibial tract
Gluteus maximus muscle
Vastus medialis muscle
Rectus femoris muscle
Vastus intermedius muscle
Vastus lateralis muscle
Iliotibial tract
Lateral intermuscular
septum of thigh
Short head
Long head
Semitendinosus muscle
Semimembranosus muscle
Rectus femoris tendon
Vastus intermedius muscle
lliotibial tract
Vastus lateralis muscle
Articularis genus muscle
Lateral intermuscular
septum of thigh
Femur
Biceps femoris muscle
Common fibular
(peroneal) nerve
Tibial nerve
Fascia lata
Branches of femoral nerve
Femoral artery and vein
Adductor longus muscle
Great saphenous vein
Obturator nerve (anterior branch)
Adductor brevis muscle
Obturator nerve
(posterior branch)
Gracilis muscle
Adductor magnus muscle
Sciatic nerve
Posterior cutaneous
nerve of thigh
Semimembranosus muscle
Semitendinosus muscle
Biceps femoris muscle (long head)
Medial intermuscular septum of thigh
Sartorius muscle
Nerve to vastus
medialis muscle
Saphenous nerve
Femoral artery and vein
Great saphenous vein
Adductor longus muscle
Gracilis muscle
Adductor brevis muscle
Deep artery and vein of thigh
Adductor magnus muscle
Sciatic nerve
Vastus medialis muscle
Sartorius muscle
Saphenous nerve and descending genicular artery
Great saphenous vein
Gracilis muscle
Adductor magnus tendon
Popliteal vein and artery
Semimembranosus muscle
Semitendinosus muscle
in adductor
canal
Biceps
femoris
muscle
Posterior intermuscular septum of thigh

12
SECTION I
CHAPTER 1 • Comprehensive lower extremity anatomy
Table 1.2  Thigh musculature
Muscle
Origin
Insertion
Function
Blood supply
Flap blood
supply
type
Innervation
Hip-related
1
Iliacus
Pelvis – iliac fossa
Lesser
trochanter of
femur
– inferior
edge
Hip flexion and
internal rotation
−
−
Femoral
nerve
– intra-
abdominal
2
Psaos major
Thoracic and
lumbar spine
(T12–L5)
Lesser
trochanter of
femur
– middle
region
Hip flexion and
internal rotation
−
−
Lumbar
spinal
nerves
Anterior
compartment
3
Sartorius
ASIS
Medial,
proximal tibia
(pes
anserinus)
Flexes, abducts,
and externally
rotates thigh at
hip; flexes,
internally
rotates leg at
knee
Multiple branches for the
superficial femoral artery
Segmental
(type IV)
Femoral
nerve
(anterior
division)
4
Rectus femoris
ASIS and ilium
Quadriceps
tendon–
patella
tendon–tibial
tuberosity
Hip flexion and
knee extension
Descending branch of
LCFA (dominant);
ascending branch of
LCFA (minor), muscular
branch of superficial
femoral artery (minor)
One
dominant
and minor
pedicles
(type II)
Femoral
nerve
(posterior
division)
5
Vastus lateralis
Shaft of femur –
upper
intertrochanteric
line, base of
greater trochanter,
lateral linea
aspera, lateral
supracondylar
ridge, and lateral
intermuscular
septum
Quadriceps
tendon–
patella
tendon–tibial
tuberosity
(lateral
aspect)
Knee extension
Descending branch of
LCFA (dominant);
transverse branch of
LCFA (minor), posterior
branches of profunda
femoris (minor), branch
of superior genicular
artery (minor)
One
dominant
and minor
pedicles
(type II)
Femoral
nerve
(posterior
division)
6
Vastus medialis
Shaft of femur –
lower
intertrochanteric
line, spiral line,
medial linea
aspera and
medial
intermuscular
septum
Quadriceps
tendon–
patella
tendon–tibial
tuberosity
Knee extension,
patellar
stabilization
Branch of superficial
femoral artery
(dominant); distal
branches of the
superficial femoral artery
(minor), branches of
descending genicular
artery (minor)
One
dominant
and minor
pedicles
(type II)
Femoral
nerve
(posterior
division)

13
The thigh
Continued
7
Vastus intermedialis
Shaft of femur –
inferior one-third
Quadriceps
tendon–
patella
tendon–tibial
tuberosity
Knee extension
Lateral direct branch from
the profunda femoris
(dominant); medial
direct branch from the
profunda femoris (minor)
One
dominant
and minor
pedicles
(type II)
Femoral
nerve
(posterior
division)
8
Articularis genu
Femur – anterior,
distal surface of
shaft
Apex of
suprapatellar
bursa
Retracts bursa as
knee extends
Direct branch of profunda
femoris
−
Femoral
nerve
(posterior
division)
Posterior
compartment
9
Biceps femoris
Long head: ischial
tuberosity
– posterior
surface Short
head: linea
aspera – middle
third and lateral
supracondylar
ridge of femur
Lateral condyle
of tibia &
head of
fibula
Long head:
extends knee
Both heads:
flexes and
laterally rotates
knee
Long head: first perforating
branch of profunda
femoris (dominant);
inferior gluteal artery
branch (minor), second
perforating branch of
profunda (minor); short
head: second or third
perforating branch of
profunda (dominant);
superior lateral genicular
artery (minor)
One
dominant
and minor
pedicles
(type II)
Long head:
tibial nerve
Short
head:
common
peroneal
nerve
10
Semitendinosus
Ischial tuberosity
– medial surface
Medial,
proximal tibia
(pes
anserinus)
– below
gracilis
insertion
Extends hip,
flexes, and
medially
rotates the
knee
First perforating branch of
profunda femoris
(dominant); inferior
gluteal artery branch
(minor), second or third
perforating branch of
profunda (minor),
superficial femoral artery
branch (minor)
One
dominant
and minor
pedicles
(type II)
Tibial nerve
11
Semimembranosus
Ischial tuberosity –
lateral surface
Medial condyle
Extends hip,
flexes, and
medially
rotates the
knee
First perforating branch of
profunda femoris
(dominant); muscular
branch of inferior gluteal
artery (minor),
descending branch of
MCFA, inferior medial
genicular artery
One
dominant
and minor
pedicles
(type II)
Tibial nerve
Adductor
compartment
12
Adductor magnus
Pubic bone –
ischiopubic
ramus
Femoral shaft,
inferior
– lower
gluteal line
and linea
aspera
Hip adduction,
internal hip
rotation
Branches from the
obturator, profunda
femoris, and superficial
femoral arteries
−
Obturator
nerve
(posterior
division)

14
SECTION I
CHAPTER 1 • Comprehensive lower extremity anatomy
Muscle
Origin
Insertion
Function
Blood supply
Flap blood
supply
type
Innervation
13
Adductor longus
Pubic bone – pubic
tubercle
Femur – inferior
aspect of
linea aspera
Hip adduction,
internal hip
rotation
Branch from profunda
femoris (artery to the
adductors); branches
from MCFA, distal
branch from the
superficial femoral artery
−
Obturator
nerve
(anterior
division)
14
Adductor brevis
Pubic bone –
superior and
inferior ramus
Femur
– superior
aspect of
linea aspera
Hip adduction
Variable – branch of
profunda femoris versus
branch from MCFA;
obturator artery
−
Obturator
nerve
(anterior
division)
15
Gracilis
Pubic bone –
ischiopubic
ramus
Medial,
proximal tibia
(pes
anserinus),
below the
sartorius
Hip adduction,
knee flexion,
and internal
rotation
Ascending branch of
MCFA (dominant); 1–2
branches from the
superficial femoral artery
One
dominant
and minor
pedicles
(type II)
Obturator
nerve
(anterior
division)
16
Pectineus
Pubic bone
Proximal femur
– below the
lesser
trochanter
Hip adduction,
knee flexion,
and internal
rotation
Branches from the MCFA,
common femoral, and
obturator arteries
−
Femoral
nerve
(anterior
division)
Extracompartmental
17
Tensor fascia latae
Iliac crest
Iliotibial
tract–lateral
tibia condyle
(anterior
surface)
Maintains knee
extension
(assists gluteus
maximus) and
hip abduction
Ascending branch of the
LCFA
One
dominant
artery
(type I)
Superior
gluteal
nerve
ASIS, anterior superior iliac spine; LCFA, lateral circumflex femoral artery; MCFA, medial circumflex femoral artery.
Table 1.2  Thigh musculature—cont’d

15
The thigh
Fig. 1.10  Arteries and nerves of thigh: anterior views. (From: Netter; © Elsevier Inc. All rights reserved.)
Anterior superior iliac spine
Inguinal ligament
Iliopsoas muscle
Superficial circumflex
iliac vessels
Superficial
epigastric vessels
Superficial dissections
Tensor fasciae latae
muscle (retracted)
Lateral femoral cutaneous nerve (cut)
Sartorius muscle (cut)
Gluteus
minimus
and medius
muscles
Iliopsoas muscle
Femoral nerve,
artery, and
vein
Pectineus
muscle
Profunda femoris
(deep femoral)
artery
Adductor
longus muscle
Saphenous
nerve
Nerve to
vastus medialis
muscle
Adductor
magnus muscle
Sartorius
muscle (cut)
Lateral
circumflex
femoral
artery
Rectus
femoris
muscle
Vastus
lateralis
muscle
Femoral
sheath
Femoral nerve,
artery, and vein
Pectineus
muscle
Profunda femoris
(deep femoral)
artery
Gracilis
muscle
Adductor
longus
muscle
Sartorius
muscle
Vastus medialis
muscle
Fascia lata (cut)
Rectus femoris muscle
Vastus lateralis muscle
Tensor fasciae latae muscle
Patellar
anastomosis
Vastus
medialis
muscle
Superficial and
Deep external
pudendal vessels
Infrapatellar
branch of
Saphenous nerve
Articular branch
of descending
genicular artery
(emerges from
vastus medialis
muscle)
Saphenous
nerve and
saphenous
branch of
descending
genicular
artery
Adductor canal
(opened by
removal of
sartorius
muscle)
Anteromedial
intermuscular
septum
covers
entrance of
femoral vessels
to popliteal fossa
(adductor hiatus)
Superior medial
genicular
artery (from
popliteal artery)
Inferior medial
genicular
artery (from
popliteal artery)
Lateral femoral cutaneous nerve
A
B