Review of Plastic Surgery – Donal W. Buck II

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Chapter 8
ANSWER 1: C. Although all of the choices listed contribute to
breast blood supply, the dominant supply is from internal IMA
perforators.
ANSWER 2: D.
ANSWER 3: C.
ANSWER 4: B. The medial pectoral nerve supplies the lateral and
inferior portions of the pectoralis major, whereas the lateral pecto­
ralis major supplies the medial portion of the muscle. This is some­
what confusing because they are named according to their origin,
with the medial nerve arising from the medial cord of the brachial
plexus and the lateral nerve arising from the lateral cord.
ANSWER 5: A. Intercostal artery perforators are the dominant
blood supply to the inferior pedicle of the breast.
ANSWER 6: B. Characteristics of Tanner stage-II breasts include
darkening and widening of the areola as well as an areola that is
elevated from the underlying palpable breast bud.
ANSWER 7: C.
ANSWER 8: B. Cutaneous branches of the 4th intercostal nerve
supply the NAC.
ANSWER 9: D. Dye flow studies report that both the axillary and
parasternal lymphatic groups receive lymph from all quadrants of
the breast.
ANSWER 10: D. Reduction mammoplasty is first-line therapy after
breast size has stabilized for 1 year or more. Reduction mammoplasty
can be performed even if the patient is younger than 18 years.
ANSWER 11: D. Reduction in blood flow or hypoplasia of
the internal thoracic artery can lead to disruption of pectoralis
major development. Hypoplasia of the branches of the brachial
artery during development could lead to upper extremity/hand
deformities.
ANSWER 12: C. Like juvenile breast hypertrophy, giant fibro­
adenomas result from abnormal sensitivity of the breast tissue to
normal hormonal levels. They are discrete benign tumors that
enlarge rapidly. Treatment is surgical excision, with possible con­
current matching procedures to achieve symmetry.
ANSWER 13: C. Moderate breast enlargement with excess skin
describes Simon grade IIB gynecomastia.
ANSWER 14: D. Ultrasound of the testes should be performed
to rule out tumor. Tumors known to cause gynecomastia include
Leydig cell and Sertoli cell tumors as well as choriocarcinomas.
mandible with bilateral sagittal split osteotomies is typically per­
formed. A distraction procedure is typically unnecessary for an
advancement of 11 mm.
Chapter 7
ANSWER 1: D. The structures that arise from the first branchial
arch primarily drain to the parotid lymph nodes. This includes the
superior helix, tragus, and helical root. The structures that arise
from the second branchial arch primarily drain to the cervical
lymph nodes.
ANSWER 2: C.
ANSWER 3: D. The prominent ear is often characterized by a
conchoscaphal angle >90 degrees, hypertrophy of the concha
cavum with a depth >1.5 cm, a prominent lobule, and an auriculo­
cephalic angle >25 degrees.
ANSWER 4: D. Cryptotia is characterized by an abnormal adher­
ence of the superior helix to the temporal skin, with varying degrees
of severity. In some cases, the helix can be pulled out to the normal
position.
ANSWER 5: C. Rim-only defects that are 1.5 cm or less in
length can be reconstructed with an Antia-Buch chondrocutane­
ous flap.
ANSWER 6: C. To achieve definition of the auricle, it is crucial to
have a well-vascularized, supple, uniform, and thin skin envelope.
This can be achieved by meticulous skin pocket dissection, with
the aim of creating a 2-mm-thick skin flap using blunt, straight
scissors.
ANSWER 7: D. Autogenous auricular reconstruction in microtia
with craniofacial deformities is challenging, because of atypical
anatomy (e.g., dislocated vestige, atypical superficial temporal
arteries, low hairline) and associated skeletal deformities. How­
ever, with careful planning by an experienced surgeon, auricular
reconstruction in these patients is possible and therefore not
contraindicated.
ANSWER 8: A. The superior helix is derived from the anterior
hillocks (1 to 3) of the first branchial arch.
ANSWER 9: D. The auricle is located approximately one ear length
(6.5 to 7.5 cm) behind the lateral orbital rim. The top of the auricle
is on line with the eyebrow, and the bottom of the auricle is on line
with the base of the columella or slightly below. The normal auricle
is inclined posteriorly 10 to 20 degrees, and the width is ~50% to
55% of the length.
ANSWER 10: A. The optimal timing of ear molding is immedi­
ately after birth. After 1 month of age, ear molding becomes less
effective. The duration of the treatment is ~6 to 8 weeks.

340
ANSWER 7: C. Linear or branching calcifications may suggest
malignancy, as may pleomorphic/granular calcifications.
ANSWER 8: A. Although treated in most instances as though it
were cancer, and given the unique definition of “stage 0,” due to
the likely progression to invasive ductal carcinoma, DCIS is NOT
cancer; it is a premalignant condition.
ANSWER 9: D. Large tumor-to-breast size may cause unacceptable
deformity. Previous external beam radiation therapy (XRT) com­
plicates the need for postlumpectomy XRT, and multifocal disease
is a risk for higher recurrence rate.
ANSWER 10: B.
ANSWER 11: D. Radiation therapy complicates all aspects of
breast reconstruction. With an expander, XRT planning is made
more difficult: Treatment of the internal mammary nodes is limited
and tightness from XRT fibrosis is a problem. However, there is no
information suggesting that risk of mortality is altered and that
XRT skin problems may be alleviated with a flap procedure. With
a free TRAM flap, XRT planning is more difficult due to the fixed
volume of the TRAM flap that does not flatten in the supine posi­
tion, as a natural breast would. Post-XRT, a TRAM flap may shrink
unpredictably and will not increase in size with time if the woman
gains weight, a typical advantage of the TRAM flap. With delayed
reconstruction, XRT is not impacted, but skin is lost and will be
fibrotic, making it harder to perform a successful reconstruction.
This can be psychologically problematic.
ANSWER 12: D. The upper inner thigh is an area with loose skin
and subcutaneous fat and can provide an autologous reconstructive
option, especially for thinner women with smaller breasts, but the
above limitations may complicate the procedure.
ANSWER 13: C. If the area of necrosis or dehiscence is small and
overvascularized tissue AND there is no need for timely postopera­
tive chemotherapy or radiation therapy, this area may be left to heal
secondarily. If the problem is larger or other therapies are planned,
excision and reclosure, either in the office or operating room, is
indicated.
Chapter 10
ANSWER 1: E. Subpectoral breast implant placement may result
in a dynamic deformity of the breast during contraction of the
pectoralis major muscle.
ANSWER 2: C. Triple-antibiotic breast irrigation is a strategy to
reduce biofilm formation and capsular contracture. It includes the
use of Cefazolin, Gentamycin, and Bacitracin.
ANSWER 3: D. The tuberous breast deformity may include hernia­
tion of breast tissue through NAC, a constricted breast base, and a
high IMF. The distance from the IMF to the nipple is typically
decreased.
ANSWER 15: A. Ketoconazole inhibits CYP450 enzymes, includ­
ing 11β-hydroxylase, necessary for adrenal androgen production.
ANSWER 16: B. Because the internal mammary vessels were pre­
viously harvested for the bypass, reliability of a medial pedicle based
on the IMA perforators may be compromised.
ANSWER 17: C. Jeune syndrome is characterized by glandular
tissue that can be congenital, surgical, or radiation induced.
ANSWER 18: C. The IMF is elevated with a tuberous breast
deformity.
ANSWER 19: D. Pectus carinatum is convex or anteriorly project­
ing sternum and ribs. It is commonly referred to as a pigeon’s chest
deformity.
ANSWER 20: A. Poland syndrome is characterized by an absence
of the sternal head of the pectoralis major muscle.
Chapter 9
ANSWER 1: C. The main advantage of duplex Doppler is the
additional information on flow quantity and direction. However,
flow is very variable and dependent on cardiac output and the state
of constriction of the vessel. More important is the knowledge that
vessels spread in all directions into the subdermal plexus. This,
together with the ability to compare relative perforator vessel sizes
in one radiological document, gives us more reliability in identify­
ing the dominant perforator in the lower abdominal wall.
ANSWER 2: C. The oncological risk for loco-regional or distant
metastasis is comparable for both reconstructive techniques and is
certainly not higher compared to ablative surgery without
reconstruction.
ANSWER 3: E. Taking into account the increased risk of local
recurrence after conservative breast surgery, the DIEAP flap should
be reserved for full breast reconstruction in case that is needed in
a later phase. Flaps with a smaller volume and skin surface than the
DIEAP flap (TDAP, LICAP, anterior intercostal artery perforator
[AICAP], and glandular flaps) should be used as a first choice.
ANSWER 4: F. These are 5 of the 8 elementary rules that form the
basis for safe perforator pedicle dissection for any type of free or
pedicled perforator flaps.
ANSWER 5: D. Sufficient scientific data are now available to show
that skin- and areola-sparing mastectomies have no increased risk
for loco-regional recurrence or distant metastasis as long as the
tumor is 1 inch (2.5 cm) away from the nipple. Primary reconstruc­
tions are as safe as secondary reconstructions but provide a better
esthetic outcome.
ANSWER 6: D. Both BRCA1 and 2 carry an 85% risk for breast
cancer; ovarian cancer risk is higher with BRCA1.

341
ANSWER 3: A. This patient has failed hernia repair with a simple
bridged synthetic mesh repair and now presents with a contami­
nated wound healing complication; therefore, bioprosthetic mesh
is indicated. It is important to provide the best possible reconstruc­
tion in this patient because the rate of reoperation increases with
each subsequent hernia repair. Component separation will allow
for primary fascial coaptation of the hernia defect without excessive
tension over the inlay bioprosthetic, thus creating a reinforced
repair with a significantly lower recurrence rate than another
bridged repair. Finally, preserving the periumbilical perforating
vessels from the epigastric arteries with the minimally invasive
component separation technique will help preserve the perfusion
of the overlying skin to avoid future wound necrosis.
ANSWER 4: D. Stage-IV pressures sores are defined as full-
thickness wounds that extend beyond the subcutaneous fat into the
underlying muscle, tendon, or bone, as seen in this patient.
ANSWER 5: C. This young paraplegic patient is at great risk of
having future pressure sores. As such, effort should be made to
maximize future flap-coverage options. The simplest option is to
readvance the flaps that she already has, which simultaneously
avoids burning any future reconstructive bridges. a is incorrect
because it would be difficult to cover a sacral decubitus ulcer with
a tensor fascia lata flap; b is incorrect because it would be more
difficult to perform a gluteus maximus musculocutaneous rotation
flap in the setting of a previous bilateral V-Y gluteus maximus
advancement flap than to simply readvance the V-Y flaps; and d is
similarly incorrect because readvancement of the V-Y flap would
be simpler than creating a new transverse back flap and would
preserve future options for reconstruction.
ANSWER 6: C. Superior gluteal artery perforator flaps provide
adequate soft-tissue coverage while preserving the superior and
inferior gluteal muscles. This minimizes donor site morbidity,
which is important in this ambulatory patient. Gluteal myocutane­
ous advancement and rotational flaps would both provide the soft-
tissue coverage but would involve harvest of the superior and
inferior gluteal muscles, which would increase morbidity. Full-
thickness skin graft does not provide stable coverage of a stage-4
sacral decubitus ulcer with exposed bone.
ANSWER 7: E. This patient has involvement of the hip joint,
which is consistent with osteomyelitis. He will need adequate bony
debridement, most likely involving resection of the femoral head
(also known as the Girdlestone procedure), followed by vascular­
ized tissue transfer to obliterate the dead space and cover the defect.
IV antibiotics alone are not sufficient for treating the osteomyelitis.
Tensor fascia lata flap, vastus lateralis flap, and ALT flaps are good
options for coverage of a trochanteric decubitus ulcer, but the
wound has to be adequately debrided to clear the infective process
before final flap coverage.
ANSWER 8: C. The muscles of the abdominal wall are innervated
by the intercostal nerves T7 to T12, and these nerves run in the plane
below the internal oblique. Hence, staying in the plane between the
ANSWER 4: D. The intercostobrachial nerve crosses the axilla
from the second rib and supplies sensation to the medial and pos­
terior aspect of the proximal arm. During a transaxillary approach
for breast augmentation, dissection should remain superficial until
the border of the pectoralis major muscle is reached.
ANSWER 5: C. Anaplastic large-cell lymphoma associated with
breast implants may present as a late seroma. Breast-implant-
associated anaplastic large-cell lymphoma is commonly found to
be CD30 positive.
ANSWER 6: E. The LICAP is predominantly used for lumpectomy
defects and for autoaugmentation of the breast in postbariatric
breast rejuvenation surgery or to supplement postmastectomy
reconstruction. Tuberous breast deformities can be reconstructed
with breast implants with (a) or without (b) antecedent tissue
expansion; in inferiorly based periareolar autoaugmentation (c), or,
more recently, with autologous fat grafting (d).
ANSWER 7: C. Dye injection studies (Taylor GI, Palmer JH. The
vascular territories (angiosomes) of the body: experimental study
and clinical applications. British Journal of Plastic Surgery.
1987;40:113-41) suggest that the inferior pedicle provides the least
significant vascular supply to the NAC.
ANSWER 8: C. Form-stable implants have less rippling (a), lower
capsular contracture rates than smooth gel devices (b), lower leak
rates at 8 years (d), and tend to have greater upper pole fullness
than round devices. However, they are currently available in a more
limited volume range relative to round, smooth, traditional silicone
implants.
ANSWER 9: D. The majority of data suggest that subglandular
placement of smooth implants is most commonly associated with
capsular contracture.
ANSWER 10: A. Patient age has not been consistently shown to
significantly impact capsular contracture rates. In contrast, factors
that impact periprosthetic inflammation, such as the biofilm theory,
radiation, incision selection, and perioperative hemostasis, have all
been linked to capsular contracture.
Chapter 11
ANSWER 1: E. In contrast to synthetic mesh, the degree of wound
contamination does not appear to significantly affect the chance of
developing major complications such as recurrent hernia, mesh
infection, or mesh explantation following abdominal-wall recon­
struction with bioprosthetic mesh.
ANSWER 2: B. Records from the National Surgical Quality
Improvement Program (NSQIP) determined that obesity, COPD,
steroid use, smoking, and low preoperative serum albumin level
were all independent risk factors for a fourfold increase in wound
infection rates. Diabetes was not found to be as significant a risk
factor.

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stimulation because the conduction block is the only issue prevent­
ing function.
ANSWER 5: A. Tension-free repair means no tension through the
full range of motion; joints should not be artificially flexed to attain
that goal.
ANSWER 6: E. The patient has median and ulnar nerve deficits;
thus, an isolated median nerve injury is unlikely. Intact elbow
flexion means the lateral cord is intact. Preserved elbow flexion and
extension rule out a middle trunk injury. There are median nerve
deficits in addition to the ulnar nerve deficits; thus, an isolated
ulnar nerve injury is unlikely. Impaired median and ulnar nerve
function with preservation of lateral cord function and posterior
cord function implicate the median cord as the site of injury.
ANSWER 7: B. Nerve amplitude is a proxy for the number of
functional axons within the nerve being evaluated.
ANSWER 8: B. Preservation of sensory nerve action potentials in
the setting of diffuse muscular palsy is pathognomonic for a pre­
ganglionic injury, because the dorsal root ganglion remains attached
to the distal nerve and can thus receive nerve action potentials.
ANSWER 9: B. An end-to-side transfer from the anterior interos­
seous nerve to the motor branch of the ulnar nerve provides inner­
vation necessary to preserve the intrinsic muscle motor end plates
and increases the likelihood of improved intrinsic function follow­
ing ulnar nerve release in the setting of severe cubital tunnel
syndrome.
ANSWER 10: D. Of the options listed, a nerve transfer from
the tibial nerve branch to the flexor hallucis longus (FHL) or
flexor digitorum longus (FDL) to the peroneal motor branch to
the tibialis anterior offers the greatest potential to restore active
dorsiflexion.
Chapter 13
ANSWER 1: A. Filariasis is the most common secondary lymph­
edema in the world due to infection of the filarial worm, especially
in Africa and India.
ANSWER 2: C. Most patients who underwent liposuction for their
lymphedematous limbs require life-long compression garment
usage; otherwise, the lymphedema will recur.
ANSWER 3: C. Toe infections, hyperkeratosis, residual or progres­
sive lymphedema, and cellulitis of the lower limb are common
complications developing post-Charles procedure.
ANSWER 4: A. The indications of vascularized lymph node flap
transfer include total occlusion of lymphoscintigraphy, partial
occlusion of lymphoscintigraphy with poor response to complete
digestive therapy for 6 months, no acute infection, and no cancer
recurrence/distal metastasis.
external oblique and the internal oblique will preserve the innerva­
tion to the muscles flaps during component separation.
ANSWER 9: A. Several options exist for vaginal reconstruction but
the pedicled vertical rectus abdominis myocutaneous (VRAM) flap
remains the gold standard for vaginal reconstruction. It has a reli­
able blood supply and can be harvested with a large skin paddle that
can be used to resurface both the vagina and perineum. It can be
also harvested as a rectoperitoneal flap, including a cuff of perito­
neum that can be used to resurface the peritoneum. Primary closure
of both perineal and vaginal defects is not the best option in a radi­
ated patient with large defects. The ALT flap has been described for
perineal reconstruction but VRAM remains the preferred option
for vaginal reconstruction. The McIndoe procedure involves using
a split-thickness skin graft along with a mold for vaginal recon­
struction especially in cases of vaginal agenesis. It usually requires
serial dilations with obturators and is not the ideal option for this
patient.
ANSWER 10: A. The dorsal nerve of the clitoris is analogous to
the dorsal nerve of the penis and is responsible for most of the
erogenous sensation associated with the clitoris. The dorsal nerve
of the clitoris is the terminal branch of the pudendal nerve. Studies
have shown that neurorrhaphy between the dorsal nerve of the
clitoris and the donor cutaneous nerve is associated with superior
sensory outcomes in phalloplasty. The posterior femoral cutaneous
nerve provides sensory innervation to the posterior aspect of the
thigh and perineum. The ilioinguinal nerve provides innervation to
the medial thigh and the labia majora and minora. The iliohypogas­
tric nerve provides innervation to the mons pubis. The lateral
femoral cutaneous nerve arises from the lumbar plexus and inner­
vates the lateral thigh.
Chapter 12
ANSWER 1: C. Timely exploration and surgical repair is indicated
for all sharp lacerations with distal nerve deficit. Electrodiagnostic
studies are not necessary. The working diagnosis should be nerve
transection.
ANSWER 2: C. At 3 years postinjury, nerve repair/transfer are not
options because the muscle is terminally denervated. Tendon trans­
fers are his only available option.
ANSWER 3: D. The cell body for the sensory nerves is located in
the dorsal root ganglia. This is important in cases of nerve root
avulsion injuries because the electrodiagnostic study of the motor
and sensory roots will show a disconnect. There will be no record­
able motor action potentials at that avulsed level, but the SNAPs
will actually be normal because the cell-body-to-nerve connection
is intact and located distal to the site of injury.
ANSWER 4: B. A neurapraxia is by definition a conduction block.
There is no Wallerian degeneration and no advancing Tinel’s sign.
However, if the nerve is explored and stimulated distal to the site
of injury/neurapraxia, stimulation can produce distal muscle

343
Chapter 15
ANSWER 1: B. An osteoid osteoma, seen in young patients (2nd
and 3rd decades of life) is typically seen as a >1-cm “lucent nidus”
(occasionally with a calcified central core) surrounded by reactive
sclerosis. An enchondroma is a well-defined, lobulated lytic lesion;
a chondrosarcoma is usually poorly defined with stippled calcifica­
tions, extreme cortical expansion, and soft-tissue extension; an
osteoscarcoma appears as a lytic lesion with an aggressive “sun­
burst” periosteal reaction.
ANSWER 2: A. The differential diagnosis of subungual pigmenta­
tion includes benign melanonychia striata, hematoma, pyogenic
granuloma, and melanoma. If unchanged in appearance for >4 to
6 weeks, biopsy is recommended.
ANSWER 3: C. The spiral cord forms from elements of the pre­
tendinous band, the lateral digital sheet, Grayson’s ligament, the
natatory ligament, and the spiral band.
ANSWER 4: D. A typical workup for hypothenar hammer syn­
drome begins with physical exam looking for a pulsatile mass.
Imaging studies include MR or CT angiogram and X ray to evaluate
any bony masses/hamate fractures. EMG is not part of the typical
workup.
ANSWER 5: B. Crush injuries to the forearm are at risk for devel­
opment of compartment syndrome. Any patient who develops
increasing pain after a crush injury should have a thorough physical
exam looking for the “5 Ps” (pain, pallor, poikilothermia, paresthe­
sia, pulselessness), and warm fingers do not exclude the diagnosis.
ANSWER 6: B. Mucous cysts are ganglion cysts originating from
the DIP joint. They are associated with degenerative joint disease.
Although mucous cysts are not visualized on plain radiographs,
they are typically associated with osteophytes of the DIP joint.
Treatment consists of debridement of the mucous cyst and removal
of the osteophytes and often requires a local rotation-advancement
flap for coverage.
ANSWER 7: C. Glomus tumors present with severe episodic pain
and extreme tenderness to palpation, usually localized to the mass.
These tumors often appear in the subungual region. X rays may
show a lytic lesion in the bone. The mass appears on MRI as a
hyperintense signal. Treatment consists of simple excision and
often requires removal of the nail plate.
ANSWER 8: B. Hypothenar hammer syndrome is described as an
aneurysm of the ulnar artery resulting from repeated blunt trauma.
This may lead to clot formation and distal embolization, resulting
in distal ulceration. Treatment consists of excision of the aneurysm
and reconstruction with arterial or venous grafts.
ANSWER 9: A. The spiral cord is formed by the pretendinous
band, spiral band, lateral digital sheet, and Grayson’s ligament. It
wraps around the neurovascular bundle and contracts, displacing
ANSWER 5: D. Lymphovenous anastomosis is more effective in
early breast-cancer-related upper limb lymphedema.
ANSWER 6: C. The destruction of smooth muscle cells results in
decreases of the tunica media and dilation of the lymphatic channel.
ANSWER 7: D. Lymphovenous bypass is most effective in patients
with an earlier stage of lymphedema.
ANSWER 8: B. Sex difference does not contribute to aggravation
of the lymphedema.
ANSWER 9: A. Lymphangiosarcoma is one of the lymphedema-
related malignancies known as Stewart-Treves syndrome.
ANSWER 10: A. Chronic lymph stasis impairs local immune sur­
veillance by disrupting trafficking of the immunocompetent cells in
the lymphedematous region.
Chapter 14
ANSWER 1: C. Typically, a simple, incomplete syndactyly of a
central webspace can be released between 1 and 2 years of age.
Border digits, especially the thumb, may require earlier release.
ANSWER 2: D. Sensory function of the retained thumb should be
within normal limits following correction of radial polydactyly.
ANSWER 3: B. Polydactyly is the most common congenital hand
malformation, affecting ~1 in 500 live births.
ANSWER 4: D. The thumb metacarpal is not usually present
or is hypoplastic and cannot be resected in most patients under­
going pollicization. Division of this structure is not typically
performed.
ANSWER 5: C. Symbrachydactyly and amniotic band syndrome
are both typically sporadic; thus, patients would not typically have
a family history of either condition.
ANSWER 6: B. Apert syndrome and its anomalies are the result
of a mutation of the FGFR-2 gene.
ANSWER 7: D. Holt-Oram syndrome is the likely diagnosis for a
child who has bilateral absent thumbs and cardiac septal defect. The
most common cardiac anomaly is an atrial septal defect. This is an
autosomal dominant disorder with wide variability in expression of
cardiac and limb anomalies.
ANSWER 8: C. The patient demonstrates right small-finger clino­
dactyly with a delta phalanx visible on radiographs.
ANSWER 9: D.
ANSWER 10: E. A Blauth type-IIIB classification indicates an
unstable CMC joint. The best option would be for amputation of
the hypoplastic thumb and index pollicization.

344
reduction without disrupting the soft-tissue envelope around the
bone. d may be offered as a salvage if there is significant secondary
posttraumatic arthrosis.
ANSWER 10: B. Dorsal blocking, whether by splint or temporary
pin, should maintain a flexion arc within the confines in which the
joint remains concentrically reduced. Therefore, a is not optimal.
Because the PIP joint is stable and concentrically reduced past 20
degrees of flexion, the force-coupler is unnecessary.
Chapter 17
ANSWER 1: B. The described defect is quite large, and the FDMA
flap could be used to provide coverage of this area of the thumb.
The other options are inappropriate for the described defect.
ANSWER 2: B. Replantation of single digits amputated within the
zone-II level is relatively contraindicated due to postoperative stiff­
ness. It is also contraindicated when the postoperative rehabilita­
tion will significantly delay the patient’s ability to return to work,
as in the case of the construction worker in b. Replantation should
be considered for any digit in healthy children and for all thumb
amputations.
ANSWER 3: C. In small-fingertip injuries without a bony amputa­
tion or with minimum exposed bone (<0.5 mm), the most appro­
priate method of reconstruction to obtain good sensation and
function is to allow the wound to heal by secondary intention with
the use of moist dressings.
ANSWER 4: D. In the patient described, the majority of the sterile
matrix is scarred, and the nail cannot adhere to the nail bed.
Reconstruction requires removal of the scarred sterile matrix, fol­
lowed by split-thickness nail-bed grafting. Of note, reconstruction
of the germinal matrix, unlike the sterile matrix, requires a full-
thickness nail-bed graft, typically from the toes.
ANSWER 5: B. The flexor tendons in the scenario described have
been avulsed from the musculotendinous junction, which is indica­
tive of significant injury to the digital arteries that will severely limit
the success of replantation.
ANSWER 6: D. For this manual laborer who desires to return to
work quickly, the most appropriate management is revision ampu­
tation, especially given the avulsive nature of his injury.
ANSWER 7: D. Pollicization can be used for amputations of the
thumb between the middle of the first metacarpal and at the CMC
joint, but it works best for amputation at the level of the CMC joint.
In this patient, the index finger is injured and will otherwise have
minimal function. Therefore, the injured index finger should be
pollicized to reconstruct the thumb reconstruction and serve as a
stable post.
ANSWER 8: B. A reverse cross-finger flap is used to cover soft-
tissue defects on the dorsum of an adjacent digit. The skin on the
the bundle centrally and superficially and giving the appearance
that the bundle spirals around the cord. The bundle is often found
immediately deep to the skin and may be easily injured on incision
or initial dissection.
ANSWER 10: E. Cleland’s ligament is not involved in Dupuytren’s
pathoanatomy. The lateral digital sheet contributes to spiral and
lateral cords. The spiral band and Grayson’s ligament each contrib­
ute to spiral cords. The pretendinous band is the key element of the
central cord and also contributes to spiral cords.
Chapter 16
ANSWER 1: C. The 5th CMC joint has a larger arc, often >20
degrees. The greater degree of extension allows for greater flexion
deformity of the fracture fragment, compared with adjacent digits.
ANSWER 2: A. If the subungual hematoma involves <50% of the
nail surface area, trephination alone is adequate. Minimally dis­
placed fracture responds well to closed treatment.
ANSWER 3: D. Given the chronicity of the injury and the com­
minution, these preclude ORIF, closed reduction percutaneous
pinning (CRPP), or force-coupler dynamic pinning, which are
usually used in the acute setting. The hemi-hamate gives the best
chance at an anatomic reconstruction and long-term function.
ANSWER 4: D. By definition, gamekeeper’s thumb is a chronic
injury with attenuated tissue that is irreparable. Therefore, it will
not respond to treatment modalities intended for an acute injury.
ANSWER 5: C. The adductor pollicus (AP) and the APL result in
adduction of the 1st metacarpal with proximal and dorsal subsid­
ence of the metacarpal relative to the articular fracture fragment.
The reduction maneuvers to overcome these forces are axial trac­
tion, abduction, and pronation of the thumb.
ANSWER 6: C. If there is minimal articular surface involvement,
closed treatment alone is usually sufficient to restore the extensor
function at the distal interphalangeal joint (DIPJ).
ANSWER 7: D. The volar plate can impinge in the joint space. The
other structures can create a noose around that metacarpal head
that can tighten with axial traction, thereby making repeated
attempts at closed reduction more difficult.
ANSWER 8: A. The flexion deformity at the DIPJ will lead to long-
term imbalance of the flexors and the extensors, resulting in com­
pensatory hyperextension at the PIP joint. This is known as a
swan-neck deformity.
ANSWER 9: C. Given the degree of comminution and instability,
open fracture and closed treatment alone are usually unable to
control the fracture fragments or provide the necessary axial dis­
traction forces to maintain the reduction. On the other hand, the
ligamentotaxis provided by an external fixator can allow for proper

345
ANSWER 4: A. PRC involves excision of the proximal row of the
carpus (scaphoid, lunate, triquetrum). The capitate then articulates
with the lunate fossa of the radius and therefore must be free of
arthritic disease. In such cases, alternative forms of partial wrist
fusion (four-corner fusion) or complete wrist fusion should be
pursued.
ANSWER 5: B. Trigger finger is one of the most common com­
plaints in hand surgery. Initial management involves corticosteroid
injection(s), which is curative for many patients. Surgical release of
the A1 pulley is performed in patients who fail corticosteroid injec­
tion. However, the A1 pulley should never be released in patients
with rheumatoid arthritis because this can result in worsening of
ulnar drift of the involved digit. In such patients, tenosynovectomy
and excision of intratendinous nodules is the procedure of choice.
ANSWER 6: A. After disruption of the SL interosseous ligament,
there is dissociation of the scaphoid and lunate resulting in a DISI
deformity. This is characterized by a SL angle >60 degrees and a gap
of >3 mm (Terry Thomas sign).
ANSWER 7: D. If left untreated, displaced fractures of the proxi­
mal scaphoid are at risk for developing proximal pole avascular
necrosis (AVN) and humpback deformity due to scaphoid nonun­
ion. This nonunion is termed SNAC and can progress to pancarpal
arthritis. This is different from a SLAC wrist, which develops from
an untreated SL ligament tear.
ANSWER 8: C. A PRC involves removal of the scaphoid, lunate,
and trapezium, allowing the capitate to act as the main contact
point between the radius and carpus as it articulates with the radius
in the lunate fossa. Arthritic changes of the head of the capitate are
a contraindication to PRC, and other salvage procedures must be
used.
ANSWER 9: A. Four-corner fusion is a salvage procedure to treat
wrist arthritis. It involves removal of the scaphoid and fusion of the
lunate, triquetrum, capitate, and hamate.
ANSWER 10: E. A carpal tunnel view allows the hamate to be seen
in an axial view, which is useful for identifying fractures of the hook
of hamate.
ANSWER 11: B. In a Mayfield stage-IV perilunate dislocation, the
lunate becomes dislocated volarly out of the lunate fossa. For this
to happen, its attachments to the scaphoid and triquetrum must be
completely disrupted. These are the SL and lunotriquetral liga­
ments, respectively.
ANSWER 12: A. The EPL is most at risk for rupture following a
distal radius fracture. The EPL is responsible for thumb extension,
which is absent after rupture. Treatment includes tendon transfers
to restore thumb extension.
ANSWER 13: C. Complete tear of the SL interoseous ligament will
result in a DISI deformity over time. With complete dissociation of
donor finger is incised on the side closest to the recipient finger and
elevated off of the underlying dorsal subcutaneous tissue. The
dorsal subcutaneous tissue of the donor finger is raised as a flap
based on the side closest to the recipient finger. The flap is sutured
to the recipient finger and is used as a bed to receive a full-thickness
skin graft. The native skin is then returned to the dorsum of the
middle phalanx of the donor finger.
ANSWER 9: C. Hook nail deformity results from a loss of nail
support following trauma to the distal fingertip, causing the nail to
curve in a volar direction. The severity of hook nail deformity
depends on the degree of bone loss, the amount of remaining nail
bed, and the degree of scar contracture at the hyponychial-pulp
interface.
ANSWER 10: D. Subungual hematomas secondary to nail-bed
injuries cause pressure in the closed space between the nail plate
and nail bed, resulting frequently in throbbing pain. When the
hematoma is <50% of the nail, trephination can be performed for
pain relief. The hole should be large enough to allow for prolonged
drainage.
Chapter 18
ANSWER 1: D. Non- or minimally displaced fractures, regardless
of styloid involvement or intra-articular nature, may be treated
with closed reduction, splinting, and close clinical and radiographic
follow-up. Indications for ORIF include intra-articular fractures
with >2 mm cortical step-off or displacement, loss of radial height
(positive ulnar variance) of >3 mm, loss of volar angulation of 10
degrees or more, and any fractures (intra- or extra-articular) with
significant displacement or comminution.
ANSWER 2: B. SL ligament injury or disruption is suspected when
the SL interval is >2 mm. The “clenched fist” draws the capitate
proximally and emphasizes the SL interval. Ideally, the clenched fist
view should be performed in supination and ulnar deviation. Radial
deviation has the opposite effect and decreases the SL gap. If a liga­
mentous injury is suspected based on radiographic SL widening,
comparison to the unaffected contralateral wrist is often key in
establishing the diagnosis. The pronated oblique view is helpful for
assessing the scapho-trapezoid-trapezial (STT) joint. The Roberts
view is used to optimize visualization of the thumb CMC joint.
ANSWER 3: C. Waist and proximal pole fractures of the scaphoid
are prone to nonunion and avascular necrosis, secondary to the
retrograde vascular supply of the bone. Scaphoid nonunion or
malunion “humpback deformity” can progress to arthritis and
scaphoid nonunion advanced collapse (SNAC) wrist deformities.
Management relies on either nonvascularized or vascularized bone
grafting to achieve union. In a young patient in whom nonvascular­
ized bone grafting has failed, a vascularized graft affords the best
chance of successful bony union. Total wrist arthoplasty and total
wrist fusion are options for recalcitrant wrist arthritis and chronic
pain. Performance of either option in an active young patient would
significantly limit range of motion and activity long term.

346
ANSWER 8: C. The flexor pollicis longus is deep and radial within
the carpal tunnel. Its distal end will flex the tip of the thumb.
Finding its proximal end can be difficult but very important to
avoid the above complication and need for reoperation. This
tendon is usually the radial-most tendon in the carpal tunnel. It
takes origin distal in the forearm, leading to the lowest amount of
stretch when passively extended. Unlike the FDS and FDP, it will
not share a common muscle belly. It lies deep to the FDP.
ANSWER 9: B. The 2nd and 4th annular pulleys have been shown
in multiple biomechanical and clinical studies to be the most
important structures for preventing bowstringing of the flexor
tendons and maintenance of normal joint biomechanics in the
finger.
ANSWER 10: A. The classic tendon transfers to restore function
for radial nerve injury are (1) PT to ECRB; (2) FCU, FCR, or FDS
IV to EDC; and (3) PL to FDS to EPL. However, in this patient, the
PT was likely avulsed or injured from the degloving, which also
involved the adjacent radial nerve. In this setting, a is the only
choice that avoids zone of injury and allows improved motion.
Chapter 20
ANSWER 1: C. The macrophage is the predominant cell within a
healing wound at 48 to 72 hours.
ANSWER 2: A. In expanded skin, the total collagen content and
total surface are increased, but tensile strength and elasticity are
decreased. Likewise, the dermis is thinner, but the epidermis shows
apparent increased thickness.
ANSWER 3: D.
ANSWER 4: A. The most likely mechanism by which NPWT exerts
healing is through macro- and microdeformation of the wound.
ANSWER 5: D. The most widely accepted mechanism by which
silicone improves wound healing is through increased hydration
from occlusion.
ANSWER 6: C. A reasonable approach to extravasation/infiltration
injuries consists of elevation, warmth, and occasionally, if a toxic
substance is infiltrated, dilution of the offending drug assisted with
hyaluronidase to limit toxic concentrations in the skin. Debridement
may be necessary as the injury evolves and the area of skin necrosis
declares itself. There is no evidence of compartment syndrome in
this patient.
ANSWER 7: B. The only FDA-approved enzymatic debrider in
the United States currently is collagenase (Santyl). It is approved
as a debrider and should not be used for closure, but only when
there is nonviable material such as slough in the wound. A major
mechanism of action is by removing biofilm. Most film and hydro­
gel dressings work in part by encouraging autolytic debridement
(the body’s own enzymes and cells debride the wound), whereas an
the scaphoid and lunate, the scaphoid assumes a flexed position and
the lunate an extended position, which increases the SL angle >60
degrees.
ANSWER 14: C. The trapeziometacarpal joint, or basilar joint, is
the most common site of arthritis in the hand. Patients often com­
plain of difficulty opening jars and pain at the base of the thumb.
Chapter 19
ANSWER 1: A. The carpal canal contains 9 tendons and the
median nerve. The anatomic relationships to the carpal canal are
consistent: FDS tendons to the ring and middle finger lie most
volar, with the FDS tendons to the index and small fingers imme­
diately deep or dorsal to this. The FDP tendons lie on the dorsal
floor of canal, and the FPL tendon lies radial, deep, and adjacent to
the scaphoid and trapezium.
ANSWER 2: C. The strength of a tendon repair can be increased
by an increasing number of core suture strands across the repair
site, locking sutures, epitendinous sutures, and early mobilization
and range of motion.
ANSWER 3: B. Because of its insertion onto the base of the third
metacarpal, the ECRB is considered the prime wrist extensor.
ANSWER 4: A. The patient in this scenario has the classic signs
and symptoms of de Quervain’s tenosynovitis. This is characterized
by entrapment of the APL and extensor pollicis brevis within the
first extensor compartment.
ANSWER 5: C. The classic treatment for the “fist-in-palm”
deformity is the FDS-to-FDP or superficialis-to-profundus (STP)
transfer.
ANSWER 6: D. The extensor digitorum brevis manus (EDBM)
muscle is an anomalous muscle identified in 2% to 3% of the popu­
lation. In addition to the EDC and extensor indices proprius, this
finger extensor can extend the index, long, or ring finger. Its pres­
ence should be noted to be sure the distal EIP muscle and this
anomalous muscle are not mistaken for one another. Its repair is
optional in the setting of intact EDC. It may also be identified in
the dorsal wrist as a painful mass. The EDBM is innervated by the
posterior interosseous nerve, which is the distal extension of the
radial nerve.
ANSWER 7: C. Closed injury of the sagittal band can lead to
subluxation of the extensor tendon off of the metacarpal head into
the intermetacarpal space ulnar to the joint. In this setting, the
patient can maintain active passive finger extension, and there is an
associated subluxation when the finger is placed back in flexion. In
these cases, active extension of the finger is often not possible. This
is seen in rheumatoid patients due to attritional rupture and ulnar
drift. It is also seen following blows to the MPJ, most commonly of
the prominent long finger. Extension splinting or repair is
indicated.

347
ANSWER 2: D. The “fight bite” wound can easily lead to inocula­
tion of the MPJ when the MPJ is flexed (as it would be when punch­
ing). The inoculation can then get trapped in the joint space as the
extensor tendon slides back, resulting in a septic arthritis that is best
treated with exploration and washout of the MPJ.
ANSWER 3: A. Fournier gangrene is a necrotizing fasciitis of the
genitals and perineum. This life-threatening infection requires
urgent surgical debridement to optimize outcomes.
ANSWER
4:
D. Community-acquired methicillin-resistant
Staphylococcus aureus (MRSA) infections are increasingly common,
especially within the pediatric population. Of the options pre­
sented, sulfamethoxazole/trimethoprim (Bactrim) is the most
appropriate oral antibiotic for pediatric MRSA infections.
ANSWER 5: E. Kanavel’s cardinal signs for suppurative flexor
tenosynovitis include all of the answers except for the fingers being
held in an intrinsic plus position, which would include having the
interphalangeal joints extended (and not flexed).
ANSWER 6: D. The patient described has clinical findings consist­
ent with a necrotizing soft-tissue infection. The initial management
of this group of conditions includes resuscitation, administration
of broad-spectrum IV antibiotics, and extensive debridement of
involved tissues.
ANSWER 7: B. The most appropriate next step is to update his
tetanus status and observe for signs of envenomation.
ANSWER 8: D. The patient described has Hurley stage-III hidrad­
enitis suppurativa. Nonsurgical management will not be effective.
The patient requires excision of the affected axillary skin and sub­
sequent reconstruction.
ANSWER 9: C. The patient described has a bite injury involving
the MCP joint, with established infection. In this scenario, he
should undergo immediate surgical drainage of the joint to prevent
joint destruction and osteomyelitis. Administration of IV antibiot­
ics, splinting, and elevation are important, but given alone would
be insufficient.
ANSWER 10: B. The patient has signs and symptoms suggestive
of flexor tenosynovitis.
Chapter 22
ANSWER 1: A. First-degree burns are not used in calculating
TBSA for fluid resuscitation. Upper extremity surface area is 9%
and anterior surface of lower extremity is 9%.
ANSWER 2: C. Parkland formula calls for Ringer’s lactate as the
initial resuscitation fluid of choice.
ANSWER 3: D. The initial treatment for most chemical burns is
copious irrigation with water. The exception to that rule is in the
enzymatic debrider is a pharmacologic means of active debride­
ment. Silver ions, in particular, and pH changes can inactivate an
enzymatic ointment.
ANSWER 8: D. Chronic wounds usually have a variety of causes
that contribute to their nonhealing status. Regardless of the type of
wound (venous, diabetes-related, pressure sore, or arterial ulcer),
most chronic wounds share the common causal factors of occurring
in patients who are older, having the presence of a decrease in tissue
perfusion (as a result of swelling, microvascular impairments, or
vascular disease), and are all colonized with a critical level of bac­
teria in the form of biofilm. Successful management of these
wounds requires attention to all of these parameters.
ANSWER 9: C. The patient has developed a hypertrophic scar,
which is more common in patients of Asian descent and in areas
of tension, such as the midportion of an abdominoplasty scar.
These are best treated with conservative measures, including scar
ointments and silicone gel sheeting (both of which likely work by
increased hydration of the epidermis), massage, and steroid injec­
tions as first-line treatments. Excision followed by radiation treat­
ment would likely be useful but better indicated for treatment of
problematic keloids. It is not indicated for the treatment of this
6-month-old hypertrophic scar. Therapeutics targeting TGF-β in
the form of antisense compounds are not approved nor available.
Lasers have been shown to be quite useful for the treatment of
problem scars and are rapidly becoming accepted therapies for
many types of problematic scars. Pulsed-dye lasers, Nd:YAG lasers,
and fractionated ablative and nonablative CO2 lasers all have a place
in treating hypertrophic and problematic scars.
ANSWER 10: C. The patient likely has an inflammatory ulcer,
such as pyoderma gangrenosum, or a vasculitic ulcer. These most
commonly present in patients with a systemic condition such as
arthritis or inflammatory bowel disease. The back is unlikely to
have ischemia that impairs healing, and most wounds here (even
in patients on arthritis medications) should heal uneventfully. The
progressive nature of the enlarging wound despite presumably good
wound care is suggestive of either an inflammatory ulcer or a malig­
nancy, and a diagnostic biopsy of the wound edges is essential to
differentiating between these two possibilities to enable proper
therapy. If an inflammatory ulcer is indicated, these usually respond
dramatically to systemic steroids and proper wound care. A skin
graft usually is unsuccessful in these wounds, nor is HBO. Steroids
should only be used once the possibility of a malignancy has been
excluded.
Chapter 21
ANSWER 1: B. Venomous rattlesnake bites are best treated pri­
marily with antivenom (CroFab) early. Although the clinical pres­
entation can often be similar to a compartment syndrome,
compartment pressures are often normal on formal testing and
if mildly elevated will often improve with the administration of
antivenom.

348
ANSWER 7: B. The treatment of chondrodermatitis, which also
yields a pathology specimen, is conservative wedge excision of both
skin and cartilage.
ANSWER 8: D. A cutaneous neurofibroma, a benign Schwann cell
tumor, can occur in any part of the body. A single lesion is not
indicative of von Recklinghausen’s nor is a cafe au lait spot alone.
ANSWER 9: A. A Mongolian spot is a childhood skin discoloration
usually located in the lumbosacral skin. The spots are not darkly
colored, usually disappear in later childhood, and seldom require
formal excision.
ANSWER 10: C. Lipomata are commonly multiple, can be bilat­
eral and symmetrical, and have histologically different subgroups
that are not clinically important. They are not caused by trauma.
ANSWER 11: D. Epidermoid cysts contain the skin protein keratin,
which has an odor. Rapid growth may indicate inflammation, and
inflammation may necessitate I&D, with excision deferred. Most
have the same histology.
Chapter 24
ANSWER 1: D. Clear cell acanthoma is a common, benign
tumor of the skin, occurring primarily on the lower extremities. It
appears as a shiny, red papule or plaque measuring up to 2 cm in
diameter. The surface is frequently crusted. Histologically, the
lesion consists of a proliferation of pale, glycogenated keratinocytes
within the epidermis. The differential diagnosis of clear cell acan­
thoma includes SCC, nodular malignant melanoma, and pyogenic
granuloma. Leukoplakia, Hutchinson’s freckle (also known as
lentigo maligna or melanoma in situ), and keratoacanthoma are all
premalignant lesions.
ANSWER 2: C. UVA, which penetrates the skin more deeply than
UVB, has long been known to play a major part in skin aging and
wrinkling (photoaging); it damages keratinocytes in the basal layer
of the epidermis, contributing to squamous call and basal cell car­
cinoma. UVB radiation damages DNA and its repair system and
alters the immune system, resulting in progressive genetic altera­
tions, contributing to basal cell carcinoma. Even small exposures to
gamma radiation are well known to cause a variety of cancer such
as lymphoma, multiple myeloma, breast cancer, and colon cancer,
although not skin cancer.
ANSWER 3: C. Curettage and electrodessication is limited to small
(<1 cm), well-defined, and well-differentiated tumors. Mohs micro­
graphic surgery is a specialized technique used to achieve the
narrowest margins necessary to avoid tumor recurrence, while
maximally preserving cosmesis (not a concern in the scalp). In a
prospective case series of 141 SCCs, a 4-mm margin was adequate
to encompass all subclinical microscopic tumor extension in more
than 95% of well-differentiated tumors up to 19 mm in diameter.
Wider margins of 6 to 10 mm were needed for larger or less-
differentiated tumors or tumors in high-risk locations (e.g., scalp,
initial treatment of elemental metal burns, for which water is con­
traindicated. Calcium gluconate gel is used after water irrigation of
hydrofluoric acid.
ANSWER 4: C. Mafenide acetate penetrates eschar and cartilage
and is the topical of choice for the treatment or prevention of
Pseudomonas and Staphylococcus, the most common organisms
found in chondritis.
ANSWER 5: B. Rewarming in 40-degree water has been shown to
be the best way to initially treat frostbite.
ANSWER 6: C. Findings suggest compartment syndrome, which
should be treated with fasciotomies.
ANSWER 7: D. Even small burns involving critical areas (hands,
feet, face, and genitalia) are considered major burns according to
the ABA.
ANSWER 8: D. SIRs are generally triggered after a burn involving
>30% TBSA.
ANSWER 9: B. The distinction between high and low voltage is
generally considered to be above 1000 V (although some make that
distinction at 500 V).
ANSWER 10: A. Small children have limited glycogen stores.
Chapter 23
ANSWER 1: C. In rare circumstances, a nevus sebaceous may also
transform into sebaceous carcinoma.
ANSWER 2: B. Although this is somewhat controversial, most
agree that for atypical pigmented nevi, 2- to 5-mm margins of exci­
sion are recommended.
ANSWER 3: A. Madelung’s disease is a rare condition character­
ized by the development of symmetric lipomas. The disease seems
to be correlated with alcohol abuse, and symptoms are usually
localized to the trunk and upper limbs.
ANSWER 4: D. Dermatofibromas are benign growths, typically on
the extremities. If they are asymptomatic, they can be observed or
removed, depending on preference.
ANSWER 5: A. Pilomatrixoma is a relatively common childhood
dermal or subdermal lesion. It typically presents as a firm nodule
that may or may not exhibit skin discoloration. Treatment is wide
local excision, and with clean margins, the lesions do not usually
recur.
ANSWER 6: A. Chondrodermatitis is a tender red nodule found
on the helical rim. Choices b and c are not credible. An inflamed
or infarcting hemangioma might be confused, but should be pur­
plish, deeper in the skin, and, even inflamed, compressible.

349
ulcerated, a Clark level IV, or shows extensive regression. Patients
with palpable lymphadenopathy require additional screening for
metastatic disease, lymph node biopsy, and possible completion
lymphadenectomy.
ANSWER 8: A. Immunosuppression profoundly increases the
odds of developing Merkel cell carcinoma. It is seen 30 times more
frequently in patients with chronic lymphocytic leukemia, and solid
organ transplant recipients have a 10-fold-increased risk compared
with the general population. Patients with smaller tumors (<2 cm)
that have not yet metastasized have an expected 5-year survival rate
of more than 80%. Once a lesion has metastasized regionally, the
rate drops to ~50%. Merkel cell carcinomas invade locally, typically
metastasize early to regional lymph nodes, and also spread aggres­
sively through the blood vessels. Adjuvant radiotherapy has been
shown to be effective in reducing rates of recurrence and in increas­
ing the survival of patients.
ANSWER 9: D. SCCs resulting from Marjolin’s ulcer or xeroderma
pigmentosum have a much greater tendency to metastasize than do
tumors resulting from sun-induced skin changes. SCCs of the ears,
nostrils, scalp, and extremities are more prone to metastasize than
those of the trunk. Of the two general types of SCC, the verrucous
and exophytic type is a slow-growing variety that may be locally
invasive but less likely to metastasize. The second general type is
more nodular and indurated and associated with rapid growth and
early ulceration.
ANSWER 10: B. Mohs surgery is least useful with tumors with
discontiguous growth patterns because the technique involves
successive excision of tissue specimens until the margins are judged
to be free of tumor. The most suitable tumors are those that are
seen easily microscopically, tend to grow in a continuous pattern,
are located in anatomically sensitive areas, and have ill-defined
margins clinically. Mohs surgery has use in the treatment of der­
matofibrosarcoma protuberans, where the tumor extends far
beyond the clinical margins into the local surrounding soft tissue,
and in extramammary Paget’s disease, where margin-controlled
surgical excision of the involved epidermis is the most effective
treatment.
Chapter 25
ANSWER 1: C. The buccinator muscle is often included with the
facial artery myomucosal (FAMM) flap to enhance vascularity.
ANSWER 2: B. In instances where the IMA has been harvested, a
rectus abdominis flap can be based off of the 8th intercostal artery,
although it provides less reliable vascularity.
ANSWER 3: A. The reverse lateral arm flap is often used for cover­
age of defects of the antecubital fossa and olecranon. Its dominant
pedicle is off of the radial recurrent artery.
ANSWER 4: B. Harvest of the rectus femoris muscle will often
result in 10 to 15 degrees of extensor lag.
ears, eyelids, nose, and lips). Although the diameter of this lesion
is less than 19 mm, it is located on the scalp, which is a high-risk
location.
ANSWER 4: B. The Clark classification is as follows:
Level I—Lesions involving only the epidermis (in situ
melanoma); not an invasive lesion.
Level II—Invasion of the papillary dermis; does not reach the
papillary-reticular dermal interface
Level III—Invasion fills and expands the papillary dermis but
does not penetrate the reticular dermis.
Level IV—Invasion into the reticular dermis but not into the
subcutaneous tissue
Level V—Invasion through the reticular dermis into the
subcutaneous tissue
ANSWER 5: B. A randomized trial compared narrow margins
(1 cm) with wide margins (≥3 cm) in patients with melanomas no
thicker than 2 mm; no difference was observed between the two
groups in the development of metastatic disease, disease-free sur­
vival (DFS), or overall survival (OS). Evidence suggests that lesions
no thicker than 2 mm may be treated conservatively with radial
excision margins of 1 cm. Indications for SLNB are any lesion
>.76 mm depth, without any palpable nodes; therefore, this patient
may benefit from SLNB.
ANSWER 6: B. Melanomas are divided into four common types,
based on growth patterns. Superficial spreading melanoma is the
most common type (50% to 80%) and is generally a flat-appearing
lesion with variations in color and possible nodular components. It
can develop in an existing lesion or de novo. These are typically
slow growing and grow horizontally before undergoing a vertical
growth phase. Nodular melanoma, comprising ~20% to 30% of all
melanomas, are more aggressive, with an earlier vertical growth
phase and a higher incidence of ulceration and metastases.
Acrolentiginous melanomas are significantly less common lesions
that are found on the distal extremities, such as the palms and soles,
and subungually. They occur in all ethnicities but are the more
common type of melanoma in blacks and other darker-complected
individuals. They grow rapidly with an early vertical growth phase.
Because of their aggression and location, they are often diagnosed
in advanced stages. Lentigo maligna melanomas are an unusual
variant. They are classically described as melanoma in situ, but on
resection, they frequently have areas of invasive disease. Lentigo
maligna melanomas commonly occur on the face and hands with
the appearance of a brownish-red patch. They can be quite large
and have indistinct margins, which may lead to incomplete
resection.
ANSWER 7: C. SLNB is a method of examining regional lymph
nodes in the absence of other evidence of metastatic disease.
Current recommendations for examination and staging of patients
with melanoma include SLNB for patients with melanoma exceed­
ing 0.76 to 1 mm in thickness and with no other evidence of meta­
static disease. Selected patients with melanomas measuring <1 mm
thick can be considered for SLNB if the primary melanoma is

350
ANSWER 5: D. The most commonly used flap for reconstructing
small-to-moderate lid defects (<50% width) is the Tenzel rotation-
advancement flap. It can be used to reconstruct the anterior lamella.
Conjunctiva, advanced from the fornix, can be used to line the
posterior aspect of the flap. Occasionally, a periosteal flap, or alter­
native graft material, may be necessary for middle lamellar
reinforcement.
ANSWER 6: C. In cases of impaired eyelid closure or failure of eye
pressure patching, conjunctivotomy with release of fluid should be
performed. This procedure can be easily performed in the office
with administration of 2.5% phenylephrine and topical tetracaine
drops.
ANSWER 7: C. In cases of severe cicatricial entropion, grafts to
the posterior lamella can increase its height and reconstruct a
smooth conjunctival surface against the globe.
ANSWER 8: B. Superficial injection of Botox into the lateral aspect
of the eyelid chemodenervates the pretarsal orbicularis. As a result,
the lid margin will elevate temporarily, simulating the effect of a
ptosis repair.
ANSWER 9: A. The arcus marginalis formally separates the lower
eyelid from the cheek. It sends fascial extensions to the skin, known
as the orbitomalar ligament, that must be divided to access the
cheek for a midface lift or resuspending orbital fat.
ANSWER 10: D. Corneal abrasions are a common injury when
patients are under anesthesia, especially if they are undergoing a
blepharoplasty. Common preventive tactics include using scleral
shields and ocular lubricants.
Chapter 27
ANSWER 1: C. A transcolumellar incision divides the columellar
artery during the open approach.
ANSWER 2: D. A spreader graft placed between the dorsal septum
and upper lateral cartilage can improve airflow through the internal
valve and the appearance of dorsal esthetic lines.
ANSWER 3: D. Subdermal defatting of the nasal tip in combina­
tion with the open approach can compromise blood supply to the
nasal tip.
ANSWER 4: D.
ANSWER 5: C. At the level of the orbital rim, the supratrochlear
artery is located superficial to the periosteum.
ANSWER 6: C. Spreader grafts would correct airway obstruction
due to the internal valve. Septoplasty and turbinate reduction can
be useful to address other causes of airway obstruction. Tip grafts
would be more likely used for cosmetic refinement of the nasal tip
rather than to address airway obstruction.
ANSWER 5: D. Leech therapy can place patients at risk for infec­
tious complications related to inoculation with Aeromonas
hydrophila. To reduce this risk, patients undergoing leech therapy
should receive prophylactic antibiotics from the fluoroquinolone
and/or aminoglycoside families.
ANSWER 6: D. The ALT is supplied by perforators arising from
the descending branch of the lateral femoral artery.
ANSWER 7: C. The landmark for finding the SGA is the junction
of the middle and medial thirds of the piriformis, and the artery is
usually above or cephalad to the piriformis at this point.
ANSWER 8: B. The superficial radial nerve can be and not infre­
quently is damaged if great care is not taken with harvest of the
radial forearm flap.
ANSWER 9: D. The sartorius is a type 4 because it is supplied by
segmental vessels.
ANSWER 10: A. The latissimus dorsi does not border the quad­
rangular space; it lies just distal to it.
Chapter 26
ANSWER 1: B. The extracanthal portion of the orbicularis (lateral
to the medial canthus) is responsible for forceful eyelid closure,
squeezing, and strong animated movements of the eyelid. The int­
racanthal portion is responsible for blinking, tone of the eyelid, and
the lacrimal pumping mechanism. The intracanthal portion is
innervated by the buccal branch of the facial nerve. This explains
why subciliary incisions, which violate the zygomatic branches of
the facial nerve, do not disrupt normal, resting lid tone.
ANSWER 2: B. The arcuate expansion of Lockwood’s ligament is
the anatomic structure that separates the central and lateral lower
lid retroseptal fat pads. Its release from the orbital rim facilitates
retroseptal fat repositioning across the inferior orbital rim in
patients with a distinct palpebral-malar groove, otherwise known
as a defined lid-cheek junction.
ANSWER 3: D. Prominent eyes measure 18 mm or greater with a
Hertel exophthalmometer. The device rests upon the lateral orbital
rim, and this reference point is the bony landmark from which the
measurement to the corneal surface is made. Prominent eyes place
lower eyelids at risk for malposition following lower eyelid surgery.
ANSWER 4: A. If the examiner cannot correct lower lid malposi­
tion with a single finger directed upward at the lateral canthus, it is
unlikely that a lateral canthal tendon tightening procedure alone
will be effective in correcting the deformity. Correction achieved
with upward pressure of a second figure at the midpoint of the
lower lid, in the absence of skin shortage, generally indicates that a
middle lamellar graft, in conjunction with lateral canthal tighten­
ing, will be effective in restoring the lower lid to its native resting
position at the lower corneoscleral limbus.

351
platysma, and is therefore at greatest risk for injury with attempted
resection of the gland.
ANSWER 10: A. The SMAS is continuous with the temporopari­
etal fascia superiorly and the platysma inferiorly. The parotid fascia
and masseteric fascia are both deep to the SMAS and help protect
the underlying facial nerve.
Chapter 29
ANSWER 1: B. The lateral femoral cutaneous nerve is at risk for
injury during abdominoplasty. The nerve emerges superficially
~2 cm medial to the anterior superior iliac spine (ASIS), and dis­
section in this area should be superficial to protect the nerve and
reduce the risk of developing neuralgia paresthetica, a syndrome
characterized by numbness, tingling, and burning pain.
ANSWER 2: B. The most likely finding is a neuroma of the
medial antebrachial cutaneous nerve of the arm. This nerve extends
down the ulnar side of the arm, medial to the brachial artery,
pierces the deep fascia with the basilic vein (about the middle of
the arm), and divides into a volar and an ulnar branch. Injury is
uncommon but may occur if dissection down to the basilic vein
occurs distally.
ANSWER 3: B. The best option for treating vertical and horizontal
excess of the abdomen is the abdominoplasty with a fleur-de-lis or
vertical component. Failure to excise skin in the vertical dimension
will leave a significant amount of epigastric laxity and this will
appear worse with abdominal plication.
ANSWER 4: C. The most likely cause of an upper abdominal
bulge 8 weeks out from surgery is failure to adequately plicate the
tissues above the level of the umbilicus. Failure to plicate all the
way to the xiphoid can also produce a prominent bulge
postoperatively.
ANSWER 5: D. The tumescent technique has the lowest amount
of blood loss in the aspirate (1%).
ANSWER 6: C. The landmarks most commonly used for reposi­
tioning the umbilicus is the intersection of a line connecting the
highest point of the iliac crest with the midline.
ANSWER 7: A. During closure of a medial thigh lift, the medial
thigh flap is advanced upward, and the deep dermis is sutured to
the Colles’ fascia. This helps to support and pull the skin flap
upward and relieves tension on the skin closure. If this is not per­
formed, distortion of the vulva can result.
ANSWER 8: E. The most common complication directly related
to ultrasound-assisted liposuction is the formation of a seroma,
defined as a fluid collection at the operative site of >50 mL and/or
requiring repeated aspiration for control. This complication is
observed in ~10% of patients following large-volume ultrasound-
assisted liposuction of the abdomen.
ANSWER 7: D. Resection of the medial crura will decrease tip projec­
tion. The other answers all contribute to increasing tip projection.
ANSWER 8: C. Saddle nose deformity can be caused by overresec­
tion of the nasal dorsum as well as excessive resection of the nasal
septum, leading to loss of dorsal structural support.
ANSWER 9: C. A forehead flap would cover the defect, but would
require multiple stages and incur a greater likelihood of complica­
tions in an elderly woman with a relatively small defect size. Local
flaps are therefore preferable.
ANSWER 10: C. The ideal nasolabial angle in a female patient is
approximately 100 to 110 degrees. In men, the nasolabial angle is
closer to 90 degrees.
Chapter 28
ANSWER 1: B. The great auricular nerve, a branch of C2 and C3,
travels on the superficial surface of the sternocleidomastoid muscle
and enters the lower, posterior surface of the ear. Its branches
supply the lobule as well as the helix, antihelix, and most of the
cranial surface of the ear.
ANSWER 2: D. Hematomas are one of the most common compli­
cations after rhytidectomy, particularly in males. The treatment of
a hematoma is immediate evacuation. Blood pressure control is the
most important preventive measure; however, vomiting, coughing,
anxiety, and pain should be controlled. Drains do not prevent
hematomas but can help with postoperative swelling/bruising.
ANSWER 3: D. The cervical branch innervates the platysma, which
plays a role in depression of the oral commissure in patients with
full denture smile. The other possibility of a marginal mandibular
branch injury is unlikely because the patient is able to evert and
purse the lower lip.
ANSWER 4: C. A male patient is at increased risk for a hematoma,
especially if he has a history of hypertension. The clinical presenta­
tion of unrelenting, asymmetric ear and facial pain is a hematoma
until proven otherwise.
ANSWER 5: D. A deep plane facelift denotes dissection deep to the
SMAS layer. The other techniques do not involve any dissection
beneath the SMAS layer.
ANSWER 6: B. The incidence in females ranges from 2% to 4%
in most series in the literature.
ANSWER 7: C. The incidence in males is more than twice that in
females and is thought to be ~8%.
ANSWER 8: B.
ANSWER 9: C. The marginal mandibular nerve typically lies just
superficial to the submandibular gland capsule, deep to the

352
ANSWER 5: A. The Nd:YAG laser targets red, orange, and brown
pigments.
ANSWER 6: D. Water is the target chromophore for ablative CO2
lasers.
ANSWER 7: A. The FDA currently recognizes injectable silicone
only for ophthalmic use.
ANSWER 8: B. The phases of hair growth are anagen (active
growth), catagen (active hair loss), and telogen (quiescence).
ANSWER 9: C. Hair transplantation is followed by one month of
hair growth, then hair loss, then normal growth after three months.
ANSWER 10: B. Botox works through preventing the release of
acetylcholine at the neuromuscular junction leading to flaccid
paralysis and muscle atrophy.
ANSWER 9: D. During brachioplasty, the risk for contour deform­
ities and unfavorable scarring will be reduced if the skin flaps are
permanently sutured to the axillary fascia.
ANSWER 10: A. Of all body contouring procedures, abdomino­
plasty is most strongly associated with deep venous thrombosis and
pulmonary embolism. In any patient presenting with systemic
systems after abdominoplasty, pulmonary embolism should be sus­
pected and ruled out.
Chapter 30
ANSWER 1: D. At least 1 year should pass after stopping Accutane
in order to allow adnexal healing and proper reepithelialization.
ANSWER 2: C. Croton oil is a component of the Baker-Gordon
phenol peel.
ANSWER 3: D. Skin coagulation and collagen synthesis are desired
effects of chemical peels. Hypopigmentation is problematic but
cardiotoxicity is the most serious side effect of phenol peels.
ANSWER 4: A. Croton oil concentration has been found to be a
more powerful determinant of depth of penetration of phenol than
other factors.

353

Index
Page numbers followed by “f” indicate
figures, “t” indicate tables, and “b” indicate
boxes.
A
Abdominal bulge, after abdominoplasty,
334, 351
Abdominal nerves, in body contouring of
trunk, 295f
Abdominal wall
anatomy of, 99-100, 100f
defects of, 100-103
functions of, 99-100
innervation of, 99
musculature of, 99-100
reconstruction of, 100-103
components separation in, 101-103,
103f
goals of, 100-101
staging, 101
with synthetic mesh, 317-318, 341
vascular supply of, 99
Abdominoplasty, 294
with a fleur-de-lis or vertical
component, 334, 351
Abductor pollicis brevis, 323, 344
Abductor pollicis longus, in de Quervain’s
tenosynovitis, 326, 346
Accessory breast tissue, 78
location of, 315, 339
Accutane, 335-336, 352
Acellular dermal matrices, for wound
healing, 215
Acetaminophen, 5t
Acetaminophen/hydrocodone, 5t
Acinic cell carcinoma, 19
“Acne rosacea”, 230-231, 231f
Acoustic meatus, external, 60
Acquired arteriovenous fistula, 156
Acral lentiginous melanoma, 237
Acrochordon, 232
Acrofacial dysostosis, 41
Actinic keratosis (AK), 228, 228f-229f
Adductor pollicis, 323, 344
Adenocarcinoma, 20
Adenoid cystic carcinoma, 19, 310-311, 336
Adhesions
as complication of extensor tendon
repair, 206
as complication of flexor tendon repair,
200-201
Adipofascial turn down flap, 179
Adjacent tissue transfer closure, 308, 336
Adjacent tissue transfer codes, 7
Aeromonas hydrophila, in leech therapy,
331, 350
Aging, affecting wound healing, 213
Aging face, anatomy of, 287f
Aging nose, 272
Alar batten grafts, 276-278, 276f
Alar rim grafts, 276, 277f
Alexandrite laser, 304t
Allen’s test, 155
Allergic rhinitis, treatment for, 270
Alloplastic frameworks, 65
Alopecia
male-pattern, 305-306
treatment for, 307
from rhytidectomy, 284
Alopecia areata, 305
Alopecia totalis, in female, 305
Amastia, 78
Amazia, 78
Ambulatory status, in pressure sores, 111
Amelanotic melanoma, 237
Ameloblastoma, 23
American Society of Anesthesiologists
(ASA) classification, 6, 6t, 308, 336
Amniotic band syndrome, 147, 148f, 321,
343
Amputation, reconstruction versus, of
lower extremity, 130
Anagen, 304
Analgesics, 5t
Anaplastic large cell lymphoma (ALCL),
89
Anastomotic thrombosis, in microsurgery,
258
Anatomy
facial nerve, 9
head and neck, 9-18
orbital, 16
temporal, 9
trigeminal nerve, 12
Anemia, affecting wound healing, 213
Anesthesia, 1-8
complications of, 4-5
general, 1-2
local, 2-3
Angio-CT, 316-317, 340
Angiosarcoma, 241
Angle of divergence, 272, 273f
Angle’s classification of occlusion, 56f
Animal-skin nevus, 238f
Ankle, muscle compartments of, 129f
Annular pulleys, 327, 346
Anosmia, rhinoplasty and, 280
Anterior plagiocephaly. see Unilateral
coronal synostosis.
Anterior thoracic hypoplasia, 79
Anterolateral thigh (ALT) flap, 255, 257f,
331, 350
myocutaneous, 130
for vaginal reconstruction, 103
Antia-Buch flap, 67, 68f
chondrocutaneous, 314, 339
Antibiotics, for bisphosphonate-related
osteonecrosis, 311, 337
Antiemetic agents, 4t
Antimicrobial agents, for burns, 226
Antimicrobial mouthwashes, for
bisphosphonate-related osteonecrosis,
311, 337
Antivenin, for snake bites, 219
Apert syndrome, 38-40, 39f, 148-149, 149f,
321, 343
classification of, 149t
Apligraf, for wound healing, 215
Arch bar, for noncomminuted mandibular
body fracture, 311, 337
Arcuate line, 100
Arm, anatomy of, 296f-297f
Arterial arcades, of eyelid, 260
Arterial insufficiency, in lower extremity,
133
Arterial supply, of eyelid, 260, 260f
Arterial thrombosis, in microsurgery, 258
Arterialized venous flaps, 244
Arterialized venous “flow-through” flap,
244
Arthrodesis, 190, 190f
total wrist, 191
Arthroplasty, for osteoarthritis, 190
Arthroscopy, 191
Asian eyelids, 266
Asian nose, 272
Aspiration biopsy, for hand masses, 151
Atasoy-Kleinert/Tranquilli-Leali flap, 177,
177f
Athelia, 78
Atypical pigmented nevus, surgical margins
for, 330, 348
Augmentation, 95

354

Augmentation mammaplasty, 94-96
complications of, 95-96
preoperative consideration for, 94-96
age as, 94
implant position as, 94-95
implant size as, 94
implant type as, 94
incision placement as, 95
texture as, 94
subglandular, 94
subpectoral, 94
techniques for, 95
Auricle, 314, 339
middle third of, 70f
proportional analyses of, 62f
Auricular artery, perforating sites of, 61f
Auricular chondritis, 71
Auricular composite grafts, 72-73
Auricular hematoma, 72f
Auriculotemporal nerve, 310, 337
Autogenous auricular reconstruction, 314,
339
in microtia with craniofacial deformities,
314, 339
Autogenous versus prosthetic techniques,
65
Autologous breast reconstruction, 316, 340
implants versus, 316, 340
Autologous collagen/autolagen, 300t-301t
Autologous products, 300t-301t
Autologous tissue reconstruction, 87-88
Avian-derived hyaluronic acids, 300t-301t
Axial flap, 243-244
Axillary fascia, in brachioplasty, 335, 352
Axonotmesis, 113
Axons, decreased number of intact, 319,
342
B
Back reconstruction, 105-106, 106f
Bacterial-cultured hyaluronic acids,
300t-301t
Ballistic injuries to the face, 33
Basal cell carcinoma (BCC), 238-240
clinical spectrum of, 239f
diagnosis of, 238
histologic subtypes of, 238
nevus sebaceous and, 330, 348
risk factors for, 238
treatment for, 238-239
Bell’s palsy, 9
“Benign mixed tumor”, 19
Benign salivary gland tumors, 19
Benign skin conditions, 228-234
Benign skin lesions, 228-232
Benign skin masses, 232-233
Bennett fracture, 171, 171f
Benzodiazepines, 2
Bilateral cleft lip, 45, 45f
repair of, 49, 49f
complications of, 49
Bilateral coronal synostosis, 37
Bilateral sagittal split osteotomy, 57
Bilateral V-Y advancement flaps, 177, 177f
Billing, 7
Bilobed flaps, 247, 247f
for nasal reconstruction, 280, 280f
Binder syndrome (nasomaxillary
dysplasia), 42
Biobrane, for wound healing, 215
Biopsy, of melanoma, 237
Bisphosphonate-related osteonecrosis
(BRON), 23-24
Bites, 219-220
Black widow spider, spider bites from, 219
Blauth type-IIIB classification, 321, 343
Blepharochalasis, 267
Blepharoplasty, 260-268
for lower eyelid, 265-266
for upper eyelid, 265
Blepharoptosis, 264-265
etiologies of, 264-265
Blepharoptosis repair, for upper eyelid,
265
Blepharospasm, 266
Blood pressure control, for hematomas,
333, 351
Blue nevus, 230, 231f
Body contouring, 294-298
of lower extremity/medial thighlift, 297,
298f
of trunk, 294
abdominal nerves in, 295f
complications of, 294
lateral femoral cutaneous nerve in,
295f
of upper extremity, 296-297
anatomy in, 296, 296f-297f
complications in, 296-297
technical point in, 296
Body dysmorphic disorder (BDD), in
plastic surgery patients, 274
Bone scan, for hand masses, 151
Botulinum toxin, ptosis correction and,
332, 350
Botulinum toxin A, 299
versus botulinum toxin type B, 302
Botulinum toxin type B, 299-302
versus botulinum toxin A, 302
Boutonniere deformity, as complication of
extensor tendon repair, 206
Bovine collagen, 300t-301t, 302
Brachial plexus, 112-124
anatomy of, 116f
entrapment of, provocative test for,
119t
injury of
diagnosis of, 116
types of, 116
nerves of, origin of, 117f
Brachioplasty, 296-297
Brachioradialis flap, 252-253
Brachycephaly, 37
Brachydactyly, 145-146, 146f
Branchial arches, in Goldenhar syndrome,
313, 338
Branchial cleft remnants, 17
BRCA mutation, 83, 316, 340
Breast
anatomy of, 75-82, 75f
arterial supply of, 76, 76f-77f
congenital defects of, 75-82
development of, 75
Tanner stage-II of, 315, 339
dimensions of, 76f
embryology of, 75-82
measurements of, 91-92, 91f-92f
pectoralis major, innervation of, 77
Breast cancer, 83-90
autologous breast reconstruction and,
316, 340
diagnosis of, 83
epidemiology of, 83-89
histologic diagnostic modalities for, 83
magnetic resonance imaging of, 83
risk factors for, 83
staging of, 84t
and survival, 85t
treatment for, 85-87, 85f-86f
types of, 83-84
ultrasound of, 83
Breast conservation therapy, 85
contraindications to, 316, 340

355

Breast-feeding, postoperative,
augmentation mammaplasty and,
96
Breast reconstructions, 83-90
autologous tissue, 87-88
options for, 87-88
postoperative considerations for, 89
preoperative considerations for, 89
types of, 87-88
Breast surgery, noncancer, 91-96
augmentation mammaplasty and, 94-96
contraindications to, 91
indications for, 91
mastopexy and, 92-94
reduction mammaplasty and, 91-92
Brow asymmetry, 12
Brow position, botulinum toxin A and,
299
Brown recluse spider, spider bites from,
219
Buccal nerve branch, in rhytidectomy and
neck rejuvenation, 286t
Buccinator muscle, 15-16
in facial artery musculomucosal flap,
331-332, 349
Buerger’s disease, 156
Bulge, from body contouring of trunk, 294
Bullous pemphigoid (BP), urticarial phase
of, 229f
Bundled axon nerve fibers, 112
Bunny lines, botulinum toxin A for, 299
Bupivacaine (Marcaine), 2t
Burn center referrals, 224, 225b
Burned ear reconstruction, 72
Burns, 224-227
complications of, 226-227
initial evaluation of, 224, 224f-225f
major, 329, 348
management of, 226
physiology of, 224, 225f
reconstruction, 224-227
supportive care of, 226
volume, 224
zones of, 224
Byrd classification, of lower extremity
fractures, 127-129, 130t
C
Cadaveric collagens, 300t-301t
Calcifying epithelioma of Malherbe. see
Pilomatricoma.
Calcifying skin disorders, 234
Calcinosis cutis. see Calcifying skin
disorders.
Calciphylaxis, 234
Camptodactyly, 142-143
Cancer
see also specific cancers
head and neck, 19-25
Canthal tendons, 262, 262f-263f
Capitate, in proximal row carpectomy, 325,
345
Capitolunate, PRC and, 325, 345
Capsular contracture
augmentation mammaplasty and, 95-96,
96t
patient age and, 317, 341
Capsulopalpebral fascia, 262
Carbon dioxide (CO2), end-tidal,
increased, 308, 336
Carbon dioxide (CO2) laser, 304t
Cardiac arrhythmias, from phenol peels,
335, 352
Carpal anatomy, 184-186, 184f-186f
Carpal arthritis, 191
Carpal canal
anatomy of, 195
contents of, 326-327, 346
Carpal fractures, common, 187-190
distal radius fracture, 187-190
hamate fractures, 190
scaphoid fracture, 188-189, 190t
trapezium fractures, 190
triquetrum fractures, 189-190
Carpal ligament injuries, common, 187
lunotriquetral (LT) ligament injury,
187
perilunate dislocation, 187, 187f-189f
scapholunate (SL) ligament dissociation,
187
Carpal tunnel syndrome, 120
Carpal tunnel view, for hook of hamate
fracture, 325, 345
Carpenter syndrome, 40
Carpometacarpal (CMC) joint
fifth, 322-323, 344
first, arthritis of, 191, 191t
Cartilage graft with posterior auricular
tunnel procedure of Converse, 69,
69f
Cat bites, 219
Catagen, 305
Caudal septum, deviation to right of, 313,
338
CD30, 317, 341
CDCR. see Conjunctivodacryocystorhi­
nostomy (CDCR).
Celecoxib, 5t
Cell-cultured collagen, 300t-301t
Central hand deficiencies, 146, 146b,
147f
Cephalic index, 38t
Cephalic trim, 275, 275f
Cephalometric analysis, in orthognathic
surgery, 56f
Cervical branch injury, mentalis muscle
and, 309, 336
Cervical mental angle, normal range of,
334, 351
Cervical nerve branch, in rhytidectomy
and neck rejuvenation, 286t
Cheek, sensory innervation of, 13
Chemodenervation, botulinum toxin A for,
299
Chemotherapy
for breast cancer, 86
for melanoma, 238
Chest wall
anatomy of, 97, 97f
bony framework of, 97
defects of, 97-99
musculature of, 97, 98t
reconstruction of, 97-99
Chloroprocaine (Novocain), 2t
Choanal atresia, 17
Chondritis, auricular, 71
Chondrodermatitis nodularis helicis, 72,
72f, 231-232, 231f, 330, 348
Chondrosarcoma, of hand, 151, 154
Chronic wounds, nonhealing, reasons for,
327, 347
Cicatricial release, with posterior lamellar
palatal grafting, 332, 350
Circumferential body lift/lower body lift,
294
Clear cell acanthoma, 330-331, 348
Cleft hand, characteristics of, 146t
Cleft lip deformities, 44
incidence of, 45t
Cleft lobe repair, 73
Cleft palate, 313, 338
Cleft palate deformities, 44
incidence of, 45t

356

Clefts, 44-59
care, 48-53
surgical protocol, 48t
craniofacial, 57-58
inheritance of, 45
palate, 45-46
repair, 49
Cleland’s ligament, in Dupuytren’s disease,
322, 343-344
Clenched fist AP view, 325, 345
Clindamycin, 317, 340
Clinodactyly, 143, 143f, 321, 343
Clonidine, 4t
Closed nerve injuries
algorithm for, 115f
repair principles for, 113-114
Closed rhinoplasty, 274-276
Code modifiers, 7-8
Codeine, 5t
Coding, 7
Collagenase injection, for Dupuytren’s
contracture, 158
Collagens, in wound healing, 213-214
Collar button abscess, 221
Colles’ fascia, 297
in medial thigh lift, 335, 351
Columella-septal suture, 278, 279f
Columellar artery, 333, 350
Columellar strut graft, 278, 278f
Combined nerve palsy, tendon transfers
for, 210
Common peroneal nerve, 135f
compression of, 121-122, 133
injury, 133
Compartment syndrome, 157
in lower extremity, 130
Complete syndactyly, 142
Complex regional pain syndrome (CRPS),
122, 122t, 124f
Complex syndactyly, 142
Compliance, in pressure sores, 106-111
Complicated syndactyly, 142
Components separation, 308, 336
plane of dissection for, 318, 341-342
Composite wiring, for fracture
stabilization, 161t
Compression garment, for lymphedema,
320, 342
Compression neuropathies, 112-124, 319, 342
Computed tomography (CT) angiography,
of lower extremity, 129
Computed tomography (CT) scan, for
hand masses, 151
Condylar fractures, ORIF of, 33
Congenital disorders, 17
Congenital hand disorders, 140-150
classification of, 140
“Congenital” trigger fingers, 149-150
Conjunctivodacryocystorhinostomy
(CDCR), 263-264
Conscious sedation, 3
used agents for, 4t
Core biopsy, for breast cancer, 83
Core needle biopsy, for hand masses,
151
Corneal abrasion, 333, 350
Coronal craniosynostosis, 37
“Cortical ring sign”, 187
Cranial sutures, 35, 35f
Craniofacial clefts, 57-58
Craniofacial microsomia, 40-43
spectrum and incidence of associated
extracranial malformations in,
42t
Craniofacial syndromes, 35-43
Craniofacial terms, common, 36
Craniofacial trauma, 26-34
anatomy of, 26-27
ballistic injuries to the face, 33
frontal sinus and frontal bone fractures,
27-28
isolated nasal fractures, 29-30
mandible fractures, 32-33
midface/maxillary fractures, 31-32, 31f
naso-orbital ethmoid (NOE) fractures,
30
orbital fractures, 28-29
pediatric fractures, 33
preoperative considerations for, 27
zygoma and zygomaticomaxillary
complex fractures, 30-31
Craniofrontonasal dysplasia, with
hypertelorbitism, 312, 338
Craniosynostosis, 35-43, 36f
characteristic skull shape depending on
sutural involvement in, 36f
nomenclature and information, 35-36
skull deformity in, 37t
syndromic, 38-40
treatment of, 37
CREST (calcinosis, Raynaud’s
phenomenon, esophageal dysmotility,
sclerodactyly, and telangiectasia)
syndrome, 156-157, 234
Cross-finger flap, 177, 178f
reverse, 177-179, 179f
Crotalidae polyvalent immune fab ovine
(CroFab), for rattlesnake bites,
328-329, 347
Croton oil, 335, 352
Crouzon syndrome (craniofacial
dysostosis), 39, 40f
Crow’s feet, botulinum toxin A for, 299
Cryptotia, 63, 64f, 314, 339
CSF leak, 27-28
Cubital tunnel syndrome, 120
Cultured epidermal autografts, for wound
healing, 215
Current procedural terminology (CPT)
codes, 7
definitions, 7-8
Customer service experience, 308, 336
Cutler-Beard flap, 268
D
de Quervain’s disease, 207
de Quervain’s tenosynovitis, 326, 346
Deep inferior epigastric artery perforator
(DIEAP) flap, 316, 340
Deep peroneal nerve, 135f
nerve injury/compression of, 133
Deep plane facelift, 288t, 291f, 334, 351
Deep venous thrombosis, 6
Deformational plagiocephaly, 38, 38f
Delayed flap, 243
Dental caries, tooth extraction of 3rd molar
and, 311, 337
Depressor septi nasi, 269
Dermabrasion, 303
Dermagraft, for wound healing, 215
Dermal melanocytosis, congenital, 230,
230f
Dermatofibroma, 232-233, 232f
treatment for, 330, 348
Dermatofibrosarcoma protuberans (DFSP),
241, 242f
Dermoid cyst, 232
Desflurane, 2t
Desmoid tumor, 233
Desmoplastic melanoma, 237
Dextran, for thrombosis, 258
Diabetes, abdominal-wall reconstruction
and, 318, 341

357

Diabetes mellitus, affecting wound healing,
213
Diabetic ulcers, in lower extremity, 133
Diazepam, 4t
Diclofenac, 5t
Dieffenbach’s technique, for reconstruction
of middle third of auricle, 70f
Diethyl ether, 2t
Diplopia, 29
Distal carpal row, 184
Distal phalanx
bifid, 144f, 144t
duplicated, 144f, 144t
Distal radioulnar joint (DRUJ), 184-186
Distal radius fracture, splint removal for,
322, 343
Dog bites, 219
Dolichocephaly. see Sagittal
craniosynostosis.
Donor dominance concept, 307
Dorsal blocking, 323, 344
Dorsal intercalated segment instability
(DISI) deformity, 187, 325, 345
Dorsal nasal flap, for nasal reconstruction,
280, 280f
Dorsal skin flaps, for web-space
resurfacing, 142, 142f
Double bubble deformity, 95
Double crush phenomenon, 117
“Double jaw” surgery, 57
Dressings, for wound, 215
Dry eye syndrome, 266
Ductile carcinoma in situ (DCIS), 316, 340
Duplication disorder (type III), 143-144
Dupuytren’s contracture, 157-158
fascial anatomy of, 157t
treatment of, surgical options for, 158t
Dural tear, 311, 337
Dysfunctional tear syndrome, 266
Dystopia, orbital, from dural tear, 311, 337
E
Ear
burned, reconstruction, 72
deformations/congenital malformations,
63-65
external, 60
sensory innervation of, 62
stages in development of, 60f
framework fabrication, rib cartilage
harvest for, 66f
lop, neonate, 64f
moderately constricted, 63f
normal, 62
anatomical relationships of, 62f
prominent, 63
prosthesis, osseointegrated implants
with, 67f
reconstruction, 60-74
anatomy of, 60-62, 60f
embryology of, 60-73
replantation, 71
sensory innervation of, 13
Stahl’s, 63, 64f
trauma, 71
Ear deformity, optimal timing of
correction of, 314, 339
Ear molding, optimal timing of, 314, 339
Earlobe
reconstruction of, 71f
repair of, 74f
Ectopic breast tissue, 78
Ectropion, 227
from blepharoplasty, 266
involutional, versus involutional
entropion, 267
Edema, rhinoplasty and, 280
Electrical injury, 227
high and low voltage in, 330, 348
Electrical stimulation, of distal nerve end,
309, 336
Electrodiagnostic studies, for brachial
plexus injuries, 116
Electromyography (EMG), for peripheral
nerve injuries, 113
Electrophysiology testing, for peripheral
nerve injuries, 113
Embolism, pulmonary
after abdominoplasty, 335, 352
from body contouring of trunk, 294
from suction-assisted lipectomy, 298
Emergent operative reduction, for trapdoor
orbital floor fracture, 311, 337
Encephaloceles, 17
Encephalopathy, from body contouring of
trunk, 294
Enchondroma, of hand, 151, 153
End-to-side anterior interosseous nerve
(AIN)-to-ulnar nerve transfer, 319,
342
Enflurane, 2t
Enophthalmos, 29
Entropion, involutional, versus involutional
ectropion, 267
Enzymatic debriding agents, 216
in wound management, 327, 346-347
Epiblepharon, 266-267, 266f
Epidermal cyst. see Epidermoid cysts.
Epidermal inclusion cyst, 152, 152f
Epidermoid cysts, 232, 330, 348
Epinephrine, 3
Epineurium, 112
Epithelial cell migration, in wound healing
process, 212
Epithelioid sarcoma, of hand, 151, 154
Eponychium, 173
Erbium laser, 304t
Erythema, lasers and, 303
Escharotomy, for burns, 226
Esthetic septorhinoplasty, 273-274
Ethmoidal nerve, of nose, 269
Etomidate, 1t
Eustachian tube, 60
Evaluation and management (E/M) codes,
7
Ewing sarcoma, of hand, 154-155
Excisional biopsy
for breast cancer, 83
for hand masses, 151
Exorbitism, 36
Extensor carpi radialis brevis (ECRB), 326,
346
Extensor digitorum brevis manus (EDBM),
346
Extensor pollicis brevis, in de Quervain’s
tenosynovitis, 326, 346
Extensor pollicis longus (EPL) tendon,
rupture of, 188
Extensor tendon
anatomy of, 202-205, 202f-204f
compartments of, 205
general repair principles of, 206
injuries of, 206-208
de Quervain’s disease as, 207
intersection syndrome as, 208
at zone-1, 206-208
at zone-2, 207
at zone-3, 207
at zone-4, 207
at zone-5, 207
at zone-6, 207
at zone-7, 207
at zone-9, 207

358

intrinsic, 205
zones of, 205, 206f
External acoustic meatus, 60
External carotid artery, branches of, 16
External ear, 60
sensory innervation of, 62
stages in development of, 60f
External fixation, for fracture stabilization,
161t
External nasal valve, 269
External oblique, 98t, 99-100, 102f
External oblique turnover flap, 251
Extravasation injuries, wound healing and,
215-216
Extrinsic carpal ligaments, 185, 185f-186f
Eyebrow reconstruction, 307
Eyelid
anatomy of, 260-268, 260f
canthal tendons in, 262, 262f-263f
inferior oblique muscle in, 262
Lockwood ligament in, 262
lower layers of, 260
orbicularis oculi muscle, 261, 261f
orbital fat, 260
orbital septum in, 261
orbitomalar ligament/orbicularis
retaining ligament in, 262, 262f
retractors, 261-262
sensory innervation in, 261, 261f
upper layers of, 260-262
vascular supply in, 260, 260f
Whitnall ligament in, 262
blepharoplasty for, 260-268
evaluation of, 264
external examination in, 264
globe position in, 264
laxity in, 264
levator function on, 264
ptosis in, 264
tear production in, 264
visual acuity in, 264
physiology of, 263-264
closed, 263
lacrimal drainage system in, 263-264,
263f
lacrimal function in, testing of, 263
lacrimal pump failure in, 263
normal tear flow in, 263
open, 263
reconstruction of, 267-268
Eyelid retractors, 261-262
chemodenervation of, blepharoptosis
and, 265
Eyes, prominent, measurement of, 332,
350
F
Face
layers of, 16
and neck, vascular anatomy of, 61f
region, surgical options for, 12b
sensory nerves of, 14f
sensory supply of, 13f
Facial artery musculomucosal flap, 248,
252f
Facial artery myomucosal flap, 49, 52f
Facial buttresses, 26-27
Facial dyskinesis, 12
Facial nerve, 9-17
buccal branch of, 332-333, 350
cervical branch of, 334, 351
repair/reconstruction of, 11-12
Facial nerve branching, pattern of, 10f
Facial palsy, 9-11
head and neck anatomy and, 9-18
“False ribs”, 97
Fanconi’s anemia, 141t
Fasanella-Servat procedure, 265
Fascia defects, approach to, 101
Fascicle, 112
Fasciotomies, decompressive, for
compartment syndrome, 329,
348
Fat grafting, 302
Felon, 222
anatomy of, 222f
Female-to-male surgery, 105
Femoral arteries, 126f
Femoral head, resection of, 318, 341
Femoral triangle, 297, 298f
Fentanyl, 4t
Fibroadenoma
of breast, 78-79, 79f
giant, surgical excision for, 315, 339
Fibroblast growth factor receptor type 2
(FGFR-2), in Apert syndrome, 321,
343
Fibronectin, 212
Fibrous histiocytoma. see Dermatofibroma.
Fibula flap, 133
Filariasis, 320-321, 342
Fine-needle aspiration, for breast cancer,
83
Fingers, flexors of, 195
flexor digitorum profundus (FDP), 195
flexor digitorum superficialis (FDS),
195
flexor pollicis longus (FPL), 195
injury to, 201
Fingertip, soft-tissue amputation of,
173-183, 176f
common local flaps in, 177-179,
177f-179f
First-degree burns, 224, 329-330, 347
First dorsal metacarpal artery flap, 179-181,
180f, 323-324, 344
First dorsal metatarsal artery flap, 133
First web-space free flap, 181
Fist-in-palm deformity, 211
Flaps, 243-259
classification of, 244
Mathes-Nahai, 244, 245f
type-I, 244b
type-II, 244b
type-III, 245b
type-IV, 245b
type-V, 245b
considerations in, 259
definitions of, 243-244
of head and neck, 248
facial artery musculomucosal, 248,
252f
forehead, 248, 250f-251f
scalp, 248, 248f-250f
submental myocutaneous, 248, 252f
temporoparietal fascia, 248
local, common, 245-247
bilobed, 247, 247f
rhomboid, 245, 246f
W plasty, 245, 246f
Z plasty, 245-247, 246f
of lower extremity, 130-133, 253-256
anterolateral thigh, 255, 257f
free fibula, 255-256
gastrocnemius, 255
gluteal artery, 253
gracilis, 254, 257f
great toe, 256
groin, 253, 256f
iliac crest osteocutaneous, 253-256
lateral calcaneal, 256
medial femoral condyle, 255
Extensor tendon (Continued)

359

medial plantar artery, 256
peroneal artery perforator, 255
rectus femoris, 254
reverse sural artery, 255, 258f
sartorius, 254
Shaw, 253
soleus, 255
monitoring of, 259
of trunk, 248-252
external oblique turnover, 251
latissimus dorsi, 248
pectoralis major, 248-252
rectus abdominis, 251-252
scapular/parascapular, 249-251, 253f
serratus anterior, 248-249
trapezius, 248, 252f
of upper extremity, 252-253
brachioradialis, 252-253
lateral arm, 252, 254f
medial arm, 252
posterior interosseous artery, 252-253
radial forearm, 253, 255f
visceral, 258
jejunal, 258
omental, 258
Fleur-de-lis, 294
Flexor carpi radialis (FCR), 195
Flexor carpi ulnaris (FCU), 195
Flexor digitorum profundus (FDP), 195
Flexor digitorum superficialis (FDS), 195
Flexor digitorum superficialis (FDS)
tendons, 326-327, 346
to flexor digitorum profundus transfer,
326, 346
Flexor pollicis longus (FPL), 195, 326, 346
injury to, 201
Flexor tendon
anatomy of, 195
general repair principles, 195-201, 200b
annular pulley disruptions, 199-200
complications of, 200-201
early postoperative motion in, 201
partial tendon lacerations, 199
strength of, 199
technique for, 199
healing of, 195, 200f
injuries of, 201
at flexor pollicis longus, 201
spaghetti wrist as, 201
stenosing tenosynovitis as, 201
zone-1 injury as, 201
zone-2 injury as, 201
zones-3 to 5 injury as, 201
zones of, 195, 200f
Flexor tenosynovectomy, for trigger finger,
325, 345
Flexor tenosynovitis, 221
management of, 329, 347
“Floating ribs”, 97
Floor of mouth (FOM) cancer, 22
Fluid resuscitation, for burn, 226
Flumazenil, 4t
5-Fluorouracil, for chondrodermatitis, 330,
348
Folate, for wound healing, 212
Fonticulus frontalis, failed closure of, 17
Foot
anatomy of, 138f
muscle compartments of, 125, 129f
Foramen, 14
Foramen rotundum, 309, 336
Forehead, sensory innervation of, 13
Forehead flap, 248, 250f-251f, 333, 351
for nasal reconstruction, 281, 282f
Forehead rhytids, botulinum toxin A for,
299
Foreign language, fluency in, 308, 336
Form-stable breast implants, 317, 341
Four-corner fusion, 191, 325, 345
Four-flap Z (4Z) plasty, 141, 141f
Fournier gangrene, 220, 328, 347
Frankfurt horizontal plane, 55
Free fibula flap, 255-256
Free flaps, of lower extremity, 129
Free functioning muscle transfers, 211,
211b
Free radial forearm flap, 104
Free toe pulp flap, 179
Free transverse rectus abdominis
myocutaneous (TRAM) flap, 316,
340
Freestyle flap, 243
Frey’s syndrome, 20
Frontal bone fractures, 27-28
Frontal nerve branch, in rhytidectomy and
neck rejuvenation, 286t
Frontal sinus, 27-28
anatomy, 27
development, 27-28
fractures
treatment algorithm, 28f
treatment for, 311, 337
Frontalis suspension, 265
Fronto-orbital advancement, for unilateral
coronal synostosis, 312, 338
Frostbite, 227, 329, 348
Full abdominoplasty, 294
Furlow double-opposing Z plasty, 50f
Furlow palatoplasty, 54
Furnas conchomastoid sutures, placement
of, 73f
G
Gabapentin, 5t
Galactorrhea, 82
Gamekeeper’s thumb, 170, 170f
treatment for, 323, 344
Gamma radiation, 330, 348
Ganglion cysts, of hand, 151-154, 152f
Garrod’s nodules, 158
Gastrocnemius flap, 130, 255
Gender reassignment surgery, 104-105
Genetic skin disorders, 233-234, 233t
Genioplasty, 57
Genital reconstruction, 104-105
Genodermatoses, 233-234, 233t
Geometric wedge resection, 68f
Germinal matrix, of nails, 173
Giant cell fibroblastoma. see
Dermatofibrosarcoma protuberans
(DFSP).
Giant cell tumor, of hand, 152-153, 153f
Gilula’s lines, 186, 186f
Glabellar rhytids, botulinum toxin A for,
299
Glomus tumors, 322, 343
in hand, 156, 156f
Gluteal artery flap, 253
Gluteal fold flap, for vaginal
reconstruction, 103
Glycolic acid peel, 302
Goldenhar syndrome, 40
branchial arches in, 313, 338
Gorlin syndrome, 239-240
Gout, of hand and wrist, 194, 194t
Gracilis flaps, 130, 254, 257f
myocutaneous, for vaginal
reconstruction, 103
Grafts, used in rhinoplasty. see
Rhinoplasty, grafts used in.
Great auricular nerve, 309, 336
Great toe flap, 256
Groin flap, 253, 256f

360

Gross flexion deformity, treatment for, 323,
344
Growth factors, in wound healing process,
212, 213t
Gunshot wound, 116
Gustillo classification, of lower extremity
injury, 125-127
Gynecomastia, 80-81
classification of, 81t
diagnosis of, 81, 81f
etiology of, 80b
karyotyping of, 81
pharmacologic sources of, 80b
Simon grade IIB, 315, 339
treatment options for, 81
H
Hair
anatomy of, 304-307, 305f
growth of, 304-306
Hair loss, in female, 305
Hair restoration, 304-307
anatomy in, 304-307, 305f
hair growth and, 304-306
Hair transplantation, 336, 352
Halothane, 2t
malignant hyperthermia and, 308, 336
Hamate fractures, 190
Hamilton-Norwood classification system,
for male-pattern alopecia, 306,
306f
Hand
abscess, 221-223
arthritis, 184-194
deep spaces of, 221f
development of, 321, 343
embryology of, 140
formation of, timing of, 140t
gout, 194, 194t
incisions of, 222f
infections of, 221-223, 223t
osteoarthritis of, 190-191, 190f
basilar/first carpometacarpal (CMC)
joint arthritis, 191, 191t
carpal arthritis and, 191
psoriatic arthritis of, 194t
rheumatoid arthritis of, 191-193, 192t
finger involvement in, 192,
192f-193f
joint involvement in, 192
management of, 192
treatment of, 193
wrist involvement in, 192
scleroderma of, 193, 194t
systemic lupus erythematosus of,
194t
tendon ruptures in, 193
trigger finger, 193
vascular tumors of, 155-156
Hand disorders, congenital, 140-150
Hand fractures and dislocations, 160-172
distal phalanx injuries, 161-164
distal phalanx fractures and DIPJ
fracture dislocations, 163-164
intra-articular fracture/DIPJ fracture
dislocation, 164, 164f
jersey finger, 162, 162t, 163f
mallet finger, 161-164, 162f
metacarpal and phalangeal fractures
complications of, 172
general treatment of, 160-161, 160f,
161t
metacarpal phalangeal joint (MCPJ)
injuries, 168-170
dislocation, 168-170, 168f
fracture dislocation, 169, 169f,
169t
metacarpal fractures and, 169-170,
170f
proximal phalanx/proximal
interphalangeal joint injuries,
164-167, 164f-168f
thumb injuries, 170-171
Hand masses, 151-159
benign, 151-154
malignant, 154-155
Hanging columella, 273
Head and neck
anatomy, 9-18
essential sensory innervation of, 13
flaps of. see Flaps, of head and neck
lymph nodes, drainage pattern of,
20f
Headache, with sensory changes on
tongue, in lidocaine toxicity, 308-309,
336
Health Insurance Portability and
Accountability Act (HIPAA),
5-6
Hemangioma, 19, 24-25
in hand, 155-156, 155f
vascular, 310, 337
Hematoma, 71, 334, 351
augmentation mammaplasty and, 96
auricular, 72f
from rhytidectomy, 284
Hemi-hamate arthroplasty, 323, 344
Hemostasis, in wound healing, 212
Heparin-induced thrombocytopenia
(HIT), flaps and, 259
Hereditary arthro-ophthalmopathy, 43
Herpetic whitlow, 223
Hertel exophthalmometer, 264
Hidradenitis suppurativa, 220
Hurley stage-III, complete excision for,
329, 347
High median nerve palsy, tendon transfers
for, 209-210
Hildreth’s sign, 156
Holt-Oram syndrome, 141t, 321, 343
Hook nail deformity, 174, 175f, 324, 345
Hook of hamate fracture, carpal tunnel
view for, 325, 345
Horizontal buttresses, 26, 26f
Horizontal nasal lines, botulinum toxin A
for, 299
Horner syndrome, blepharoptosis and, 265
Horseshoe abscess, 221
Hughes tarsoconjunctival flap, 267, 267f
Human bites, 219-220
“Humpback deformity”, 189
Hyaluronic acid, 299
Hyaluronidase, in infiltration injury, 327,
346
Hydromorphone, 5t
Hyoid bone, excision of central portion of,
309, 336
Hyperbaric oxygen, for wound healing, 216
Hyperpigmentation, lasers and, 303
Hypertelorbitism, craniofrontonasal
dysplasia with, 312, 338
Hypertelorism, 36
Hyperthermia, malignant, 4-5, 308, 336
halothane and, 308, 336
Hypertrophic scars, 216, 217t
from body contouring of upper
extremity, 296
laser treatment of, 327, 347
Hyphema, 267
Hypoglycemia, in burned child, 330, 348
Hyponychium, 173
Hypopharyngeal cancer, 22
Hypopharynx, 22

361

Hypoplasia, of internal thoracic artery, 315,
339
Hypoplastic thumb, 141
Hypotelorism, 36
Hypothenar hammer syndrome, 121
workup for, 322, 343
I
Ibuprofen, 5t
Iliac crest osteocutaneous flap, 253-256
Iliohypogastric nerve, in body contouring
of trunk, 294
Ilioinguinal nerve, in body contouring of
trunk, 294
Imiquimod (Aldara)
for basal cell carcinoma, 239
for squamous cell carcinoma, 241
Implant-based breast reconstruction, 87
Implantable venous Doppler, in flap
monitoring, 259
Incision and drainage (I&D), for infection,
312, 337
Incisional biopsy, for hand masses, 151
Incomplete syndactyly, 142
Incontinence, pressure sores and, 106
Infection
augmentation mammaplasty and, 95
in metacarpal and phalangeal fractures,
172
rhytidectomy and, 284
Inferior alveolar nerve, 12
Inferior border locking plate, for
noncomminuted mandibular body
fracture, 311, 337
Inferior gluteal artery perforator (IGAP)
flaps, 88
Inferior oblique muscle, 262
Inflammatory phase, of wound healing,
212
Inflammatory ulcer, biopsy of, 328, 347
Inframammary fold, nipple and, distance
between, 314, 339
Infraorbital nerve, 13
of eyelids, 261
of nose, 269
Infratrochlear nerve
of eyelids, 261
of nose, 269
Infundibulum, 304
Inhalational agents, 1
important characteristics of, 2t
Injectables, 299-302
complications of, 299
definition of, 299-302
types of, 299-302, 300t-301t
Integra, for wound healing, 215
Intense pulsed light (IPL) laser, 304t
Intercostal artery, eighth, 331, 349
Intercostal artery perforators, 314, 339
Intercostal nerve
4th, cutaneous branches of, 315, 339
in body contouring of trunk, 294
Intercostobrachial nerve, in breast
augmentation, 317, 341
Interdomal sutures, 278, 279f
Interferon-α2b, for melanoma, 238
Interfragmentary fixation, for fracture
stabilization, 161t
Intermetacarpal ligament, 323, 344
Internal mammary artery (IMA)
perforators, 314-316, 339
Internal mammary/parasternal lymph
nodes, lymph drainage of, 315, 339
Internal nasal valve, 269
Internal oblique, 100, 102f
Intersection syndrome, 208
Intra-articular fracture, nondisplaced, with
radial styloid involvement, 324-326,
345
Intramedullary device, for fracture
stabilization, 161t
Intraosseous wires, for fracture
stabilization, 161t
Intratendinous nodule excision, for trigger
finger, 325, 345
Intravenous agents, 1-2
clinical characteristics of, 1t
Intrinsic carpal ligaments, 185, 185f-186f
Intrinsic flexors, 195, 200f
Inverted V deformity, nasal, 279
Ischial pressure sores, flaps for, 111
Isoflurane, 2t
Isolated anterior table fractures, 27
Isolated cleft palate, 45
Isolated limb perfusion, for melanoma,
238
Isolated nasal fractures, 29-30
Isolated zygomatic arch fracture, 30
J
Jersey finger, 162, 163f
Leddy-Packer classification of, 162, 162t
Jessner’s solution, 302
Jeune syndrome, 315, 340
Jones-I test, for lacrimal function testing,
263
Jones-II test, for lacrimal function testing,
263
Jones tests, for lacrimal function testing,
263
Jugular foramen, 14
“Jumping man” flap, 141
Juvenile breast hypertrophy, 78
Juvenile melanoma, 230, 230f
K
Kaposi’s sarcoma, 242
Keloid scars, 216, 217t, 327, 346
Keratoacanthoma, 228-232, 228f, 240,
241f
Kernahan’s classification, 46f
Ketamine, 1, 1t, 4t
Ketoconazole, gynecomastia and, 315, 340
Ketorolac, 5t
Kirschner pins, for fracture stabilization,
161t
Klippel-Trenaunay syndrome, 24
Kutler flap, 177, 177f
L
Laceration, exploration and repair/graft
for, 318-319, 342
Laceration injury, 116
Lacrimal drainage system, 263-264, 263f
Lacrimal nerve, of eyelids, 261
Lactation, postoperative, augmentation
mammaplasty and, 96
Lambdoid craniosynostosis, 37
Lambdoid synostosis, 312, 338
Laryngeal cancer, 22
Larynx, 22
Laser hair removal, 307
Lasers, 303, 304t
Lat dorsi myocutaneous flap, 88
Lateral arm flap, 252, 254f
Lateral calcaneal flap, 256
Lateral canthal tendon, 262, 262f
Lateral cord, of brachial plexus, 116
Lateral crural strut graft, 278, 278f
Lateral femoral cutaneous nerve, in body
contouring of trunk, 294, 295f
Lateral femoral cutaneous neuralgia,
334-335, 351

362

Lateral intercostal artery perforator flap
(LICAP), 317, 341
Lateral plantar nerve, nerve injury/
compression of, 136
Latissimus dorsi, 98t, 99, 332, 350
Latissimus dorsi flap, 248
Laxity, eyelid, 264
Leddy-Packer classification, of Jersey
finger, 162, 162t
Leech therapy, 331, 350
LeFort fractures, 31, 31f
LeFort I advancement
and BSSO setback, followed by cleft
rhinoplasty, 313, 338
and BSSOs of the mandible, 313, 338-339
LeFort I osteotomy, 55-57, 57f
LeFort II osteotomy, 312, 338
Lentigo maligna melanoma, 237
Lesion, Clark classification of, 331, 349
Levator aponeurosis reinsertion/
advancement, 265
Levator complex, 261
Levator labii superioris, 269
Levator veli palatini muscle, 50f, 53
Lid tone, 264
Lidocaine (Xylocaine), 2t
Lidocaine toxicity, headache with sensory
changes on tongue in, 308-309, 336
Light amplification by stimulated emission
of radiation. see Lasers.
Linea semilunaris, 100
Lingual thyroid glands, 17
Lip(s)
cancer, 21-22
reconstruction, 21f
full-thickness musculocutaneous flaps
for, 22f
sensory innervation of, 13
TNM clinical staging system for, 21t
Lipectomy, suction-assisted, 297-298
Lipoabdominoplasty, 294
Lipoma, 232-233
of hand, 152
Lipomata, 330, 348
Liposuction, necklift and, 292
Littler neurovascular island flap, 179-181,
181f
Lobule-type microtia, 65f
Local anesthetic agents, 2t
Lockwood’s ligament, 262
arcuate expansion of, 332, 350
Lop ear, neonate with, 64f
Lorazepam, 4t
Love’s sign, 156
Low median nerve palsy, tendon transfers
for, 209
Lower extremity
anatomy of, 125-136
arterial insufficiency in, 133
diabetic ulcers in, 133
flaps of. see Flaps, of lower extremity
lymphedema in, 136
muscle compartments of, 125
nerve injury/compression in, 133-136
reconstruction of, 125-139
trauma of, 125-130
classification of, 125-129, 129t
management for, 129-130
vascular supply of, 125f-126f
venous stasis ulcers in, 133
Lower eyelid malposition, from
blepharoplasty, 266
Lower lateral cartilages (LLCs), 269
Lower leg
muscle compartments of, 125, 128f
muscles of, 132f
Lower-third defects, in ear, 71
Lunate fossa, in proximal row carpectomy,
325, 345
Lund and Browder method, estimation of
burn size using, 224, 225f
Lunotriquetral (LT) ligament, 185,
185f-186f, 187
injury to, 187
Lunula, 173
Lymph node dissection, for breast cancer,
86
Lymphangiosarcoma, 321, 343
Lymphatic drainage, 60
Lymphedema, 125-139, 321, 343
nonsurgical treatment for, 320, 342
Lymphovenous anastomosis, 320, 343
Lymphovenous bypass, 320, 343
M
Macrodactyly, 145, 145f
Macrodeformation, of wound edges, 327,
346
Macromastia, 91-92
Macrophage, 327-328, 346
in wound healing, 212
Madelung’s disease, 330, 348
Mafenide acetate, 329, 348
for burns, 226
Magnetic resonance imaging (MRI)
for breast cancer, 83
for hand masses, 151
Malar hollowing, secondary to malar fat
pad resorption, rhytidectomy and,
284
Male-to-female surgery, 105
Malignant hyperthermia, 308, 336
halothane and, 308, 336
Malignant salivary gland tumors, 19-20
Malignant skin conditions, 235-242
Mallet finger, 161-164, 162f
Malnutrition, affecting wound healing,
213
Malposition, augmentation mammaplasty
and, 95
Malunion, in metacarpal and phalangeal
fractures, 172
Mammaplasty
augmentation, 94-96
reduction, 91-92
vertical, 92
Mammography, 83
linear or branching calcifications in, 316,
340
Mandible fractures, 32-33
classification of, 32f
Mandibular sagittal split osteotomies, 58f
Mandibular tumors, 23-24
Mandibulectomy, segmental, for squamous
cell carcinoma, of oral cavity, 310,
337
“Mandibulofacial dysostosis”, 40-41, 42f
Marginal mandibular nerve, 334, 351
branch, in rhytidectomy and neck
rejuvenation, 286t
injury to, mentalis muscle and, 309,
336
Margolin’s ulcer, tumors associated with,
331, 349
Mastectomy, 86
skin flap loss in, management of, 317,
340
Mastopexy, 92-95
breast ptosis and, 93, 93f
complications of, 94
goal of, 92-94
preoperative considerations for, 93
techniques for, 93

363

Maxillary division of the trigeminal nerve
(V2), 12
Medial antebrachial cutaneous nerve, in
body contouring of trunk of upper
extremity, 296
Medial arm flap, 252
Medial brachial cutaneous nerve, in body
contouring of trunk of upper
extremity, 296-297
Medial canthal tendon, 262, 263f
Medial cords
of brachial plexus, 116
injury to, 319, 342
Medial crura, resection of, 333, 351
Medial crural sutures, 278, 279f
Medial femoral condyle flap, 255
Medial pectoral nerve, 314, 339
Medial plantar artery flap, 133, 256
Medial plantar nerve, injury/compression
of, 136
Median nerve, 119f
compression of, 119-120
entrapment of, provocative test for,
119t
Mediastinitis, following sternotomy, 97
Medpor (porous polyethylene)/prosthetic
reconstruction, 65
Melanin, in laser hair removal, 307
Melanocytosis, congenital dermal, 330,
348
Melanoma, 235-238, 235f-236f
diagnosis of, 235-236
histologic subtypes/growth patterns of,
237
incidence of, 235-238
risk factors for, 235
staging of, 236, 237b, 237t
superficial spreading, 331, 349
surgical excision for, 331, 349
TNM classification of, 236t
Mental foramen, anatomic landmark of,
309, 336
Mental nerve, 13
Mentalis muscle, nerve injury and, 309,
336
Mepivacaine (Carbocaine), 2t
Merkel cell carcinoma, 241-242, 331, 349
Mesotherapy, 297
Metacarpal fractures, 169-170
base, 169, 170f
general complications of, 172
general treatment of, 160-161, 160f
fracture stabilization techniques in,
161t
indications for, 161t
head, 170
neck, 170
shaft, 170
Metacarpal phalanx
bifid, 144f, 144t
duplicated, 144f, 144t
Metacarpophalangeal joint (MCPJ)
in “fight bite” wound, 328, 347
injuries in, 168-170
dislocation, 168-170, 168f
fracture dislocation, 169, 169f, 169t
metacarpal fractures and, 169-170,
170f
surgical drainage of, 329, 347
Methemoglobinemia, 5
Methicillin-resistant Staphylococcus aureus
(MRSA), 220-221
Metopic craniosynostosis, 36-37
Metopic suture, 312, 338
Micrografting hair growth cycle, 307
Microsurgery, flaps and, 243-259
general considerations in, 258-259
Microtia, 63-65
with craniofacial deformities, 314, 339
lobule-type, 65f
Nagata three-dimensional framework
for, 66f
Midazolam, 1t, 4t
Middle ear, 60
Middle lamellar spacer graft, 332, 350
Middle-third defects, 70
Midface/maxillary fractures, 31-32, 31f
Milk line, of breast, 75, 75f
“Milk streak,” of breast, 75, 75f
Miniabdominoplasty, 294
Minimal access cranial suspension (MACS)
lift, 288t, 290f
Minimally invasive component separation,
with inlay bioprosthetic mesh,
for recurrent ventral hernia, 318,
341
Minor contour deformities, nasal, 280
Minoxidil, 305-306
Mirror hand, 144, 144b, 145f
Moberg flap, 181, 181f
Mobius syndrome, 42-43
Moderately constricted ear, 63f
Mohs surgery, 242, 331, 349
Moist dressings, in small-fingertip injuries,
323, 344
Mongolian spot, 230, 230f, 330, 348
Morphine, 5t
Motor nerve cell body, 112
Mucoepidermoid carcinoma, 19
Mucous cyst, 152, 152f, 322, 343
Muenke syndrome, 40
Müller’s muscle, 261-262
resection, 265
Multisuture craniosynostosis, 37
Muscle spasticity, tendon transfers for,
210-211
Muscle transfer, free neurotized, 11-12
Muscles, of nose, 269, 271f
Mustarde sutures, placement of, 73f
Myasthenia gravis, blepharoptosis and, 265
Mycobacterial infections
atypical, 223
nontuberculosis, augmentation
mammaplasty and, 95
Myelomeningocele, reconstruction for, 106,
107f-108f
Myofibroblasts, in wound healing process,
212
N
Nager syndrome, 41, 312, 338
Nail, growth and physiology of, 173, 174f
Nail-bed
and fingernail anatomy, 173, 174f
injuries to, 173-183
hook nail deformity, 174, 175f
lacerations, 173
nonadherence (onycholysis), 174
pincer nail deformity, 174, 175f-176f
split nail deformity, 176
subungual hematoma, 173-176, 175f
Nail-plate removal, for subungual
pigmentation, 322, 343
Nail trephination, and closed treatment of
fracture, 322, 344
Naloxone, 4t
Nasal analysis, ideal, 272, 272f
external, 273t
Nasal deformities, postoperative, 279-280
inverted V, 279
minor contour, 280
open roof, 279
pollybeak, 279

364

rocker, 279
saddle nose, 279-280
Nasal dermoid cyst, 17
Nasal gliomas, 17
Nasal lining, 269
Nasal reconstruction, 280-281
bilobed flap for, 280, 280f
dorsal nasal flap for, 280, 280f
forehead flap for, 281, 282f
of lining, 281, 282f
mucoperichondrial flap for, 281
nasolabial flap for, 281, 281f
options for, 280-281
rhinophyma and, 281
Nasal subunits, 269
Nasal valves, 269, 271f
Naso-orbital ethmoid (NOE) fractures,
30
classification of, 30f
type-III, 311, 337
Nasofrontal duct injury, 27
Nasolabial angle, ideal, 333, 351
Nasolabial flap, for nasal reconstruction,
281, 281f
Nasopalatine nerve, of nose, 269
Nd:YAG laser, 335, 352
Neck, youthful, 291f
Neck dissection, for squamous cell
carcinoma, of oral cavity, 310,
337
Neck rejuvenation, 284-293
Necklift, 284-293
anterior/submental open, 292, 293f
complications of, 293
preoperative considerations for, 284-293,
291f-292f
techniques for, 292-293
Necrosis, skin, from body contouring of
trunk, 294
Necrotizing fasciitis, 220
Necrotizing soft-tissue infections, 220
surgical debridement for, 328, 347
Negative pressure wound therapy
(NPWT), 327, 346
effects on wound, 214-215
Neoadjuvant therapy, for breast cancer,
86
Nerve(s)
anatomy of, 112
physiology of, 113
and rhytidectomy, 286f, 286t
schematic presentation of, 112f
severed, 113f
vascular supply of, 112
Nerve amplitude, 319, 342
Nerve conduction studies (NCSs), for
peripheral nerve injuries, 113
Nerve decompression codes, 7
Nerve entrapment, 117-122
Nerve grafting, of facial nerve, 11
Nerve injury
in body contouring of upper extremity,
296-297
in lower extremity, 133-136
from rhytidectomy, 284
Nerve roots, anterior and posterior, 112,
112f
Nerve transfer, 114, 114b
of facial nerve, 11
Neurapraxia, 113, 319, 342
Neurilemmoma, 233
of hand, 153f
Neurofibroma, 233
Neurofibroma, cutaneous, 330, 348
Neuroma, 122, 123f
Neuroma, of medial antebrachial
cutaneous nerve of arm, 334,
351
Neuromuscular blocking agents, 2
Neuropraxia, from suction-assisted
lipectomy, 298
Neurotmesis, 113
Nevoid basal cell carcinoma, 239-240,
240b
Nevus of Ito, 230
Nevus of Ota, 230, 230f
Nevus sebaceous, 229-230, 229f
“Nevus sebaceous of Jadassohn”, 229-230,
229f
Nipple-areolar complex (NAC), diameter
of, 314, 339
Nitrous oxide, 2t
Node of Ranvier, 112
Nodular melanoma, 237
Nodulo-ulcerative tumor, 240f
Nondepolarizing agents, 2
Nonsynostotic syndromes, 40-43
Nonunion, in metacarpal and phalangeal
fractures, 172
Normal ear, 62
anatomical relationships of, 62f
Nose
anatomy of, 269, 270f
inner layer of, 269
muscles of, 269, 271f
nasal valves in, 269, 271f
outer layer of, 269
sensory innervation of, 269, 272f
subunits of, 269
vascular supply of, 269, 271f
deformity, 47f
physiology of, 270
airway obstruction in, 270
nasal functions in, 270
Nostrils, teardrop configuration of, 272
Notta’s node, 150
Numbness, from body contouring of
trunk, 294, 295f
Nutrients, for wound healing, 212-213
Nutrition
burns and, 226
pressure sores and, 106
O
Occlusion, 55
Oculocardiac reflex, 337
Oculodermal melanocytosis, 230f
Odontogenic keratocyst (OKC), 23-24
follow-up for, 310, 336
Odontogenic tumors, 19-25
Omentum, 99, 99f
Open fracture, classification of, in lower
leg, 129t
Open nerve injuries
algorithm for, 115f
repair principles for, 113
Open reduction internal fixation (ORIF),
33
for distal radius fractures, 188
Open rhinoplasty, 274
Open roof deformity, nasal, 279
Ophthalmic division of the trigeminal
nerve (V1), 12
Opioids, 2
Optic nerve, 309, 336
injury to, 311-312, 337
Oral cavity, 20-22
squamous cell carcinoma of, with
mandibular cortical invasion,
treatment of, 310, 337
TNM clinical staging system for, 21t
Orbicularis oculi muscle, 261, 261f
Nasal deformities, postoperative (Continued)

365

Orbicularis retaining ligament, 262, 262f
Orbital anatomy, 16
surgical, 16f
Orbital cellulitis, 220
Orbital fat, 260
Orbital floor reconstruction, for trapdoor
orbital floor fracture, 311, 337
Orbital fractures, 28-29
Orbital orbicularis muscle, 261
Orbital septum, 261
Orbitomalar ligament, 262, 262f, 333, 350
Orbits, surgical anatomy of, 28f
Orthognathic surgery, 54-57
anatomy in, 45-46, 46f
embryology and, 44
epidemiology in, 44-45
Orthopedics, presurgical, 48
Orticochea chondrocutaneous flap, 69, 69f
Osteoarthritis, of wrist and hand, 190-191,
190f
basilar/first carpometacarpal (CMC)
joint arthritis, 191, 191t
carpal arthritis and, 191
Osteochondroma, of hand, 154, 154f
Osteocutaneous free fibula flap, 104
Osteoid osteoma
of hand, 154
radiographic appearance of, 321-322, 343
Osteomyelitis, pressure sores and, 106
Osteonecrosis, bisphosphonate-related, risk
factors for, 310, 337
Osteoradionecrosis, 21
Osteosarcoma, of hand, 154
Osteotomies, in rhinoplasty, 274, 274f
Otoplasty, 73
complications of, 71
Outer root sheath, 304
P
Pain, from body contouring of trunk, 294,
295f
Pain control, 5
Palatal fistula repair, 49-53
Palatal prosthesis, 313, 338
Palmar interossei, 205
Palmaris longus (PL), 195
as common tendon donor site, 208
Panniculectomy, 294
Papillary cystadenoma lymphomatosum, 19
Parkes Weber syndrome, 25
Parkland formula, 329, 347
Paronychia, 221-222
Paronychium, 173
Parotid duct transection, 309, 336
Parotid nodes, 313-314, 339
Parry-Romberg syndrome/disease
(progressive hemifacial atrophy),
43
Partial tibial nerve transfer, to the tibialis
anterior, 319, 342
Patient safety, 6
Pectoralis major, 98, 98t
Pectoralis major flap, 248-252
Pectus carinatum, 79, 316, 340
Pectus excavatum, 79
Pediatric fractures, 33
Pedicle
inferior, 317, 341
medial, 315, 340
Pedicle vertical rectus abdominis muscle
flap, 318, 342
Peels, 302, 302t
Pencil Doppler, in flap monitoring, 259
Penile reconstruction, 104-105
Perforator flap, 130, 243
dissection of, 316, 340
Perichondritis, 71
Perilunate dislocation, 187, 187f-189f
Mayfield stage-IV, 326, 345
Perineum, reconstruction of, 103, 104f
Perineurium, 112
Perionychium, 173
Periostitis, acute, rhinoplasty and, 280
Peripheral nerve injuries, 112-124
classification of, 113
diagnosis of, 113
repair principles, 113-114
types of, treatments for, 114t
Peroneal artery perforator flap, 255
Peroneal/nerve transfer, 319, 342
Pfeiffer syndrome, 39, 39f
PHACE syndrome, 24
Phalangeal fractures
general complications of, 172
general treatment of, 160-161, 160f
fracture stabilization techniques in,
161t
indications for, 161t
Phalanx
distal, injuries of, 161-164
fractures and DIPJ fracture
dislocations as, 163-164
intra-articular fracture/DIPJ fracture
dislocation as, 164, 164f
Jersey finger as, 162, 162t, 163f
Mallet finger as, 161-164, 162f
proximal, injuries of, 164-167, 167f-168f
Pharyngeal cancer, 20-22
Pharyngeal flaps, posterior, 54, 54f
Pharyngeal wall augmentation, posterior,
54
Pharyngoesophageal reconstruction,
advantages and disadvantages of
commonly used flaps for, 23t
Phenol peel, 302
depth of, 335, 352
Phyllodes tumor, 89f
Pierre Robin sequence, 45
Pilogen, 335, 352
Pilomatricoma, 232, 232f
Pilomatrixoma, 330, 348
Pincer nail deformity, 174, 175f-176f
Plagiocephaly, deformational, 38, 38f
Plantaris, as common tendon donor site,
208
Plates and screws, for fracture stabilization,
161t
Pleomorphic adenoma, 19
Poland syndrome, 79-80, 79f, 149, 149f, 316,
340
Pollicization, index finger, 324, 344
Pollybeak deformity, 279
Poly-L-lactic acid, 302
Polydactyly, 143-144, 321, 343
radial, correction of, complication of,
343
Polymastia, 78
location of, 315, 339
Polymorphonuclear (PMN) leukocytes, in
wound healing, 212
Polythelia, 78
location of, 315, 339
Pontine lesions, 9
Porous polyethylene, 65
Postauricular transposition skin flap, in
ear, 66
Postaxial polydactyly, 143
Postburn contracture, 226-227
Posterior auricular artery, 313, 339
Posterior auricular tunnel procedure of
Converse, cartilage graft with, 69,
69f
Posterior cord, of brachial plexus, 116

366

Posterior interosseous artery flap, 252-253
Posterior interosseous nerve, 326, 346
Posterior table fractures, 27
Posterior thigh flaps, for vaginal
reconstruction, 103
Posterior tibial nerve, compression of, 122
Postoperative nausea and vomiting
(PONV), 4
Posttraumatic carotid-cavernous fistula,
29
Practice management, 5-6
Preaxial polydactyly, 144
Prefabricated flap, 243, 243f
Pregabalin, 5t
Prelaminated flap, 243
Preseptal orbicularis fibers, 261
Pressure sores, 97-111
flaps by location for, 111
postoperative considerations for, 111
preoperative considerations for,
106-111
stage IV, 318, 341
staging of, 106, 109f-110f
Pressure therapy, for keloid scars, 216
Presynaptic acetylcholine release, blockade
of, botulinum neurotoxin in, 336,
352
Pretarsal orbicularis fibers, 261
Prilocaine (Citanest), 2t
Procaine (Novocain), 2t
Profunda arteries, 126f
Proliferative/fibroplastic phase, of wound
healing, 212
Prominent ear, 63, 314, 339
Propecia, 305-306
Prophylaxis, 6
Propofol, 1, 1t
Provocative tests, for nerve entrapment,
119, 119t
Proximal carpal row, 184
Proximal interphalangeal joint (PIPJ),
injuries of, 164-167, 164f-167f
Proximal phalanx
bifid, 144f, 144t
duplicated, 144f, 144t
Proximal row carpectomy, 325, 345
Proximal row corpectomy, 191
Pruzansky classification, of mandibular
deformity, 41f
Pseudoaneurysm, in hand, 155
Psoriasis, female hair loss from, 305
Psoriatic arthritis, of hand and wrist,
194t
Ptosis
of breast, 93, 93f
eyelid, 264
from botulinum toxin A, 299
compensated, 265
congenital, 264, 264f
senile/involutional, 265
Pubertal development, of breast, 77, 78f
Pudendal nerve, 318, 342
Pulmonary embolism
after abdominoplasty, 335, 352
from body contouring of trunk, 294
from suction-assisted lipectomy, 298
Pulsed dye laser, 304t
Purpura fulminans, 220
Pyogenic granuloma, of hand, 153, 153f
Q
Q-switched Nd:YAG (neodymium:yttrium-
aluminum-garnet) laser, 304t
Q-switched ruby laser, 304t
R
Radial deficiencies, 141, 141t
Radial forearm flap, 253, 255f, 332, 350
Radial nerve
compression of, 121
entrapment of, provocative test for,
119t
Radial nerve palsy, 209
tendon transfers for, 209t
Radial recurrent artery, 331, 349
Radial styloidectomy, 191
Radial tunnel syndrome, 121
Thompson approach to, 121f
Radiation
for basal cell carcinoma, 239
for breast cancer, 87
effects of, in skin, 216
for keloid scars, 216
for squamous cell carcinoma, 241
for women, options for, 316, 340
Radius, distal, 186
fracture of, 187-190
splint removal for, 322, 343
Ramsay Hunt syndrome, 9
Random flap, 243
Ranula, 17
Reactive lymph nodes, 17
Reconstruction
of abdominal wall, 100-103
versus amputation, of lower extremity,
130
of back, 105-106, 106f
of chest wall, 97-99
penile, 104-105
of perineum, 103, 104f
of sternal wounds, 97-98
of trunk, 97-111
of vagina, 103, 104f-105f, 105t
Rectus abdominis, 98-99, 98t
Rectus abdominis flap, 251-252
Rectus abdominis myocutaneous (RAM)
flaps, for vaginal reconstruction,
103
Rectus fascia, failure to plicate, 334, 351
Rectus femoris flap, 254
Rectus femoris muscle, harvest of,
functional morbidity of, 331, 349
Rectus sheath, 100, 102f
Recurrence, in body contouring of upper
extremity, 296
Reduction mammaplasty, 91-92
complications of, 92
postoperative lactation in, 91
preoperative considerations for, 91-92
techniques for, 92
traditional, 92
Regional nerve block, 3
Regnault classification, of breast ptosis, 93,
93f
Remodeling phase, in wound healing,
212
Reoperation, augmentation mammaplasty
and, 95
Replantation, 173-183, 182b, 183f
digit by digit, 183
of lower extremity, 130
part by part, 183
relative contraindications, 182
relative indications for, 182-183
of single digits, contraindication to, 323,
344
of thumb, mechanism of injury and, 324,
344
Reverse cross-finger flap, 177-179, 179f, 324,
344-345
Reverse flow flap, 244
Reverse lateral arm flap, 331, 349
Reverse sural artery flap, 255, 258f

367

Revision amputation, for avulsion injury,
324, 344
Rhinitis, treatment for, 270
Rhinophyma, 231f
nasal reconstruction and, 281
Rhinoplasty, 269-283
grafts used in, 276-278
alar batten grafts, 276-278, 276f
alar rim grafts, 276, 277f
columellar strut graft, 278, 278f
lateral crural strut graft, 278, 278f
spreader grafts, 276, 277f
postoperative considerations for, 280
preoperative considerations for, 272-274
aging nose in, 272
Asian nose in, 272
body dysmorphic disorder in,
274
esthetic septorhinoplasty in, 273-274
hanging columella in, 273
photographic documentation in,
274
sutures used in, 276-278
columella-septal suture, 278, 279f
interdomal sutures, 278, 279f
medial crural sutures, 278, 279f
transdomal sutures, 278, 279f
techniques, 274-276
altering tip projection in, 276
cephalic trim in, 275, 275f
closed, 274-276
open, 274
osteotomies in, 274, 274f
septoplasty in, 275, 275f
Rhomboid flaps, 245, 246f
Rhytidectomy, 284-293
complications of, 284
facial layers and, 285f
nerves and, 286f, 286t
preoperative considerations for, 284
techniques in, 288f-291f, 288t
Ricketts’ esthetic plane, 55
Ringer’s lactate, 329, 347
Robin sequence, 312, 337
Rocker deformity, 279
Rofecoxib, 5t
Rolando fracture, 171, 171f
treatment for, 323, 344
Rosacea, 230-231, 231f
“Rule of nines,” estimation of burn size
using, 224f
Rupture
augmentation mammaplasty and, 95
as complication of extensor tendon
repair, 206
as complication of tendon repair, 201
S
Sacral pressure sores, flaps for, 111
Saddle nose deformity, 279-280, 333, 351
Saethre-Chotzen syndrome, 39
Sagittal band, injury to, 326, 346
Sagittal craniosynostosis, 36-37
Sagittal synostosis, 312, 338
Saline, in augmentation mammaplasty,
94
Salivary gland tumors, 19-20, 19t
Sartorius flap, 130, 254
Sartorius muscle, in Mathes-Nahai
classification system, 332, 350
Scalp flaps, 248, 248f-250f
Scalp layers, 27
Scalp reconstruction, with tissue
expansion, 217
Scalp reduction, for male-pattern alopecia,
307
Scalp rotation flaps, 248, 249f
Scaphocephaly (“boat-shaped head”). see
Sagittal craniosynostosis.
Scaphoid fracture, 188-189, 190t
Scapholunate advanced collapse (SLAC)
wrist, 325, 345
deformity, 187
Scapholunate interosseous ligament, tear
of, 325-326, 345-346
Scapholunate (SL) ligament, 185
dissociation in, 187
Scapular/parascapular flap, 249-251, 253f
Scar alopecia, 227
Scarring
abnormal, 216
augmentation mammaplasty and, 96
Schirmer test, 264
Schwann cell tumor, benign, 330, 348
Schwann cells, 112
Schwannoma, 233
of hand, 153, 153f
Sciatic nerve, 134f
Scleroderma, of hand, 156
and wrist, 193, 194t
Sclerotherapy, for venous malformations,
310, 337
Scorpion stings, 219
Scrotum, debridement of, for Fournier
gangrene, 328, 347
Sebaceous carcinoma, 241
Sebaceous glands, 304
Seborrheic keratosis (SK), 229
Second degree burn, 224
Second premolar, as landmark for mental
foramen, 309, 336
Sella-nasion-supramentale (SNB) angle,
55
Semilunar line, 100
Senile keratosis. see Actinic keratosis
(AK).
Senile wart. see Seborrheic keratosis (SK).
Sensory innervation
of eyelids, 261, 261f
of nose, 269, 272f
Sensory nerve action potential (SNAP),
in nerve root avulsion injuries, 319,
342
Sensory supply, of face, 287f
Sentinel lymph node biopsy (SLNB), 86,
331, 349
of melanoma, 237
Septic arthritis, 221
Septoplasty, in rhinoplasty, 275, 275f
Septorhinoplasty, esthetic, 273-274
Septum, 269
Seroma
from body contouring of trunk, 294
from ultrasound-assisted liposuction,
335, 351
Serratus anterior, 98t
Serratus anterior flap, 248-249
Sevoflurane, 2t
Sex, and lymphedema, 321, 343
Shaw flap, 253
Silicone
in augmentation mammaplasty, 94
in dermal filler, 335, 352
in wound healing, 327, 346
Silicone/silicone sheeting, for wound
healing, 213
Silver nitrate, for burns, 226
Silver sulfadiazine (Silvadene), for burns,
226
Simple syndactyly, 142
Singapore flaps, for vaginal reconstruction,
103
62 modifier, 308, 336

368

Skier’s thumb, 170, 170f
Skin closure definitions, 7
Skin closure methods, 7
Skin dehiscence, from body contouring of
trunk, 294
Skin disorders, 228-234
Skin loss, from rhytidectomy, 284
Skin necrosis, from body contouring of
trunk, 294
Skin-only upper blepharoplasty, 265
Skin perfusion, in lower abdomen, zones
of, 88f
Skin resurfacing, 302-304
definition of, 302-304
dermabrasion for, 303
lasers for, 303, 304t
peels for, 302, 302t
pretreatment considerations with, 302
tretinoin for, 304
Skin/soft-tissue deficits, approaches to, 101
Skin-sparing mastectomy, 316, 340
breast cancer recurrence after, 316, 340
“Skin tag”, 232
Skull
anterior aspects of, 15f
inferior aspect of, 15f
Skull fracture, growing, from dural tear,
311, 337
Smooth-muscle cells, destruction of, in
lymphedema, 320, 343
Snake bites, 219
Snap-back test, 264
Snip conjunctivotomy, 332, 350
Social support, in pressure sores, 106
Sodium hydroxide, burn, treatment for,
329, 347-348
Soft-tissue amputations
of fingertip, 173-183, 176f
common local flaps in, 177-179,
177f-179f
of thumb, 179-181, 180f-181f
Soft-tissue infections, 219-223
Soft-tissue masses, benign, 232-233
Solar keratosis. see Actinic keratosis (AK).
Soleus flap, 130, 255
Spaghetti wrist, 201
Spasms, in pressure sores, 111
Speech pathology terminology, 53b
Sphincter pharyngoplasty, 54, 55f
Spider bites, 219
Spiral cord, 322, 343-344
“Spitz nevus”, 230, 230f
Split nail deformity, 176
Split-thickness nail-bed grafting, from
great toe, 324, 344
Split-thickness skin graft, billing of, 309,
336
Spreader grafts, 276, 277f, 333, 350
Squamous cell cancer, of the scalp, surgical
excision for, 330, 348-349
Squamous cell carcinoma (SCC), 240-241
of hand, 151
histologic subtypes of, 240-241
treatment of, 241
Stahl’s ear, 63, 64f
Stener lesion, 170
Stenosing tenosynovitis, 201
Stensen duct, 14-15
Sterile matrix, of nails, 173
Sternal cleft, 80
Sternal wounds, reconstruction of, 97-98
classification of, 99t
flaps for, 98-99
Sternocleidomastoid muscle, nerve in,
333-334, 351
Sternum, 97
Stevens-Johnson syndrome, 227
Stickler syndrome, 43, 313, 338
Stiffness, in metacarpal and phalangeal
fractures, 172
Subcutaneous facelift, 288t, 289f
with SMASectomy, 288t, 290f
Subdermal defatting, of nasal tip, 333,
350
Subglandular breast implants, 317, 341
Submental myocutaneous flap, 248, 252f
Submucoperichondrial dissection, 275f
Submucous cleft palate, 46
Subpectoral breast implant, 317, 340
Subperiosteal facelift, 288t
Subspinale-nasion-supramentale (ANB)
angle, 55
Subungual hematoma, 322, 344
trephination for, 324, 345
Subungual pigmentation, 322, 343
Succinylcholine, 2
Suction lipectomy, 92
Sulfamethoxazole/trimethoprim, for MRSA
infections, 328, 347
“Sunburst”, 154
Superficial inferior epigastric artery (SIEA)
flap, 88
Superficial muscular aponeurotic system
(SMAS) layer, 334, 351
Superficial muscular aponeurotic system
(SMAS) plication, 288f-289f,
288t
Superficial peroneal nerve, 135f
injury/compression of, 133
Superficial radial nerve, in radial forearm
flap, 332, 350
Superficial temporal artery, in forehead
flap, 333, 350
Superficial temporal fascia, facial nerve in,
309, 336
Superior gluteal artery, landmark for, 332,
350
Superior gluteal artery perforator (SGAP)
flaps, 88
unilateral, 318, 341
Superior helix, embryologic origin of, 314,
339
Superior orbital fissure, 309, 336
Superior pharyngeal flap, 54
Supernumerary digit, 143
Supernumerary nipples, location of, 315,
339
Suppurative flexor tenosynovitis, 328,
347
Supraorbital nerve (SON), 13
of eyelids, 261
of nose, 269
Suprascapular nerve, injury to, 319, 342
Supratrochlear artery, in forehead flap, 333,
350
Supratrochlear nerve, 13
of eyelids, 261
of nose, 269
Sural artery flap, 130-133
Sural nerve, injury/compression of, 133
Surface area, in expanded skin, 327, 346
Suspension sutures, necklift and, 292
Suture closure, 36, 36f
Sutures, used in rhinoplasty. see
Rhinoplasty, sutures used in.
Swan-neck deformity, 323, 344
as complication of extensor tendon
repair, 206
Sweet syndrome, 223
Symbrachydactyly, 321, 343
Syndactyly, 142
incomplete, of 3rd webspace, release of,
321, 343

369

Syndromic craniosynostosis, 38-40
Syndromic hemangioma disorders, 24
Syndromic vascular anomalies, 24-25
Synkinesis, 309, 336
Synovial sarcoma, of hand, 155
Synthetic facial fillers, 300t-301t
Systemic inflammatory response (SIR), to
burn, 330, 348
Systemic lupus erythematosus (SLE), of
hand and wrist, 194t
Systemic sclerosis, of hand, 156
T
Tanner stages, 77
TAR syndrome, 141t
“Targeted re-innervation”, 122
Tarsal tunnel, 139f
Tarsal tunnel syndrome, 136
Tear production, evaluation of, 264
Telecanthus, 36
Telogen, 305
Telogen effluvium, female hair loss from,
305
Temporal nerve branch, in rhytidectomy
and neck rejuvenation,
286t
Temporal region, facial layers of, 11f
Temporoparietal fascia (TPF) flap, 248
Tendon
extensor
anatomy of, 202-205, 202f-204f
compartments of, 205
general repair principles of, 206
injuries to, 206-208
intrinsic, 205
zones of, 205, 206f
flexor
anatomy of, 195, 196f-199f
general repair principles of, 195-201,
200b
healing of, 195, 200f
injuries to, 201
zones of, 195, 200f
grafting of, 208, 208b
technical considerations for, 208,
208f
injuries to, 195-211
reconstruction of, 195-211
staged, 208, 208b
repair, strength of, immobilization and,
326, 346
transfers of, 209, 209b, 319, 327, 342, 346
for combined nerve palsy, 210
free functioning, 211, 211b
for high median nerve palsy, 209-210
for low median nerve palsy, 209
for muscle spasticity, 210-211
for radial nerve palsy, 209, 209t
for reconstruction after trauma, 211
technical considerations for, 209
for ulnar nerve palsy, 210
Tension-free repair, for ulnar nerve injury,
319, 342
Tensor veli palatini, 313, 338
Tenzel rotation-advancement flap, 332,
350
Tenzel semicircular flap, 268, 268f
“Terry Thomas” sign, 187
Tessier 3 cleft, 313, 338
Tessier classification of craniofacial clefts,
58f
Testes, ultrasound of, 315, 339
Tetanus prophylaxis, for bites, 219-220
Tetanus toxoid, administration of, 329,
347
Thelarche, premature, benign, 77
Thenar flap, 177, 178f
Thigh
muscle compartments of, 125, 127f
muscles of, 131f
Thiopental, 1t
Third degree burn, 224
Thrombolytics, 258
Thrombosis, in microsurgery, 258
Thumb(s)
deficiency, classification and treatment
paradigm, 141t
duplicated, classification of, 144t
extension, EPL and, 326, 345
injuries of, 170-171
1st metacarpal base fractures/fracture
dislocations as, 171,
171f
ulnar collateral ligament (UCL) injury
as, 170, 170f
soft-tissue amputations of, 179-181,
180f-181f
Thumb-in-palm deformity, 210-211, 211t
Thumb metacarpal, pollicization and, 321,
343
Thyroglossal duct cyst, 17, 336
Thyroid ophthalmopathy, 266
Tibial nerve, 137f
injury/compression of, 136
Tinea capitis, female hair loss from, 305
Tinel’s sign, 120
Tip shape, of nose, 273f
Tissue biopsy, for hand masses, 151
Tissue expansion (TE), 212-218
defined, 216-217
Tissue oxygenation, in flap monitoring, 259
Tissue plasminogen activator (tPA), for
thrombosis, 258
TNM clinical staging system for lip and
oral cavity, 21t
Toe extensors, as common tendon donor
site, 208
Toe infections, after Charles procedure,
320, 342
Tongue
cancer, 22
flap, 53, 53f
innervation to, 13
Tooth
eruption, 16
extraction, of 3rd molar, mandibular
fracture and, 311, 337
Topical anesthetics, 3
Topical cocaine, 3
Total auricular reconstruction, 65
Total collagen content, in expanded skin,
327, 346
Total glossectomy reconstruction, 310, 337
Toxic epidermal necrolysis, 227
Toxic shock syndrome, 220-221
Toxicity, 3
Traction injury, to brachial plexus, 116,
118f
Tramadol, 5t
Transaxillary augmentation, 95
Transconjunctival approach, 311, 337
TransCyte, for wound healing, 215
Transdomal sutures, 278, 279f
Transversalis fascia, 100, 102f
Transverse carpal ligament, 120f
Transverse rectus abdominis
myocutaneous (TRAM) flap, 87-88
Transverse upper gracilis myocutaneous
flaps, 88, 254, 257f
complications from, 317, 340
Transversus abdominis, 100, 102f
Trapeziometacarpal joint, arthritis in, 326,
346

370

Trapezium fractures, 190
Trapezius, 98t
Trapezius flap, 248, 252f
Trauma, ear, 71
Traumatic optic neuropathy, 29
Traumatic reconstruction, ear, 65-71
Treacher Collins syndrome, 40-41, 42f, 312,
338
Trephination, for subungual hematoma,
324, 345
Tretinoin, 304
Trichilemmal cyst, 232
Trichotillomania, female hair loss from,
305
Tricyclic acid (TCA) peel, 302, 303f
Trigeminal nerve, 12
maxillary division of, 309, 336
Trigger finger, 193
Trigonocephaly (“triangular-shaped”
head). see Metopic
craniosynostosis.
Triphalangeal component, 144f, 144t
Triphalangeal thumb, 144, 144b
Triple-antibiotic breast irrigation, 317,
340
Triple-antibiotic solutions, for irrigation,
augmentation mammaplasty and,
95
“Tripod” or “tetrapod” fracture, 31
Triquetrum fractures, 189-190
Trochanteric pressure sores, flaps for, 111
Trunk
anatomy of, 101f
flaps of. see Flaps, of trunk
reconstruction of, 97-111
Tubed flap, 244
Tuberous breast deformity, 78, 78f, 316-317,
340
Tumescent solution, 3
Tumescent technique, 335, 351
Tumors
with discontiguous growth patterns, 331,
349
odontogenic, 19-25
salivary gland, 19-20, 19t
22q chromosomal deletion
(“velocardiofacial syndrome”),
45
22q11.2 deletion syndrome, 313, 338
TWIST1 gene, mutation in, 312, 338
Two-flap palatoplasty, 50f
U
“Ugly duckling sign,” in melanoma, 236
Ulna, 186
Ulnar artery aneurysm, 322, 343
Ulnar collateral ligament (UCL) injury,
170, 170f
Ulnar nerve, 120f
compression of, 120-121
entrapment of, provocative test for,
119t
Ulnar nerve palsy, tendon transfers for,
210
Ulnar tunnel syndrome, 121
Ulnar variance, 186
Ultrasound
for breast cancer, 83
for hand masses, 151
Umbilicus, repositioning of, landmarks in,
335, 351
Unilateral cleft lip, 45-46
complications of, 49
repair, 48-49, 48f-49f
Unilateral cleft nasal deformity, 46
Unilateral coronal synostosis, 37
fronto-orbital advancement for, 312,
338
Upper extremity, flaps of. see Flaps, of
upper extremity.
Upper lateral cartilages (ULCs), 269
Upper limb
development of, 321, 343
embryogenesis of, signaling pathways of,
140t
Upper lip, levators of, dimensions of, 12t
V
V-Y gluteus maximus flaps, readvancement
of, 318, 341
VACTERL syndrome, 141t
Vacuum-assisted closure (VAC) therapy,
98
Vagina, reconstruction of, 103, 104f-105f,
105t
Van der Woude syndrome, 45
Vascular aneurysm, 155-156
Vascular anomalies, 19-25
Vascular malformations, 24, 310, 337
of hand, 155
Vascular supply
of eyelids, 260, 260f
to nose, 269, 271f
Vascularized bone graft, for scaphoid
nonunion, 325, 345
Vascularized lymph node flap transfer, 320,
342
Veau classification system, 47f
Veau-Wardill-Kilner (VWK) repair, 51f
Velocardiofacial syndrome, 45, 313, 338
Velopharyngeal dysfunction, 53-54
Velopharyngeal incompetence, 53
Velopharyngeal insufficiency, 53
Velopharyngeal port
borders of, 53-54
function of, muscles involved in, 53
Velopharynx, 53
Venous congestion, of flaps, 259
Venous flap, 244, 244f
Venous flow, flap and, 244
Venous stasis ulcers, in lower extremity, 133
Venous thrombosis, in microsurgery, 258
Vertebrate face, prominences of, 44f
Vertical buttresses, 26, 26f
Vibrio vulnificus infections, 223
Viral rhinitis, treatment for, 270
Visual acuity, in eyelid evaluation, 264
Vitamin A, for wound healing, 212
Vitamin B6 (pyridoxine), for wound
healing, 212
Vitamin C, for wound healing, 212
Vitamin E, for wound healing, 212
Volar advancement, 177, 177f
Volar carpal ligament, 120f
Volkmann’s ischemic contracture, 157
von Hippel-Lindau syndrome, 24
von Langenbeck repair, 51f
W
W plasty, flaps, 245, 246f
Waardenburg syndrome, 40
Wallerian degeneration, 113, 117, 118f
Warthin’s tumor, 19, 310, 337
Water
ablative CO2 laser and, 335, 352
for chemical burns, 329, 347-348
“Watson scaphoid shift test”, 187
Wetting solutions, 3
in suction-assisted lipectomy, 297-298
Whitnall ligament, 262
Wide local excision
for melanoma, 237
for squamous cell carcinoma, of oral
cavity, 310, 337

371

Wound(s)
chronic, 216
pressure sores and, 106
repair, temporal patterns during, 217f
Wound dehiscence, 216
Wound healing, 212-218
phases of, 212-217
process of, 212
skin substitutes in, 215
systemic factors affecting, 213, 214t
Wound infections, 221
Wrist
common fractures of, 187-190
distal radius fracture as, 187-190
hamate fractures as, 190
scaphoid fracture as, 188-189, 190t
trapezium fractures, 190
triquetrum fractures as, 189-190
flexors of, 195
flexor carpi radialis (FCR), 195
flexor carpi ulnaris (FCU), 195
palmaris longus (PL), 195
gout, 194, 194t
osteoarthritis of, 190-191, 190f
basilar/first carpometacarpal joint
arthritis, 191, 191t
carpal arthritis and, 191
psoriatic arthritis of, 194t
rheumatoid arthritis of, 191-193, 192t
finger involvement in, 192, 192f-193f
joint involvement in, 192
management of, 192
treatment of, 193
wrist involvement in, 192
scleroderma of, 193, 194t
systemic lupus erythematosus of, 194t
tendon ruptures in, 193
trigger finger, 193
X
X ray, for hand masses, 151
Xeroderma pigmentosum (XP), 233-234
Z
5Z plasty, 141, 142f
Z plasty, flaps, 245-247, 246f
Zinc, for wound healing, 213
Zygoma, 30-31
Zygomatic nerve branch, in rhytidectomy
and neck rejuvenation, 286t
Zygomaticofacial nerve, of eyelids, 261
Zygomaticomaxillary complex (ZMC)
fractures, 30-31
Zygomaticosphenoid suture, 312, 337

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Review of Plastic Surgery Donald W. Buck II, MD Prepare with confidence! Review of Plastic Surgery provides essential information on more than 40 topics found on in-service, board, and MOC exams, as well as the challenges you face in everyday practice. Using a streamlined, highly illustrated format, it efficiently covers all of the material you need to know - from basic science to clinical knowledge in plastic surgery, including subspecialty topics The high-yield format means that you'll spend more time mastering important information and less time searching for it. • Zero in on more than 40 essential topics found on in-service, board, and certifying exams in plastic surgery. • Test your mastery of the material with self-assessment sections that mimic questions encountered on board exams. • Clearly visualize key content thanks to superb, full-color illustrations throughout. • Find and retain important information that's presented in a concise, high- yield manner - through bulleted text, detailed illustrations, and easy-to- digest lists. Elsevier | ExpertConsult.com Enhanced eBooks for medical professionals Enhanced images and features allow you to interact with your content like never before -from your An- droid™, iPhone®, Pad8, PC, or Mac®. Rodoom your eBook at expertconsult.com today! • Searchable - Straightforward navigation allows you to browse and search content. • Portabie - Seamless, real-time integration between devices allows you to access content - online and offline. • Shareable - Social media features allow you to share notes and highlights with other Expert Consult users. • Perpetual - Keep your eBooks forever. Look for instructions on how to redeem your eBook on the inside front covert Use of the current edition of the electronic version of this book (eBook) is subject to the terms of the nontransferable, limited license granted on ExpertConsult.com. Access to the eBook is limited to the first Individual who redeems the PIN, located on the inside cover of this book, at ExpertConsult.com and may not be transferred to another party by resale, lending, or other means. Recommended Shelving Classification Plastic Surgery ISBN 978-0-323-35491-2 ELSEVIER 9 780323-354912