{"title":"Breast Reconstruction with the TRAM Flap","authors":"Windy A. Olaya","doi":"10.1093/MED/9780190499075.003.0066","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0066","url":null,"abstract":"Breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap offers a completely autogenous tissue reconstruction for women requesting either a delayed or immediate breast restoration. The donor site scar on the lower abdomen is hidden by most clothing styles. The flap can be harvested as a pedicle flap based on the superior epigastric vessels, including one or both rectus muscles, depending on the volume of tissue required. During immediate reconstruction, both the oncologic and reconstructive surgeons can operate simultaneously, continuously communicating during the surgical procedure about the incisions and mastectomy defect. The match between the tissue volume of the patient’s abdominal TRAM flap and her desired breast size determines the eventual aesthetic success of the reconstruction.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87577975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sphincter Pharyngoplasty for Velopharyngeal Dysfunction","authors":"Donald S. Mowlds, R. Vyas","doi":"10.1093/MED/9780190499075.003.0052","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0052","url":null,"abstract":"The surgical correction of velopharyngeal insufficiency (VPI) seeks to augment the deficient aspect of the velopharyngeal apparatus. The objective of the sphincter pharyngoplasty is to narrow the velopharyngeal gap transversely by addressing lateral pharyngeal wall motion. Superiorly based lateral palatopharyngeus myomucosal flaps are transposed 90 degrees and inset into the posterior pharyngeal wall mucosa. Following sphincter pharyngoplasty, the patient is monitored overnight for impending airway compromise. If symptomatic VPI persists, repeat diagnostic evaluation is performed. Success is determined by acceptable perceptual oral resonance, adequate velopharyngeal closure on endoscopy, and the absence of upper airway obstruction or sleep apnea.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"116 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87668022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Aging Neck","authors":"A. Matarasso, Darren M. Smith","doi":"10.1093/MED/9780190499075.003.0028","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0028","url":null,"abstract":"The isolated necklift is less frequently a focus of scholarly attention. The neck is generally considered to span from the jawline to the clavicle. Signs of aging in the neck often begin to show in the late 30s as the medial platysmal retaining ligaments become attenuated and muscular banding occurs as a result. Other changes of aging include growing prominence of pre- and subplatysmal fat, increasing skin laxity and texture changes, and hypertrophy of the digastric muscles and submandibular glands (which may also become ptotic). As reviewed in this chapter, the aging neck can be dealt with very effectively independently from the face. The ability to uncouple neck rejuvenation from facial rejuvenation is fortunate, as the aging of these regions may not coincide or be of equal concern to a given patient.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74326077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Radial Forearm Flap","authors":"Brogan G. A. Evans, G. Evans","doi":"10.1093/MED/9780190499075.003.0038","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0038","url":null,"abstract":"Radial forearm free-flaps (RFFF) offer great utility in the reconstruction of intraoral soft tissue defects. The use of a free tissue transfer with the radial forearm flap can obviate poor wound healing and replace previously irradiated tissue with well-perfused normal fascia and skin. Considerable care must be taken by the surgeon to preserve adequate function of speech and swallow, as well as to obtain good cosmesis. Knowledge of proper anatomical orientation and preoperative marking provide keys to a successful flap dissection and intraoral reconstruction. After reading this chapter, the reader should have an understanding of the assessment of intraoral defects, indications for RFFF, intraoperative techniques, and marking, as well as postoperative patient management.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89594963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Latissimus Dorsi Free Flaps","authors":"D. Song, Deana S Shenaq, Jesse Smith","doi":"10.1093/MED/9780190499075.003.0042","DOIUrl":"https://doi.org/10.1093/MED/9780190499075.003.0042","url":null,"abstract":"The latissimus dorsi myocutaneous flap for free tissue transfer has been and continues to be a workhorse for head and neck reconstruction. This chapter provides the indications and contraindications for its use and serves also to provide knowledge of its anatomy and dissection schema. The use of this flap for head and neck reconstruction allows for composite tissue transfers and lends well to a chimeric reconstruction where multiple different types of tissues (bone, skin, muscle, fascia) can be carried via a single pedicle. It also serves a role in functional restoration in facial reanimation.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89893854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Body Contouring After Weight Loss","authors":"J. Sebastian, J. Rubin, J. Capella","doi":"10.1093/med/9780190499075.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780190499075.003.0017","url":null,"abstract":"The goal of this chapter is to provide a comprehensive approach to management of massive weight loss (MWL) patients seeking plastic surgical reconstruction. The topics covered include the medical impact of obesity and the rise in bariatric surgical procedures that has increased the demand for plastic surgical reconstruction after MWL, critical factors for consideration in the preoperative evaluation of the MWL patient presenting for body contouring surgery, essential elements of intraoperative patient management, and a framework for deciding when to combine multiple procedures and when to perform them in separate stages. Preoperative evaluation of this unique cohort must take into account complex medical and psychosocial issues associated with obesity and operative planning requires unique strategies.","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2006-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82270018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Minimally invasive management of scaphoid fractures","authors":"Joseph F Slade III MD , Gregory A Merrell MD","doi":"10.1053/j.otpr.2003.09.007","DOIUrl":"10.1053/j.otpr.2003.09.007","url":null,"abstract":"<div><p><span>Percutaneous internal fixation of scaphoid fractures allows for more predictable union and less morbidity than cast treatment or open internal fixation. This technique is appropriate for both acute scaphoid waist and proximal pole fractures, as well as selected </span>nonunions<span><span>. A headless cannulated compression screw (standard Acutrak) is implanted via a dorsal percutaneous approach using fluoroscopy and </span>arthroscopy to confirm position and reduction. The details of this technique are reviewed. In a consecutive series of 27 fractures treated with arthroscopic assisted dorsal percutaneous fixation, eighteen fractures were treated acutely and 9 were treated more than 1 month after injury. CT scan confirmed 100% union rate at an average of 12 weeks with no complications.</span></p></div>","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"9 4","pages":"Pages 143-150"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.otpr.2003.09.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83848615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Minimally invasive release of the cubital tunnel","authors":"William Bruno MD , Tsu-Min Tsai MD","doi":"10.1053/j.otpr.2003.09.010","DOIUrl":"10.1053/j.otpr.2003.09.010","url":null,"abstract":"<div><p><span>Entrapment of the ulnar nerve<span> that leads to cubital tunnel syndrome is a common and often disabling disease. Current surgical treatment options involve simple decompression, medial epicondylectomy, or a variety of anterior </span></span>transposition procedures<span><span>. Such techniques often involve extensive exposure of the ulnar nerve with prolonged periods of immobilization. Because of this, patients may often experience significant postoperative pain, scarring, and </span>joint stiffness<span>. In this paper, we describe a minimally invasive technique for treating cubital tunnel syndrome using endoscopic assistance. This procedure enables complete ulnar nerve decompression through one small incision. Direct visualization of all potential anatomic compression sites for a distance of 20 cm around the medial epicondyle is possible. This endoscopic approach to cubital tunnel release is appealing, especially to those patients with mild to moderate symptoms who may otherwise be reluctant to undergo a more involved conventional surgery. It decreases postoperative pain, reduces scarring, and promotes an earlier return to activity than traditional open techniques allow, due to a decreased immobilization period.</span></span></p></div>","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"9 4","pages":"Pages 131-137"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.otpr.2003.09.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75652940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Arthroscopic excision of dorsal carpal ganglion cysts","authors":"Thomas Wiedrich MD , A.Lee Osterman","doi":"10.1053/j.otpr.2003.09.011","DOIUrl":"10.1053/j.otpr.2003.09.011","url":null,"abstract":"<div><p>Ganglion cysts<span><span> are the most common tumor in the wrist. Dorsal carpal ganglion cysts represent 60 to 70% of all ganglion cysts in the hand and wrist. Standard treatment has been limited to observation, rest, immobilization, aspiration with or without injection, and surgical excision. Arthroscopic resection of dorsal carpal ganglion cyst have been done since the late 1980s. It has the advantages of less scarring and stiffness, the ability to inspect the wrist for other pathology and wrist instability. To date, the success of arthroscopic ganglion cyst resection is at least as good (1% recurrence) as current open techniques (0 to 10% recurrence). Risks of the procedure are similar to open techniques. Patient satisfaction with the procedure is high. In the largest reported series, there have been no major complications. This technique, for those who are comfortable with </span>wrist arthroscopy, is effective and safe in treating this common wrist mass. The technique for this procedure is described as well as a brief history of treatment for dorsal carpal ganglion cysts.</span></p></div>","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"9 4","pages":"Pages 118-123"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.otpr.2003.09.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88671208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jorge L Orbay MD , Igor Indriago MD , Eduardo Gonzalez MD , Alejandro Badia MD , Roger Khouri MD
{"title":"Percutaneous fixation of metacarpal fractures","authors":"Jorge L Orbay MD , Igor Indriago MD , Eduardo Gonzalez MD , Alejandro Badia MD , Roger Khouri MD","doi":"10.1053/j.otpr.2003.09.005","DOIUrl":"10.1053/j.otpr.2003.09.005","url":null,"abstract":"<div><p>Metacarpal shaft fractures are common but consensus on the best mode of treatment has not been established. Open reduction<span> and internal fixation with plates or screws has been performed for severely displaced fractures. Unfortunately, extensor tendon adhesions and/or unsightly scars frequently follow this form of treatment. Percutaneous flexible intramedulary nailing of metacarpal fractures<span> provides an alternative method that minimizes these problems. The technique is simple and provides the ability to lock the nails to control length and rotation. The nails are inserted using a manually operated slotted awl and usually in an anterograde direction to prevent soft tissue irritation around the metacarpo-phalangeal joints. This method utilizes flexible nails (1.5 and 1.0 mm.) and closed fluoroscopically assisted reduction. Rotationally unstable or fractures with a tendency to shorten can be locked proximally using a captured transverse pin which effectively controls length and rotation. Metacarpo-phalangeal flexion block splinting can be used postoperatively and the nails are routinely removed after fracture healing. Experience with this technique has been favorable as it avoids exposure of the fracture, dissection around the extensor mechanism, and scar problems. It has provided excellent functional results and has presented a low complication rate.</span></span></p></div>","PeriodicalId":100987,"journal":{"name":"Operative Techniques in Plastic and Reconstructive Surgery","volume":"9 4","pages":"Pages 138-142"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.otpr.2003.09.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78714848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}