{"title":"Venous Stasis Disease","authors":"Allyson R. Alfonso, D. Cuzzone, E. Chiu","doi":"10.2310/ps.10099","DOIUrl":"https://doi.org/10.2310/ps.10099","url":null,"abstract":"Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.\u0000 \u0000This review contains 8 figures, 6 tables, and 51 references.\u0000Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management ","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87851956","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":"Shock","authors":"Andrew C. Bright, Yann-leei L. Lee, J. Simmons","doi":"10.2310/surg.2150","DOIUrl":"https://doi.org/10.2310/surg.2150","url":null,"abstract":"Shock represents hypoperfusion leading to cellular metabolic failure, with attendant clinical and biochemical markers indicating shock severity and response to therapy. While identifying and treating the underlying cause (source control for sepsis, hemostasis for exsanguination, etc) is paramount, the approach to shock is fundamentally straightforward. Assessment of volume responsiveness or volume tolerance, correction of vasoplegia, and modulation of pump function to improve forward flow aim to recover tissue perfusion at the macroscopic level and facilitate metabolic recovery. These strategies often must be applied simultaneously despite the traditionally used etiology-based classifications of shock. The intensivist should thus be familiar with a variety of invasive and noninvasive tools to determine the approach of greatest perceived yield and evaluate efficacy of interventions.\u0000 This review contains 4 figures, 1 table, and 50 references.\u0000Key Words: anaerobic metabolism, fluid responsiveness, hemorrhagic shock, lactic acidosis, measurement of intravascular volume, neurogenic shock, septic shock, shock, Swan-Ganz catheter, treatment of shock","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89707448","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":"Hair Transplantation: Biochemical Basis and Surgical Treatment","authors":"R. Ehrlichman, A. Parungao","doi":"10.2310/ps.10045","DOIUrl":"https://doi.org/10.2310/ps.10045","url":null,"abstract":"Modern day hair transplantation has undergone tremendous advances since the understanding of the patterns of male hair loss and miniaturization related to androgenic alopecia caused by DHT (dihydrotesterone). The concept of donor dominance, in which hairs genetically resistant to the effects of DHT can be moved to other locations where hair has been lost due to sensitivity to this hormone, is the basis for modern day hair transplantation. Early hair transplantation based on this knowledge involved moving plugs of hair from DHT resistant hairs posteriorly to the anterior hairline. These however resulted in abnormal hairlines which did not appear natural. Presently, hair transplantation is placed on the use of 1, 2, 3, and 4 hair follicular units to create more natural hairlines. In addition, knowledge of the biochemistry of hair loss has resulted in nonsurgical treatments that can regrow and maintain hair. Finasteride (Propecia) and minoxidil (Rogaine) are now important adjuncts before, during and after hair transplantation. Advances have been made in the harvesting of donor hair including the use of follicular unit extraction which removes individual 1, 2, 3 or 4 hair follicular units and the use of robots for extraction. Because of the limitations of donor sites and the fact that hair loss is progressive, future research will involve the use of stem cells.\u0000\u0000This review contains 27 figures and 106 references.\u0000Key Words: androgenic alopecia, cicatricial alopecia, DHT, donor dominance, follicular units, miniaturization, stem cells, telogen effluvium, trichophytic","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86645756","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":"Breast Screening and Evaluation, High Risk Patients","authors":"H. Cappuccino, E. Bonaccio","doi":"10.2310/surg.2390","DOIUrl":"https://doi.org/10.2310/surg.2390","url":null,"abstract":"The fundamental tasks facing surgeons evaluating patients’ breasts are to rule out malignancy, ameliorate breast symptoms, and manage premalignant breast conditions and risk factors to minimize a patient’s chances of developing cancer. Woman presenting to a surgeon should receive thorough and appropriate breast evaluation, breast cancer risk assessment, and treatment, which minimizes risks going forward. In this review, we focus on screening recommendations for (both average and high-risk) patients for breast cancer, Breast Imaging, Reporting and Data System categories, the performance of a thorough breast history and physical examination. We also discuss various breasts imaging modalities and their strengths and weaknesses. We review breast density as a confounding factor and increased risk factor, and the grading of breast density. Finally, different ways of performing breast biopsies are discussed as well as the evaluation of risk for breast cancer with interventions for enhanced screening and risk reduction.\u0000\u0000This review contains 12 figures, 7 tables, and 35 references. \u0000Key Words: BI-RADs, breast cancer risk factors, breast cancer risk reduction, breast core biopsy, breast screening, enhanced screening, BRCA, chemoprevention, mammography","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88259330","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":"Breast Benign Findings and Disease","authors":"H. Cappuccino, E. Bonaccio","doi":"10.2310/surg.2389","DOIUrl":"https://doi.org/10.2310/surg.2389","url":null,"abstract":"Patients often seek the opinion of physicians for benign breast conditions, because of substantial concern about cancer. It is important that general surgeons are armed with the necessary information to thoroughly evaluate and treat benign breast conditions. In this chapter, the more common benign breast complaints and benign breast pathology are reviewed and appropriate management is discussed. The workup and management of masses, cysts, breast pain, nipple discharge, fibrocystic changes, various fibroepithelial lesions (including fibroadenoma) will be reviewed. Borderline lesions including atypical hyperplasias radial scars, and lobular neoplasia will also be discussed with special attention directed to the comparative risks of upgrade to malignancy and the need for surgical excision. Gynecomastia will also be reviewed, along with the various causes, treatments and distinctions from malignancy. Lastly, we will review the management of breast infections and inflammatory conditions, as well as more uncommon breast lesions.\u0000\u0000This review contains 11 figures, 6 tables, and 38 references.\u0000Key Words: Breast masses, Breast pain/Mastalgia, Nipple Discharge, Fibrocystic Changes, LCIS, Radial Scar, Atypical Hyperplasia, Lobular neoplasia, Papillomas, gynecomastia","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83036499","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":"Cutaneous Scarring","authors":"R. Ogawa, D. Orgill","doi":"10.2310/surg.10077","DOIUrl":"https://doi.org/10.2310/surg.10077","url":null,"abstract":"Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloid and hypertrophic scarring. This suggests that these pathologic scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. Various external and internal postwounding stimuli may promote reticular inflammation. Specifically, it is likely that the intensity, frequency, and duration of these stimuli determine how quickly the scars appear, the direction and speed of growth, and the intensity of symptoms. These proinflammatory stimuli include a variety of local, systemic, and genetic factors. At present, physicians cannot (or at least find it very difficult to) control systemic and genetic risk factors of keloids and hypertrophic scars. However, they can use a number of treatment modalities that all, interestingly, act by reducing inflammation. These include corticosteroid injection or tape or ointment, radiotherapy, compression therapy, stabilization therapy, and surgical methods that reduce skin tension.\u0000\u0000This review contains 11 figures and 41 references.\u0000Key Words: atrophic scar, hypertrophic scar, keloid, mature scar, pathologic scar, wound healing","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89956491","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}
J. Friedstat, M. Coriddi, Eric G. Halvorson, J. Disa
{"title":"Principles of Wound Management and Soft Tissue Repair II","authors":"J. Friedstat, M. Coriddi, Eric G. Halvorson, J. Disa","doi":"10.2310/surg.2384","DOIUrl":"https://doi.org/10.2310/surg.2384","url":null,"abstract":"Wound management and soft-tissue repair can vary depending on the location. The head and neck, chest and back, arm and forearm, hand, abdomen, gluteal area and perineum, thigh, knee, lower leg, and foot all have different local options and preferred free flaps to use for reconstruction. Secondary reconstruction requires a detailed analysis of all aspects of the wound including any scars, soft tissue and/or skin deficits, functional defects, contour defects, complex or composite defects, and/or unstable previous wound coverage. Careful monitoring of both the patient and reconstruction is necessary in the postoperative period to ensure long-term success.\u0000 \u0000This review contains 2 figures and 17 references.\u0000Key Words: free tissue transfer, pedicle flaps, soft-tissue coverage, wound closure, wound healing, wound management, wound reconstruction, tissue flaps","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87671266","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":"Tumors of the Liver","authors":"A. Kim, H. Nathan","doi":"10.2310/surg.2375","DOIUrl":"https://doi.org/10.2310/surg.2375","url":null,"abstract":"Tumors in the liver arise from either the underlying hepatic parenchyma, resulting in benign or malignant lesions, or as metastatic deposit from extrahepatic malignancies. Treatment of these tumors is complex and requires a careful clinical evaluation. Recent improvement in diagnostic imaging techniques and reporting facilitates for appropriate characterization of hepatic tumors. In addition, utilization of genetics allows for careful classification of malignant potential in certain hepatic tumors. This chapter discusses several different types of hepatic tumors and examines the underlying etiologies, clinical presentation, diagnostic studies, staging, treatment, and prognosis. The staging of the malignant lesions is updated to reflect the American Joint Committee on Cancer’s eighth edition system.\u0000\u0000This review contains 7 figures, 4 tables and 82 references.\u0000Key Words: Barcelona Clinic Liver Cancer system, CAPOX, future liver remnant volume, FOLFOX, LI-RADS, stereotactic body radiation therapy, transarterial chemoembolization, transarterial radioembolization, β-catenin","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90828444","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}
Keila E. Torres, Wei-Lien Wang, A. Lazar, I. McCutcheon
{"title":"Nerve Sheath Tumors: Malignant peripheral nerve sheath tumors, Schwannomas, and Neurofibromas","authors":"Keila E. Torres, Wei-Lien Wang, A. Lazar, I. McCutcheon","doi":"10.2310/surg.16113","DOIUrl":"https://doi.org/10.2310/surg.16113","url":null,"abstract":"Peripheral nerve sheath tumors represent a spectrum of entities ranging from benign tumors, such as schwannoma, to high-grade malignant tumors termed malignant peripheral nerve sheath tumors. In this chapter, we discuss current concepts and problematic areas in the diagnosis, treatment, and management of peripheral nerve sheath tumors. We discuss the major categories of nerve sheath tumors including schwannomas, neurofibromas, and malignant peripheral nerve sheath tumors. The different benign variants and their propensity for malignant transformation are highlighted. We suggest useful guidelines for the surgical management of these challenging cases. Finally, we discuss some of the advances in molecular biology that have provided new insights into the nature of the various peripheral nerve sheath tumors and suggest potential novel targeted therapeutic strategies for these tumors.\u0000\u0000This review contains 11 figures, 5 tables and 66 references.\u0000Key Words: malignant peripheral nerve sheath tumors, nerve sheath tumor, neurofibroma, neurofibromatosis, schwannoma, schwannomatosis, NF1, NF2","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88191038","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}
R. L. Hamilton, Elizabeth Young Han, D. Drzymalski
{"title":"Nonobstetric Surgery during Pregnancy: An Overview for Anesthesia Providers","authors":"R. L. Hamilton, Elizabeth Young Han, D. Drzymalski","doi":"10.2310/anes.18190","DOIUrl":"https://doi.org/10.2310/anes.18190","url":null,"abstract":"A pregnant patient’s surgery can be challenging for the anesthesia provider—the needs of the parturient and fetus must be addressed while balancing the physiologic and pharmacologic changes that occur during pregnancy. Improved outcomes have led to an increase in the frequency of surgeries in parturients, with approximately 50,000 procedures performed annually in the US. Due to a lack of randomized controlled studies, determining the optimal anesthetic technique for nonobstetric surgery during pregnancy is predicated on understanding the physiologic changes of pregnancy. The anesthesia provider must become familiar with specific changes and challenges in each parturient to formulate a safe anesthetic plan. Here, we review physiologic and pharmacologic conditions observed in common surgical cases that may occur during pregnancy. Our goal is to inform safe clinical practices determined by the latest scientific methods for nonobstetric surgery during pregnancy.\u0000 \u0000 This review contains 5 figures, 3 tables and 45 references.\u0000Key Words: anesthesia, nonobstetric surgery, obstetric anesthesia, pregnancy, surgery, physiology, pharmacology, gynecology","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88324716","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}
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