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Key Clinical Topics in Plastic & Reconstructive Surgery
Tor Wo Chiu, Tze Yean Kong
Abdominal reconstruction
Aim
Classification
Size
Component
Partial or full thickness defects
By position
Management
Flaps for abdominal reconstruction
Muscle flaps
Cutaneous flaps
Component separation technique
Related topics of interest
Abdominoplasty
Procedures
Umbilicus
Supplementary procedures
Liposuction
Complications
Contraindications
Related topic of interest
Acute burns
Jackson's burn model
Types of thermal burn
First aid
History
Primary survey
Inhalational injury
Secondary survey
Specific assessment of burns
Depth
Area
Burn oedema
Resuscitation
Alternatives
Monitoring
Other factors
Decompression
Burns nutrition
Pain relief
Infection
Related topics of interest
Basal cell carcinoma
Risk factors
Treatment
Other treatments
Newer treatments
Others
Follow-up
Related topics of interest
Blepharoplasty
Eyelid anatomy
Other aspects
Upper blepharoplasty
Assessment
Surgery
Postoperative care
Complications
Lower eyelid
Anatomy
Assessment
Transcutaneous lower lid blepharoplasty
Transconjunctival lower blepharoplasty (TCLB)
Related topics of interest
Botulinum toxin
Rhytides
Mechanism of action
Contraindications
Complications
Immunity
Related areas of interest
Brachial plexus injuries
Types of brachial plexus injuries
Leffert classification (NEJM 1974)
Differential diagnoses
Evaluation
History
Examination
Motor examination
Sensory examination
Initial treatment
Imaging
Myelograms
Electrophysiologic
Surgery
Indications
Postoperative care
Related topic of interest
Breast augmentation
Preoperative planning
General warnings to patients
Types of implants
Filling
Shell
Shape
Placement
Submuscular
Subglandular/submammary
Access
Postoperative care
Related topic of interest
Breast augmentation – complications and safety
Other issues
Mammography
Breastfeeding
Other methods of breast augmentation
Injectables
Suction devices
Related topic of interest
Breast reconstruction
Breast conserving surgery
Oncoplastic surgery
Volume displacement
Volume replacement
Mastectomy
Timing
Reconstructive options
No reconstruction
Implant-based reconstruction
Autologous reconstruction
Pedicled flaps
Free flaps
Reconstruction and the irradiated breast
Related topics of interest
Breast reduction
Reduction mammoplasty considerations
Operative technique
Perioperative care
Postoperative care
Complications
Oncology
Related topic of interest
Brow lift
Open surgery
Endoscopic lift
Direct brow lift
Postoperative
Related topic of interest
Burn dressings
First aid and dressings
Blisters
Definitive dressings
Types of dressings
Basic dressings
Types of antiseptic
Occlusive dressings
Antimicrobials
Silver nitrate
Silver sulphadiazine (Flamazine)
Biological dressings
Enzymatic dressings
‘Typical’ dressing regimes
Related topics of interest
Burns surgery
Early surgery
Surgery
Hand burns
Wound closure
Meshing
Other specific areas
Related topics of interest
Burn reconstruction
Timing
Prevention/reduction of scar
Acute rehabilitation
Scar management
Burns contracture
Management
Specific areas
Burn itch
Related topics of interest
Chemical burns
First aid
Further management
Acids
Hydrofluoric acid
Alkali
Miscellaneous
Surgery
Extravasation injuries
Management
Chest reconstruction
Fistula
Empyema
Chest wall defects
Rigid support
Autologous
Alloplastic
Muscle cover
Other options
Sternotomy wounds
Negative pressure wound therapy (NPWT)
Congenital chest deformities
Poland's syndrome and tuberous breasts
Related topics of interest
Cleft lip
Treatment
Multidisciplinary approach
Timing
Type of surgery
Surgical techniques
Postoperative care
Presurgical orthopaedics
Bilateral clefts
Skin only techniques
Cartilage techniques
Secondary deformities
Other surgeries to consider
Nose in cleft lip
Related topic of interest
Cleft palate
Embryology
Pierre Robin Sequence (PRS)
Airway management
Classification
Problems
Speech
Feeding
Other issues
Timing
Surgical techniques
Repair of the hard palate
Repair of the soft palate musculature
Postoperative monitoring
Complications
Other treatments
Bone grafts
Velopharyngeal incompetence
Operative repair
Related topics of interest
Cold injury and frostbite
Freezing
Slow freezing
Rapid freezing
Staging
Other symptoms
Treatment
Related topic of interest
Compartment syndrome
Diagnosis
Two incision technique
Related topic of interest
Congenital breast abnormalities
Breast development
Poland syndrome
Management
Tuberous breast
Von Heimburg classification (1996)
Components of treatment
Related topics of interest
Congenital upper limb anomalies
Development
Classification of congenital upper limb anomalies
General principles of treatment
Timing
Syndactyly
Principles of treatment
Camptodactyly and clinodactyly
Undergrowth
Treatment
Brachydactyly (symbrachydactyly without the fusion)
Bell classification
Overgrowth
Constriction ring syndrome
Thumb anomalies
Wassel classification
Deficiencies
Bayne classification
Related topics of interest
Craniosynostosis
Raised intracranial pressure
Mental retardation
Crouzon syndrome
Treatment
Apert syndrome
Position moulding
Treatment of craniosynostosis
Timing
Type of surgery
Postoperative
Related topic of interest
Ear reconstruction
Microtia
Classification
Reconstruction
Timing of surgery
Preoperative preparations
Postoperative care
Hearing restoration surgery
Ear prosthesis
Avulsed ear
Related topics of interest
Electrical burns
Classification
Low voltage (<1000 V)
High voltage (> 1000 V)
Ultra high voltage (lightning)
Management
Related topics of interest
Eyelid reconstruction
Anatomy
Reconstruction
Partial thickness defects
Full thickness defects
Lower lid defects
Direct closure
Tenzel flap
Hughes flap
Cheek flaps (Mustarde)
Upper lid defects
Cutler-Beard
Lid switch (lower to upper) Heuston
Orbital reconstruction
Related topics of interest
Extensor tendon injuries
Anatomy
Management
Common injuries
Specific injuries
DIPJ, Zone 1
PIPJ, Zone 3
MCPJ, Zone 5
Rehabilitation
Complications
Related topics of interest
Facial anatomy
Embryology
Eye
Lip
Ear
Nose
Nasal subunits and zones
Related topics of interest
Facial reanimation
Causes of facial paralysis
Level of paralysis
Severity
Eye problems in facial nerve palsy
Dynamic facial reanimation
Nerve restoration
Cross-facial nerve grafting
Nerve crossovers
Muscle restoration
Local donor muscle
Related topics of interest
Finger fractures and dislocations
Dislocations
PIPJ
DIPJ
MCPJ
Carpometacarpal (CMC) joint
Thumb MCPJ
Phalangeal fractures
Metacarpal fractures
Postoperative
Related topics of interest
Fingertip injuries
Anatomy
Injuries
Fingertip amputations
Allen classification
Treatment
Amputations
Thumb fingertip injuries
Replantation
Life before limb
Assessment of the injury
Indications
Contraindications
Surgical sequence
Related topics of interest
Flexor tendon injuries
Digital flexor sheath
Nutrition
Flexor tendon injuries
Zones
Mechanism of tendon healing
Management
Type of injury
Examination
Inspection
Surgery
Related topics of interest
Ganglia
Common locations
Related topic of interest
Groin dissection
Femoral triangle
During a groin dissection
Imaging
Preoperative preparation
Incisions
Technique
Complications
Related topics of interest
Gynaecomastia
Pubertal gynaecomastia (40–65%)
Prepubertal gynaecomastia
Adult gynaecomastia
Classification
Simon classification (1973) – Grades of gynaecomastia
Webster classification (composition and treatment)
Management
Investigation
Treatment
Non-surgical treatment
Surgical treatment
Related topics of interest
Hair removal
Hair cycle
Methods of hair removal
Shaving
Depilation
Epilation
Temporary reduction of hair
Laser hair removal
Pretreatment preparation
Related topic of interest
Hair restoration
Alopecia areata
Treatments
Telogen effluvium
Male pattern baldness
Management
Medical treatments
Surgical treatments
Transplantation
Postoperative care
Related topics of interest
Hand infections
Cellulitis
Paronychia
Felon
Tenosynovitis
Bite wounds
Mycobacterium marinum
Aeromonas hydrophila
Related topic of interest
Head and neck cancer principles
Surgery
Radiotherapy (RT)
Chemotherapy
Neoadjuvant vs adjuvant
Chemo-irradiation
Chemoprevention
Related topic of interest
Healing
Inflammation with haemostasis (day 0–4)
Haemostasis
Proliferation (day 4 to 3–4 weeks)
Remodelling (3 weeks onwards)
Factors affecting wound healing
Local factors
Systemic factors
Diabetes
Hypothyroidism
Age
Perfusion
Nutrition
Smoking
Steroids
Radiation and chemotherapy
Syndromes associated with altered healing
Adjuncts to healing
Related topics of interest
Hidradenitis suppurativa and hyperhidrosis
Hidradenitis suppurativa (HS)
Management
Drugs
Hyperhidrosis
Local treatment
Systemic
Surgery
Related topics of interest
Hyperbaric oxygen therapy
Complications
Related topics of interest
Hypoplastic facial conditions
Treacher–Collins syndrome
Hemifacial microsomia
Mandible
Hemifacial atrophy of Romberg
Fibrous dysplasia
Related topics of interest
Hypospadias
Assessment
Surgery
Timing
Techniques
Single-stage techniques
Two-stage techniques: Bracka (modified Cloutier)
Postoperative care
Complications
Keloids and hypertrophic scarring
Differences between hypertrophic/keloid scars and normal scars
Differences between keloids and hypertrophic scars
Keloids
Treatment
Pressure
Silicone gel
Steroids
Excision
Lasers
Radiotherapy
Related topic of interest
Lasers: principles
Laser (light amplification by stimulated emission of radiation)
Photothermal effects: The CO2 laser
Applications of lasers in plastic surgery
Melanin and pigmented lesions
Selectivity of lasers
Fractional thermolysis
Intense pulsed light
Related topics of interest
Leeches and maggots
Leeches
Using leeches
Complications
Maggots
Complications
Related topics of interest
Leg ulcers
History and examination
Investigations
Venous ulcers
Management
Surgery
Diabetic ulcers
Management
Miscellaneous ulcer disease
Related topics of interest
Lip cancer and reconstruction
TNM staging
Investigations
Treatment
Neck disease
Reconstruction
Lower lip reconstruction
Defects one third to two thirds
Defects greater than two thirds
Upper lip
Related topics of interest
Liposuction
Principle of liposuction
Types of liposuction
Types of suction
Fluid infiltration
Preoperative considerations
Procedure
Postoperative
Complications of liposuction
Related topics of interest
Local anaesthetics
Action of local anaesthetics
Types of local anaesthetics
Toxicity
Potential problems using local anaesthetics
Reducing the pain of injection
Topical anaesthetics
Related topics of interest
Local flaps and flap classification
Specific flaps
Related topic of interest
Lower limb trauma and leg reconstruction
Lower limb trauma
Scoring systems
MESS (mangled extremity severity score)
Byrd/Cierny
Gustillo and Anderson
Amputation
Management of open tibial fractures
First procedure
Soft tissue closure (Table 43)
Lower third leg
Related topic of interest
Lymphoedema
Differential diagnosis
Primary lymphoedema
Secondary lymphoedema
Investigation
Management
Conservative
Physiotherapy
Surgical
Related topics of interest
Mandibular fractures
Assessment
Specific assessment
Imaging
Treatment
Intermaxillary fixation (IMF)
Open reduction and internal fixation
Edentulous patients
Paediatric considerations
Complications of fixation
Condylar fractures
Mastopexy
Regnault classification of breast ptosis (1973)
Management
Skin incision pattern
Projection
Postoperative
Related topic of interest
Maxillary fractures
Diagnosis
Imaging
Treatment
Le Fort types osteotomies
Related topics of interest
Melanoma
Risk factors
Giant congenital melanocytic naevus (GCMN)
Histological malignant melanoma subtypes
Signs
Prognostic factors
Investigations
Staging
Staging investigations
Imaging
Modalities
Surgery
Management of lymph nodes
Sentinel lymph node biopsy
Clinically palpable lymph nodes
Other treatments
Follow-up
Related topics of interest
Microorganisms and antibiotics
Basic definitions
Acinetobacter baumannii
Eikenella corrodens
Pasteurella multocida
Pseudomonas aeruginosa
Antibiotics
Penicillins
Antibiotics with no similarity to penicillin
Empiric treatment
Penicillin allergy
Related topic of interest
Microsurgery and tissue transfer
Postoperative management
Potential flap problems
Failing flaps
Related topics of interest
Nasal reconstruction
Small defects (<0.5 cm)
Larger defects >1.5 cm
Forehead flap
Stage 1
Stage 2
Lining
Related topics of interest
Neck dissection
Assessment
Levels of the neck nodes
Nodal status (from TNM)
Surgical management
Modified radical neck dissection
Selective neck dissection
Complications of neck dissection
Intraoperative
Skin incisions
Related topic of interest
Necrotising fasciitis
Investigations
Treatment
Related topic of interest
Nerve compression and injury
Recovery
General management
Specific nerve compression
Radial nerve
Entrapment of radial nerve
Median nerve
Entrapment of median nerve
Ulnar nerve
Entrapment of the ulnar nerve
Screening for peripheral nerve palsy
Neurofibromatosis
Neurofibromatosis type 1 (von Recklinghausen's disease, 1882)
Investigations
Neurofibromatosis type 2
Related topic of interest
Nipple areolar reconstruction
Nipple reconstruction
Common options
Nipple sharing
Local flaps
Areolar reconstruction
Postoperative care
Related topic of interest
Oral cancer
Specific areas
Subtypes
Assessment
Treatment
Nodal disease
FOM cancer
Tumour resection
Complications
Related topics of interest
Orbital fractures
Radiology
Blowout fractures
Diplopia
Causes of diplopia in trauma
Enophthalmos
Incisions for access
Repair of floor
Complications
Related topic of interest
Paediatric burns
Acute care (ABC)
Depth of burn
Surface area
Resuscitation
Long-term effects
Toxic shock syndrome
Non-accidental injury (NAI)
Related topics of interest
Parotid gland tumours
Benign parotid tumours
Pleomorphic salivary adenomas
Adenolymphomas (Warthin's tumour)
Malignant parotid tumours
Mucoepidermoid carcinomas
Adenoid cystic carcinomas
Lymphomas
Investigations for parotid masses
Imaging
Fine needle aspiration cytology (FNAC)
Superficial parotidectomy
Complications
Related topics of interest
Premalignant lesions
Leukoplakia and erythroplakia
Leukoplakia or white patch
Erythroplakia
Bowen's disease
Related topics of interest
Pressure sores
Causes
Grading of pressure sores
Management
Treatment
Stage 1 and 2: Dressings with pressure management
Stage 3 and 4: Surgery
Principles (after Conway 1930)
Sacral sores
Ischial sores
Greater trochanter
Related topics of interest
Prominent ears
Management
Non-surgical treatment
Surgery
Cartilage shaping
Suturing
Excision
Postoperative care
Complications
Ptosis of the eyelid (blepharoptosis)
Congenital ptosis
Mechanisms of ptosis
Evaluation
Examination
Ptosis measurement
Mild ptosis
Moderate ptosis
Frontalis suspension
Materials for slings
Complications
Related topics of interest
Rheumatoid arthritis and osteoarthritis
Rheumatoid arthritis
Stages in RA
Hand deformities
Boutonnière (DIPJ hyperextension)
Swan neck (PIPJ hyperextension)
Extensor tendon rupture
Osteoarthritis
Related topic of interest
Rhinoplasty
History
Examination
Surgery
Types of incision
Surgical techniques
Dorsum
Reduction
Augmentation
Nasal tip
Postoperative care
Complications (4–20%)
Related topic of interest
Rhytidectomy
Ageing face syndrome
Relevant anatomy
Retaining ligaments
Facelift surgery
Incisions
Planes
Postoperative care
Complications
Related topics of interest
Scalp reconstruction
Scalp anatomy
Scalp surgery
Scalp reconstruction
Bony defects
Options for soft tissue reconstruction
Related topics of interest
Skin grafts
Thickness of grafts
Meshing
Donor site
Related topic of interest
Skin rejuvenation – chemical peels
Actinic changes (photoageing)
Skin pigmentation
Lentigines
Naevus of Ota
Café au Lait spots
Melasma
Triple therapy
Chemical peels
Related topic of interest
Skin rejuvenation – lasers
Complications of ablative lasers
Other uses of ablative lasers
Non-ablative skin rejuvenation
Skin tightening
Related topics of interest
Soft tissue sarcomas
AJCC staging
Memorial Sloan-Kettering practical staging
General risk factors
Other useful definitions
Multidisciplinary: O&T, PRS and oncology
Limb sarcoma excision
Adjunctive treatments
Different types of sarcomas
Related topics of interest
Squamous cell carcinomas
Risk factors
Management
Treatment
Marjolin's ulcer
Follow-up
Related topics of interest
Stevens–Johnson syndrome
Causes
Diagnosis
Treatment
Suturing
Optimising results
Principles of good suturing
Incision
Suturing
Classification of suture material
Suture material
Removing sutures
Alternatives to sutures
Related topics of interest
Tattoo removal
Tattooing
Treatment options
Superficial destruction
Deep destruction
Q-switched lasers
Aftercare
Complications of QS lasers
Related topics of interest
Tissue expansion
Incisions
Expansion regime
Utilisation of expanded skin
Complications
Common complications
Related topics of interest
Tissue fillers
Temporary fillers
Others
Hyaluronic acid injection
Semipermanent fillers
Fat injection
Technical points
Permanent fillers
Complications of tissue filler injection
Related topic of interest
Ultraviolet light
Sunblock
Related topics of interest
Vacuum wound closure
Method
Pressure
Problems
Contraindications
Related topic of interest
Vascular anomalies
Haemangiomas
Infantile haemangioma
Congenital haemangioma
Management
Medical treatment
Vascular malformations
Low-flow lesions
Capillary malformations
Venous malformations
High-flow lesions
Syndromic lesions
Pyogenic granuloma
Related topic of interest
Zygomatic fractures
Assessment
Diagnosis
Management
Timing of surgery
Complications of surgery
Related topic of interest
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