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Plastic Surgery
Prema Dhanraj
CHAPTER 1:
What is Plastic Surgery
Definition
Reconstructive Surgery
Cosmetic Surgery
History
Principles of Plastic Surgery
Injuries
Unique Characteristics of Face
Challenges of a Surgeon
Cause of Injury
Investigations
Life-threatening Facial Emergencies
Classification
Types of Soft Tissue Injury
Management of Injuries
General Treatment
Local Treatment
Suture Line Care
Suture Materials
Natural Material
Synthetic Material
Absorbable
Non-absorbable
Other Closure Materials
Transplantation
Replantation
Implantation
Barter Principle
Sun Blocking Agent (Sunscreen)
Dermabrasion
Complications
Tattooing
Definition
Types of Tattoo
Traumatic Tattoo
Cosmetic Tattoo
Decorative Tattoo
Camouflage Tattoo
Tissue Expansion
Macroscopic Response
Microscopic Response
Advantages
Complications
Tissue Engineering
Definition
Laser (Light Amplification by Stimulated Emission of Radiation)
History
Action
Clinical Application
Complications of Laser
CHAPTER 2:
Wound Healing
Definition
Types of Wound
Based on Duration
Based on Mechanism
Clinical Types
Healing
Types of Healing
Mechanism of Healing
Phases of Healing
Growth Factors involved in Wound Healing
Complications
Factors Delaying Wound Healing
Local Factors
General Factors
Granulation Tissue
CHAPTER 3:
Skin and Subcutaneous Tissue
Anatomy of Skin
Functions of Skin
Structure of Skin
Important Arteries of the Head and Neck (Fig. 3.2)
Important Arteries of Upper Extremity (Fig. 3.3)
Axillary Artery
Important Arteries of the Lower Limb (Fig. 3.4)
Blood Supply of the Skin
Angiosomes
Physical Properties of Skin
Viscoelastic Properties
Skin Tension
Effects of Increased Tension
Skin Extensibility
Directional Variations
Scars
Definition
Types of Scar
A Fine Scar Depends On
Hallmark of Obtaining Best Scar
Factors Affecting Scar Contracture
Intrinsic Factors
Extrinsic Factor
Enemies of a Plastic Surgeon (Remember as PRST)
Friends of a Plastic Surgeon
Skin Lines
Treatment
Nonsurgical Methods
Hypertrophic Scar and Keloid
Introduction
Incidence
Pathogenesis
Clinical Findings
Clinical Differences
Factors Responsible for Scar Hypertrophy
Prevention of Hypertrophy
Management
Hypertrophic Scars
Keloids
Method of Injecting Triamcinolone
Complications
Necrotizing Fasciitis
Human Bite
Dog Bite
Adnexal Tumors
Pilomatrixoma (Calcifying epithelioma of malherbe)
Trichofolliculoma
Trichilemmal Cyst (Pilar cyst)
Cylindroma (Turban tumor)
Sebaceous Adenoma
Sebaceous Nevus of Jadassohn
Dermoid Cyst
Sebaceous Cyst (Wens)
Lipoma
Neurofibromatosis
Definition
Incidence
Classification
Lesions
Clinical Types
Signs and Symptoms (Remember as 15 ‘S’)
Treatment
Complications
Hidradenitis Suppurativa
Treatment
Calcinosis Cutis
Epidermal Nevus—(Linear nevus)
Congenital Melanocytic Nevi (CMN)
Definition
Giant Congenital Pigmented Nevus
Treatment Option
Vascular Anomalies
Classification
Syndromes Involving Vascular Malformations
Hemangioma vs Vascular Malformations
Premalignant Lesions
Xeroderma Pigmentosa
Introduction
Characteristic Feature (Remember as 4P)
Pathophysiology
Incidence
Clinical Features
Problems Associated
Course of the Disease
Treatment
Marjolin's Ulcer
Basal Cell Carcinoma
Introduction
Etiology
Incidence
Clinical Features
Types
Nodular Ulcerative Type
Treatment
Squamous Cell Carcinoma (Epithelioma)
Definition
Premalignant Condition
Risk Factors
Etiology
Clinical Features
Types
Spread
Treatment
Melanoma
Definition
Incidence
Etiology
Changing Mole—Suggestive of Melanoma
Clinical Features
Clinical Classification
Clinical Staging
Other Prognostic Risk Factors
Investigation
Classification
Clinicopathological
Acral Lentiginous Melanoma
Superficial Spreading
Lentigo Maligna
Mucosal Melanoma
Nodular Melanoma
Histological (Microstaging of melanoma)
Breslow's Microstaging
Clark's Histological Level of Microstaging
Treatment
Surgery of the Regional Lymph Node
Surgery for Metastatic Disease
Prognosis
Recurrence and Spread—Four Types
CHAPTER 4:
Skin Grafts
History
Anatomy
Epidermis
Dermis
Functions of Skin
Skin Grafts
Definition
Classification
Types
Split Thickness Grafts (Fig. 4.1)
Partial Thickness Grafts
Composite Graft
Tissue Cultured Cells
Selection
Harvesting
Free Hand
Power Dermatome
Hand Driven
Meshing of Grafts
Clinical Application
Preparation of Wound
Fixation of Graft
Vascularization of the Graft
Characteristics of Grafted Skin
Contraction
Primary Contraction
Secondary Contraction
Pigment Changes
Graft Reinnervation
Donor Site
Storage
CHAPTER 5:
Skin Flaps
Introduction
Definition
History
Indications
Pre-requisites
Classification of Flaps
Blood Supply
Branches of Vascular Tree
Types of Flap
Local Flaps
Rotation Flaps
Transposition Flaps
Advancement Flap
Regional Flap
Distant Flaps
Flap Delay
Advantage of Delay Flap
Prefabricated Flaps
Advantages of Flaps
Characteristics of Skin Flaps
Complications
Prevention of Complication
Measures to Improve Circulation in Skin Flap
Tests of Skin Flap Perfusion
Conclusion
CHAPTER 6:
Muscle Flaps
Introduction
Indications
Advantages of Muscle Flap
Disadvantage
Classification
CHAPTER 7:
Fasciocutaneous Flaps
History of Fasciocutaneous Flap
Classification of Flap (Fig. 7.1)
Type A
Type B
Type C
Type D
Advantages of Fasciocutaneous Flap
CHAPTER 8:
Microsurgery
History
Instrument
Sutures
Solutions
Preoperative Measures
Preventive Measures
Postoperative Measures
Clinical Assessment
Instrumentation
Types of Anastomosis
Anastomotic Methods
Planning a Free Flap (Figs 8.8 to 8.19)
Patient Factors
Regional Factors
Goal of the Surgery
Preparation
Execution
Monitoring
CHAPTER 9:
Head and Neck
Etiology
Embryology (Fig. 9.1)
Anatomy
Normal (Fig. 9.2)
Abnormal (Fig. 9.3)
Classification
Pathophysiology
General Guidelines in Cleft Lip and Cleft Palate Management
Reassure the Parents
Functional Problems
Advice on Feeding
Timing of Surgery
Goals
Postoperative Care
Postoperative Complication
Syndromes Associated with Cleft Lip
Etiology
Embryology
Classification
Muscles of Palate
Blood Supply
Timing of Cleft Palate Surgery
Problems
Surgical Goals
Treatment
Postoperative Care
Postoperative Complication (Figs 9.19 to 9.21)
Pierre Robin Sequence
Investigation
Treatment
Complication of Pharyngoplasty
Summary
Facial cleft
Cranial cleft
Apert's Syndrome (Acrocephalosyndactyly)
Definition
Incidence
Clinical Features
Radiologic Findings
Treatment
Crouzon's Syndrome
Definition
Incidence
Clinical Features
Radiologic Findings
Signs and Symptoms
Treatment
Hemifacial Microsomia
Definition
Etiology
Incidence
Clinical Findings
Treatment
Hemifacial Atrophy (Romberg s Disease)
Definition
Etiology
Clinical Features
Treatment
Treacher Collins Syndrome (Mandibulofacial dysostosis)
Definition
Incidence
Genetics
History
Clinical Features
Other features
Binder s Syndrome (Fig. 9.55)
Goldenhar's Syndrome
Fibrous Dysplasia (Figs 9.56 and 9.57)
Cherubism (Familial fibrous dysplasia) (Fig. 9.58)
Definition
Age of Onset
Etiology
Clinical Features
Treatment
Emergency Treatment
Early Evaluation and Treatment
Radiographic Examination
Delayed Treatment of Faciomaxillary Injuries
Diagnosis
Radiographic Evaluation
Indications for Surgery
Treatment
Nasal Bone Fracture (Figs 9.59 and 9.60)
Zygomatic Fractures (Fig. 9.61)
Diagnosis
Investigation
Treatment
Maxillary Fractures (LeFort)
Diagnosis
Radiographic Evaluation
Treatment
LeFort I Fracture
LeFort II Fracture
Lefort III Fracture
Mandibular Fractures (Figs 9.64 and 9.65)
Classification
Diagnosis
Radiographic Evaluation
Treatment
Panfacial Fracture
Treatment Principles
Head and Neck Reconstruction
Reconstructive Principles of Eyelid
Basic Principles in Lid Reconstruction (Figs 9.73 and 9.74)
Facial Palsy (Fig. 9.75)
Etiology
Treatment
Ear Deformities
Embryology
Anatomy
Etiology
Classification
Reconstructive Principles of Lip
Anatomy
Goals of Reconstruction
Principles of Reconstruction
Goals of Upper Lip Reconstruction
Philtral Region
Reconstruction of Lower Lip
Ameloblastoma (Adamantinoma)
Definition
Incidence
Embryology
Age of Onset
Clinical Features
Types
Radiological Features
Treatment
Pterygium Colli (Figs 9.87 and 9.88)
Torticollis (Figs 9.89 and 9.90)
Types
Temperomandibular Ankylosis
Introduction
Classification
Etiology
Clinical Features (Figs 9.91 to 9.94)
Investigation
Orthopantogram Reveals
CT Scan
Aim of Treatment
Discussion
Operative Steps
Intraoperative Complications
Recommendation
Results
CHAPTER 10:
Breast and Chest Wall Deformities
Poland's Syndrome (1841)
Gynecomastia
Definition
Questions to Ask
Etiology
Physiologic
Pathologic
Pharmacologic
Medical Therapy
Incision
Complication
CHAPTER 11:
Upper Extremity
Congenital Defects
Embryology
Incidence
Etiology
Classification
Defects
Deformities
Embryological Classification
Syndactyly (syn in Greek means—together)
Polydactyly
Camptodactyly
Clinodactyly
Constriction Ring Syndrome (Streeter dysplasia, Annular band syndrome, Amniotic band syndrome)
Ectrodactyly
Arthrogryposis
CHAPTER 12:
Lower Extremity
Congenital Deformities of Lower Limb
Macrodactyly
Definition
Clinical Findings
Types of Macrodactyly
Problems
Goal
Important Points to Note
Complications
Ulcer
Definition
Classification
Lymphedema
Definition
Classification
Etiology
Pathophysiology
Developmental Abnormalities
Clinical Features
Signs and Symptoms
Grading of Lymphedema (Brunner's clinical grading)
Complications
Investigation
Management
Conservative Management
Medical Management
Surgical
Physiological (Lymphatic bypass)
Reduction Operations
Complications
Postoperative Management
Prevention and Control
Lymphangioma Circumscripta
Pressure Sore (Bedsore, Pressure ulcer)
Definition
Epidemiology
Location
Pathogenesis
Classification
Treatment
Surgical Management
Diabetic foot
Incidence of Diabetes
Pathophysiology
Surgical Problems
Investigations
Medical Treatment
Surgical Treatment
Indications for Flaps
Indications for VAC
Contraindications for VAC
Foot Care
Introduction
Definition
Aim
Embryology
Associated Anomalies:
Risk Factors
Classification
Management
Timing of Surgery
Testosterone Stimulation
Orthoplasty
Techniques used for Correction of Chordee
Perioperative Considerations
Complications
Follow up
CHAPTER 13:
Thermal Injury
Introduction
Definition
First Aid
Causes of Burns
Assessment of Burn Injury
Estimating Burn Size
Estimating Burn Depth
Pathophysiology
Burn Shock
Changes at Vascular Level
Changes at Cellular Level
Changes at Tissue Level
Systemic Response to Local Injury
Cardiovascular Response
Renal
Oliguric Renal Failure
High Output Failure
Respiratory System
Hematologic Changes
Gastrointestinal System
Musculoskeletal System
Immune System
Metabolic Nutritional Response
Acute Management of Burns
Classification
Type of Injury
Pathophysiology of Systemic Changes
Clinical Features
Management
Complications
Rehabilitation
First aid Management
Classification
Freezing
Thawing
Treatment
Introduction
History
Composition of Body Fluids
Types of Fluid
Various Formulas
Fluid Calculation
Tests to Reflect Perfusion
Complications
Function of Skin
Jackson's Zone of Injury (Fig. 13.21)
Immunological Aspect of Burn Injury
Burn Wound Edema
Role of Mediators
Burn Inflammation
Burn Eschar
Burn Blister
Management of Burn Wound
Topical Agent Commonly Used is Silver Sulfadiazine
Advantages
Disadvantages
Treatment of Superficial Burns
Treatment of Full Thickness Burn
Methods of Surgical Wound Closure
Type of Burn Wound Excision
Different Dressing
Wound Sepsis
Signs and Symptoms
Policy to Follow
Local Signs of Burn Wound Infection (Figs 13.29 to 13.31)
Conclusion
Introduction
Advantages of Skin Substitutes
Properties of Skin Substitutes
Types of Skin Substitutes
Biological
Synthetic Skin Substitutes
Biosynthetics (Rational for developing)
Temporary Skin Substitutes
Advantages
Disadvantages
Culture Derived Tissue (Permanent Skin Replacement)
Conclusion
Helicoll Skin Substitute
Wound Healing and Collagen
Helicoll Characteristics
Advantages
Indications
Storage
Application Process
Helicoll Action
Effectiveness of Helicoll
Comparing Helicoll with Integra Skin Substitute
Helicoll is Different from other Collagen
Accelerated Healing (Fig. 13.38)
Reduces Scar Formation
Biological Characteristics of Helicoll
Wounds Treated with Helicoll
Clinical Evidence for Product Efficacy
Histological Study
Clinical Trials
Introduction
Clinical Manifestation
Adult Respiratory Distress Syndrome (ARDS)
Clinical Phases of ARDS
Treatment of ARDS
Introduction
Disturbances in Metabolism
Metabolic Response following Burn Injury (Flow Chart 13.1)
The Goals of Aggressive Nutritional Support
Nutrition Requirement
Assessment of Nutritional Status
Total Count and Differential Count
Serum Transferrin [Serum Transferrin is calculated from Total iron-binding capacity (TIBC)]
Routes of Nutritional Support
Conclusion
Reconstructive Principles Area-wise
Conclusion
Introduction
Classification
Treatment
Advantages
Introduction
Anatomy of the Foot
Classification
Dorsal Burn Scar Contractures
Plantar Surface Burn Scar Contractures
Joint Deformities
Treatment
Nonsurgical
Surgical
Physiotherapy and Splinting
Pitfalls
Nursing Issues
Rehabilitation Issues
Long-term Goals
Conclusion
Introduction to Hand Burns
Facts
Pathology of Hand Burns
Contributing Factors to Post-burn Deformity
Aim of Treatment
Classification of Hand Deformity
Soft Tissue Deformity
Joint Deformity
Nail Deformity
Amputation Deformity
Treatment
Nonsurgical Approach to Burn Reconstruction
Surgical
Splinting and Physiotherapy for the Burned Hand
Pressure Therapy for Scar Management
Summary
Nonsurgical
Surgical
Surgical Disadvantage
Goals
Cosmetic Camouflage
Characteristics of Ideal Cosmetic
Medical Make-up Specialist
Camouflage Technique
Subtle Concealment
Full Concealment
Color Blending
Key to Successful Make-up
Types of Make-up
Conclusion
Psychosocial Rehabilitation of Burn Survivors
Introduction
Do's
Dont's
Avoid
Smoking
Flame Burns
Scald Burns
Acid Burns
Electrical Burns
Burns due to Fire Crackers
Car Fire
General Measures
Prevention
Burn Unit
First Floor
Second Floor
Third Foor
In Summary
CHAPTER 14:
Esthetic Surgery
Rhinoplasty
Breast
Reduction Mammoplasty
Abdominoplasty
Liposuction
INDEX
TOC
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