Essentials of Plastic Surgery E-Book

Jeffrey Janis

• Herausgeber: Thieme Medical Publishers
• Kategorie: Fachliteratur
• Sprache: Englisch

Veröffentlichungsjahr: 2023

Beschreibung

The go-to pocket, computer, tablet and smartphone reference on plastic surgery essentials

Essentials of Plastic Surgery, Third Edition by renowned plastic surgeon Jeffrey E. Janis and an impressive group of esteemed colleagues, retains its reader-friendly formatting, while featuring extensive updates that reflect significant changes in the field. The book is organized by the same seven sections as the prior edition: Fundamentals and Basics; Skin and Soft Tissue; Head and Neck; Breast; Trunk and Lower Extremity; Hand, Wrist, and Upper Extremity; and Aesthetic Surgery. The new edition includes 127 chapters, as well as updated and expanded references that guide readers to classic and definitive articles and chapters.

New chapters include Pain Management in Plastic Surgery, Decreasing Complications in Plastic Surgery, Basics of Plastic Surgery Wound Closure, Scars and Scar Management, Skin Grafting, Posterior Trunk Reconstruction, Perineal Reconstruction, Nerve Transfers, Targeted Muscle Reinnervation, Hand Rehabilitation, Basics of Skin Care, Aesthetic Facial Anatomy, Secondary Rhinoplasty, Buttock Augmentation, and Male and Female Aesthetic Genital Surgery. Breakout chapters covering breast reconstruction and nonsurgical facial rejuvenation reflect new procedures developed since publication of the second edition.

Key Highlights

• Contributions from a cadre of global plastic surgeons including new and completely rewritten chapters reflect accurate, state-of-the-art, contemporary plastic surgery practice
• Key points at the end of each chapter provide a quick source of information and a refresher on essential content
• Meticulous graphics such as new tables, charts, diagrams, pictures, and prior edition images updated in four color provide visually-rich insights

This unique pocket guide provides high-impact information across the breadth and depth of plastic surgery, making it a must-have resource for medical school, residency and fellowship training, preparation for maintenance of certification, and beyond.

This print book includes complimentary access to a digital copy on https://medone.thieme.com.

Leseprobe

Essentials of

Plastic Surgery

Essentials of

Plastic Surgery

Third Edition

Edited by

JEFFRE E. JANIS, MD, FACS

ProfessorDepartment of Plastic and Reconstructive Surgery;Chief of Plastic Surgery (University Hospital);Adjunct Professor, Departments of Neurosurgery,Neurology, and Surgery;Co-Director, Center for Abdominal Core HealthThe Ohio State University Wexner Medical Center;Past President, American Society of Plastic Surgeons, American Councilof Academic Plastic Surgeons, and Migraine Surgery Society;President, American Hernia SocietyColumbus, Ohio, USA

With Illustrations by

Brenda L. Bunch, MA, MS; Amanda L. Tomasikiewicz, MA; Sarah J. Taylor, MS, BA; Jennifer N. Gentry, MA, CMI; and Graeme Chambers, BA (Hons.)

1395 illustrations

New York • Stuttgart • Delhi • Rio de Janeiro

Library of Congress Cataloging-in-Publication Data is available from the publisher.

Illustrators: Brenda L. Bunch, MA, MS; Amanda L. Tomasikiewicz, MA; Sarah J. Taylor, MS, BA; Jennifer N. Gentry, MA, CMI; and Graeme Chambers, BA (Hons.)

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.

333 Seventh Avenue, 18th Floor

New York, NY 10001, USA

www.thieme.com

[phone]

[email protected]

Cover design: © Thieme

Cover image source: Picasso, Pablo (1881-1973) © Artist Rights Society (ARS), NY. Girl Before a Mirror. Boisgeloup, March 1932. Oil on canvas, 64̋ x 51.̋ Gift of Mrs. Simon Guggenheim. (2.1938). The Museum of Modern Art, New York, NY, USA. Digital Image © The Museum of Modern Art/Licensed by SCALA/Art Resource, NY. © 2006 Estate of Pablo Picasso/ARS, New York.

Typesetting by Thomson Digital, India

Printed in Canada by Marquis Book Printing Inc. 5 4 3 2 1

ISBN 978-1-62623-847-3

Also available as an e-book:

eISBN (PDF): 978-1-62623-848-0

eISBN (epub): 978-1-63853-548-5

Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

Thieme addresses people of all gender identities equally. We encourage our authors to use gender-neutral or gender-equal expressions wherever the context allows.

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage.

To my wonderful wife, Emily, and our three incredible children, Jackson, Brinkley, and Holden, who are both my inspiration and bedrock. Nothing is possible without your unconditional love and support.

To my mother and father, who have shaped and molded me, and have provided the examples of how to live and love.

To my mentors, who have guided, taught, infl uenced, and supported me more than they ever knew.

And to all of plastic surgery, for your passionate dedication to our great specialty and your unwavering commitment to your patients.

Jeff rey E. Janis, MD, FACS

Contents

CONTRIBUTORS

FOREWORD

PREFACE

ACKNOWLEDGMENTS

PART I ◆ FUNDAMENTALS AND BASICS

1.WOUND HEALING

Thornwell Hay Parker III, Jenny C. Barker, Bridget Harrison†

2.GENERAL MANAGEMENT OF COMPLEX WOUNDS

Jeffrey E. Janis, Bridget Harrison†, Jenny C. Barker

3.SUTURES AND NEEDLES

Joseph M. Baylan, Huay-Zong Law

4.BASICS OF FLAPS

Deniz Basci, Amanda A. Gosman

5.PERFORATOR FLAPS

Brian P. Bradow

6.TISSUE EXPANSION

Janae L. Kittinger, Nellie V. Movtchan, Raman C. Mahabir, Joshua A. Lemmon

7.VASCULARIZED COMPOSITE ALLOGRAFTS AND TRANSPLANT IMMUNOLOGY

Thet Su Win, Bohdan Pomahac, Tae Chong

8.BASICS OF MICROSURGERY

Geoffroy C. Sisk, Patrick B. Garvey, Jeffrey E. Janis

9.BIOMATERIALS

Sumanas W. Jordan, Dinah Wan

10.NEGATIVE PRESSURE WOUND THERAPY

Chris M. Reid, Raman C. Mahabir, Jeffrey E. Janis

11.LASERS IN PLASTIC SURGERY

John E. Hoopman, Amanda K. Silva

12.ANESTHESIA

Babatunde Ogunnaike

13.PAIN MANAGEMENT IN PLASTIC SURGERY

Jenny C. Barker, Jeffrey E. Janis

14.PHOTOGRAPHY FOR THE PLASTIC SURGEON

Amanda Y. Behr

15.DECREASING COMPLICATIONS IN PLASTIC SURGERY

Edward Davidson, Brandon J. De Ruiter, Zoe Diana Draelos, Bridget Harrison†, Ibrahim Khansa, Jeffrey E. Janis

PART II ◆ SKIN AND SOFT TISSUE

16.THE BASICS OF SKIN

Brian P. Bradow

17.BASICS OF PLASTIC SURGERY: WOUND CLOSURE

Shahryar Tork, Jeffrey E. Janis

18.SCARS AND SCAR MANAGEMENT

Ibrahim Khansa, Jeffrey E. Janis

19.SKIN GRAFTING

Jason D. Hehr

20.BASAL CELL CARCINOMA, SQUAMOUS CELL CARCINOMA, AND MELANOMA

Smita R. Ramanadham, Danielle M. LeBlanc, Dawn D. Wells

21.BURNS

Mohammed Asif, C. Scott Hultman, Reza Kordestani

22.VASCULAR ANOMALIES

James R. Seaward, Samer Abouzeid, Christopher A. Derderian

23.CONGENITAL MELANOCYTIC NEVI

Geoffrey E. Hespe

PART III ◆ HEAD AND NECK

24.HEAD AND NECK EMBRYOLOGY

Thornwell Hay Parker III, Huay-Zong Law

25.SURGICAL TREATMENT OF MIGRAINE HEADACHES

Ibrahim Khansa, Jeffrey E. Janis

CONGENITAL CONDITIONS

26.CRANIOSYNOSTOSIS

Abby Culver, Christopher A. Derderian

27.CRANIOFACIAL CLEFTS

Huay-Zong Law, Christopher A. Derderian

28.DISTRACTION OSTEOGENESIS

Christopher A. Derderian, Samer Abouzeid, Jeffrey E. Janis

29.CLEFT LIP

Bridget Harrison†, Anna Schoenbrunner, Amanda A. Gosman

30.CLEFT PALATE

Chris M. Reid, Marcin Czerwinski, Amanda A. Gosman

31.VELOPHARYNGEAL DYSFUNCTION

James R. Seaward

32.MICROTIA

Christopher A. Derderian, Kristin K. Constantine

33.PROMINENT EAR

Christopher A. Derderian, Jeffrey E. Janis

TRAUMATIC INJURIES

34.FACIAL SOFT TISSUE TRAUMA

Victoria L. Aimé, Raman C. Mahabir, James B. Collins

35.FACIAL SKELETAL TRAUMA

Scott J. Farber, Adam H. Hamawy

36.MANDIBULAR FRACTURES

Ryan C. Jefferson, Lance A. Read

37.BASIC ORAL SURGERY

Dorothy W. Bird

ACQUIRED DEFORMITIES

38.PRINCIPLES OF HEAD AND NECK CANCER: STAGING AND MANAGEMENT

Kristin K. Constantine, Steven A. Schulz, Jeffrey E. Janis

39.SCALP AND CALVARIAL RECONSTRUCTION

Jeffrey E. Janis, Smita R. Ramanadham, Jason E. Leedy

40.EYELID RECONSTRUCTION

Kristoffer B. Sugg, Theodore A. Kung

41.NASAL RECONSTRUCTION

Fadi C. Constantine

42.CHEEK RECONSTRUCTION

Diana Carrau, Raman C. Mahabir

43.EAR RECONSTRUCTION

Margaret S. Roubaud, Christopher M. Shale, Amanda A. Gosman

44.LIP RECONSTRUCTION

Raman C. Mahabir, James B. Collins

45.MANDIBULAR RECONSTRUCTION

Geoffroy C. Sisk, Patrick B. Garvey

46.PHARYNGEAL AND ESOPHAGEAL RECONSTRUCTION

Phillip D. Khan, Raman C. Mahabir, Steven A. Schulz

47.FACIAL REANIMATION

Raman C. Mahabir, J. Byers Bowen

48.FACE TRANSPLANTATION

Tae Chong, Thet Su Win, Bohdan Pomahac

PART IV ◆ BREAST

49.BREAST ANATOMY AND EMBRYOLOGY

Raman C. Mahabir, Melissa A. Crosby

50.CONGENITAL BREAST DEFORMITIES

Wendy Chen

51.BREAST AUGMENTATION

Jacob G. Unger, Konrad Sarosiek

52.MASTOPEXY

Joshua A. Lemmon, Ryan C. Jefferson

53.AUGMENTATION-MASTOPEXY

Purushottam A. Nagarkar

54.BREAST REDUCTION

Smita R. Ramanadham, Daniel O. Beck

55.GYNECOMASTIA

John T. Stranix

56.BREAST CANCER

Patricia A. Cronin, Raman C. Mahabir

57.AUTOLOGOUS BREAST RECONSTRUCTION

Mark V. Schaverien

58.IMPLANT-BASED BREAST RECONSTRUCTION

Casey T. Kraft

59.SECONDARY BREAST RECONSTRUCTION

Casey T. Kraft

60.NIPPLE-AREOLAR RECONSTRUCTION

Deniz Basci

PART V ◆ TRUNK AND LOWER EXTREMITY

61.CHEST WALL RECONSTRUCTION

Jeffrey E. Janis, Ryan C. Jefferson, Adam H. Hamawy

62.ABDOMINAL WALL RECONSTRUCTION

Ibrahim Khansa, Jeffrey E. Janis

63.POSTERIOR TRUNK RECONSTRUCTION

Alexander F. Mericli

64.PERINEAL RECONSTRUCTION

Steven A. Schulz

65.GENITOURINARY RECONSTRUCTION

Carrie K. Chu, Daniel R. Butz, Sam Fuller

66.PRESSURE SORES

Jeffrey E. Janis, Juan L. Rendon

67.LOWER EXTREMITY RECONSTRUCTION

Jeffrey E. Janis, Casey T. Kraft

68.FOOT ULCERS

John T. Stranix, Gangadasu Reddy

69.LYMPHEDEMA

Benson J. Pulikkottil, Jason D. Hehr, Roman Skoracki

PART VI ◆ HAND, WRIST, AND UPPER EXTREMITY

70.HAND ANATOMY AND BIOMECHANICS

Douglas M. Sammer, David S. Chang

71.BASIC HAND EXAMINATION

Jeffrey E. Janis

72.CONGENITAL HAND ANOMALIES

Alexander J. Davit III, Rey N. Ramirez

73.CARPAL BONE FRACTURES

Jason D. Wink, Cassandra A. Ligh, Benjamin Chang, Timmothy R. Randell, Prosper Benhaim

74.CARPAL INSTABILITY AND DISLOCATIONS

Tarik M. Husain, Joshua A. Lemmon

75.DISTAL RADIUS FRACTURES

Wendy Lynne Czerwinski, Stacy Wong

76.METACARPAL AND PHALANGEAL FRACTURES

Purushottam A. Nagarkar, Tarik M. Husain

77.PHALANGEAL DISLOCATIONS

Casey T. Kraft

78.FINGERTIP INJURIES

Ryan E. Austin, Joshua A. Lemmon, Tarik M. Husain, Jeffrey E. Janis

79.NAIL BED INJURIES

Joshua A. Lemmon, Bridget Harrison†, Tyler A. Evans, Sonu A. Jain

80.FLEXOR TENDON INJURIES

Ryan E. Austin, Joshua A. Lemmon, Prosper Benhaim

81.EXTENSOR TENDON INJURIES

Casey T. Kraft, Bishr Hijazi

82.TENDON TRANSFERS

Bishr Hijazi, Purushottam A. Nagarkar

83.NERVE TRANSFERS

M. Asher Schusterman II, Jignesh V. Unadkat

84.HAND AND FINGER AMPUTATIONS

Ryan E. Austin, Essie Kueberuwa Yates, Prosper Benhaim

85.REPLANTATION

Ryan E. Austin

86.HAND TRANSPLANTATION

Tae Chong

87.TARGETED MUSCLE REINNERVATION

J. Byers Bowen

88.HAND REHABILITATION

Joanna H. Ng-Glazier, Jodi Seftchick

89.THUMB RECONSTRUCTION

John T. Stranix, Wendy L. Czerwinski

90.SOFT-TISSUE COVERAGE OF THE HAND AND UPPER EXTREMITY

Sam Fuller, Ryan C. Jefferson

91.COMPARTMENT SYNDROME

Alison Shore, Andrew L. O’Brien

92.UPPER EXTREMITY COMPRESSION SYNDROMES

Amy M. Moore, Prosper Benhaim, Andrew L. O’Brien

93.BRACHIAL PLEXUS

Debra A. Bourne

94.NERVE INJURIES

Amy M. Moore

95.HAND INFECTIONS

Tarik M. Husain, Bishr Hijazi, Alexander J. Davit III

96.BENIGN AND MALIGNANT MASSES OF THE HAND

Vickram J. Tandon, Russell A. Ward

97.DUPUYTREN’S DISEASE

Douglas M. Sammer

98.RHEUMATOID ARTHRITIS

Douglas M. Sammer

99.OSTEOARTHRITIS

Trung Q. Ho, Wendy L. Czerwinski, Ashkan Ghavami

100.VASCULAR DISORDERS OF THE UPPER EXTREMITY

David M. Turer, Alex Spiess, Robert A. Weber, Anna R. Barnard, Alex P. Jones, Jeffrey E. Janis

PART VII ◆ AESTHETIC SURGERY

101.AESTHETIC FACIAL ANATOMY

Christopher C. Surek, Jason Roostaeian

102.FACIAL ANALYSIS

Janae L. Kittinger, Raman C. Mahabir

103.BASICS OF SKIN CARE

Raj P. TerKonda, Sarvam P. TerKonda

104.NEUROTOXINS

Aaron M. Kearney, Sammy Sinno

105.SOFT-TISSUE FILLERS

Christopher C. Surek, Jacob Grow

106.CHEMICAL PEELS

Christopher C. Surek, Jacob Grow

107.FAT GRAFTING

Phillip B. Dauwe

108.HAIR TRANSPLANTATION

Jeffrey E. Janis, Diana Carrau, Manuel A. Medina

109.BROW LIFT

Jeffrey Lisiecki, Jonathan Bank, Theodore A. Kung

110.BLEPHAROPLASTY

Christopher C. Surek

111.BLEPHAROPTOSIS

Sarah Crandall, Wendy Chen, Ernest K. Manders

112.FACE LIFT

Christopher C. Surek, Jason Roostaeian

113.NECK LIFT

Aaron M. Kearney, Sammy Sinno

114.PERIORAL REJUVENATION

Aditya Sood

115.RHINOPLASTY

Michael R. Lee, Jamil Ahmad

116.SECONDARY RHINOPLASTY

Jamil Ahmad

117.GENIOPLASTY

Lee W.T. Alkureishi, Matthew R. Greives, Aditya Sood

118.LIPOSUCTION

Fadi C. Constantine, Luis M. Rios Jr.

119.BRACHIOPLASTY

Jeffrey E. Janis, Jacob G. Unger, Christodoulos Kaoutzanis

120.ABDOMINOPLASTY

Wesley N. Sivak, Luis M. Rios Jr., James C. Grotting

121.MEDIAL THIGH LIFT

Luis M. Rios Jr.

122.BODY CONTOURING IN THE MASSIVE-WEIGHT-LOSS PATIENT

Luis M. Rios Jr.

123.BUTTOCK AUGMENTATION

Ryan E. Austin, Jamil Ahmad

124.MALE AESTHETIC PLASTIC SURGERY

Luis M. Rios Jr., Douglas Steinbrech

125.FEMALE AESTHETIC GENITAL PLASTIC SURGERY

Ryan E. Austin, Jamil Ahmad

126.GENDER AFFIRMATION SURGERY

Juan L. Rendon

127.NONINVASIVE BODY CONTOURING

Michael R. Bykowski, Darren M. Smith

INDEX

Contributors

Samer Abouzeid, MD

Lecturer

Saint-Joseph-University

Hotel Dieu de France University

Beirut., Lebanon

Jamil Ahmad, MD, FRCSC

Director of Research and Education

The Plastic Surgery Clinic

Mississauga, Ontario, Canada

Victoria L. Aimé, MD

Plastic Surgeon

Mayo Clinic

Phoenix, Arizona, USA

Lee W. T. Alkureishi, MD

Assistant Professor

Plastic, Reconstructive and Cosmetic Surgery, and Otolaryngology - Head and Neck Surgery

University of Illinois Health – Chicago;

Plastic and Craniofacial Surgeon

Shriners Childrens - Chicago

Chicago, Illinois, USA

Mohammed Asif, MD

Clinical Instructor

Department of Plastic and Reconstructive Surgery

Johns Hopkins School of Medicine

Johns Hopkins Burn Center

Baltimore, Maryland, USA

Ryan E. Austin, MD, FRCSC

Plastic & Reconstructive Surgeon

The Plastic Surgery Clinic

Mississauga, Ontario, Canada Lemmon

Jonathan Bank, MD, FACS

NYBRA – New York Breast Reconstruction and Aesthetic Plastic Surgery

Clinical Assistant Professor

Zucker School of Medicine at Hofstra/Northwell

Great Neck, New York, USA

Jenny C. Barker, MD, PhD

Integrated Plastic Surgery Resident

The Ohio State University Medical Center

Columbus, Ohio, USA

Anna R. Barnard, FRCS (Plast), Dip Hand Surg

Consultant Hand & Plastic and Reconstructive Surgeon

Clinical Director Plastic Surgery

Department of Plastic Reconstructive Surgery and Burns

Major Trauma Centre

James Cook University Hospital (South Tees Hospitals NHS Foundation Trust)

Middlesbrough, UK

Deniz Basci, MD

President & Founder

Dallas Premier Plastic Surgery, PLLC

Chief of Plastic Surgery

Dallas, Texas, USA

Joseph M. Baylan, MD

Plastic Surgeon

My Houston Surgeons

Houston, Texas, USA

Daniel O. Beck, MD

Plastic Surgeon

Private Practice; SCULPT Aesthetic Center

Frisco, Texas, USA

Amanda Y. Behr, MA, CCA, CMI, FAMI

Associate Professor, Department of Medical Illustration

Anaplastologist, DCG Anaplastology Clinic

Augusta University

Augusta, Georgia, USA

Prosper Benhaim, MD

Associate Professor and Chief of Hand Surgery

Division of Plastic Surgery

Department of Orthopedic Surgery

UCLA Medical Center

Los Angeles, California, USA

Dorothy W. Bird, MD

Helen F. Graham Cancer Center

Department of Surgery

Division of Plastic Surgery

ChristianaCare

Newark, Delaware, USA

Debra A. Bourne, MD

Plastic Surgeon

Department of Plastic and Reconstructive Surgery

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, USA

J. Byers Bowen, MD, MS

Plastic Surgeon

Galardi | Bowen Plastic Surgery 

Virginia Beach, Virginia, USA 

Brian P. Bradow, MD

Reconstructive Plastic Surgeon

Kaiser Permanente

Denver, Colorado, USA

Daniel R. Butz, MD

Plastic and Reconstructive Surgeon

Quintessa Aesthetic Centers

Mequon, Wisconsin, USA

Michael R. Bykowski, MD, MS

Assistant Professor of Plastic Surgery

Division of Pediatric Plastic Surgery;

Surgical Director, Vascular Anomalies Center;

Surgical Director, Craniofacial Scleroderma Center

UPMC Children’s Hospital of Pittsburgh

Pittsburgh, Pennsylvania, USA

Diana Carrau, MD

Plastic and Reconstructive Surgeon

Naples Aesthetic Institute

Naples, Florida, USA

Benjamin Chang, MD, FACS

Professor of Clinical Surgery

Division of Plastic Surgery

Hospital of the University of Pennsylvania

Perelman Center for Advanced Medicine

Philadelphia, Pennsylvania, USA

David S. Chang, MD, FACS

Assistant Clinical Professor

University of California

San Francisco, California, USA

Wendy Chen, MD, MS

Assistant Professor

Plastic & Reconstructive Surgery

McGovern Medical School

UTHealth Houston

Houston, Texas, USA

Tae Chong, MD

Associate Professor

Department of Surgery, University of Colorado

Division of Plastic and Reconstructive Surgery

Boulder, Colorado, USA

Carrie K. Chu, MD, MSCR, FACS

Associate Professor

Department of Plastic Surgery

The University of Texas MD Anderson Cancer Center

Houston, Texas, USA

James B. Collins, MD

Plastic Surgery

Charlie Norwood VAMC

Augusta, Georgia, USA

Fadi C. Constantine, MD

Plastic Surgeon

Constantine Plastic Surgery Center

Dallas, Texas, USA

Kristin K. Constantine, MD

Adult & Pediatric Otolaryngology

Baylor Scott & White ENT Consultants of North Texas

Dallas, Texas, USA

Sarah Crandall, MD

Plastic Surgeon

St. Clare Hospital

Hillsboro, Oregon, USA

Patricia A. Cronin, MD, FRCS, FACS

Consultant Surgeon

Assistant Professor of Surgery

Mayo Clinic Arizona

Phoenix, Arizona, USA

Melissa A. Crosby, MD, FACS

Private Practice

Dr. Crosby Plastic Surgery

Sugar Land, Texas, USA

Marcin Czerwinski, MD, PhD

Plastic Surgeon

Plastic and Reconstructive Surgery

Baylor Scott & White Health

Temple, Texas, USA

Wendy Lynne Czerwinski, MD, PhD, FRCSC, FACS

Associate ProfessorDivision of Plastic Surgery Baylor Scott and White 

Texas A&M

Temple, Texas USA

Phillip B. Dauwe, MD

Plastic Surgeon

Dauwe Plastic Surgery

Dallas, Texas, USA

Edward Davidson, MD, FACS

Associate Professor

Department of Plastic Surgery

Case Western Reserve University

Cleveland, Ohio, USA

Alexander J. Davit III, MD, FAAP

Advisory Dean

University of Pittsburgh School of Medicine;

Assistant Professor

University of Pittsburgh

Department of Plastic Surgery;

Director, Pediatric Hand Surgery / Brachial Plexus Clinic

Director, Pediatric Wound Healing Clinic

Division of Pediatric Plastic Surgery

UPMC Children’s Hospital of Pittsburgh

Pittsburgh, Pennsylvania, USA

Christopher A. Derderian, MD

Assistant Professor

Department of Plastic Surgery

UT Southwestern Medical Center

Dallas, Texas, USA

Brandon J. De Ruiter, BS

Research Fellow

Montefiore Medical Center

Albert Einstein College of Medicine

Bronx, New York, USA

Zoe Diana Draelos, MD

Dermatologist

Dermatology Consulting Services

High Point, North Carolina, USA

Tyler A. Evans, MD

Plastic, Hand and Reconstructive Surgeon

Springfield Clinic

Clinical Instructor at UICOM-P

Peoria, Illinois, USA

Scott J. Farber, MD

Scott J Farber, MD FACS

Managing Partner

Hill Country Plastic Surgery

San Antonio, Texas

Sam Fuller, MD

Hand and Plastic Surgeon

South Bend Orthopedics

South Bend, Indiana, USA

Patrick B. Garvey, MD, FACS

Professor of Plastic Surgery

The University of Texas MD Anderson Cancer Center

Department of Plastic Surgery

Houston, Texas, USA

Ashkan Ghavami, MD

Assistant Clinical Professor

David Geffen School of Medicine at UCLA

Los Angeles, California, USA;

Private Practice

Beverly Hills, California USA;

President-Elect 

The Rhinoplasty Society

Amanda A. Gosman, MD

Professor and Chief of Plastic Surgery

UCSD, Division of Plastic Surgery

Chief of Plastic Surgery Rady Children’s Hospital San Diego

San Diego, California, USA

Matthew R. Greives, MD, MS, FACS

Thomas D. Cronin Chair of Plastic Surgery

Associate Professor, Department of Surgery and Pediatric Surgery 

McGovern Medical School at UTHealth Houston

Houston, Texas, USA

James C. Grotting, MD, FACS

Clinical (Adjunct) Professor of Plastic Surgery, The University of Alabama at Birmingham

and The University of Wisconsin 

Private Practice Grotting Plastic Surgery

Birmingham, Alabama, USA

Jacob Grow, MD

Plastic Surgeon

Southern Indiana Aesthetic & Plastic Surgery 

Columbus, Indiana, USA 

Adam H. Hamawy, MD, FACS

Plastic Surgeon,

Princeton Plastic Surgeons

Princeton, New Jersey, USA

Bridget Harrison, MD†

Assistant Professor

Baylor College of Medicine

Dallas, Texas, USA

Jason D. Hehr, MD

Plastic Surgeon

Columbus Aesthetic & Plastic Surgery

Columbus, Ohio, USA

Geoffrey E. Hespe, MD

House Officer V

University of Michigan 

Department of Surgery

Section of Plastic Surgery

Ann Arbor, Michigan, USA

Bishr Hijazi, MD FACS

Hand and Microsurgery

The Hand & Wrist Specialty Center

Las Vegas, Nevada, USA

Trung Q. Ho, MD

Plastic and Hand Surgery

Baylor St Luke Medical Group

Lufkin, Texas, USA

John E. Hoopman, CMLSO

Professor

UT Southwestern Medical Center

Dallas, Texas, USA

C. Scott Hultman, MD

Director

Johns Hopkins Burn Center

Professor and Vice Chair

Department of Plastic Surgery

John Hopkins School of Medicine

Baltimore, Maryland, USA

Tarik M. Husain, MD, FACS

Plastic and Aesthetic Surgeon

Orthopaedic, Hand, Sports Surgeon

Miami Beach, Florida, USA

Sonu A. Jain, MD, FACS

Associate Professor of Plastic Surgery and Orthopaedics;

Associate Program Director, Hand and Upper Extremity Surgery Fellowship

Hand and Upper Extremity Center;

Chief, Division of Hand Surgery;

Department of Plastic and Reconstructive Surgery

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Jeffery E. Janis, MD, FACS

Professor

Department of Plastic and Reconstructive Surgery;

Chief of Plastic Surgery, University Hospital;

Adjunct Professor

Departments of Neurosurgery, Neurology, and Surgery;

Co-Director

Center for Abdominal Core Health

The Ohio State University Wexner Medical Center;

Past President, American Society of Plastic Surgeons, American Council of Academic Plastic Surgeons, and Migraine Surgery Society;

President, American Hernia Society

Columbus, Ohio, USA

Ryan C. Jefferson, MD

Plastic Surgeon

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Alex P. Jones, FRCS (Plast), BSc (Hons)

Consultant Plastic and Reconstructive Surgeon

Deputy Clinical Director Plastic Surgery

Department of Plastic Reconstructive Surgery and Burns

Major Trauma Centre

James Cook University Hospital (South Tees Hospitals NHS Foundation Trust)

Middlesbrough, UK

Sumanas W. Jordan, MD, PhD

Assistant Professor

Division of Plastic and Reconstructive Surgery

Northwestern University Feinberg School of Medicine

Chicago, Illinois, USA

Christodoulos Kaoutzanis, MD, FACS

Assistant Professor

Division of Plastic and Reconstructive Surgery

University of Colorado

Aurora, Colorado, USA

Aaron M. Kearney, MD

Plastic Surgery Resident

Division of Plastic Surgery

Northwestern University

Chicago, Illinois, USA

Phillip D. Khan, MD

Plastic Surgeon

Coastal Plastic Surgery

Southport, North Carolina, USA

Ibrahim Khansa, MD FAAP

Assistant Professor of Plastic and Reconstructive Surgery

The Ohio State University;

Craniofacial surgeon

Co-Director, Hemangioma and Vascular Malformations Program

Nationwide Children’s Hospital

Columbus, Ohio, USA

Janae L. Kittinger, MD

Plastic Surgeon

Owensboro Health

Owensboro, Kentucky, USA

Reza Kordestani, MD

Plastic Surgeon

Affiliates in Plastic Surgery

McLean, Virginia, USA

Casey T. Kraft, MD

Clinical Instructor

Department of Plastic Surgery

The Ohio State University Wexner Medical center

Columbus, Ohio, USA

Theodore A. Kung, MD

Assistant Professor

Department of Plastic Surgery

University of Michigan

Ann Arbor, Michigan, USA

Huay-Zong Law, MD

Plastic Surgeon

Law Plastic Surgery

International Craniofacial Institute

Dallas, Texas, USA

Danielle M. LeBlanc, MD, FACS

Private Practice

LeBlanc Plastic Surgery

Clinical Assistant Professor

Department of Plastic Surgery

UT Southwestern Medical Center

Dallas, Texas, USA

Michael R. Lee, MD

Plastic Surgeon

Park Cities Cosmetic Surgery

Dallas, Texas, USA

Jason E. Leedy, MD

Plastic Surgeon

Cleveland Plastic Surgery Institute

Mayfield Heights, Ohio, USA

Joshua A. Lemmon, MD

Plastic Surgeon

Regional Plastic Surgery Center, Dallas, Texas

Richardson, Texas, USA

Cassandra A. Ligh, MD

Attending surgeon

Kaiser Permanente

Colorado, Denver, USA

Jeffrey Lisiecki, MD

Aesthetic Surgery Fellow

Dallas Plastic Surgery Institute

Dallas, Texas, USA

Raman C. Mahabir, MD, MSc, FRCSC, FACS

Plastic, Reconstructive and Cosmetic Surgeon

Tucson Plastic Surgery

Tucson, Arizona, USA

Ernest K. Manders, MD

Professor of Plastic Surgery, Emeritus

Department of Plastic Surgery

University of Pittsburgh

Pittsburgh, Pennsylvania, USA

Manuel A. Medina, MD

Plastic Surgeon

Department of Plastic and Reconstructive Surgery

The Ohio State University Wexner Medical center

Columbus, Ohio, USA

Alexander F. Mericli, MD

Associate Professor

Department of Plastic Surgery

M.D. Anderson Cancer Center

The University of Texas

Houston, Texas, USA

Amy M. Moore, MD

Professor and Chair

Robert L. Ruberg, MD Alumni Endowed Chair

Department of Plastic and Reconstructive Surgery

The Ohio State University Wexner Medical Center

Columbus, OH. USA 

Nellie V. Movtchan, MD

Plastic and Reconstructive Surgery Resident

Mayo Clinic Arizona

Phoenix, Arizona, USA

Purushottam A. Nagarkar, MD

Assistant Professor

Department of Plastic Surgery

University of Texas Southwestern Medical Center

Dallas, Texas, USA

Joanna H. Ng-Glazier, MD

Resident

Department of Plastic Surgery

University of Pittsburgh School of Medicine

Pittsburgh, Pennsylvania, USA

Andrew L. O’Brien, MD, MPH

Clinical Instructor, House Staff

Department of Plastic and Reconstructive Surgery

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Babatunde Ogunnaike, MD

Professor

Department of Anesthesiology and Pain Management

University of Texas Southwestern Medical Center

Dallas, Texas, USA

Thornwell Hay Parker III, MD

President

Skin Cancer Consultants

Dallas, Texas, USA

Bohdan Pomahac, MD

Roberta and Stephen R. Weiner Distinguished Chair in Surgery

Brigham and Women’s Hospital;

Director, Plastic Surgery Transplantation;

Professor of Surgery, Harvard Medical School

Plastic Surgery, Restorative Surgery

Brigham’s and Women’s Hospital

Boston, Massachusetts, USA

Benson J. Pulikkottil, MD FACS

Medical Director

Burn and Reconstructive Center at Swedish Medical Center

Englewood, Colorado, USA

Smita R. Ramanadham, MD, FACS

Owner & Founder

SR Plastic Surgery

East Brunswick, New Jersey, USA

Rey N. Ramirez, MD

Assistant Professor

Yale School of Medicine

Yale - New Haven Hospital

New Haven, Connecticut, USA

Timmothy R. Randell, MD

Surgeon

Midstate Orthopedic and Sports Medicine Center

Alexandria, Louisiana, USA

Lance A. Read, DDS

Oral & Maxillofacial Surgeon

Baylor Scott and White Health

Temple, Texas, USA

Gangadasu Reddy, MD, MS, FACS

Plastic Surgeon

Plastic and Reconstructive/ Hand Surgeon

Creighton University School of Medicine

Omaha, Nebraska, USA

Chris M. Reid, MD

Assistant Professor of Surgery

Division of Plastic Surgery;

Director of Medical Student Plastic Surgery Education

UC San Diego Health

San Diego, California, USA

Juan L. Rendon, MD, PhD

Plastic Surgeon

South Bay Plastic Surgeons

Torrance, California, USA

Luis M. Rios, Jr., MD

Clinical Assistant and Professor

Department of Plastic Surgery 

UT Southwestern Medical Center

Dallas, Texas, USA

Jason Roostaeian, MD

Plastic Surgeon

Department of Plastic Surgery

Ronald Reagan UCLA Medical Center

UCLA Medical Center Santa Monica

Los Angeles, California, USA

Margaret S. Roubaud, MD

Assistant Professor

Plastic Surgery

The University of Texas

MD Anderson Cancer Center

Houston, Texas, USA

Douglas M. Sammer, MD

Associate Professor of Plastic SurgeryDirector Hand Surgery FellowshipChief of Plastic Surgery, Parkland HospitalUT Southwestern Medical CenterDallas, Texas, USA

Konrad Sarosiek, MD

Plastic Surgeon

Cool Springs Plastic Surgery

Nashville, Tennessee, USA

Mark V. Schaverien, MBChB, MSc, MEd, MD, FRCS (Plast)

Associate Professor

Department of Plastic Surgery

The University of Texas M.D. Anderson Cancer Center

Houston, Texas, USA

Anna Schoenbrunner, MD, MAS

Plastic Surgeon Resident

Department of Plastic and Reconstructive Surgery

The Ohio State University

Columbus, Ohio, USA

Steven A. Schulz, MD

Plastic Surgeon

Department of Plastic Surgery

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

M. Asher Schusterman II, MD

Houston Methodist Institute for

Reconstructive Surgery

Houston, Texas, USA

James R. Seaward, FRCS(Plast.)

Associate Professor

UT Southwestern Medical Center

Dallas, Texas, USA

Jodi Seftchick, MOT, OTR/L, CHT

Senior Occupational Therapist

Certified Hand Therapist

Centers for Rehab Services

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, USA

Christopher M. Shale, MD

Plastic and Reconstructive Surgeon

Intermountain Healthcare

McKay-Dee Hospital

Ogden, Utah, USA

Alison Shore, MD

Plastic Surgeon

Lakeview Plastic Surgery

Chicago, Illinois, USA

Amanda K. Silva, MD

Assistant Professor of Surgery

Section Chief of Microvascular Surgery

Division of Plastic and Reconstructive Surgery

University of Kentucky

Lexington, Kentucky, USA

Sammy Sinno, MD

Private Practice

TLKM Plastic Surgery

Chicago, Illinois, USA

Geoffroy C. Sisk, MD

Assistant Professor

Division of Plastic, Maxillofacial, and Oral Surgery

Duke University Medical Center

Durham, North Carolina, USA

Wesley N. Sivak, MD, PhD

Adjunct Assistant Professor

Department of Plastic Surgery

Ohio State University

Columbus, Ohio, USA

Roman Skoracki, MD

Plastic Surgeon

Department of Plastic Surgery

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Darren M. Smith, MD

Plastic Surgeon

Private Practice 

New York, New York, USA

Aditya Sood, MD, MBA, FACS

Plastic, Reconstructive and Aesthetic Surgeon

Private Practice

Chicago, Illinois, USA

Alex Spiess, MD

Assistant Professor of Orthopaedics;

Assistant Professor of Plastic Surgery;

Co-Director, UPMC Center for Nerve Disorder;

Division Chief, Hand Surgery (Plastic Surgery)

UPMC Department of Plastic Surgery

Pittsburgh, Pennsylvania, USA

Douglas Steinbrech, MD, FACS

Plastic Surgeon

Gotham Plastic Surgery

New York, New York, USA

John T. Stranix, MD

Assistant Professor

Department of Plastic Surgery

Department of Urology

UVA Health

Charlottesville, Virginia, USA

Kristoffer B. Sugg, MD, PhD

Plastic Surgeon

Trinity Health IHA Medical Group

Plastic & Reconstructive Surgery

Ann Arbor, Michigan, USA

Christopher C. Surek, DO, FACS

Private Practice, Surek Plastic Surgery 

Clinical Assistant Professor of Plastic Surgery

University of Kansas Medical Center

Assistant Professor of Anatomy

Kansas City University

Kansas City, Missouri, USA

Vickram J. Tandon, MD

Plastic Surgeon

Section of Plastic and Reconstructive Surgery

University of Michigan

Ann Arbor, Michigan, USA

Raj P. TerKonda, MD, FACS

Facial Plastic & Reconstructive Surgeon

Cherry Creek Face & Skin

Denver, Colorado, USA

Sarvam P. TerKonda, MD

Plastic Surgeon

Co-Director, Mayo Clinic Cosmetic Center

Department of Plastic Surgery

Mayo Clinic Florida

Jacksonville, Florida, USA

Shahryar Tork, MD

Plastic Surgeon

The Plastic Surgery Group

Cincinnati, Ohio, USA

David M. Turer, MD, MS

Plastic Surgery Resident

Department of Plastic Surgery

University of Pittsburgh School of Medicine

Pittsburgh, Pennsylvania, USA

Jignesh V. Unadkat, MD

Assistant Professor of Plastic Surgery

Department of Plastic Surgery

University of Pittsburgh School of Medicine

Pittsburgh, Pennsylvania, USA

Jacob G. Unger, MD

Plastic SurgeonNashville Plastic Surgery Institute 

Clinical Assistant Professor of Plastic Surgery

Vanderbilt University

Nashville, Tennessee, USA

Dinah Wan, MD

Plastic Surgeon

Southlake Plastic Surgery

Southlake, Texas, USA

Russell A. Ward, MD

Clinical Associate Professor

Baylor Scott and White Health;

Texas A&M University

Temple, Texas, USA

Abby J. Culver, MD

Assistant Professor

Department of Plastic Surgery

UT Southwestern Medical Center

Dallas, Texas, USA

Robert A. Weber, MD

Vice Chair and Professor of Surgery

Chief, Section of Hand Surgery;

Plastic Surgery Division Director

Baylor Scott & White Health/Texas A&M College of Medicine

Bryan, Texas, USA

Dawn D. Wells, PA-C, MPAS

Dermatologist

Platinum Dermatology

Highland Village, Texas, USA

Thet Su Win, MD, PhD

Post-doctoral Research Fellow

Plastic Surgeon

Department of Plastic Surgery

Brigham’s and Women’s Hospital

Boston, Massachusetts, USA

Jason D. Wink, MD, MS

Assistant Professor of Clinical Surgery

Division of Plastic Surgery

Hospital of the University of Pennsylvania

Philadelphia, Pennsylvania, USA

Stacy Wong, MD

Plastic Surgeon

UCHealth Plastic and Reconstructive Surgery

Colorado Springs, Colorado, USA

Essie Kueberuwa Yates, MD 

Plastic & Reconstructive Surgeon

Yates Institute of Plastic Surgery

Fort Lauderdale, Florida, USA

Foreword

Essentials of Plastic Surgery, Third Edition edited by Dr. Jeffrey E. Janis represents the continued summation of decades of persistent dedication and excellence in academic plastic and reconstructive surgery. The handbook has become the standard-bearer for efficient dissemination of knowledge to all levels of training and skill, representing thousands of hours of effort by its authors. These authors have all once been medical students, residents, fellows, and faculty members at private and academic institutions in our wonderful field of plastic and reconstructive surgery.

This absolutely superlative handbook provides the most up-to-date foundation of knowledge for students of plastic surgery at any level. If one were to come to this book with limited knowledge, they would walk away with a profound understanding of the true sheer variety of this dynamic field. As such, the third edition of Essentials of Plastic Surgery has evolved with our ever-changing field. The book contains parts consisting of 127 chapters brimming with information, knowledge, and wisdom. For example, the most recent edition of the handbook now contains chapters on the fundamentals of perforator flaps, targeted muscle reinnervation, and gender affirmation surgery. These topics represent the vanguard of cutting-edge plastic and reconstructive surgery, and the knowledge is right here at your fingertips. Each chapter represents a systematic approach to the topic at hand. The simplicity of the format underscores its power: anatomy, preparation, surgery, postoperative care, and key points. The structure of the handbook leads to its function. It literally builds an information machine for the reader.

In 1997, I met Dr. Jeffrey E. Janis when we were both medical students on the interview trail for Plastic and Reconstructive Surgery residency. Years later, in 2007, it came as no surprise to me, while finishing my microvascular training at the MD Cancer Center in Houston, Texas, as I held the first edition of the book edited by Dr. Janis. I remembered Dr. Janis on the interview trail and recalled his absolute blazing passion for the field of academic plastic and reconstructive surgery. I used the first edition to study for my very own written and oral board examinations. This handbook has always been for Dr. Janis a manifestation of his intense desire to educate and train others. I also vividly remember the day when I passed on my copy of the first edition of Essentials of Plastic Surgery to a mentored medical student and explained that this handbook would not only excite their passion for plastic surgery, but would also help create the framework on which they would build their knowledge base for years to come.

When I was asked by Dr. Janis to write the foreword for this book, I couldn’t have been more humbled and excited at the opportunity to help contribute in a small way to the future education of the field. There are books in one’s life that you remember from the first moment you look at it and can remember all the times that you leaned on it in order to get to another level. Essentials of Plastic Surgery is one of those rare books. Elegant in format, it is beyond robust in the factual and acquired information that it imparts to its reader. The complexities of plastic surgery are broken down and transmitted efficiently. This book is perfect for maintenance of certification exams, written and oral board preparation, and overall general knowledge of how to understand the field of plastic and reconstructive surgery. It is my hope to convey to the reader of this handbook that this is not just an educational tool but a gift from the field to the future. Dr. Janis and the collaborators in this book deserve great appreciation for once again rising the tide all around us so that we can go even further with our specialty.

Justin M. Sacks, MD, MBA, FACSChief, Division of Plastic and Reconstructive Surgery Professor of SurgerySydney M. Jr. and Robert H. Shoenberg Chair Department of SurgeryWashington University in St. Louis School of MedicineSt. Louis, Missouri, USA

Preface

It is hard to believe that it has been 19 years since I sat at the kitchen table of one of my best friends, José Rios, in 2003 in Dallas, Texas, where the idea for Essentials of Plastic Surgery was born, basically on the back of a napkin. At the time, we wanted to create a “quick and dirty one-stop shop” utility book for medical students, residents, and fellows to get high impact information across the breadth and depth of plastic surgery in order to be better prepared for their training programs. The design was to have an exceptional-quality, portable pocket reference book, whether for the emergency department consult, operating room case, clinic patient, or teaching conferences. Neither of us had any idea that the book would turn into an item that would be used by so many people around the world. A testament to its success has been neither the number of copies sold, nor the number of requests for a third edition, but the countless “thank yous” along the way from people who have told me how invaluable this resource was in their training and practice of plastic surgery. In the 8 years that have passed since the second edition was published, there have been many significant changes in the field of plastic surgery, so it was high time to publish a more updated book.

The third edition has preserved the familiar bullet point style and format of the first and second editions, which made them useful, digestible, and navigable. It also continues to incorporate tips, providing additional insights and practical advice not always available in textbooks or articles, and concludes each chapter with key points, which provide the reader a quick source of information and refresher for the essential points highlighted in the chapter. This book is not meant to be an exhaustive shelf reference on the entirety of plastic surgery. Rather, it is intended to convey the “essentials” and provide a valuable plastic surgery foundation.

In this third edition, we have expanded the number of chapters by 25%, from 102 to 127 (the first edition, published in 2007, only had 88!). This reflects the increasing knowledge and understanding of plastic surgery that has occurred since 2014. New chapters such as Pain Management in Plastic Surgery, Decreasing Complications in Plastic Surgery, Basics of Plastic Surgery: Wound Closure, Scars and Scar Management, Skin Grafting; breakout chapters on breast reconstruction (autologous, implant-based, and secondary), Posterior Trunk Reconstruction, Perineal Reconstruction, Nerve Transfers, Targeted Muscle Reinnervation, Hand Rehabilitation, Basics of Skin Care; breakout chapters on nonsurgical facial rejuvenation (neurotoxins, soft tissue fillers, and chemical peels), Aesthetic Facial Anatomy, Secondary Rhinoplasty, Buttock Augmentation, and Male and Female Aesthetic Genital Surgery join updated chapters across the entire table of contents. The book retains its familiarity, though, in that it is still divided into seven parts: Fundamentals and Basics; Skin and Soft Tissue; Head and Neck; Breast; Trunk and Lower Extremity; Hand, Wrist, and Upper Extremity; and Aesthetic Surgery. References have been updated and expanded to guide the reader to classic and definitive articles and chapters.

There have been major advances in the graphics—using a four-color palette now throughout the book for the first time ever in the Essentials series (it started as black and white!). This includes the creation of new tables, charts, cartoons, diagrams, and pictures, and updating previous ones, if necessary, to four color. This richly augmented and visually robust content should make the text even more clear to the reader.

As this book belongs to all of plastic surgery, a group of new and selected prior authors from around the country were solicited to update, and in many cases completely rewrite, the chapters to make the information current, accurate, and contemporary.

Along its journey, the popularity of this book has spawned other members of the Essentialsfamily. For instance, after the publication of the second edition of Essentials of Plastic Surgery, Alex Jones (from the UK) and I co-edited a companion Q&A book to complement the parent book by asking, and answering, questions related to the content. This proved to be so successful that we have simultaneously released the second edition of this companion Q&A book with this third edition of Essentials of Plastic Surgery. In addition, in 2018, the first edition of Essentials of Aesthetic Surgery was released, which has been a phenomenal success as a deep dive into the world of cosmetic surgery. A Q&A companion book, co-edited by Sammy Sinno and I, is forthcoming as well. So as you can see, the entire family of Essentials is expanding due to the popularity and utility of the parent book.

Ultimately, this book reflects the tremendous effort of a great number of authors and contributors, taking all of the most useful aspects of the second edition and building upon that foundation with improvements in content, graphics, and utility. To that end, an e-book version of this book will also be available. This will be useful to readers as they journey through residency training, fellowship training, preparation for maintenance of certification, and beyond.

The true test of its utility will lie with you, the reader, as you decide what book to use as your “go-to” reference book, whether in your pocket, on your computer, or on your tablet or smartphone. My hope is that this edition will be the most visited, virtually bookmarked, or the book with a cracked and worn spine, creased pages, and absolutely no dust.

Jeffrey E. Janis, MD, FACS

Acknowledgments

Like the two editions, this book truly is a labor of love that simply could not have come to life without the tremendous time and effort invested in it by so many people.

First credit must go to the authors across the country who have given a significant amount of time to pour through the literature in order to carefully craft these chapters, and who endured a rigorous editing process where every word, figure, table, and illustration was carefully scrutinized. As they will clearly attest, meticulous attention to detail and emphasis on quality and accuracy demanded much energy and determination. To them, I am sincerely grateful for their time and for the fruit of their efforts.

Distinct recognition also must go to Snehil Sharma and Judith Tomat, who oversaw and managed the entire project from start to finish from the editing side, and to Sue Hodgson and Karen Edmonson at Thieme Publishers, for their leadership and strong support of the Essentials series. Special gratitude goes to Brenda Bunch and her illustrators, who deserve an incredible amount of credit for all of the graphics that were drawn from scratch, which makes this book pop alive with color, clarity, and flavor. This team has individually and collectively poured their hearts and souls into this book and have created a book that could not be done by anyone else.

Most of all, with tremendous sincerity, I want to thank my wife, Emily, and our children, Jackson, Brinkley, and Holden, for their understanding and patience, and above all else, their unconditional love and support. Without them, this book would not be possible, and my life would be empty.

Jeffrey E. Janis, MD, FACS

Acknowledgments

Like the two editions, this book truly is a labor of love that simply could not have come to life without the tremendous time and effort invested in it by so many people.

First credit must go to the authors across the country who have given a significant amount of time to pour through the literature in order to carefully craft these chapters, and who endured a rigorous editing process where every word, figure, table, and illustration was carefully scrutinized. As they will clearly attest, meticulous attention to detail and emphasis on quality and accuracy demanded much energy and determination. To them, I am sincerely grateful for their time and for the fruit of their efforts.

Distinct recognition also must go to Snehil Sharma and Judith Tomat, who oversaw and managed the entire project from start to finish from the editing side, and to Sue Hodgson and Karen Edmonson at Thieme Publishers, for their leadership and strong support of the Essentials series. Special gratitude goes to Brenda Bunch and her illustrators, who deserve an incredible amount of credit for all of the graphics that were drawn from scratch, which makes this book pop alive with color, clarity, and flavor. This team has individually and collectively poured their hearts and souls into this book and have created a book that could not be done by anyone else.

Most of all, with tremendous sincerity, I want to thank my wife, Emily, and our children, Jackson, Brinkley, and Holden, for their understanding and patience, and above all else, their unconditional love and support. Without them, this book would not be possible, and my life would be empty.

Jeffrey E. Janis, MD, FACS

PART I

Part I opening art: Picasso, Pablo (1881-1973) © Artist Rights Society (ARS), NY. Girl Before a Mirror. Boisgeloup, March 1932.Oil on canvas, 64̋ × 51̋. Gift of Mrs. Simon Guggenheim.The Museum of Modern Art, New York, NY, USA. Digital Image© The Museum of Modern Art/Licensed by SCALA/Art Resource, NY. © 2006 Estate of Pablo Picasso/ARS, New York.

1. Wound Healing

Thornwell Hay Parker III, Jenny C. Barker, Bridget Harrison†

THREE PHASES OF WOUND HEALING1–4

1.Inflammatory phase (days 1 to 6)

2.Fibroproliferative phase (day 4 to week 3)

3.Maturation/remodeling phase (week 3 to 1 year)

The timing of the phases of wound healing is a common exam question

Inflammatory Phase (Days 1 to 6)

■Vasoconstriction: Constriction of injured vessels for 5–10 minutes after injury

■Coagulation: Clot formed by platelets and fibrin, contains growth factors to signal wound repair

■Vasodilation and increased permeability: Mediated by histamine, serotonin (from platelets), and nitric oxide (from endothelial cells)

■Chemotaxis: Signaled by platelet products (from alpha granules), coagulation cascade, complement activation (C5a), tissue products, and bacterial products

■Cell migration

•Margination: Increased adhesion to vessel walls

•Diapedesis: Movement through vessel wall

•Fibrin: Creates initial matrix for cell migration

■Cellular response

•Neutrophils (24–48 hours): Produce inflammatory products and phagocytosis, not critical to wound healing

•Macrophages (48–96 hours): Become dominant cell population (until fibroblast proliferation), most critical to wound healing; orchestrate growth factors

•Lymphocytes (5–7 days): Role poorly defined, possible regulation of collagenase and extracellular matrix (ECM) remodeling

•Failure to transition to fibroproliferative phase results in a chronic wound

Chronic wounds are hallmarked by prolonged, unresolved inflammation. The goal of debridement for chronic wounds is to remove inflammatory mediators and senescent cells to turn a chronic wound into an acute wound, thus “resetting” the wound healing process.

Fibroproliferative Phase (Day 4 to Week 3)

■Matrix formation

•Fibroblasts: Move into wound on days 2–3, dominant cell at 7 days, high rate of collagen synthesis from day 5 to week 3

•Glycosaminoglycan (GAG) production

▶Hyaluronic acid first

▶Then chondroitin-4 sulfate, dermatan sulfate, and heparin sulfate

▶Followed by collagen production (see later)

•Tensile strength begins to increase on days 4–5

■Angiogenesis: Stimulated by low O2 tension and high lactate, vascular endothelial growth factor (VEGF) and PDGF-B

■Epithelialization (see later)

TIP: Angiogenesis is the formation of new blood vessels from existing ones. Vasculogenesis is the process of blood vessel formation de novo.

NOTE: The foreign body response to implanted materials parallels the normal wound healing phases. Likewise, tissue engineering relies on these same wound healing phases and principles to create tissue de novo from biologic scaffolds.

Maturation/Remodeling Phase (Week 3 to 1 Year)

■After 3–5 weeks, equilibrium is reached between collagen breakdown and synthesis

■Subsequently no net change in quantity

■Increased collagen organization and stronger cross-links

■Type I collagen replacement of type III collagen, restoring normal 4:1 ratio

■Decrease in GAGs, water content, vascularity, and cellular population

■Tensile strength: 3% at 1 week, 30% at 3 weeks, 80% at 3 months

TIP: The timing of extracellular matrix remodeling and collagen deposition determines allowable postoperative physical activity. It also informs appropriate suture selection, which is determined by the balance of suture degradation as it overlaps with new extracellular matrix deposition.

COLLAGEN PRODUCTION

■Collagen is composed of three polypeptides wound together into a helix

■High concentration of hydroxyproline and hydroxylysine amino acids

■More than 20 types of collagen based on amino acid sequences

■Type I: Most abundant (90% of body collagen); dominant in skin, tendon, and bone

■Type II: Cornea and hyaline cartilage

■Type III: Vessel and bowel walls, uterus, and skin

■Type IV: Basement membrane only

GROWTH FACTORS (Table 1.1)

Table 1.1 Growth Factors

Growth Factor

Function

FGF

Fibroblast and keratinocyte proliferation; fibroblast chemotaxis

VEGF

Angiogenesis: Endothelial cell proliferation and migration

TGF-beta

Fibroblast migration and proliferation

PDGF

Proliferation and chemotaxis of neutrophils, macrophages, fibroblasts, endothelial and smooth muscle cells; induces production of extracellular matrix proteins/collagen

EGF

Keratinocyte and fibroblasts division and migration

EGF, epidermal growth factor; FGF, fibroblast growth factor; PDGF, platelet-derived growth factor; TGF-β, transforming growth factor-β; VEGF, vascular endothelial growth factor.

EPITHELIALIZATION

Multipotent epithelial progenitor cells reside in the hair follicle “bulge” stem cell niche, although not exclusively5

■Mobilization: Loss of contact inhibition—cells at edge of wound or in appendages (in partial thickness wounds) flatten and break contact (integrins) with neighboring cells

■Migration: Cells move across wound until meeting cells from other side, then contact inhibition is reestablished

■Mitosis: As cells at edge migrate, basal cells further back from the wound edge proliferate to support cell numbers needed to bridge wound

■Differentiation: Reestablishment of epithelial layers is from basal layer to stratum corneum after migration ceases

CONTRACTION

■Myofibroblast: Specialized fibroblast with contractile cytoplasmic microfilaments and distinct cellular adhesion structures (desmosomes and maculae adherens)

■Dispersed throughout granulating wound; act in concert to contract entire wound bed

■Appear on day 3; maximal on days 10–21; disappear as contraction is complete

■Less contraction when more dermis is present in wound, just as full-thickness skin grafts have less secondary contraction than split-thickness grafts

TIP: Myofibroblasts are implicated in Dupuytren’s contracture. This is a common exam question.**

TYPES OF WOUND HEALING

■Primary: Closed within hours of creation by reapproximating edges of wound

■Secondary: Wound allowed to heal on its own by contraction and epithelialization

■Delayed primary: Subacute or chronic wound converted to acute wound by sharp debridement, then closed primarily; healing comparable to primary closure

FACTORS AFFECTING WOUND HEALING

Genetic

■Predisposition to hypertrophic or keloid scarring

■Hereditary conditions (Table 1.2)

■Skin type: Pigmentation (Fitzpatrick type), elasticity, thickness, sebaceous quality, and location (e.g., shoulder, sternum, earlobe)

■Age affects all stages of wound healing6

•Hemostasis: Increased platelet aggregation and degranulation

•Inflammation: Increased early neutrophils, delayed monocyte infiltration, impaired macrophage function, altered adhesion molecule profile, increased secretion of proinflammatory mediators, decreased VEGF production, delayed T cell infiltration

•Proliferation: Reduced response to hypoxia (decreased HIF-1α and SDF-1), delayed angiogenesis, reduced fibroblast proliferation, migration and responsiveness to TGF-B1 resulting in delayed collagen deposition, reduced keratinocyte proliferation and migration resulting in delayed re-epithelialization

•Remodeling: Reduced collagen turnover, increased fibroblast senescence

Table 1.2 Diseases and Conditions

Defect

Characteristics

Surgical Intervention

Ehlers-Danlos syndrome

Mutation in COL5A1,

COL5A2, or

COL1A1

genes

Hyperflexible joints

Stretchy, fragile skin

Easy bruising

Vascular aneurysms

Not recommended

Progeria

Mutation in LMNA gene

Limited growth

Full body alopecia

Wrinkled skin

Atherosclerosis

Large head,

narrow face,

beaked nose

Not recommended

Werner syndrome

Mutation in WRN gene

Graying of hair

Hoarse voice

Thickened skin

Diabetes mellitus

Atherosclerosis

Cataracts

Not recommended, but reported for temporary improvements

Pseudoxanthoma elasticum

Fragmentation and mineralization of elastic fibers

Cutaneous laxity

Yellow skin papules

Vision loss

Redundant skin folds can be treated with surgical excision

Cutis laxa

Mutation in elastic fibers

Loose, wrinkled skin Hypermobile joints

Surgical excision of redundant skin produces temporary benefit but patients do not have wound healing problems

Systemic Health

■Comorbidities

•Diabetes

•Atherosclerotic disease

•Renal failure

•Immunodeficiency

•Nutritional deficiencies

TIP:It is imperative to optimize medical comorbidities to reduce wound complications for elective operations or to mitigate delayed wound healing in chronic wounds.

Vitamins

TIP: Supplements typically only help when deficiencies exist.

■Vitamin A: Reverses delayed wound healing from steroids; does not affect immunosuppression

•25,000 IU by mouth once per day increases tensile strength, or 200,000 IU topical every 8 hours increases epithelialization

■Vitamin C: Vital for hydroxylation reactions in collagen synthesis

•Deficiency leads to scurvy: Immature fibroblasts, deficient collagen synthesis, capillary hemorrhage, decreased tensile strength

■Vitamin E: Antioxidant; stabilizes membranes

•Large doses inhibit healing, but unproven to reduce scarring and may cause dermatitis

■Vitamin D: Receptor required for normal macrophage response and epithelial regeneration7,8

■Zinc: Cofactor for many enzymes

•Deficiency causes impaired epithelial and fibroblast proliferation

Drugs

■Smoking: Cigarette smoke contains more than 4,000 constituents

•Nicotine: Constricts blood vessels, increases platelet adhesiveness

•Carbon monoxide: Binds to hemoglobin and reduces oxygen delivery

•Hydrogen cyanide: Inhibits oxygen transport

TIP: Smoking cessation should occur 4 weeks prior to any elective operation. Consider preoperative urine cotinine testing.

■Steroids

•Decrease inflammation

•Inhibit epithelialization

•Decrease collagen production

•Chronic steroids thin the dermis, making skin more susceptible to wounding, more difficult for suture or grafting, and more easily damaged by adhesive used for wound care

■Antineoplastic agents

•Early evidence suggested diminished wound healing, but clinical reports have not substantiated this9

•Few or no adverse effects if administration is delayed for 10 to 14 days after wound closure

■Anti-inflammatories: May decrease collagen synthesis

■Lathyrogens: Prevent cross-linking of collagen, decreasing tensile strength

•Beta-aminopropionitrile (BAPN): Product of ground peas and d-penicillamine

•Possible therapeutic use for decreasing scar tissue

Local Wound Factors

■Oxygen delivery

TIP: The most common cause of failure to heal and wound infection is poor oxygen delivery associated with various comorbidities and local conditions (microvascular disease).

•Atherosclerosis, Raynaud’s disease, scleroderma

•Adequate cardiac output, distal perfusion, oxygen delivery (hematocrit, oxygen dissociation curve)

•Hyperbaric oxygen: Increases angiogenesis and new fibroblasts

■Infection

•Clinical infection: Decreases oxygen tension, lowers pH, increases collagenase activity, retards epithelialization and angiogenesis, prolongs inflammation and edema

•Biofilm: Represents a protected mode of growth for bacteria in a matrix termed “Extracellular Polymeric Substance (EPS)”

▶Biofilm is a fundamentally different state from the planktonic state (free floating bacteria)

▶Evades host immune response and standard therapies10

▶Clinical challenges of biofilm:

♦Typically NOT detected by routine culture

♦Recalcitrant to antimicrobials despite known susceptibility in planktonic state

♦Creates chronic inflammation and evades host immune response

♦Recurs after debridement

♦Disables skin barrier function

♦Produces proteins that degrade soft tissues

♦Requires a surface for growth (prosthetic implants) or can exist in microcolony aggregates within soft tissues

CAUTION: Negative culture does NOT rule out biofilm infection. Biofilm is a MAJOR saboteur to wound healing and reconstructive success.

■Radiation therapy

•Causes stasis/occlusion of small vessels, damages fibroblasts, chronic damage to DNA

•Clinically, irradiated wounds demonstrate slower epithelialization, decreased tensile strength, and higher infection and dehiscence rates

■Moisture

•Speeds epithelialization

■Warmth

•Increased tensile strength (better perfusion)

■Free radicals

•Reactive oxygen species increased by ischemia, reperfusion, inflammation, radiation, vitamin deficiencies, and chemical agents

SCARRING

■Hypertrophic scars (HTS) (Fig. 1.1)

•Primarily type III collagen oriented parallel to epidermal surface with abundant myofibroblasts and extracellular collagen

•Scar elevated but within borders of original scar; more common than keloids (5–15% of wounds)

▶Predisposition of areas of tension and flexor surfaces

▶Less recurrence following excision and adjuvant therapy

■Keloid scars (Fig. 1.2)

•Derived from Greek chele, or crab’s claw

•Grow outside original wound borders

•Disorganized type I and III collagen, hypocellular collagen bundles

•Only seen in humans; rare in newborns or elderly

•May occur with deep injuries (less common than HTS)

▶Genetic and endocrine influences (increased growth in puberty and pregnancy)

▶Rarely regress and more resistant to excision and therapy

•Because of high recurrence rates, multimodality therapy is recommended11,12 (Table 1.3)

■Widenedscars (Fig. 1.3)

•Wide and depressed from wound tension perpendicular to wound and mobility during maturation phase

■Fetal healing

•Potentially scarless healing in first two trimesters

•Higher concentrations of type III collagen and hyaluronic acid, no inflammation, no angiogenesis, relative hypoxia

■Scar management13

•Silicone sheeting is recommended as soon as epithelialization is complete and should be continued for at least 1 month

▶Mechanism of action not known, but suggested mechanisms include increases in temperature and collagenase activity, increased hydration, and polarization of the scar tissue

•If silicone sheeting is unsuccessful, corticosteroid injections may be used

▶Potential risks include subcutaneous atrophy, telangiectasia, and pigment changes

•Pressure therapy and massage have been recommended and may reduce scar thickness, but evidence is weak14

•Improvement with topical vitamin E is not supported—may cause contact dermatitis15

•Topical onion extract (Mederma, Merz Pharmaceuticals, Greensboro, NC) has not shown improvement in scar erythema, hypertrophy, or overall cosmetic appearance16

Fig. 1.1 Hypertrophic scar.

Fig. 1.2 Keloid scar.

Fig. 1.3 Widened scar.

Table 1.3 Keloid Treatments

Treatment

Mechanism

Recurrence Rates

Silicone sheeting

Hydration, increased temperature

Most effective as preventive method

Corticosteroids

Reduce collagen synthesis and inflammatory mediators

9–50%

Interferon

Reduce fibroblast production of glycosaminoglycans, increase collagenase

54%

5-Fluorouracil

Inhibits fibroblast proliferation

19%

Cryotherapy

Modifies collagen synthesis and fibroblast differentiation

50–80% obtain volume reduction

Excision

Removal of abnormal tissue

50–100%

Radiation

Inhibition of angiogenesis and fibroblasts

2–33%

(Adapted from Sidle DM, Haena K. Keloids: prevention and management. Facial Plast Surg Clin North Am 19:505–515, 2011; and Chike-Obi CJ, Cole PD, Brissett AE. Keloids: pathogenesis, clinical features, and management. Semin Plast Surg 23:178–184, 2009.)

Key Points

🗹TheThe three stages of wound healing are inflammatory phase (macrophage most important), fibroproliferative phase, and maturation phase.

🗹ThePeak tensile strength occurs in 42–60 days (80% of original strength).

🗹TheEpithelialization is initiated by loss of contact inhibition.

🗹TheThe amount of dermis present is inversely proportional to the amount of secondary contraction (i.e., more dermis equates to less secondary contraction).

🗹TheVitamin A is used to reverse detrimental effects of steroids on wound healing.

🗹TheBiofilm presents a refractory challenge for wound healing.

🗹TheHypertrophic scars and keloids are distinguished clinically; both have high recurrence rates unless combined modalities are used.

References

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2.Glat P, Longaker M. Wound healing. In: Aston SJ, Beasley RW, Thorne CH, et al, eds. Grabb and Smith’s Plastic Surgery, 5th ed. Philadelphia: Lippincott-Raven; 1997

3.Janis JE, Kwon RK, Lalonde DH. A practical guide to wound healing. Plast Reconstr Surg 2010;125(6):230e–244e

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11.Sidle DM, Kim H. Keloids: prevention and management. Facial Plast Surg Clin North Am 2011;19(3):505–515

12.Chike-Obi CJ, Cole PD, Brissett AE. Keloids: pathogenesis, clinical features, and management. Semin Plast Surg 2009;23(3):178–184

13.Mustoe TA, Cooter RD, Gold MH, et al; International Advisory Panel on Scar Management. International clinical recommendations on scar management. Plast Reconstr Surg 2002;110(2):560–571

14.Shin TM, Bordeaux JS. The role of massage in scar management: a literature review. Dermatol Surg 2012;38(3):414–423

15.Khoo TL, Halim AS, Zakaria Z, Mat Saad AZ, Wu LY, Lau HY. A prospective, randomised, double-blinded trial to study the efficacy of topical tocotrienol in the prevention of hypertrophic scars. J Plast Reconstr Aesthet Surg 2011;64(6):e137–e145

16.Chung VQ, Kelley L, Marra D, Jiang SB. Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study. Dermatol Surg 2006; 32(2):193–197

2. General Management of Complex Wounds