Plastic and Reconstructive Surgery Chapter 19

Plastic and Reconstructive Surgery

Functions Skin or Cutaneous Membrane Skin or Cutaneous Membrane Protection from UV light Protection from UV light Defense against disease Defense against disease Preservation of fluid balance Preservation of fluid balance Body temperature maintenance Body temperature maintenance Excretion of waste (sweat) Excretion of waste (sweat) Sensory receptors Sensory receptors Synthesis of Vitamin D Synthesis of Vitamin D

Anatomy Epidermis Epidermis Consists of epithelial cells but contains no blood vessels. Consists of epithelial cells but contains no blood vessels. Contains melanin and keratin Contains melanin and keratin 5 Layers 5 Layers Basale Basale Spinosum Spinosum Granulosum Granulosum Lucidum Lucidum Corneum Corneum

Anatomy Dermis Dermis Connective tissue under the epidermis. Connective tissue under the epidermis. Contains nerves, blood vessels, hair follicles, nails, sweat and oil glands. Contains nerves, blood vessels, hair follicles, nails, sweat and oil glands. 2 layers 2 layers Reticular Reticular Papillary Papillary Fingerprints Fingerprints

Anatomy Dermis Dermis Sebaceous Gland Sebaceous Gland Oil gland produces sebum Oil gland produces sebum Keeps skin and hair soft and pliable Keeps skin and hair soft and pliable Sudoriferous Gland Sudoriferous Gland Sweat gland Sweat gland Merocrine Merocrine Apocrine Apocrine Ceruminous Ceruminous

Anatomy Subcutaneous Layer Subcutaneous Layer Serves as an anchor and binds the skin to the underlying structures. Serves as an anchor and binds the skin to the underlying structures. Contains adipose tissue and provides insulation and protection. Contains adipose tissue and provides insulation and protection.

Anatomy Palate Palate Roof of the mouth. Roof of the mouth. Anterior portion is known as the hard palate. Anterior portion is known as the hard palate. Posterior portion is known as the soft palate. Posterior portion is known as the soft palate.

Anatomy Hand Hand That thing at the end of your arm! That thing at the end of your arm! 3 regions 3 regions Wrist Wrist Palm Palm Fingers Fingers Volar - Palm Volar - Palm Dorsal – Back of the hand Dorsal – Back of the hand Radial – Thumb side Radial – Thumb side Ulnar – Medial side Ulnar – Medial side

Bones of the Hand Carpals Carpals 8 bones of the wrist arranged in 2 rows of 4 bones. 8 bones of the wrist arranged in 2 rows of 4 bones. Metacarpals Metacarpals 5 Bones of the palm 5 Bones of the palm Numbered starting with the thumb Numbered starting with the thumb Phalanges Phalanges 14 bones of the fingers 14 bones of the fingers 3 each except for thumb 3 each except for thumb

Bones of the Hand

Nerves of the Hand Radial nerve Radial nerve Median nerve Median nerve Ulnar nerve Ulnar nerve

Tendons/Muscles of the Hand Almost 40 muscles and tendons are responsible for movement of the hands, wrist, and fingers. Almost 40 muscles and tendons are responsible for movement of the hands, wrist, and fingers. Palmaris longus – Flexes the hand Palmaris longus – Flexes the hand Transverse carpel ligament acts as a covering and tunnel for 9 tendons and the median nerve. Transverse carpel ligament acts as a covering and tunnel for 9 tendons and the median nerve. Carpel tunnel syndrome Carpel tunnel syndrome

Blood Vessels of the Hand Brachial artery divides into two main arteries supplying the hand and forearm with blood. Brachial artery divides into two main arteries supplying the hand and forearm with blood. Radial Artery Radial Artery Ulnar Artery Ulnar Artery

Burns First-degree: Affects just the epidermis First-degree: Affects just the epidermis Second-degree: Affects epidermis and dermis Second-degree: Affects epidermis and dermis Third-degree: Full thickness burn. Permanent tissue damage Third-degree: Full thickness burn. Permanent tissue damage Fourth-degree: Char burns Fourth-degree: Char burns

Burn Depth

Rules of Nines

Pathology Affecting the Skin Acne Acne Aging Aging Sun Exposure Sun Exposure Neoplasms Neoplasms

Pathology Affecting the Skin Cleft lip and palate Cleft lip and palate Cheiloschisis (Cleft or hare lip) Cheiloschisis (Cleft or hare lip) Palatoschisis (Cleft palate) Palatoschisis (Cleft palate) Congenital deformity. Congenital deformity. May occur with just one or both areas affected. May occur with just one or both areas affected. May cause difficulty in swallowing, sucking, and forming proper sounds. May cause difficulty in swallowing, sucking, and forming proper sounds.

Plastic and Reconstructive Surgery CLEFT LIP AND PALATE

Plastic and Reconstructive Surgery UNILATERAL CLEFT PALATE

Plastic and Reconstructive Surgery

Pathology Affecting the Hand Carpel tunnel Carpel tunnel Pressure on the median nerve. Pressure on the median nerve. Syndactyly Syndactyly Webbed digits Webbed digits Polydactyly Polydactyly Extra digits Extra digits De Quervains De Quervains Inflammation of the tendons of the wrist. Inflammation of the tendons of the wrist.

Pathology Affecting the Hand Trigger Finger Trigger Finger Inflammation of the tendon of the digits. Inflammation of the tendon of the digits. Dupuytrens Dupuytrens Non-painful nodules usually at the 4/5 th digits causing palmar contractions. Non-painful nodules usually at the 4/5 th digits causing palmar contractions. Ganglion Ganglion Benign cyst filled with synovial fluid Benign cyst filled with synovial fluid Arthritis Arthritis Inflammation of the joint. Inflammation of the joint. Autoimmune disease Autoimmune disease

Plastic and Reconstructive Surgery

Ganglion Cyst Ganglion Cyst

Pathology Affecting the Breast Males Males Gynecomastia Gynecomastia Females Females Function of the breast is to produce milk for newborn. Function of the breast is to produce milk for newborn. Aesthetic breast surgery has little to do with this function. Aesthetic breast surgery has little to do with this function.

Plastic and Reconstructive Surgery Instrumentation Oscillating Blade Type Dermatome Oscillating Blade Type Dermatome

Plastic and Reconstructive Surgery Instrumentation Electric or nitrogen powered. Electric or nitrogen powered. Uses a oscillating blade to cut thin slices of skin for grafting. Uses a oscillating blade to cut thin slices of skin for grafting. STSR/surgeon can adjust width and depth of graft. STSR/surgeon can adjust width and depth of graft. Sterile mineral oil is used a skin lubricant to minimize friction. Sterile mineral oil is used a skin lubricant to minimize friction.

Plastic and Reconstructive Surgery Instrumentation Mesh Graft Device Mesh Graft Device

Plastic and Reconstructive Surgery Instrumentation Used to expand the size of the split thickness skin graft (STSG) Used to expand the size of the split thickness skin graft (STSG) Harvested skin is placed on a derma carrier and passes through a manual roller with sharp raised surfaces. Harvested skin is placed on a derma carrier and passes through a manual roller with sharp raised surfaces. Creates evenly spaced slits. Creates evenly spaced slits. Mesh Mesh Fishnet Fishnet

Skin Grafts Autologous: Patient’s own body. Autologous: Patient’s own body. Homografts: Same species Homografts: Same species Cadaver Cadaver Heterografts/Xenografts: Dissimilar species (pig, calf) Heterografts/Xenografts: Dissimilar species (pig, calf)

Plastic and Reconstructive Surgery Skin Graft Categories Skin Graft Categories Skin Graft Categories Full-thickness Full-thickness Epidermis and all of the dermis and may include the underlying subcutaneous tissue Epidermis and all of the dermis and may include the underlying subcutaneous tissue Split-thickness Split-thickness Epidermis, approximately half of the dermis Epidermis, approximately half of the dermis

Surgical Procedures Rhytidectomy Rhytidectomy Blepharoplasty Blepharoplasty Abdominalplasty Abdominalplasty Cheiloplasty/Palatoplasty Cheiloplasty/Palatoplasty Ganglion Cyst excision Ganglion Cyst excision Reduction Mammoplasty Reduction Mammoplasty

Plastic and Reconstructive Surgery Eye Surgery Eye SurgeryBlepharoplasty

Plastic and Reconstructive Surgery Abdominoplasty Abdominoplasty

Plastic and Reconstructive Surgery Syndactyly Repair Syndactyly Repair

Plastic and Reconstructive Surgery Syndactyly Repair Syndactyly Repair

Plastic and Reconstructive Surgery Syndactyly Repair Syndactyly Repair

Plastic and Reconstructive Surgery Reduction Mammoplasty Reduction Mammoplasty

Plastic and Reconstructive Surgery Reduction Mammoplasty

Plastic and Reconstructive Surgery Augmentation Mammoplasty Augmentation Mammoplasty

Plastic and Reconstructive Surgery Augmentation Mammoplasty Augmentation Mammoplasty

Plastic and Reconstructive Surgery QUESTIONS? QUESTIONS?