1. 1 Chapter 29 Plastic and Reconstructive Surgery

2. 2 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Review terms and definitions listed at beginning of chapter  Use your medical dictionary if necessary

3. 3 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Plastic and reconstructive surgical procedures  Correction of congenital defects or deformities  Alteration of patient’s appearance for cosmetic purposes  Special psychological needs must be met

4. 4 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Integumentary system The epidermis and the dermis. (From Thibodeau GA, Patton KT: Anthony's textbook of anatomy and physiology, ed 17, St Louis, 2003, Mosby.)

5. 5 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Dermis  Lies directly beneath the epidermis  Contains nervous and blood supply of skin  Contains hair follicles and sebaceous and sweat glands

6. 6 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Skin appendages  Hair  Sweat glands  Sebaceous glands

7. 7 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Perioperative considerations  Prepping and draping Prep solutions of choice  Betadine –Used for liposuction or burns  pHisoHex and Hibiclens –Used on face

8. 8 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Draping Application of the head drape. The corners of the towel must be handled carefully to avoid contamination.

9. 9 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Draping (cont.) Application of the head drape. The corners of the towel must be handled carefully to avoid contamination.

10. 10 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction Draping (cont.) Application of the head drape. The corners of the towel must be handled carefully to avoid contamination.

11. 11 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Equipment and instruments  Dermabrader  Liposuction instruments  CO 2 laser  Facial implants  Dermatome  Mesher  Endobrow instruments

12. 12 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction Brown dermatome and graft knife. (A from Fortunato N, McCullough SM: Plastic and reconstructive surgery, St Louis, 1998, Mosby; B from Rothrock J: Alexander’s care of the patient in surgery, ed 17, Philadelphia, Mosby, 2007.)

13. 13 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Mesher Manual skin mesher. (From Fortunato N, McCullough SM: Plastic and reconstructive surgery: Perioperative nursing series, St Louis, 1998, Mosby.)

14. 14 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Pneumatic power drill  To model bone tissue  To create anchor holes for wire or screw  To cut through bone with an oscillating saw blade

15. 15 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Endobrow instruments  Include variety of periosteal elevators and instruments for blunt and sharp dissection Usually are included in a set Many are adapted to cautery to aid in hemostasis Set also includes a cannula for endoscope to be passed through  The endoscope may or may not be included in the set of instruments; 4- or 5-mm endoscopes in 0- and 30-degree angles are the endoscopes of choice

16. 16 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Debridement  Chemical debridement  Surgical debridement  Pressurized saline

17. 17 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Excision of superficial lesions  Removed for diagnostic purposes  Removed to prevent or treat malignancy

18. 18 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Scar revision  Performed on scars that have not healed properly Includes keloid or hyperpigmented scars

19. 19 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Rotational Flap The lesion is removed and a flap raised from the perinalar area. The flap is rotated to fit over the defect and the graft site skin closed after healing. (From Garden O, Bradbury A, Forsythe J, Parks R: Principles and Practice of Surgery, ed 5, Edinburgh, 2007, Churchill Livingston Elsevier.)

20. 20 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Debridement of burns  Superficial partial thickness (1 st degree)  Partial thickness (2 nd degree)  Full thickness (2 nd degree)  Full thickness (3 rd degree)

21. 21 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Debridement for burns  Performed to excise burned and damaged tissue  Burns caused by transfer of heat from external source to the body  Burns are classified as to depth of tissue affected

22. 22 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Skin grafting  Biological graft Allograft Autograft Composite graft Split-thickness skin graft Full-thickness skin graft Xenograft

23. 23 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Skin graft  Synthetic Silicone Polyethylene GORE-TEX

24. 24 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Debridement for burns  Superficial partial thickness, first degree Only the outer layer of the epidermis is injured. The skin is red or pink, dry, and painful to touch

25. 25 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Debridement for burns (cont.)  Partial thickness, second degree The epidermis and various degrees of the dermis are injured. The skin is blistered, red, and moist  Full thickness, second degree The epidermis and full dermis are injured. These burns are characterized by a white, smooth, shiny surface with dry blisters and edema

26. 26 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Debridement for burns (cont.)  Full thickness, third degree  The skin, the subcutaneous tissue, the muscle, and the bone are burned. The third-degree burn is centered in an area of second-degree injury. The skin may be white, brown, or black and appears waxy. There is no pain because the nerves have been destroyed.

27. 27 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Skin Grafts A dermatome taking a skin graft. (From Barret JP, Herndon DN: Color atlas of burn care, Philadelphia, 2001, Saunders.)

28. 28 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Pedicle graft  Provides coverage of a soft tissue defect  Classification Near graft Distant graft (From Garden O, Bradbury A, Forsythe J, Parks R: Principles and Practice of Surgery, ed 5, Edinburgh, 2007, Churchill Livingston Elsevier.)

29. 29 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Otoplasty  Surgical recreation of the external ear  Performed to correct a congenital malformation  Primary deformity is absence of the antihelix and/or the conchal bowl

30. 30 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Blepharoplasty  Resection of the eyelid to improve vision Upper lid blepharoplasty. A, Retraction of the skin incision using dull rakes. Small bleeders have been coagulated with bipolar electrosurgical unit (ESU). The fat pad is exposed and may be removed with Westcott scissors. B, Closure using 6-0 Vicryl sutures. (From Chen W, Khan J, McCord C: Color atlas of cosmetic oculofacial surgery, 2004, Butterworth Heinemann.)

31. 31 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Lower-Lid Blepharoplasty A, Infraciliary incision. B, Upside-down view of the lower lid margin. (From Chen W, Khan J, McCord C: Color atlas of cosmetic oculofacial surgery, 2004, Butterworth Heinemann.)

32. 32 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Lower-Lid Blepharoplasty (cont.) C, Canthotomy and resection. D, Lid following resection. (From Chen W, Khan J, McCord C: Color atlas of cosmetic oculofacial surgery, 2004, Butterworth Heinemann.)

33. 33 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Brow lift  Procedure done to lift the supportive structures of the brow and alleviate drooping of the skin, muscle, and fascia  Can be done as an open or endoscopic procedure

34. 34 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Open Brow Lift A, Incisions for brow lift. (From LaTrenta G: Atlas of aesthetic face and neck surgery, Philadelphia, 2004, Saunders.)

35. 35 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Open Brow Lift (cont.) B, Closure and removal of redundant scalp tissue. (From LaTrenta G: Atlas of aesthetic face and neck surgery, Philadelphia, 2004, Saunders)

36. 36 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction Endoscopic Brow Lift A, Incisions for endoscopic lift. B, Subperiosteal dissection. (From LaTrenta G: Atlas of aesthetic face and neck surgery, Philadelphia, 2004, Saunders.)

37. 37 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Rhytidectomy  Redundant and sagging supportive tissue of the face is reduced and modified to provide a more aesthetic appearance A, Undermining in the temporal area. (From LaTrenta G: Atlas of aesthetic face and neck surgery, Philadelphia, 2004, Saunders.)

38. 38 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Rhytidectomy (cont.) B, Closure of skin flaps and areas of resection. (From LaTrenta G: Atlas of aesthetic face and neck surgery, Philadelphia, 2004, Saunders.)

39. 39 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Laser skin resurfacing  Performed to reduce effects of aging or photo damage  Skin is resurfaced using laser

40. 40 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Facial augmentation  Mentoplasty (chin augmentation)  Cheek augmentation  Cheiloplasty (lip augmentation)

41. 41 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Mastopexy  Performed to lift the breast and remove excess skin  Performed to correct breast ptosis  Can have significant role in improving body image of patient

42. 42 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Augmentation mammoplasty  Performed to increase the size and improve the shape of the breast

43. 43 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Reduction mammoplasty  Performed to remove breast tissue with reconstruction to provide a more aesthetic appearance

44. 44 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Transverse rectus abdominis myocutaneous (TRAM) flap  Breast reconstruction without the use of implants  Nipple reconstruction Grafting sites  Medial thigh crease  Postauricular region  Labia

45. 45 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction Transverse rectus abdominis myocutaneous (TRAM) flap (cont.) (From Fortunato N, McCullough SM: Plastic and reconstructive surgery, St Louis, 1998, Mosby.)

46. 46 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Liposuction  Performed to remove excess deep fat

47. 47 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Plastics and Reconstruction  Panniculectomy (abdominoplasty)  Performed to remove excess abdominal wall skin and adipose tissue and tighten abdominal wall muscles