Parascapular and free fibula flaps
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The parascapular flap uses skin and bone from the back to reconstruct large cheek defects. It provides reliable reconstruction with appropriate bulk and contour for the cheek. The flap has the disadvantages of a tedious dissection due to numerous branches that must be divided and no possibility for a sensate flap. The free fibula osteocutaneous flap uses the fibula and overlying skin to reconstruct mandibular, maxillary and other bone defects. It has advantages of large vessels, long vascular pedicle, well-vascularized bone that can be shaped. Disadvantages include donor site morbidity such as delayed wound healing and nerve injury. Preoperative vascular problems and poor skin quality can also be issues.
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The free fibula flap involves harvesting the fibula bone with its vascular pedicle for reconstruction at a recipient site. The fibula is well-suited for this due to its length, cortical thickness, and vascular anatomy. It can reconstruct mandibular and other skeletal defects when paired with skin, muscle, or nerve grafts. Advantages include the ability to harvest a long segment of bone and concurrently operate at donor and recipient sites. Proper knowledge of fibula anatomy is important for designing and performing the flap successfully.
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1) The history, indications, levels, preoperative evaluation, operative techniques, postoperative care, and complications of amputation.
2) Details on different amputation levels for the upper and lower extremities.
3) The importance of criteria for an ideal stump, including adequate length and muscle coverage, full range of motion in the proximal joint, and a healthy scar.
Fingertip injuries surgical management 1
This document provides an overview of the evaluation and treatment approaches for soft-tissue injuries of the fingertip. It begins with the anatomy of the fingertip and principles of evaluation, including history, physical exam, and injury details. Treatment approaches are then described based on the type and extent of injury. For soft-tissue loss without bone exposure, options include secondary healing, skin grafting, or local flaps. With bone exposure, principles include bone shortening avoidance and various flap techniques. Treatment algorithms are provided based on injury location and geometry. Reconstruction priorities include coverage, sensation, length and function.
OMR ppt.pptx
- Reconstructive surgery after head and neck cancer resection aims to cover vital structures, allow functions like speech and swallowing, and restore aesthetics. Immediate reconstruction is preferred to prevent complications and allow adjuvant therapy.
- Reconstruction options include primary closure for small defects, skin grafts for larger areas, and local, regional, or distant flaps based on named vessels to reconstruct larger resections. New techniques using CAD/CAM help reconstruct large bony defects with free flaps like fibula. The overall goal is to restore form and function and quality of life.
Gastrocnemius and Forehead flap
This document describes two types of flaps: the gastrocnemius flap and the forehead flap. The gastrocnemius flap uses the medial or lateral head of the gastrocnemius muscle and surrounding tissue to cover defects of the proximal or anterior leg. The forehead flap uses skin and tissue from the forehead, supplied by the supratrochlear artery, to reconstruct nasal or periorbital defects. Key details about the vascular anatomy, dimensions, and applications of each flap are provided.
Plastic and reconstructive surgery presentation.pptx
This document provides an overview of plastic and reconstructive surgery techniques. It discusses various types of grafts and flaps used to manage soft tissue defects, including split thickness skin grafts, full thickness skin grafts, nerve grafts, tendon grafts, random flaps, axial flaps, pedicled flaps, and free flaps. Specific techniques are described for cross leg flaps, biceps femoris flaps, gastrocnemius flaps, soleus flaps, and peroneous brevis flaps to cover defects in the lower limbs. Key principles of plastic surgery like adequate debridement and minimal skin tension are also summarized.
Compartment syndromes
The document discusses various compartment syndromes that can occur in different parts of the body including the extremities, abdomen, and head. It covers the causes, clinical presentation, diagnosis, and treatment of these conditions with a focus on rapid fasciotomy to release pressure in the affected compartments. Extremity compartment syndromes require urgent recognition and management to prevent permanent muscle and nerve damage.
Amputation stump
1. The earliest recorded prosthetic limb dates back to 484 BC, while the oldest preserved prosthetic limb was made of copper and wood from 300 BC.
2. Factors requiring amputation include trauma, ischemia, tumor removal, infection, and complications of diseases like diabetes.
3. An ideal amputation stump heals well, has a gentle contour with muscle padding, sufficient length to bear a prosthesis, and a thin, mobile scar that does not interfere with function.
Saphenous Vein Harvesting
This document discusses saphenous vein harvesting for coronary artery bypass grafting (CABG). It covers the anatomy of the saphenous vein, techniques for harvesting including open and endoscopic methods, tips for avoiding complications, and postoperative care. The saphenous vein is commonly used as a graft due to its accessibility and handling properties, though the internal mammary artery is preferred due to better long-term patency rates. Care must be taken during harvesting to avoid intimal injury, nerve damage, and ensure hemostasis and wound closure to prevent infection.
Giant cell tumour of bone
Giant Cell Tumor of Bone is a benign but locally aggressive bone tumor comprising 5% of all bone tumors. It typically occurs in long bones near the knee in adults aged 20-40. Imaging shows an eccentric lytic lesion in the epiphysis or metaphysis. Treatment involves intralesional curettage with adjuvant therapies like phenol or PMMA cementing to reduce the high recurrence risk of 60% with curettage alone. Wide resection can control the tumor but risks complications from reconstruction. Recurrence usually occurs within 2 years and is treated with repeat curettage.
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Eyelid reconstruction
The document discusses eyelid reconstruction, including:
1. It describes the anatomy of the eyelid, including the palpebral fissure size, positions of the canthi and eyelid margins, and layers of the eyelid.
2. Common reasons for eyelid reconstruction include congenital anomalies, tumors, and trauma. Principles of reconstruction include thorough evaluation, debridement of nonviable tissue, and aligning all tissue layers.
3. Various flap techniques are described for reconstructing different areas of the eyelid, including tarsoconjunctival flaps, cheek flaps, forehead flaps, and V-Y flaps. Complications of reconstruction include issues like corneal abrasion
Vascular anomalies
This document discusses vascular anomalies including infantile hemangioma and various types of vascular malformations such as capillary, venous, arteriovenous, and lymphatic malformations. It covers the classification, clinical features, investigations, management, and complications of these conditions. Key points include that infantile hemangiomas have a distinct growth cycle of proliferation, involution, and involuted phases while vascular malformations are present at birth and grow proportionally with the child. Management involves observation, medications like corticosteroids and propranolol, laser therapy, surgery, and embolization depending on the specific anomaly and risk of complications.
Tissue expansion- principles and techniques
Tissue expansion is a surgical technique used to generate additional skin and soft tissue for reconstructive purposes. It involves inserting a temporary implant called a tissue expander under the skin and gradually inflating it with saline over 6-12 weeks to stretch the overlying tissue. This causes mechanical and biological tissue growth. The expander is then removed and the expanded skin is advanced to reconstruct areas of skin loss or defects. Complications can include hematoma, seroma, expander deflation or migration, and skin thinning or necrosis but tissue expansion provides a good source of autologous tissue for reconstruction when other options are limited.
Principles of tendon transfer
Tendon transfers involve rerouting a functioning muscle tendon unit to restore lost function according to established principles. The key principles are having supple joints at the donor and recipient sites, maintaining soft tissue equilibrium, ensuring the donor has adequate excursion and strength, choosing an expendable donor, maintaining a straight line of pull, selecting donors and recipients with synergistic functions, and performing single tendon transfers for single functions. Tendon transfers can restore grasp, pinch and upper extremity motions according to these principles.
Tenosynovitis
This document discusses tenosynovitis, including its definition, etiology, prognosis, pathophysiology, history, physical examination findings, workup, treatment, and postoperative care. Tenosynovitis is inflammation of the tendon sheath that can be caused by overuse, infection, or inflammatory conditions like rheumatoid arthritis. Physical exam may reveal tenderness, swelling, or limited range of motion. Treatment depends on the cause but may include rest, splinting, anti-inflammatories, corticosteroid injections, or surgery. Prognosis is generally good if treated early without comorbidities, while complications can include adhesion formation or tendon rupture if left untreated.
Tendon transfer- principles and techniques
1. Tendon transfers involve rerouting a functioning muscle tendon unit to restore a function lost due to nerve injury or other conditions. Common indications include nerve injuries or trauma.
2. Key principles of tendon transfer include having supple joints, adequate excursion of the donor muscle, and maintaining a straight line of pull. Common procedures restore functions like finger extension, thumb opposition, and wrist extension.
3. Rehabilitation after tendon transfer focuses on immobilization followed by gentle range of motion and strengthening exercises over 8-12 weeks before returning to full activity.
Temporomandibular joint
- The temporomandibular joint (TMJ) is located between the condylar process of the mandible and the mandibular fossa and articular eminence of the temporal bone. It is a bi-arthroidal hinge joint containing synovial fluid that allows for translational and rotational movements.
- Temporomandibular disorders (TMD) is a collective term used for clinical problems involving the masticatory muscles, TMJ, and associated structures. Common signs and symptoms include pain and limited opening of the mouth.
- Disc displacement is the most common TMJ articular disorder and can involve reduction or lack of reduction of the articular disc. Conservative treatments include
Suture techniques, Z-plasty
The document describes various suture techniques including simple interrupted sutures, which are the gold standard, subcuticular sutures which avoid external knots, half-buried horizontal mattress sutures which keep knots on one side, continuous over-and-over sutures which can be placed rapidly but are less precise than interrupted sutures, skin staples which are a timesaving alternative to sutures, skin tapes and adhesives which can be used in low tension areas, and Z-plasties which help prevent or limit scarring and contractures. It also outlines indications, contraindications and potential complications of Z-plasty techniques.
Replantation of the hand and Upper extremity
1. Replantation involves reattaching a completely amputated body part to restore blood flow, while revascularization reattaches incompletely amputated parts.
2. Factors that determine replantation success include patient health, injury details, and surgical team skill.
3. The operative technique prioritizes veins, arteries, bones, tendons, and nerves with the goal of minimizing warm ischemia time.
Skin donation, skin banking, skin culture
1. Skin banking involves procuring skin from donors after death, processing it which may include cryopreservation or lyophilization, and storing it to be used for burn patients or other wounds.
2. The first skin bank was established in 1971 and they continue to improve techniques like reducing immunogenicity and potential for disease transmission.
3. Skin culture techniques also allow creating skin substitutes using fibroblasts, keratinocytes and endothelial cells grown on collagen gels or cadaver dermis in organotypic culture.
Nerves of hand
The document summarizes the anatomy and branches of the ulnar, radial, and median nerves in the upper limb. It describes the course and branches of each nerve in the axilla, arm, and forearm. It also discusses the separation of motor and sensory components within the nerves and provides diagrams of fascicular patterns. Key points include that the ulnar nerve supplies medial forearm muscles and skin of the little and half of the ring finger, the radial nerve innervates posterior forearm muscles and skin of the dorsal hand, and the median nerve gives branches in the forearm and palm.
Neck lift, forehead and thread lift
This document discusses various surgical approaches for forehead and brow lifting as well as neck lifting. For forehead lifts, it describes techniques like the coronal approach and its disadvantages like scalp numbness. It also covers other approaches like the temple approach and endoscopic approach. For neck lifts, it discusses factors to consider like skin elasticity and platysma muscle treatment. It provides details on the surgical process for different grades of neck laxity and describes techniques like subcutaneous lipectomy and platysma plication. Post-operative care is also outlined for both forehead and neck procedures.
Mandibular fracture- diagnosis
This document discusses the classification, diagnosis, and treatment of mandibular fractures. Key points include:
- Mandibular fractures are classified based on location and examined clinically and radiographically.
- Treatment options include closed or open reduction, with closed reduction used for minimally displaced fractures and open reduction for more complex cases.
- Internal fixation methods like miniplates are used to achieve rigid stabilization during open reduction, while intermaxillary fixation can be used short-term for closed reduction.
- Potential complications include hemorrhage, infection, nonunion, and neurosensory changes. Proper treatment aims to restore occlusion and minimize complications.
Skin healing and repair
This document discusses the stages of skin graft take, including plasmatic imbibition, inosculation and capillary ingrowth, and revascularization. It describes graft fixation, contraction, reinnervation, pigmentation, and factors that can lead to graft failure. The stages of graft take typically involve serum imbibition for 24-48 hours, development of fine vasculature in a fibrin layer, and eventual blood flow as the graft becomes pink. Revascularization may occur through direct vessel anastomoses, new vascular channel formation, or a combination. Proper fixation and aftercare are important for successful graft take.
Liposuction- techniques and indications
Liposuction is a surgical procedure to remove unwanted fat deposits from beneath the skin. It was originally introduced in the 1980s and involves using suction to aspirate fat through small incisions. There are several techniques including traditional suction-assisted liposuction, ultrasound-assisted, power-assisted, vaser-assisted, and laser-assisted liposuction. Patient selection, pre-operative evaluation and planning, anesthesia technique, and post-operative care are important considerations to achieve optimal results and avoid complications from liposuction.
Local flaps classifications
This document describes different types of local flaps that can be used in skin grafting and reconstructive procedures. It outlines pivotal flaps, advancement flaps, and hinge flaps. Pivotal flaps involve rotation, transposition, or interpolation of skin and come in various shapes. Advancement flaps can be unipedicled, bipedicled, or in a V-Y or Y-V configuration. They take advantage of skin elasticity or use Burrow triangles to advance the skin. Pantographic expansion is another advancement technique but carries more risk.
Flexor tendon repair
Flexor tendon repair requires protecting the tendon repair while allowing early controlled motion to minimize adhesions. This involves splinting the fingers in flexion after primary repair or tendon grafting, followed by progressive range of motion exercises. Complications can include infection, scarring and joint contractures, but good outcomes are achieved with protocols emphasizing early motion like Duran or Kleinert methods.
Gracilis and Latissimus Dorsi flap
The gracilis muscle is a thin muscle in the thigh that can be used as a free flap for reconstruction. It is 25-30 cm in length with a 10-12 cm tendon. The muscle is innervated by the obturator nerve and receives its blood supply from the gracilis vessels of the medial femoral circumflex artery system. It is commonly used in head and neck reconstruction or to repair soft tissue defects. The latissimus dorsi muscle is one of the largest muscles in the body and can be harvested as a pedicled or free flap, often with a skin paddle. It is innervated by the thoracodorsal nerve and receives its blood supply from the thoracod
Electric burn injury- diagnosis and management
Electrical injuries can cause damage through direct tissue damage, thermal energy, and mechanical injury. They result in around 1000 deaths and 3000 burns center admissions per year in the US. The main mechanisms of injury are electrical energy altering cell membranes, massive tissue destruction from heat, and physical trauma. Management involves following ATLS protocols, monitoring for cardiac issues, treating potential myoglobinuria, aggressive wound care, and surgery as needed. Prevention focuses on electrical safety practices and seeking shelter during storms.
Microtia- diagnosis and management
Microtia is a congenital deformity where the external ear is underdeveloped, ranging from small ears to complete absence of the auricular tissues. Treatment options include autologous costal cartilage grafts and prosthetic reconstruction. The Tanzer, Brent, and Nagata techniques use harvested rib cartilage to construct an ear framework, with differences in staging and sculpting of features. Complications can include chest wall deformities, skin necrosis, infection, and resorption of the cartilage graft over time.
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Parascapular and free fibula flaps
- 2. Anatomy
- 10. • pedicle length of 6-10cm • 10-14cm of bone can be obtained with a width of 2–3cm • skin island of up to 10cm x 30cm • If the width of skin is more than 10cm, skin grafting is required • Calliber from 2 to 4 millimeters
- 11. Technique • Lateral decubitus • Arm free • Marking • Inferior dissection • superficial to the deep fascia overlying the muscles of shoulder • Pedicle at superior border of the teres major • Superior dissection
- 12. Advantages • free-tissue transfers for large cheek defects • reliability, • appropriate bulk for the cheek • lack of atrophy • excellent contour • Composite flap
- 13. Disadvantages • Dissection of vascular pedicle can be tedious because of numerous muscular and bony branches that must be divided • Donor site does not have a cutaneous sensory nerve, and there is no possibility for a sensate flap • closure of the donor site • color mismatch
- 14. Free fibula osteocutaneous flap
- 15. Indications Reconstruction of • oromandibular and midface/maxillary defects; • upper and lower limb long bones; • the pelvis; • joints
- 16. Advantages • Large vessels • Long vascular pedicle • Well vascularised bone • Long length of donor bone (>25cm) • Adequate bone stock • Bony strength permits good screw fixation and solid reconstruction • Bony reconstruction can be shaped with multiple segmental osteotomies
- 17. • Stable bicortical osseointegrated dental implant fixation is possible • Thin, pliable overlying skin (usually) • Skin island adequate for most head and neck reconstructions • Very little soft tissue bulk (usually) • Simultaneous cancer resection and harvesting of flap possible
- 18. Disadvantages Donor site morbidity: • Delayed wound healing • skin graft loss especially following peroneal tendon exposure; • nerve injury; • ankle instability; • Pseudocompartment syndrome • Muscle necrosis
- 19. Preoperative vascular problems: • Peripheral vascular disease, venous insufficiency, • previous deep vein thrombosis, • congenital absence of lower leg vessels • Peronea magna
- 20. • Poor skin quality: Obesity, stasis and ischemia • Previous lower limb trauma: Fractures, vascular injury
- 21. Anatomy
- 22. Muscles encountered when raising a FFF • Peroneus longus • Peroneus brevis • Extensor digitorum longus • Tibialis posterior • Soleus • Flexor hallucis longus (The muscles subsequently reattach to scar tissue and the divided interosseous membrane
- 25. • Not sensate. • Large caliber of 1.5 to 4 mm • Two venae, usually similar in size to the artery • The short pedicle can be made longer by dissecting it free of the proximal fibula
- 26. Pre op • Vascularity • X rays