Principles Of Plastic Surgery Research Articles

Plastic surgery in rural Ethiopia.

From this brief experience in Ethiopia I believe that plastic and reconstructive surgery can contribute much to the lives of many people in such underdeveloped regions of the world. If one will teach the principles of plastic surgery to the general surgeons and paramedical people who do most of the work in these areas, it can amplify and expand their capabilities. Surgery is, of course, only one link in the long chain of basic health issues, and the ultimate solutions are on a different level. Yet, the magnitude of the problems is a compelling reason to make the effort, to take the time, and to contribute our skills in developing regions of the world. Though we cannot alone conquer the entire problem, we can do our bit.

Use of a tailored abdominal pedicle flap for surgical reconstruction of the hand

We have presented the highlights and the most recent innovations in our technique of applying abdominal pedicle flaps to the hand—a technique which we have modified progressively over the past twenty years. These changes have evolved as we have attempted to apply the principles of plastic surgery more fully in the transfer and shifting of skin in the treatment of extensive injuries of the hand. These technical innovations include the following: 1. Patterns are used for pedicle flaps. These patterns are laid out on the donor area to correspond to the recipient site and in making the patterns liberal use is made of points and darts of tissue at the borders of flap to break up undesirable straight-line sears. 2. Only enough subcutaneous fat should remain on pedicle flaps to meet the requirements of the planned reconstruction and flaps may safely be made as thin as desired. 3. Kirschner wires are useful as temporary fixation to maintain the functional position of the hand and to control pronation and supination of the forearm in relation to the abdominal pedicle flap.

Use of a Tailored Abdominal Pedicle Flap for Surgical Reconstruction of the Hand

We have presented the highlights and the most recent innovations in our technique of applying abdominal pedicle flaps to the hand—a technique which we have modified progressively over the past twenty years. These changes have evolved as we have attempted to apply the principles of plastic surgery more fully in the transfer and shifting of skin in the treatment of extensive injuries of the hand. These technical innovations include the following: 1. Patterns are used for pedicle flaps. These patterns are laid out on the donor area to correspond to the recipient site and in making the patterns liberal use is made of points and darts of tissue at the borders of flap to break up undesirable straight-line sears. 2. Only enough subcutaneous fat should remain on pedicle flaps to meet the requirements of the planned reconstruction and flaps may safely be made as thin as desired. 3. Kirschner wires are useful as temporary fixation to maintain the functional position of the hand and to control pronation and supination of the forearm in relation to the abdominal pedicle flap.

Sliding skin grafts in the treatment of anal fissures.

Summary The basic principles of plastic surgery for sliding skin graft have been employed routinely in and about the anal canal. In 2,072 patients operated upon by the authors the infected fissure and crypt-bearing hemorrhoidal tissue was excised and the defect closed primarily with a broad-based sliding skin graft. Any associated disease—hemorrhoids, cryptitis, etc.—was also removed, employing the closed technic. Excision of a chronic fissure in ano and covering of the defect with a sliding-flap broad-based skin graft offers the advantages of: 1) decreased postoperative pain; 2) decreased postoperative wound care, in both hospital and office; 3) decreased incidence of postoperative complications (recurrent anal fissure and stenosis are rare, the diameter of the anus is actually increased and is our procedure of choice for anal stenosis); 4) primary vs. secondary wound healing, i.e., a) healing more rapid, b) decreased scar and resultant deformity, c) decreased postoperative inflammatory response and infection; 5) the increased operative time is not harmful to the patient under caudal or epidural anesthesia.

Penile Reconstruction of Congenital Urogenital Malformation: Penile Duplication, Bifid Scrotum, Symphisiolysis, and Remnant Urachus

Background: This report describes the penile reconstruction of a congenital urogenital malformation.Patient and Method: A 12 year-old boy came to our hospital with ‘penile duplication’, bifid scrotum, symphisiolysis, and remnant urachus. The procedures were done by the urologist, pediatric surgeon, and plastic surgeon. Urethral evaluation done by the urologist determined which penis was tenable, pediatric surgeon then excised the remnant urachus, and we performed urethroplasty onto the chosen urethra. The medial side of the penis was deepithelialized and both penis were put within one skin covering.Results: Patient was able to control micturition, and has normal erectile function. In the future, we plan to do further reconstruction of the pubic symphisiolysis at pubertal age.Summary: Surgery was performed by a team dedicated to their specialties. There is no single standard procedure for urogenital malformation, and we must emphasize the functional and aesthetic results in reconstruction surgery. It is important to master the basic principles of plastic surgery.

Symposium on Surgery of the Ocular Adnexa.

manual consists of 18 chapters ranging from basic principles in ophthalmic plastic surgery to the nonsurgical treatment of tumors of the ocular adnexa. Preface to this volume gives a concise and accurate summation: This book is a compilation of the lectures from the Symposium on Surgery of the Ocular Adnexa given at the Fourteenth Annual Session of the New Orleans Academy of Ophthalmology, February 14 to 19, 1965. The authors are outstanding ophthalmologists in the various fields of their subjects. They have discussed the pathogenesis and diagnosis of each condition and have described the treatment that they have found most satisfactory by their own personal experience. Differences of opinion are brought out in the Round Table Discussion included in the back of the book. final 40 pages, devoted to the Round Table Discussion, are very interesting. There are 82 questions and answers which cover many of the

Reconstructive Surgery of the Eyelids and Ocular Adnexa.

The fundamental principles of ophthalmic plastic surgery have long been known. Starting from these, the possible variations on basic techniques are almost innumerable. Each surgeon usually develops and prefers his own modification. The author's wide experience with ophthalmic reconstructive problems merits close attention to his opinions concerning procedures he has found most effective. Clear line drawings help the concise text immensely. Doctor Callahan's most recent volume is highly recommended to those interested in reparative surgery.

Rehabilitation by skin grafting.

SKIN grafting has become such an integral part of all phases of head and neck surgery that the two subjects cannot be taken separately, either in regard to reconstruction or rehabilitation. Rehabilitation by skin grafting in this anatomic area in particular requires the use of all plastic surgery principles regarding the application of grafts. This is especially true because of the variation and characteristics of the skin in the individual anatomic areas of the face and neck dramatized, for example, by the contrast between the thin delicate skin of the eyelids and the thick sebaceous skin of the lobule of the nose. The purpose of this article is to review basic disciplines regarding technique and to acquaint the reader with my reasoning and clinical applications. The use of skin grafts extends from otologic microsurgery to major replacements for tissue losses from trauma or radical resection. 4,8-10 It has become essential

Primary Abbe flap in bilateral cleft lip

Summary The Abbe flap has been described as a primary procedure for the correction of bilateral clefts of the lip associated with considerable agenesis of tissue. The procedure is a logical application of the principles of plastic surgery to the closure of a large defect where there is inadequate local tissue. Hitherto, closure even of the widest clefts has been achieved by drawing together local tissues under tension. Despite ingenious techniques a taut upper lip and flattened nose are inevitable under such circumstances and require secondary corrective procedures including an Abbe flap. The primary Abbe flap repair is a safe and justifiable operation in such cases.

Fundamental Principles of Plastic Surgery as Applied to Injuries of the Upper Extremity

Fundamental Principles of Plastic Surgery as Applied to Injuries of the Upper Extremity

Principles of Plastic Surgery for Nurses

Principles of Plastic Surgery for Nurses

Principles of Plastic Surgery for Nurses

Principles of Plastic Surgery for Nurses

Book ReviewThe Principles and Art of Plastic Surgery.

Book ReviewThe Principles and Art of Plastic Surgery.

The Principles of Plastic Surgery of the Sound-Conducting Apparatus

The Principles of Plastic Surgery of the Sound-Conducting Apparatus

CICATRICIAL STENOSIS OF THE HYPOPHARYNX TREATED WITH SKIN GRAFT

THE CASE to be described is one of stricture of the hypopharynx following ingestion of lye which did not respond satisfactorily to bougienage. A successful result was brought about by applying the principles of plastic surgery. Through an external approach a skin graft was applied to the cicatrized area after resection of the stricture. Since 1918, skin grafts have been successfully applied onto freshly denuded surfaces in the presence of salivary secretions, which contain the bacterial flora of the mouth. At that time Waldron, Gillies and Pickerill1introduced a stent with the skin graft directly into the mouth. Arbuckle,2in 1930, was among the first to report the application of free skin grafts to laryngeal stenoses. Figi,3in 1947, reported that he applied this technic to cicatrized laryngeal stenoses with success. REPORT OF A CASE A Negro woman aged 20 had ingested lye in a suicidal attempt.

EFFECT OF A TYPICAL NASAL PLASTIC CORRECTION ON FACIAL EXPRESSION

IT WAS Joseph 1 who first described the surprising alteration of facial expression after treatment according to the principles of nasal plastic surgery. He depicted the subjects of plastic surgery dancing in a happy mood, and it was his belief that the newly acquired state of satisfaction was mainly psychologic, due to the absence of the previous nasal disfigurement. Some of my patients who were treated by nasal plastic surgery without anything else showed such a remarkable spontaneous improvement in their entire countenance that the question could be asked whether this change of facial expression was actually caused only by psychologic uplift. Or is it possible that nasal surgery alone can effect indirectly changes of facial expression? To answer this question, I undertook the following study. Figure 1 shows the same patient before and after nasal repair. The second picture was taken seven weeks after the first. The preoperative diagnosis was:

Principles in Reparative Plastic Surgery

Principles in Reparative Plastic Surgery

Dermoplasty of war wounds of the lower leg

A method composed of recognized surgical procedures is herein presented for the best physiological revision of war wounds of the lower leg, based upon selected and proven principles of plastic surgery. The method is detailed and illustrated. Its purpose is maximum revision of soft tissue deformity to give optimum conditions for subsequent orthopedic or plastic reconstruction and functional rehabilitation. The method consists of absolute excision of all soft tissue disorders followed by the best available combined methods of grafting defects. It additionally reduces to a minimum the use of extensive free grafting, which is not the best method of tissue replacement for functional as well as cosmetic reasons. This is made possible by the combination of a double pedicle flap, with a reduction in the circumference of the leg, and the secondary use of full thickness skin over a small residual surgically created area. It has been shown by this method that a complex injury to the lower leg can with more speed and better results be reduced to a simple closed wound or fracture in preparation for ultimate rehabilitation of the patient.

Traumatic injuries to the eye and its adnexa

1. 1. Restoration of proper function and appearance of the lids after injury, requires a knowledge of the anatomy and physiology of the parts and of the fundamental principles of plastic surgery. Many emergency operations are poorly done. 2. 2. The extraocular muscles themselves are rarely injured but their functions are often disturbed by contusion of the nerve supply, fractures and lacerations. 3. 3. Contusions of the globe, however simple, often prove serious to sight; therefore every eyeball so injured should receive careful scrutiny both inside and out. 4. 4. The importance of detection of minute perforations of the globe is emphasized because of their aid in detecting possible intraocular foreign bodies. Bed rest and careful observation for complications in all perforating wounds of the globe are indicated. Sympathetic ophthalmia has not developed in this group. 5. 5. Traumatic cataracts may arise from contusions as well as from penetrating wounds of the globe and should be removed at the proper time, provided the posterior segment of the eye is intact. 6. 6. Intraocular foreign bodies may or may not prove serious to sight; their character and location plus the element of infection are the determining factors. All foreign bodies should be removed as soon as detected whenever, possible. Sometimes, however, haste makes waste and should be avoided. 7. 7. Injection of foreign protein in some form to produce fever and stimulate antibody formation is widely used in the practice of ophthalmology. The amount of fever produced seems to be the criterion of its effectiveness. Typhoid H-antigen is generally preferred for prophylactic purposes, although its exact value is difficult to judge. Induced fever by the use of the Kettering hypertherm cabinet does not destroy exogenous intraocular infection. 8. 8. Second and third degree burns of the eye are destructive to sight and disappointing to treat. Research investigation so far has contributed little to improvement in method of treatment. 9. 9. Fractures of the malar bone and zygomatic arch are the most disfiguring and may produce binocular imbalance and asymmetry of the eyes. Intraocular damage is also a possibility. Repair should be done if possible before swelling occurs or immediately after it subsides. The Caldwell-Luc operation is the method of approach mostly employed. Fractures of the optic foramen may produce optic atrophy.

USE OF RECONSTRUCTIVE SURGERY IN CERTAIN TYPES OF DEFORMITIES OF THE FACE

A large number of deformities, for correction of which reconstructive surgery is required, are seen primarily by laryngologists. Consequently, we are considering some applications of the principles of this type of surgery for certain types of deformities of the face that are of especial interest to laryngologists. There are certain general principles in reconstructive surgery that are the same whether applied to this field or to others. Some of these principles are applied in the making of a tubed flap, a delayed flap, a fullthickness skin graft or a Thiersch graft, or in the grafting of bone or cartilage. However, in operations about the face certain problems require additional consideration, owing to local anatomic, functional and cosmetic requirements. No field of surgery requires more careful preoperative study, exacting surgical technic, care in handling tissues, and close postoperative observation. Of the many deformities that occur about the face, we have selected