Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 8 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 10 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 8 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 8 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 8 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 8 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 8 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 8 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 8 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.

This review contains 8 figures, 6 tables, and 51 references.

Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management 

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.

This review contains 1 figure, 3 videos, and 58 references. 

Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Flaps are the basis for reconstructive surgery and allow the movement of tissue both locally and distantly, to cover wounds, restore form, and reestablish function. Some flap surgeries have been performed for thousands of years; a clear testament to their efficacy. For today’s plastic surgeon, the understanding of flap anatomy and physiology is an absolutely key. This chapter familiarizes the reader with the history and evolution of flap surgery as well as science behind them. We review the multiple classifications for various flap types. We begin with simple, random skin flaps and work up the reconstructive ladder to composite free flaps. Specific flaps will be discussed, including anatomy, operative techniques, and clinical applications. Finally, we examine various ways flaps may be modified to better meet complex reconstructive challenges.

This review contains 17 figures, 4 tables, 1 video, and 36 references. 

Key words: Flap, random, pedicled, axial, free, microsurgery, skin, muscle, musculocutaneous, fasciocutaneous, perforator, fabrication, prefabrication, prelamination, supercharging, turbocharging

Flaps are the basis for reconstructive surgery and allow the movement of tissue both locally and distantly, to cover wounds, restore form, and reestablish function. Some flap surgeries have been performed for thousands of years; a clear testament to their efficacy. For today’s plastic surgeon, the understanding of flap anatomy and physiology is an absolutely key. This chapter familiarizes the reader with the history and evolution of flap surgery as well as science behind them. We review the multiple classifications for various flap types. We begin with simple, random skin flaps and work up the reconstructive ladder to composite free flaps. Specific flaps will be discussed, including anatomy, operative techniques, and clinical applications. Finally, we examine various ways flaps may be modified to better meet complex reconstructive challenges.

This review contains 17 figures, 4 tables, 1 video, and 36 references. 

Key words: Flap, random, pedicled, axial, free, microsurgery, skin, muscle, musculocutaneous, fasciocutaneous, perforator, fabrication, prefabrication, prelamination, supercharging, turbocharging

Flaps are the basis for reconstructive surgery and allow the movement of tissue both locally and distantly, to cover wounds, restore form, and reestablish function. Some flap surgeries have been performed for thousands of years; a clear testament to their efficacy. For today’s plastic surgeon, the understanding of flap anatomy and physiology is an absolutely key. This chapter familiarizes the reader with the history and evolution of flap surgery as well as science behind them. We review the multiple classifications for various flap types. We begin with simple, random skin flaps and work up the reconstructive ladder to composite free flaps. Specific flaps will be discussed, including anatomy, operative techniques, and clinical applications. Finally, we examine various ways flaps may be modified to better meet complex reconstructive challenges.

This review contains 17 figures, 4 tables, 1 video, and 36 references. 

Key words: Flap, random, pedicled, axial, free, microsurgery, skin, muscle, musculocutaneous, fasciocutaneous, perforator, fabrication, prefabrication, prelamination, supercharging, turbocharging

Flaps are the basis for reconstructive surgery and allow the movement of tissue both locally and distantly, to cover wounds, restore form, and reestablish function. Some flap surgeries have been performed for thousands of years; a clear testament to their efficacy. For today’s plastic surgeon, the understanding of flap anatomy and physiology is an absolutely key. This chapter familiarizes the reader with the history and evolution of flap surgery as well as science behind them. We review the multiple classifications for various flap types. We begin with simple, random skin flaps and work up the reconstructive ladder to composite free flaps. Specific flaps will be discussed, including anatomy, operative techniques, and clinical applications. Finally, we examine various ways flaps may be modified to better meet complex reconstructive challenges.

This review contains 17 figures, 4 tables, 1 video, and 36 references. 

Key words: Flap, random, pedicled, axial, free, microsurgery, skin, muscle, musculocutaneous, fasciocutaneous, perforator, fabrication, prefabrication, prelamination, supercharging, turbocharging

Flaps are the basis for reconstructive surgery and allow the movement of tissue both locally and distantly, to cover wounds, restore form, and reestablish function. Some flap surgeries have been performed for thousands of years; a clear testament to their efficacy. For today’s plastic surgeon, the understanding of flap anatomy and physiology is an absolutely key. This chapter familiarizes the reader with the history and evolution of flap surgery as well as science behind them. We review the multiple classifications for various flap types. We begin with simple, random skin flaps and work up the reconstructive ladder to composite free flaps. Specific flaps will be discussed, including anatomy, operative techniques, and clinical applications. Finally, we examine various ways flaps may be modified to better meet complex reconstructive challenges.

This review contains 17 figures, 4 tables, 1 video, and 36 references. 

Key words: Flap, random, pedicled, axial, free, microsurgery, skin, muscle, musculocutaneous, fasciocutaneous, perforator, fabrication, prefabrication, prelamination, supercharging, turbocharging

Flaps are the basis for reconstructive surgery and allow the movement of tissue both locally and distantly, to cover wounds, restore form, and reestablish function. Some flap surgeries have been performed for thousands of years; a clear testament to their efficacy. For today’s plastic surgeon, the understanding of flap anatomy and physiology is an absolutely key. This chapter familiarizes the reader with the history and evolution of flap surgery as well as science behind them. We review the multiple classifications for various flap types. We begin with simple, random skin flaps and work up the reconstructive ladder to composite free flaps. Specific flaps will be discussed, including anatomy, operative techniques, and clinical applications. Finally, we examine various ways flaps may be modified to better meet complex reconstructive challenges.

This review contains 17 figures, 4 tables, 1 video, and 36 references. 

Key words: Flap, random, pedicled, axial, free, microsurgery, skin, muscle, musculocutaneous, fasciocutaneous, perforator, fabrication, prefabrication, prelamination, supercharging, turbocharging

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.

This review contains 17 figures, 3 tables, and 119 references.

Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. 

This review contains 12 figures, 6 tables, 1 video, and 74 references.

Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

Reconstructive surgery plays an integral role in helping restore form and function in patients with complex oncologic wounds. The intricate process of wound healing can be adversely affected by exposure to chemotherapeutic and radiation therapies. Assessment of available donor tissue quality, previous radiation therapy, vascular status, and donor site morbidity are essential when determining the most appropriate reconstructive approach for definitive wound management. The timing of reconstruction in relation to chemotherapy or radiotherapy regimens influences wound healing. Additionally, the timing of reconstruction is important in order to avoid delaying additional adjuvant therapies. Optimizing nutritional status is critical for improved patient outcomes in the oncologic patient population. At times, palliative efforts by means of surgical debulking are required of a reconstructive surgeon as advanced cancers can leave patients with disfiguring, fungating masses.

Keywords: wounds in cancer, wounds in the cancer patient, oncologic wounds, oncologic wound healing, oncologic wound management, wound complications, effect of chemotherapy on wound healing, effect of radiation therapy on wound healing, oncologic reconstruction

Reconstructive surgery plays an integral role in helping restore form and function in patients with complex oncologic wounds. The intricate process of wound healing can be adversely affected by exposure to chemotherapeutic and radiation therapies. Assessment of available donor tissue quality, previous radiation therapy, vascular status, and donor site morbidity are essential when determining the most appropriate reconstructive approach for definitive wound management. The timing of reconstruction in relation to chemotherapy or radiotherapy regimens influences wound healing. Additionally, the timing of reconstruction is important in order to avoid delaying additional adjuvant therapies. Optimizing nutritional status is critical for improved patient outcomes in the oncologic patient population. At times, palliative efforts by means of surgical debulking are required of a reconstructive surgeon as advanced cancers can leave patients with disfiguring, fungating masses.

Keywords: wounds in cancer, wounds in the cancer patient, oncologic wounds, oncologic wound healing, oncologic wound management, wound complications, effect of chemotherapy on wound healing, effect of radiation therapy on wound healing, oncologic reconstruction

Reconstructive surgery plays an integral role in helping restore form and function in patients with complex oncologic wounds. The intricate process of wound healing can be adversely affected by exposure to chemotherapeutic and radiation therapies. Assessment of available donor tissue quality, previous radiation therapy, vascular status, and donor site morbidity are essential when determining the most appropriate reconstructive approach for definitive wound management. The timing of reconstruction in relation to chemotherapy or radiotherapy regimens influences wound healing. Additionally, the timing of reconstruction is important in order to avoid delaying additional adjuvant therapies. Optimizing nutritional status is critical for improved patient outcomes in the oncologic patient population. At times, palliative efforts by means of surgical debulking are required of a reconstructive surgeon as advanced cancers can leave patients with disfiguring, fungating masses.

Keywords: wounds in cancer, wounds in the cancer patient, oncologic wounds, oncologic wound healing, oncologic wound management, wound complications, effect of chemotherapy on wound healing, effect of radiation therapy on wound healing, oncologic reconstruction

Reconstructive surgery plays an integral role in helping restore form and function in patients with complex oncologic wounds. The intricate process of wound healing can be adversely affected by exposure to chemotherapeutic and radiation therapies. Assessment of available donor tissue quality, previous radiation therapy, vascular status, and donor site morbidity are essential when determining the most appropriate reconstructive approach for definitive wound management. The timing of reconstruction in relation to chemotherapy or radiotherapy regimens influences wound healing. Additionally, the timing of reconstruction is important in order to avoid delaying additional adjuvant therapies. Optimizing nutritional status is critical for improved patient outcomes in the oncologic patient population. At times, palliative efforts by means of surgical debulking are required of a reconstructive surgeon as advanced cancers can leave patients with disfiguring, fungating masses.

Keywords: wounds in cancer, wounds in the cancer patient, oncologic wounds, oncologic wound healing, oncologic wound management, wound complications, effect of chemotherapy on wound healing, effect of radiation therapy on wound healing, oncologic reconstruction

Reconstructive surgery plays an integral role in helping restore form and function in patients with complex oncologic wounds. The intricate process of wound healing can be adversely affected by exposure to chemotherapeutic and radiation therapies. Assessment of available donor tissue quality, previous radiation therapy, vascular status, and donor site morbidity are essential when determining the most appropriate reconstructive approach for definitive wound management. The timing of reconstruction in relation to chemotherapy or radiotherapy regimens influences wound healing. Additionally, the timing of reconstruction is important in order to avoid delaying additional adjuvant therapies. Optimizing nutritional status is critical for improved patient outcomes in the oncologic patient population. At times, palliative efforts by means of surgical debulking are required of a reconstructive surgeon as advanced cancers can leave patients with disfiguring, fungating masses.

Keywords: wounds in cancer, wounds in the cancer patient, oncologic wounds, oncologic wound healing, oncologic wound management, wound complications, effect of chemotherapy on wound healing, effect of radiation therapy on wound healing, oncologic reconstruction

Reconstructive surgery plays an integral role in helping restore form and function in patients with complex oncologic wounds. The intricate process of wound healing can be adversely affected by exposure to chemotherapeutic and radiation therapies. Assessment of available donor tissue quality, previous radiation therapy, vascular status, and donor site morbidity are essential when determining the most appropriate reconstructive approach for definitive wound management. The timing of reconstruction in relation to chemotherapy or radiotherapy regimens influences wound healing. Additionally, the timing of reconstruction is important in order to avoid delaying additional adjuvant therapies. Optimizing nutritional status is critical for improved patient outcomes in the oncologic patient population. At times, palliative efforts by means of surgical debulking are required of a reconstructive surgeon as advanced cancers can leave patients with disfiguring, fungating masses.

Keywords: wounds in cancer, wounds in the cancer patient, oncologic wounds, oncologic wound healing, oncologic wound management, wound complications, effect of chemotherapy on wound healing, effect of radiation therapy on wound healing, oncologic reconstruction

Reconstructive surgery plays an integral role in helping restore form and function in patients with complex oncologic wounds. The intricate process of wound healing can be adversely affected by exposure to chemotherapeutic and radiation therapies. Assessment of available donor tissue quality, previous radiation therapy, vascular status, and donor site morbidity are essential when determining the most appropriate reconstructive approach for definitive wound management. The timing of reconstruction in relation to chemotherapy or radiotherapy regimens influences wound healing. Additionally, the timing of reconstruction is important in order to avoid delaying additional adjuvant therapies. Optimizing nutritional status is critical for improved patient outcomes in the oncologic patient population. At times, palliative efforts by means of surgical debulking are required of a reconstructive surgeon as advanced cancers can leave patients with disfiguring, fungating masses.

Keywords: wounds in cancer, wounds in the cancer patient, oncologic wounds, oncologic wound healing, oncologic wound management, wound complications, effect of chemotherapy on wound healing, effect of radiation therapy on wound healing, oncologic reconstruction

Reconstructive surgery plays an integral role in helping restore form and function in patients with complex oncologic wounds. The intricate process of wound healing can be adversely affected by exposure to chemotherapeutic and radiation therapies. Assessment of available donor tissue quality, previous radiation therapy, vascular status, and donor site morbidity are essential when determining the most appropriate reconstructive approach for definitive wound management. The timing of reconstruction in relation to chemotherapy or radiotherapy regimens influences wound healing. Additionally, the timing of reconstruction is important in order to avoid delaying additional adjuvant therapies. Optimizing nutritional status is critical for improved patient outcomes in the oncologic patient population. At times, palliative efforts by means of surgical debulking are required of a reconstructive surgeon as advanced cancers can leave patients with disfiguring, fungating masses.

Keywords: wounds in cancer, wounds in the cancer patient, oncologic wounds, oncologic wound healing, oncologic wound management, wound complications, effect of chemotherapy on wound healing, effect of radiation therapy on wound healing, oncologic reconstruction

Reconstructive surgery plays an integral role in helping restore form and function in patients with complex oncologic wounds. The intricate process of wound healing can be adversely affected by exposure to chemotherapeutic and radiation therapies. Assessment of available donor tissue quality, previous radiation therapy, vascular status, and donor site morbidity are essential when determining the most appropriate reconstructive approach for definitive wound management. The timing of reconstruction in relation to chemotherapy or radiotherapy regimens influences wound healing. Additionally, the timing of reconstruction is important in order to avoid delaying additional adjuvant therapies. Optimizing nutritional status is critical for improved patient outcomes in the oncologic patient population. At times, palliative efforts by means of surgical debulking are required of a reconstructive surgeon as advanced cancers can leave patients with disfiguring, fungating masses.

Keywords: wounds in cancer, wounds in the cancer patient, oncologic wounds, oncologic wound healing, oncologic wound management, wound complications, effect of chemotherapy on wound healing, effect of radiation therapy on wound healing, oncologic reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.

This review contains 7 figures and 29 references.

Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.  

Key words: open rhinoplasty, nasal anatomy, Nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, 3 tables, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, 3 tables, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 

This review contains 18 figures, and 31 references.

Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike.

This review contains 7 figures, 1 video, 1 table, and 79 references.

Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

This review contains 15 figures, 5 tables, and 41 references.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

This review contains 15 figures, 5 tables, and 41 references.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues.  Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages.  Simultaneous scalp and calvarial reconstruction is now routinely performed.  Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures.

Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

This review contains 13 figures, 4 tables, and 42 references.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

This review contains 13 figures, 4 tables, and 42 references.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

This review contains 13 figures, 4 tables, and 42 references.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.

This review contains 13 figures, 4 tables, and 42 references.

Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

This review contains 6 figures, 2 tables, and 27 references.

Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

This review contains 6 figures, 2 tables, and 27 references.

Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

This review contains 6 figures, 2 tables, and 27 references.

Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

This review contains 6 figures, 2 tables, and 27 references.

Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

This review contains 6 figures, 2 tables, and 27 references.

Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

This review contains 6 figures, 2 tables, and 27 references.

Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

Keywords: lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

This review contains 6 figures, 2 tables, and 27 references.

Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

This review contains 6 figures, 2 tables, and 27 references.

Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation. 

This review contains 6 figures, 2 tables, and 27 references.

Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

Key words: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

Key words: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

This review contains 7 figures, 2 tables and 49 references

Keywords: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

This review contains 7 figures, 2 tables and 49 references

Keywords: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

This review contains 7 figures, 2 tables and 49 references

Keywords: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

This review contains 7 figures, 2 tables and 49 references

Keywords: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

This review contains 7 figures, 2 tables and 49 references

Keywords: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

This review contains 7 figures, 2 tables and 49 references

Keywords: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

Key words: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Autologous techniques continue to be an excellent choice for breast reconstruction in many patients undergoing mastectomy. While free tissue transfers, such as the deep inferior epigastric artery perforator (DIEP) flap, have become increasingly common in autologous breast reconstruction, pedicled flaps remain a good alternative for some patients. Pedicled autologous reconstruction can be used to reconstruct both total and partial mastectomy defects. The two most common pedicled flaps in autologous breast reconstruction are the latissimus dorsi musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. In this chapter we discuss the relevant anatomic landmarks, preoperative evaluation, and critical operative steps for each procedure. Oncoplastic volume replacement techniques commonly used for the reconstruction of partial mastectomy defects are also described. Finally, we review the postoperative care of these patients, as well as discuss future advances and innovations we anticipate for pedicled flap reconstruction in the coming years.

This review contains 7 figures, 2 tables and 49 references

Keywords: pedicled autologous reconstruction, pedicled flap, latissimus dorsi flap, tram flap, breast cancer, partial breast reconstruction, oncoplastic reconstruction

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.

Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation 

This review contains 3 figures, 6 tables, 31 references

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. 

This review contains 5 figures, 5 tables, and 14 references

Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

This review contains 7 figures, 1 video, 2 tables, and 38 references.

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

This review contains 7 figures, 1 video, 2 tables, and 38 references.

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

This review contains 7 figures, 1 video, 2 tables, and 38 references.

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

This review contains 7 figures, 1 video, 

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

This review contains 7 figures, 1 video, 

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

This review contains 7 figures, 1 video, 

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

This review contains 7 figures, 1 video, 

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.

This review contains 7 figures, 1 video, 

Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand tumors represent a wide array of varying pathologies, most of which are benign. However, the surgeon must be keenly aware of certain characteristics requiring heightened awareness for malignancy, and be prepared to provide more extensive treatment and complex reconstruction when needed. From an oncologic standpoint, the location of these tumors is somewhat advantageous, as visibility of the hand and forearm generally enables detection at an early stage. However, recent studies on soft tissue tumors of the upper extremity who develop metastases show a survival of only 14 months. This highlights the importance of the need for the hand surgeon to cultivate a thorough understanding of the optimal management and surgical treatment of these tumors. In addition to a thorough history, examination and work up, an understanding of the pathophysiology of these tumors will enable the surgeon to communicate to the patient clearly what the potential extent of the procedure will be, including what specific structures may be affected, and what their recovery will be like. In this way, patients will have a realistic understanding of what the post-operative course and ultimate outcome will be.

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

This review contains 7 figures, 4 tables, and 54 references.

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

This review contains 7 figures, 4 tables, and 54 references.

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

This review contains 7 figures, 4 tables, and 54 references.

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused. 

Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

This review contains 5 figures, 2 tables and 34 references

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

This review contains 5 figures, 2 tables and 34 references

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

This review contains 5 figures, 2 tables and 34 references

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

This review contains 5 figures, 2 tables and 34 references

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

This review contains 5 figures, 2 tables and 34 references

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

This article presents a comprehensive overview of reduction mammoplasty, a common plastic surgery procedure aimed at alleviating chronic pain and stress caused by symptomatic macromastia in women. The chapter covers various aspects of the procedure, including anatomical considerations, surgical approaches, patient indications, and cancer screening. By reviewing the pertinent anatomy and disease pathogenesis, the article establishes the need for reduction mammoplasty in significantly improving patients' quality of life. The procedure is shown to have a favorable risk profile, and its success in reducing symptomology is well-supported by literature and experience. Furthermore, the article emphasizes the importance of informed patient counseling based on pre-operative factors, post-operative expectations, and the potential for breastfeeding post-surgery to achieve successful outcomes.

This review contains 5 figures, 2 tables and 34 references

Keywords: Breast reduction, reduction mammaplasty, breast hypertrophy, macromastia, inferior pedicle, superomedial pedicle, oncoplastic reduction, plastic surgery, reconstructive surgery

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

The advent of microsurgery has profoundly impacted the field of hand surgery, providing a means for precise coaptation of vessel and nerve, consequently allowing salvage of amputated parts. Despite these technical advances, the overall goal of management following amputation remains the same – provide the most functional outcome for each patient’s individual occupational and vocational needs. Therefore, it is not only the surgeon’s task to competently perform a replantation when necessary, but also understand in which patients and injuries a revision amputation may ultimately provide a superior outcome. Candidacy for replantation should be resolved by way of a focused history, physical examination, radiographic imaging, and a thorough discussion regarding the need for rehabilitation and potential for secondary procedures. Ultimately, there are very few absolute indications or contraindications for replantation, and each case must be considered on an individual basis.

This review contains 3 figures, 4 tables, and 28 references.

Key words: amputation, upper extremity, hand, digit, salvage, replant, replantation, revascularization, surgery of the hand

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Keywords

Dupuytren’s contracture; Dupuytren disease; contracture; CCH injections; collagenase; needle aponeurotomy; fasciectomy; dermatofasciectomy; lipofilling; flexion contracture

This review contains 16 figures, 2 tables, and 60 references.

Abstract

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Keywords

Dupuytren’s contracture; Dupuytren disease; contracture; CCH injections; collagenase; needle aponeurotomy; fasciectomy; dermatofasciectomy; lipofilling; flexion contracture

This review contains 16 figures, 2 tables, and 60 references.

Abstract

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Keywords

Dupuytren’s contracture; Dupuytren disease; contracture; CCH injections; collagenase; needle aponeurotomy; fasciectomy; dermatofasciectomy; lipofilling; flexion contracture

This review contains 16 figures, 2 tables, and 60 references.

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Abstract

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Keywords

Dupuytren’s contracture; Dupuytren disease; contracture; CCH injections; collagenase; needle aponeurotomy; fasciectomy; dermatofasciectomy; lipofilling; flexion contracture

This review contains 16 figures, 2 tables, and 60 references.

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Keywords

Dupuytren’s contracture; Dupuytren disease; contracture; CCH injections; collagenase; needle aponeurotomy; fasciectomy; dermatofasciectomy; lipofilling; flexion contracture

This review contains 16 figures, 2 tables, and 60 references.

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Abstract

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Keywords

Dupuytren’s contracture; Dupuytren disease; contracture; CCH injections; collagenase; needle aponeurotomy; fasciectomy; dermatofasciectomy; lipofilling; flexion contracture

This review contains 16 figures, 2 tables, and 60 references.

Abstract

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Keywords

Dupuytren’s contracture; Dupuytren disease; contracture; CCH injections; collagenase; needle aponeurotomy; fasciectomy; dermatofasciectomy; lipofilling; flexion contracture

This review contains 16 figures, 2 tables, and 60 references.

Dupuytren’s disease is a common pathology encountered by the hand surgeon. The numerous available treatment modalities can confuse patients and clinicians alike. The anatomy involved in the contracture is predictable and well defined. Clear surgical indications are critical in order to minimize the risk of iatrogenic problems such as worsening contracture necessitating revisional surgery. Meticulous presurgical planning, careful intraoperative dissection and atraumatic tissue handling are required to achieve a satisfactory result. Aside from these technical points, it is equally important to thoroughly understand the patient’s goals and to communicate the realistic outcomes and limitations of what can be achieved through surgery, since recurrent disease is not uncommon.

Keywords

Dupuytren’s contracture; Dupuytren disease; contracture; CCH injections; collagenase; needle aponeurotomy; fasciectomy; dermatofasciectomy; lipofilling; flexion contracture

This review contains 16 figures, 2 tables, and 60 references.

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation.

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

This review contains 11 figures, 3 tables and 51 references

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation.

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

This review contains 11 figures, 3 tables and 51 references

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation.

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation.

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation.

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation.

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation.

Humans interact with the world largely due to the complexity, dexterity and sensitivity of the hand and wrist. Proper hand and wrist function is essential and becomes a potential source of devastating morbidity accounting for nearly 30% of all emergency department injuries (1). This high incidence is mirrored in healthcare costs with a median total cost of $6951.00 per case of hand or wrist injury (2). This chapter focuses on ligamentous injuries of the hand and wrist highlighting the unique anatomy, mechanism of injuries and current literature as well as practice patterns surrounding their respective management.

Keywords:  Ligament injury of hand/wrist, extrinsic and intrinsic wrist ligament injury, TFCC injury, perilunate dislocation, SL and LT interosseous ligament injury, DISI deformity, VISI deformity, Watson’s shift test, thumb CMC dislocation, PIP and DIP dislocation.

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

This review contains 8 figures, 2 tables, and 52 references.

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

This review contains 

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

This review contains 

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

This review contains 

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail.

This review contains 

Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold 

This review provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

This review provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

This article provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

This article provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

This article provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

This article provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

This article provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

This article provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

This article provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

This article provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 

Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty

This review contains 15 figures, 2 tables, and 50 references.

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

This review contains 3 figures, 2 tables, and 39 references.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

This review contains 3 figures, 2 tables, and 39 references.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

This review contains 3 figures, 2 tables, and 39 references.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

This review contains 3 figures, 2 tables, and 39 references.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

This review contains 3 figures, 2 tables, and 39 references.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

This review contains 3 figures, 2 tables, and 39 references.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

This review contains 3 figures, 2 tables, and 39 references.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts.  These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles.  This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon.

Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve