Preoperative imaging for autologous breast reconstruction

A complete understanding of vascular anatomy is now integral to planning most, if not all, vascularized flaps in plastic surgery. Recent advances in preoperative imaging have provided an unheralded ability to investigate the vascular anatomy of planned donor and recipient sites for plastic surgical reconstruction, and as such, have been associated with a significant decrease in operative morbidity, operative time, and surgeon stress. This chapter provides a comprehensive review of the most recent advances in preoperative planning investigations for plastic surgery in the thorax and abdomen and autologous breast reconstruction.

Craniofacial implants in a failed autologous reconstruction of microtia: a case report

Plastic surgical reconstruction is considered to be the gold standard for the repair of microtia as the results are permanent and constructed from the patient’s own tissue; however, the multiple surgeries required and the difficulty in attaining adequate cosmetic results often result in patients choosing a prosthesis as a long-term rehabilitation. Advances in osseointegration in the craniofacial region have improved the outcomes with auricular prosthetics by providing a reliable method of attachment of the prosthesis and increasing patient acceptance. A case presentation illustrates the results of both treatment modalities and examines the outcomes on the same patient.

Body Contouring After Weight Loss

The goal of this chapter is to provide a comprehensive approach to management of massive weight loss (MWL) patients seeking plastic surgical reconstruction. The topics covered include the medical impact of obesity and the rise in bariatric surgical procedures that has increased the demand for plastic surgical reconstruction after MWL, critical factors for consideration in the preoperative evaluation of the MWL patient presenting for body contouring surgery, essential elements of intraoperative patient management, and a framework for deciding when to combine multiple procedures and when to perform them in separate stages. Preoperative evaluation of this unique cohort must take into account complex medical and psychosocial issues associated with obesity and operative planning requires unique strategies.

Ghost Protocol: Greatest Healing Opportunity for Soft Tissue, a Treatment Paradigm for Complex Sarcoma Reconstruction

Modern sarcoma treatment has created new challenges for plastic surgeons. This study was designed to review the recent experience and practice patterns following complex sarcoma resection at a large sarcoma center. All cases from October 2013 to October 2014 involving rare nonepithelial tumors, a multidisciplinary surgical team, radiation and/or chemotherapy treatments, and plastic surgical reconstruction were included in the analysis. In addition to evaluating clinical outcomes, cases were reviewed to identify factors associated with excellent or poor patient care. Review of these cases formed the basis of the greatest healing opportunity for soft tissue (GHOST) protocol. Our patient population included seven males (64%) and four females (36%). All except one patient was exposed to radiotherapy, chemotherapy, or some combination. Diverse procedures were used for reconstruction. Early complications occurred in two patients (18%), and late complications in four patients (36%). Sarcoma resection was found to be highly morbid in our series. Patients with poor preoperative nutritional status were more likely to experience complications postoperatively. The decision to stage a reconstruction was complex and influenced by several factors. Multimodal sarcoma treatments may involve highly morbid procedures and create complex wounds. The GHOST protocol is a useful reference for plastic surgeons.

Tumours and hand reconstruction

♦ Hand tumours are common♦ The vast majority are benign♦ Soft tissue – commonest Giant cell tumour of tendon sheath. Treatment marginal excision♦ Bone – commonest – Enchondroma. Treatment – leave if incidental or currette +/− bone grafting♦ Malignant – need full work up with detailed clinical examination, investigation, and planning in a multidisciplinary meeting♦ Treatment is wide/radical excision often with partial amputation +/− plastic surgical reconstruction.