Plastic Surgery Simulator
One of the distal arthrogryposes, a congenital myopathy, usually of autosomal dominant inheritance, with facial and orthopaedic deformities.Anaesthesia may be required for inguinal hernia repair, orchidopexy, feeding gastrostomy, muscle biopsy, release of contractures around the mouth, or plastic surgery (Guyuron & Winkler 1988). Guyuron B,Winkler PA 1988 Craniocarpotarsal dysplasia the whistling face syndrome. Annals of Plastic Surgery 20 86-8. Jones R, Delacourt JL 1992 Muscle rigidity following halothane anesthesia in two patients with Freeman-Sheldon syndrome. Anesthesiology 77 599-600.
Use of the bipedicled TRAM for unilateral reconstruction has invoked substantial controversy in the plastic surgery literature. Antagonists claim the morbidity from bilateral muscle harvest, including abdominal wall weakness and the propensity toward future back pain, can no longer be defended in the current realm of reliable microsurgical capability and surgical delay.97 Conversely, proponents claim that the split muscle technique and addition of mesh reinforcement limit functional morbidity and that the resultant abdominal wall integrity is dependent upon the closure technique used.98 They adhere to its use as a reliable alternative in high-risk patients.
The transverse rectus abdominis myocutaneous flap, one of the most ingenious techniques in plastic surgery, has established itself over time as the flap of choice for autogenous breast reconstruction. It presents the reconstructive surgeon with the opportunity to a create a breast of unsurpassed esthetic beauty, is unparalleled in its ability to simulate the opposite breast, and secondarily improves the contour of the lower abdomen. Attaining consistently good results requires careful planning and technical proficiency. The lower abdomen consistently provides exceptional and sufficient tissue for unilateral and, in the majority of patients, bilateral breast reconstruction. The procedure is versatile and reliable when performed within its recognized vascular and volumetric constraints. Hartrampf's landmark introduction of the TRAM flap in 1982, still the gold standard for autologous breast reconstruction, provided the foundation for the modern era of breast reconstruction.61
Data on prophylactic bilateral mastectomy in humans are limited. The often-cited studies by Pennisi and Capozzi133 and Woods and Meland134 in the plastic surgery literature each reported on at least 1,500 women who underwent subcutaneous mastectomies, and in both studies, the subsequent incidence of breast carcinoma was less than 1 percent. However, both these studies have been criticized for their limited applicability to truly high-risk women, since many of the prophylactic procedures were
Perhaps the most striking aspect of ancient Indian medicine was the range of surgical interventions and the level of success claimed by the disciples of Susruta and Caraka. Vedic myths speak of remarkable operations on men and gods, such as a cure for impotence achieved by transplanting the testes of a ram to the afflicted god Indra. Ayurvedic texts describe more prosaic but still formidable operations such as cesarean section, lithotomy (removal of bladder stones), couching the cataract, tonsillectomy, amputations, and plastic surgery. Thus, the Ayurvedic surgical tradition offers an interesting challenge to Western assumptions that systematic human dissection, animal vivisection, and the rejection of humoral pathology are essential for progress in surgery. In ancient India, surgeons mastered many major operations without these supposed prerequisites. The Susruta Samhita describes many difficult operations, such as couching the cataract, lithotomy, opening the chest to drain pus, and...
The recent upsurge in the practice of laparoscopic surgery and other forms of 'minimal access surgery' has ushered in a new era of surgical treatment which is having profound effects on surgical management across the various specialities. Although the new approach has been initiated by adult general surgeons and gynaecologists, there is increasing interest in performing laparoscopic endoscopic procedures in other specialities, such as paediatric surgery, urology, orthopaedic surgery, otorhinolaryngology, cardiovascular surgery, neurosurgery and plastic surgery.
Ruben's flap A, Bilateral flap design B, Immediate postoperative projection demonstrated. Reproduced with permission from William W. Shaw, MD, Division of Plastic Surgery, UCLA. Figure 11-9. Ruben's flap A, Bilateral flap design B, Immediate postoperative projection demonstrated. Reproduced with permission from William W. Shaw, MD, Division of Plastic Surgery, UCLA.
This material along with polytetrafluoroethylene (Goretex or Teflon) or a composite material of the two represents the majority of prosthetic materials used today. The classic use of these materials is either as an inset patch or as reinforcement of a primary tissue repair of myofascia. Placement of these materials can be done extrafascial or above the fascia, extraperitoneal and subfascial, or intraperitoneal. This too continues to be a much-debated topic. Complications of the use of mesh include separation of the mesh from the fascia, contact injury (eg, adherence to other structures, erosion, and fistula formation), and infection. Autogenous tissue is considered by some to be the ideal material to close complex myofascial defects. The source of the tissue can be regional musculofascial flaps most commonly represented by rectus abdominis advancement, which can be achieved using one of several plastic surgery tissue advancement techniques, or the use of distant flaps,...