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Plastic Surgery

PRS Awards, 5 Step Blepharoplasty, & Foundations Hits Print!

Also: Upper lid marking for bleph, the Sunday quiz, & 3 articles to bookmark.

thePlasticsPaper

Best AI Scribe, 3 Flaps That Changed Lower Limb Surgery, & PlasticsPro Upgrade

Also: New round of Sunday quiz, Foundations update, & recap of live event

thePlasticsPaper

Don’t Always Trust That Summary, 3 Lessons from Breast Reconstruction, & Recap of Live Event

Also: Lejour’s marking method, new journal club article, & 3 recommended reads.

thePlasticsPaper

Timing of Oral Feeding Following Head and Neck Mucosal Free Flap Reconstruction: Systematic Review & Meta-Analysis

This systematic review analysed early vs late oral feeding following mucosal free flap reconstruction. Early feeding was associated with reduced fistula formation, pneumonia, and hospital stay. No increase in flap failure or dehiscence. Study heterogeneity and bias limit generalisability.

Journal Club

Breast Reduction and Mastopexy: Anatomy, Techniques, & Complications

Mastopexy and breast reduction are reshaping procedures involving skin excision and NAC repositioning. Mastopexy restores shape without volume loss, while reduction also removes tissue to ease symptoms. Technique depends on ptosis grade, volume, and patient goals.

Breast

P'Fella's First Live Event, 3 Truths About Surgical Training, & Foundations.

Also: Why journals are falling behind, the Sunday quiz, & journal club feature.

thePlasticsPaper

Advancement Flap: Design Principles, Indications, & Common Variants

Advancement flaps slide adjacent skin on a single vector to seal small–moderate defects, exploiting subdermal plexus flow and RSTLs. Best for nasal, lip, cheek, & limb gaps with adequate laxity. Plan parallel cuts, Burow triangles, & layered closure. U, H, V-Y, cervicofacial variants expand reach.

Ulnar Nerve Tendon Transfers: Anatomy, Presentation, & Procedure

Ulnar nerve tendon transfers restore key hand functions such as grip strength, key pinch, and correct clawing after ulnar nerve palsy. By transferring muscles like the extensor carpi radialis brevis (ECRB) or flexor digitorum superficialis (FDS), tendon transfers improve hand movement and strength.

Upper Limb

Radial Nerve Tendon Transfers: Principles, Anatomy, & Surgery

Radial nerve tendon transfers restore wrist, finger, and thumb extension when direct nerve repair isn't possible. Using tendons like Pronator Teres or Flexor Carpi Ulnaris, the procedure requires supple joints and healthy tissue. Success rates are high, with 80-90% achieving good outcomes.

Upper Limb

Lower Limb Reconstruction: Clinical Assessment, Decision Algorithm, & Flap Options

Lower-limb soft-tissue reconstruction depends on the zone of injury, fixation needs, and distal flow. After ATLS, debride within 12h, stabilize the bone, and apply NPWT. Choose muscle or perforator flaps per defect. Post-op includes elevating the limb, monitoring the flap, & anti-coagulation.

Lower Limb

Abdominoplasty: Clinical Assessment, Surgical Techniques, & Complications

Abdominoplasty excises redundant abdominal skin/fat, repairs rectus diastasis, and repositions the umbilicus. Huger vascular zones guide safe flap elevation. Standard low-transverse excision with rectus plication is used. Seroma is frequent and venous thromboembolism is the most severe complication.

Cosmetic

Giving Birth to a Textbook, 3 Local Anaesthetic Tricks, & Live Events

Also: Sneak peek at Foundations, the Sunday quiz, & how to inject LA guide.

thePlasticsPaper

Rhinoplasty: Nasal Analysis, Assessment, & Surgical Techniques

Rhinoplasty merges airway function and aesthetics. Patient selection and nasal analysis guide strategy. Open access enables grafting; closed suits minor tweaks. Structural or preservation methods refine the septum, dorsum, & tip. Watch for airway issues, bleeding, & scarring.

Cosmetic

Financial Incentives Only Work in the Short Term, 3 Scalp Flap Tips, & Quiz Winners

Also: Textbook update, rotation flap technique, & 3 recommended reads on scalp surgery.

thePlasticsPaper

Upper Eyelid Anatomy: Layers, Neurovascular Supply, & Clinical Applications

The upper eyelid contains a mixture of skin, muscle, fat, tarsal plate, and conjunctiva and is divided into 3 compartments (anterior, middle, and posterior lamellae). Understanding the anatomy is fundamental for oculoplastics.

Anatomy

Velopharyngeal Dysfunction (VPD): Anatomy, Clinical Assessment, & Surgical Management

Velopharyngeal dysfunction (VPD) is the inability to close the velopharyngeal sphincter during speech, resulting in hypernasal speech, nasal air escape, poor oral pressure, and reduced intelligibility.

Lower Eyelid Anatomy: Anatomical Layers & Surgical Relevance

Lower-eyelid surgery demands precise knowledge of its three lamellae: skin-orbicularis anteriorly, septum with fat pads and SOOF centrally, and tarsus-conjunctiva with retractors posteriorly. Key ligaments, vessels, and lacrimal drainage define support, aging changes, and surgical risk.

Anatomy

Abdominal Wall Anatomy: Surface Landmarks, Skeletal Structure, & Layers

The abdominal wall supports and protects organs, anchors trunk motion, and adapts to pressure shifts. Anterolateral muscles, fascial layers, and key landmarks (linea alba, arcuate line, inguinal canal) guide flap harvest and hernia repair, making precise anatomy vital in reconstruction.

Anatomy

Perineal Reconstruction: Indications, Principles, & Flap Options

Perineal reconstruction uses local, regional, or free flaps, often gracilis or VRAM, to close oncologic, traumatic, or infectious defects. Goals: fill dead space, provide vascular coverage, protect pelvic organs, preserve continence and sexual function, and cut wound issues.

MicrosurgeryAbdomen

Blepharoplasty: Anatomy, Evaluation, & Surgical Technique

Blepharoplasty rejuvenates eyelids. Upper: excise extra skin and fat to fix dermatochalasis. Lower: transconjunctival or transcutaneous access to adjust fat, release ligaments, and support the canthus. Preop check dry eye, MRD1, laxity, vector. The biggest risk is retrobulbar hematoma.

Cosmetic

Cleft Palate: Anatomy, Classification, & Surgical Repair

Isolated cleft palate is a congenital gap in hard/soft palate behind incisive foramen. Classified into complete, incomplete, or submucous. Repair before 18 months (Furlow, intravelar veloplasty) to restore speech, protect growth, & prevent fistula. Monitor for VPD, fistula, & maxillary retrusion.

Paediatrics

Compartment Syndrome of the Hand: Clinical Assessment, Investigations, & Management

Compartment syndrome of the hand is a rare surgical emergency where rising intracompartmental pressure (often after trauma) causes ischemic pain out of proportion, especially on passive stretch. It’s diagnosed clinically; urgent fasciotomy within 6 h is crucial to preserve tissue and function.

Upper Limb

External Ear Anatomy: Neurovascular Supply, Landmarks, & Aesthetic Subunits

External ear: elastic cartilage with tight skin, ridges (helix, concha, tragus) that channel sound into the 25 mm S-shaped external auditory canal, terminating at the tympanic membrane. Blood via superficial temporal and posterior auricular branches. Sensory via V3, VII, X, C2-3.

Anatomy

Systematic Review and Meta-Analysis of Mobilisation Following Open Reduction and Internal Fixation of Hand Fractures

A systematic review (53 studies, 1,822 hand fractures) examined the timing of mobilisation post-ORIF. Immediate mobilisation showed faster healing but higher adverse events. Delayed mobilisation had fewer complications. Heterogeneity and lack of standardised PROMs limit conclusions.

Journal Club