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.
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 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.
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.
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.
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.
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.
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.
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.
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.
Also: Journal club article, final round of the Sunday quiz, & original Seymour's publication.
Rhomboid (Limberg) flap is a 120° transposition design for closing cutaneous defects with minimal tension. Plan flap along relaxed skin tension lines, preserve subdermal plexus, variations adapt geometry to site. Complications are rare, mostly due to tension or vascular issue.
Scalp reconstruction balances inelastic hair-bearing skin, robust dual blood supply, & curved skull. Small defects use primary closure, VAC, second intention, or skin anchors. Grafts need a vascular bed and no planned radiation. Larger gaps need local, rotation, or advancement flaps.
Also: A book recommendation, the Sunday quiz, & events calendar.
Also: Why flaps beat grafts, punch biopsy pitfalls, & the Sunday quiz.
Also: Foundations update, the Sunday quiz, & events calendar.
Securing a plastic surgery residency is no easy task, and excelling in your Sub-Is is arguably one of the most important steps. This guide offers 10 actionable strategies to prepare for plastic surgery sub-I rotations in the USA.
Toxic Epidermal Necrolysis (TEN) is a severe dermatologic condition affecting >30% TBSA, triggered by drugs like sulfonamides and antiepileptics. Symptoms include painful skin detachment and mucosal erosions. Management prioritizes causative agents, supportive care, and adjunctive therapies.
Chemical peels apply controlled acids to resurface skin and spark collagen repair. Superficial, medium, and deep depths offer escalating gains for photoaging, acne, and pigment issues, yet also rising downtime and risks; deep phenol/TCA peels need strict monitoring.
Prominent ears (>30° tilt or >2 cm from skull) usually lack a defined antihelical fold or have a hypertrophic concha. Otoplasty reshapes cartilage with techniques like Mustardè or Furnas, restoring natural projection; recovery needs headband support and hematoma vigilance.
Also: Opening a second waitlist?, the Sunday quiz, & 3 recommended cleft lip reads.
Systematic review (48 studies, 7,045 patients) found 49 % of breast-implant recipients reported BII symptoms: fatigue, joint pain, brain fog. After explantation, 57 % improved. Autoimmune, psychiatric, and cancer comorbidities were common; diagnosis remains unclear.
Also: BIA-ALCL signs, the Sunday quiz, & 3 recommended reads.
Chest-wall reconstruction restores support, organ protection, ventilation, & contour after tumour resection, trauma, or infection. Defects > 5 cm or ≥ 4 ribs need rigid mesh/PTFE/titanium plus vascular flaps (pectoralis, lat dorsi, rectus). Sepsis or poor lung reserve contraindicate.
