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 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.
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.
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.
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.
Also: Sneak peek at Foundations, the Sunday quiz, & how to inject LA guide.
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.
Also: Textbook update, rotation flap technique, & 3 recommended reads on scalp surgery.
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.
