An angiosome is a 3D block of tissue supplied by a single artery-vein pair. Understanding these vascular territories and their choke-vessel connections allows surgeons to design flaps with reliable perfusion, apply delay techniques, and plan reconstructions with reduced necrosis and morbidity.
Paronychia affects the nail folds and is often bacterial, while a felon is a deep abscess in the fingertip pulp, causing intense pain. Both require early recognition and drainage to prevent complications like osteomyelitis, septic arthritis, or fingertip sensory loss.
Fractures are three-dimensional injuries best described using the PLACES framework: Pattern, Location, Alignment, Closed/open status, Examination findings, and Special investigations. At least two orthogonal X-rays are required to assess fracture type, displacement, joint involvement, and severity.
The upper limb is divided by fascia into compartments with specific muscles, nerves, and vessels. The arm has anterior (flexor) and posterior (extensor) groups & the forearm has volar, dorsal, and lateral compartments. Rising pressure causes compartment syndrome requiring urgent fasciotomy.
Suturing choice depends on wound type. Simple interrupted sutures give strength and versatility, mattress sutures evert edges and spread tension, and deep dermal ones relieve surface stress. Subcuticular sutures improve appearance, while vertical mattress and secure knots prevent dehiscence.
Transposition flaps are essential in reconstructive surgery. An ideal option for redirecting tissue into adjacent defects, with superior cosmetic outcomes compared to simple rotation or advancement flaps.
Surgical instruments improve efficiency and minimize trauma. Scalpels suit different incisions, forceps may be toothed or atraumatic, retractors provide exposure, scissors vary by tissue, & electrosurgery offers cutting & coagulation. Proper selection, handling, & set preparation enhance outcomes.
A summary of the classification of sutures, common materials used in plastic surgery, the USP sizing system, needle designs, and practical guidelines for choosing and removing sutures.
Local flaps move adjacent, vascularized tissue. Classified by perfusion (random/axial/perforator), composition (cutaneous→osseomyocutaneous), and movement (advancement/rotation/transposition/interpolation). Selection hinges on defect, tension vectors, and aesthetic subunits.
The reconstructive ladder guides wound closure from simple to complex: secondary intention, primary closure, skin grafts, local flaps, pedicled flaps, & free tissue transfer. Choice is defect- and patient-specific, evidence-based, with “elevator” jumps when higher rungs optimize outcomes.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Congenital haemangiomas are GLUT-1–negative vascular tumours fully formed at birth. They appear as solitary violaceous plaques and follow RICH (rapid), PICH (partial), or NICH (none) involution. Diagnosis is clinical; observe unless bleeding, ulcer, or cosmetic concern warrants surgery/laser.
The nose is a layered unit: thin bony vault, cartilaginous middle/tip, and skin-soft tissue cloak. Key angles guide aesthetics (nasofrontal 115-130°, nasolabial 90-105°, Goode ratio). Septum, valve, & turbinates ensure airflow; rich carotid vessels and trigeminal nerves supply it.
Hartrampf divides lower‑abdominal TRAM/DIEP flaps into four perfusion zones around the dominant perforator: Zone I being best, and Zone IV worst. Later imaging showed ipsilateral lateral tissue (Zone III) may out‑perfuse contralateral medial (Zone II) & that patterns shift with perforator row.
Microsurgery employs magnification, delicate tools, and 8-0–11-0 sutures to join vessels/ nerves ≤2 mm, powering free flaps, replantation, nerve and lymphatic repair. Outcomes rely on ergonomic setup, meticulous vessel prep, apt end-to-end or end-to-side stitches, and vigilant flap monitoring.
Lipomas are common benign tumours of mature adipocytes, presenting as soft, mobile subcutaneous nodules. Most need only observation, but imaging (US, MRI) and excision are advised for pain, rapid growth, deep/large size, or diagnostic doubt to exclude liposarcoma.
Flap vascular compromise, arterial ischaemia or venous congestion, usually emerges within 72 h post‑op. Watch colour, cap‑refill, Doppler/NIRS. Early re‑exploration or adjunct venous‑drainage within 6 h can salvage >60 % of flaps; delays sharply cut survival.
Extensor tendon injuries affect hand and finger extension and are classified by anatomical zones. They result from lacerations, rupture, or attrition, with Zone I injuries (mallet finger) being most common. Assessment includes Elson’s test and imaging. Management varies by zone and injury severity.
Fasciocutaneous flaps use skin, fat, and fascia (without muscle) for thin, pliable, well-vascularized coverage. Supplied by perforator-fed plexuses, they’re classified by vascular entry or pedicle type. Ideal for trauma and oncologic reconstruction, with low donor morbidity and muscle preservation.
Burn size guides triage, fluids, and outcomes. Lund-Browder is most accurate, especially in children. Rule of Nines is quick but less precise in kids/obesity. Palmar method is handy for small burns. The revised Baux score uses age, TBSA, and inhalation risk to predict mortality. Accuracy is vital.
Burn management depends on type, depth, extent, location, and patient factors. Initial care includes cooling, preventing hypothermia, ABCDE assessment, and fluid resuscitation. Wound care involves debridement, dressings, and grafting. Complications range from sepsis to scarring.
Fat grafting transfers autologous adipose tissue for volume restoration, contour correction, and tissue repair. The process involves harvesting, processing, and reinjection. Key complications include fat resorption, necrosis, and embolism.
Upper limb cellulitis is a bacterial infection of the skin and subcutaneous tissue, causing erythema, warmth, and swelling. Diagnosis is clinical and involves imaging. Treatment includes cephalexin for mild cases, IV antibiotics for severe infections, and drainage for abscesses.
Rotation flaps are curvilinear pivotal flaps ideal for triangular defect repair, commonly used for facial, cheek, chin, and scalp reconstruction. Success depends on defect triangulation, flap circumference, and pivot point positioning. Post-op focuses on hematoma prevention and sun avoidance.
Finger replantation restores function, sensation, and aesthetics following the traumatic or surgical loss of a digit. Success depends on injury type, ischemia time, and microsurgical repair. Complications like venous insufficiency and arterial thrombosis require early management.
Laser treatments provide minimally invasive procedures in resurfacing, scar revision, & lesion removal. Mechanisms involve collimated, monochromatic, & coherent light-targeting chromophores.
Breast Ptosis is the descent of the nipple below the inframammary fold, caused by aging, pregnancy, weight changes, and genetics. Classified into Grades 1–3 (Regnault system), it’s managed with mastopexy, augmentation, or reduction, with risks like hematoma, infection, and scarring.
BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma) features include delayed seroma and swelling, with diagnosis relying on imaging and CD30 immunohistochemistry. En-bloc resection is critical, with chemotherapy or radiotherapy for advanced cases.
Cleft lip results from incomplete fusion of embryologic structures, leading to lip and nasal deformities. It is classified by laterality and completeness. Repair occurs at 3–6 months using techniques like Millard’s and Fisher’s subunit repair to restore function, symmetry, & aesthetics.
Oncological breast reconstruction aids recovery post-mastectomy or lumpectomy, using autologous tissue, implants, or both. Decision-making involves preoperative assessment, radiation plans, and patient preferences.
Keloids are fibrotic scars extending beyond the original wound, driven by genetic predisposition, inflammation, and abnormal fibroblast activity. Treatment involves non-surgical options like lasers and silicone sheeting, pharmaceuticals like corticosteroids, or surgery with adjuvant therapy.
The DIEP flap is a gold standard for autologous breast reconstruction, offering superior vascularity and minimal donor-site morbidity.
Trigger finger, or stenosing tenosynovitis, occurs when the flexor tendon is trapped at the A1 pulley, leading to pain during finger movement. Common risk factors include manual labor, older age, and diabetes. Treatment options range from splinting and corticosteroids to surgical A1 pulley release.
Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic pain disorder. It involves dysregulation of the nervous system with sensory, motor, and autonomic disturbances. Diagnosis is clinical, and treatment is multidisciplinary, including physical therapy, medications, and surgical options.
Infantile haemangiomas (IHs) are caused by dysregulated vasculogenesis and angiogenesis, and can be superficial or deep. Diagnosis is primarily clinical but may include imaging and histology. Treatments include propranolol, laser therapy, and surgery for complications.
Pressure sores are localized skin and tissue injuries over bony prominences, caused by prolonged pressure, shear, friction, and moisture. Treatment varies by stage, from conservative care to debridement, antibiotics, and reconstruction.
Penile reconstruction addresses tissue loss from trauma, fibrosis, cancer, and infection. The primary goal is to construct a phallus with a neo-urethra for standing urination and sufficient bulk for a prosthesis. Techniques include glans, shaft, and scrotal reconstruction.
Wound dressings vary from non-occlusive to occlusive, with antimicrobial options like silver dressings. Dressing choice depends on wound factors, and adjuncts like NPWT can enhance healing.
Soft tissue sarcomas are rare, malignant tumors of mesenchymal origin. They are classified into over 70 subtypes, with risk factors including environmental exposures and genetic predispositions. Management involves surgery, radiotherapy, and sometimes chemotherapy, tailored to the sarcoma type.
Median nerve tendon transfers restore thumb opposition, flexion of the index and middle fingers, and thumb flexion. The procedure involves relocating functional tendons to compensate for lost function due to nerve injury.
Nipple-Areolar Complex (NAC) reconstruction aims for symmetry, projection, pigmentation, durability, and minimal complications while addressing functional sensation and patient needs. Techniques include tattooing, flaps, and grafts, with careful pre-op marking and post-op care.
Thoracic outlet syndrome (TOS) is the compression of neurovascular structures at the brachial plexus. It commonly presents with neurogenic symptoms, such as pain and tingling. Management involves physiotherapy, pain control, and surgery for severe cases.
Capsular contracture is the thickening and hardening of the capsule around breast implants, leading to pain and deformity. Classified by Baker's system (I-IV), treatment ranges from conservative management to surgical interventions such as capsulectomy.
Macrodactyly involves disproportionate digit overgrowth, often due to lipofibromatosis of the nerve and PiK3CA mutations. Diagnosed via X-rays, MRI, and genetic tests, it's treated surgically to debulk and stop growth. Surgical management focuses on nerve issues to reduce recurrence.
An overview of congenital dermoid cysts, benign growths from ectodermal entrapment, common in the head and neck. Focus on orbital and nasal presentations and surgical management to prevent complications.
Thatte and Thatte classify venous flaps into three types based on vein number and function. Venous flaps are infrequently used due to low survival rates and venous congestion, despite their reliable anatomy and minimal donor site morbidity.
The Mathes and Nahai Classification, introduced in 1981, describes the vascular supply to muscle and musculocutaneous flaps based on major and minor pedicles. This system is essential for planning reconstructive surgeries to ensure optimal flap survival and function.
The cervical lymph nodes of the neck are organized into levels based on their anatomical locations and drainage patterns. These nodes drain specific areas of the head and neck, aiding in identifying primary tumor sites and guiding surgical management.
Congenital Brachial Plexus Palsy: Upper limb movement loss at birth, often from birthing traction. Early surgical exploration recommended if no biceps function after 3 months.
Breast augmentation uses implants to enhance size and shape, with techniques tailored to patient needs and potential complications like BIA-ALCL.
Giant Cell Tumours are neoplastic lesions on tendon sheaths, often in hands. Diagnosed via physical exam and imaging, often treated with surgical excision. Recurrence is common.
Dupuytren's disease causes progressive hand contractures from fibrous nodules in the palm. Common in older Northern European men, it's linked to genetics and manual labor. Diagnosis is clinical, with treatments including collagenase injections, needle aponeurotomy, or surgery.
Gynecomastia is male breast enlargement due to glandular growth and fat, caused by hormonal imbalances. It often presents as painless and bilateral. Diagnosis involves history, tests, and imaging. Treatment ranges from lifestyle changes and medication to surgery for persistent cases.
Poland syndrome is a congenital condition involving unilateral chest wall deformity and hand anomalies. It can be managed surgically for functional and aesthetic improvement.
Hemifacial microsomia is the commonest craniofacial abnormality. This article details the genetics, clinical features, classifications and management.
Treacher Collins Syndrome is a genetic craniofacial syndrome characterised by hypoplasia, external ear and eyelid malformations and visual disturbance.
Pierre Robin Sequence is glossoptosis, micrognathia and upper airway respiratory obstruction. This article details pathophysiology, causes and treatment.
Ulnar Tunnel Syndrome involves compression of the ulnar nerve at the wrist. It manifests as motor and sensory issues, varying based on the compression site. Diagnosis primarily uses X-rays, while management ranges from non-surgical interventions to surgical decompression.
Anterior Interosseous Nerve Syndrome (AINS) affects the median nerve's motor branch, leading to muscle paralysis without sensory loss. Diagnosis involves physical exams, EMG, and imaging. Initial treatment is conservative, followed by surgery if symptoms persist.
Pronator Syndrome involves compression of the median nerve in the forearm, often affecting middle-aged women. It typically presents with forearm pain and a positive Tinel sign. Management starts conservatively with rest and splinting, progressing to surgery if symptoms persist.
Progressive Hemifacial atrophy is the progressive wasting of facial structures. This article details the causes, clinical features and management.
Craniofacial clefts are skeletal and soft-tissue abnormalities. This article details the Tessier Classification, types of clefts and their management.
Burns Fluid resuscitation aims to restore volume and preserve perfusion. This article details indications, types of fluids, formula calculations and complications.
Electrical Burns can be high voltage, low voltage, direct, or alternating current. They cause skin and deep tissue injury. This article details their causes, management, and complications.
Neck dissections are described as radical, extended, modified, and selective. This article details the indications, anatomy, and complications of neck dissections.
Tumours of the oral cavity are most commonly squamous cell carcinoma. This article details anatomy, staging, surgical, and reconstructive options.
The most common chemical burns are acids and alkalis. This article details their mechanisms, clinical features, and management.
Burns result in local and systemic complications. This article details these complications and management in burn patients.
Thumb MCPJ UCL injuries range is typically diagnosed with stress tests and imaging. Conservative treatment for partial tears to surgical repair for complete tears and avulsions.
Seymour fractures are open, displaced distal phalangeal fractures in children, often caused by crushing injuries and associated with nail bed damage. Treatment includes irrigation, debridement, reduction, fixation, and antibiotics.
Ring avulsion injuries range from lacerations to amputation, typically caused by a ring catching on an object. Proper assessment and treatment depend on the severity, involving everything from suturing to amputation.
Salivary gland tumours involve the parotid, submandibular, sublingual, and minor glands. This article details the anatomy, classifications and treatment options.
The facial nerve has intracranial, intratemporal and extracranial anatomical sections. This article details the origin, course, branches and variations of the facial nerve.
Mandibular defects are classified and reconstructed based on their location and size. This article details the anatomy, classifications, and reconstructive algorithms.
The lip is a composite soft tissue structure of the skin, muscle and mucosa. This article details lip innervation, blood supply, muscles and function.
The radial artery forearm flap is a fasciocutaneous flap. This article details the flap's anatomy, elevation, and dissection.
An ectropion is an eversion of the lower eyelid. This article details the causes, classification, assessment, and treatment of an ectropion.
Congenital Melanocytic Naevi are pigmented lesions present at birth. This article details clinical features, management and risk of malignancy.
Lip reconstruction is guided by defect location, size, and depth. This article details the local flap, free flap, and primary closure options for lip reconstruction.
Dynamic facial nerve palsy reconstruction involves nerve grafts, nerve transfers, muscle transfers or muscle flaps. This article details the decision-making process and techniques.
Hypertelorism is an increase in interorbital distance. This article details causes, classifications, and treatment options.
Squamous cell carcinoma (SCC) of the skin arises from epidermal keratinocytes. This article details the clinical picture, treatment options, risk groups, staging and guidelines
Polydactyly is the radial, ulnar, or central duplication of digits. This article details the classification, treatment, and aetiology of this congenital condition.
Upper Limb development occurs during weeks 4-8 of gestation. This article details the mechanisms of development and critical milestones.
Septic arthritis of the hand arises from direct inoculation, local infection spread, or hematogenous routes, often due to Staphylococcus aureus. Diagnosis involves clinical signs, imaging, and lab tests, with treatment requiring surgical debridement and antibiotics.
Flexor Tenosynovitis is a surgical emergency needing admission, elevation, IV antibiotics, and usually surgical washout within 24 hours.
Camptodactyly is the progressive flexion deformity of the PIPJ. This article details the aetiology, features, classification, and management of this congenital hand condition.
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