Download Plastic and Reconstructive Surgery

Plastic and
Reconstructive Surgery
Chapter 19
Plastic and Reconstructive
Surgery
Functions

Skin or Cutaneous Membrane
Protection from UV light
 Defense against disease
 Preservation of fluid balance
 Body temperature maintenance
 Excretion of waste (sweat)
 Sensory receptors
 Synthesis of Vitamin D

Anatomy

Epidermis
Consists of epithelial cells but
contains no blood vessels.
 Contains melanin and keratin
 5 Layers

Basale
 Spinosum
 Granulosum
 Lucidum
 Corneum

Anatomy

Dermis
Connective tissue under the
epidermis.
 Contains nerves, blood vessels,
hair follicles, nails, sweat and oil
glands.
 2 layers

Reticular
 Papillary


Fingerprints
Anatomy

Dermis

Sebaceous Gland
Oil gland produces sebum
 Keeps skin and hair soft and pliable


Sudoriferous Gland
Sweat gland
 Merocrine
 Apocrine
 Ceruminous

Anatomy

Subcutaneous Layer
Serves as an anchor and binds
the skin to the underlying
structures.
 Contains adipose tissue and
provides insulation and protection.

Anatomy

Palate
Roof of the mouth.
 Anterior portion is known as the
hard palate.
 Posterior portion is known as the
soft palate.

Anatomy

Hand


That thing at the end of your arm!
3 regions







Wrist
Palm
Fingers
Volar - Palm
Dorsal – Back of the hand
Radial – Thumb side
Ulnar – Medial side
Bones of the Hand

Carpals


8 bones of the wrist arranged in 2
rows of 4 bones.
Metacarpals

5 Bones of the palm


Numbered starting with the thumb
Phalanges

14 bones of the fingers

3 each except for thumb
Bones of the Hand
Nerves of the Hand



Radial nerve
Median nerve
Ulnar nerve
Tendons/Muscles of the Hand

Almost 40 muscles and tendons
are responsible for movement of
the hands, wrist, and fingers.


Palmaris longus – Flexes the hand
Transverse carpel ligament acts
as a covering and tunnel for 9
tendons and the median nerve.

Carpel tunnel syndrome
Blood Vessels of the Hand

Brachial artery divides
into two main arteries
supplying the hand
and forearm with
blood.
Radial Artery
 Ulnar Artery

Burns




First-degree: Affects just the
epidermis
Second-degree: Affects
epidermis and dermis
Third-degree: Full thickness
burn. Permanent tissue damage
Fourth-degree: Char burns
Burn Depth
Rules of Nines
Pathology Affecting the Skin




Acne
Aging
Sun Exposure
Neoplasms
Pathology Affecting the Skin

Cleft lip and palate
Cheiloschisis (Cleft or hare lip)
 Palatoschisis (Cleft palate)




Congenital deformity.
May occur with just one or both
areas affected.
May cause difficulty in
swallowing, sucking, and
forming proper sounds.
Plastic and Reconstructive
Surgery
CLEFT LIP AND PALATE
Plastic and Reconstructive
Surgery
UNILATERAL
CLEFT PALATE
Plastic and Reconstructive
Surgery
Plastic and Reconstructive
Surgery
Pathology Affecting the Hand

Carpel tunnel


Syndactyly


Webbed digits
Polydactyly


Pressure on the median nerve.
Extra digits
De Quervains

Inflammation of the tendons of the
wrist.
Pathology Affecting the Hand

Trigger Finger


Dupuytrens


Non-painful nodules usually at the 4/5th
digits causing palmar contractions.
Ganglion


Inflammation of the tendon of the digits.
Benign cyst filled with synovial fluid
Arthritis


Inflammation of the joint.
Autoimmune disease
Plastic and Reconstructive
Surgery
Plastic and Reconstructive
Surgery

Ganglion Cyst
Pathology Affecting the Breast

Males


Gynecomastia
Females
Function of the breast is to
produce milk for newborn.
 Aesthetic breast surgery has little
to do with this function.

Plastic and Reconstructive
Surgery Instrumentation

Oscillating Blade Type
Dermatome
Plastic and Reconstructive
Surgery Instrumentation




Electric or nitrogen powered.
Uses a oscillating blade to cut
thin slices of skin for grafting.
STSR/surgeon can adjust width
and depth of graft.
Sterile mineral oil is used a skin
lubricant to minimize friction.
Plastic and Reconstructive
Surgery Instrumentation

Mesh Graft Device
Plastic and Reconstructive
Surgery Instrumentation



Used to expand the size of the
split thickness skin graft (STSG)
Harvested skin is placed on a
derma carrier and passes
through a manual roller with
sharp raised surfaces.
Creates evenly spaced slits.
Mesh
 Fishnet

Skin Grafts

Autologous: Patient’s own body.

Homografts: Same species


Cadaver
Heterografts/Xenografts:
Dissimilar species (pig, calf)
Plastic and Reconstructive
Surgery Skin Graft Categories


Full-thickness


Skin Graft Categories
Epidermis and all of the dermis
and may include the underlying
subcutaneous tissue
Split-thickness

Epidermis, approximately half of
the dermis
Surgical Procedures






Rhytidectomy
Blepharoplasty
Abdominalplasty
Cheiloplasty/Palatoplasty
Ganglion Cyst excision
Reduction Mammoplasty
Plastic and Reconstructive
Surgery
Eye Surgery
Blepharoplasty

Plastic and Reconstructive
Surgery

Abdominoplasty
Plastic and Reconstructive
Surgery

Syndactyly Repair
Plastic and Reconstructive
Surgery

Syndactyly Repair
Plastic and Reconstructive
Surgery

Syndactyly Repair
Plastic and Reconstructive
Surgery

Reduction Mammoplasty
Plastic and Reconstructive
Surgery Reduction
Mammoplasty
Plastic and Reconstructive
Surgery

Augmentation Mammoplasty
Plastic and Reconstructive
Surgery

Augmentation Mammoplasty
Plastic and Reconstructive
Surgery
 QUESTIONS?