Essentials for students - depts.washington.edu

1 Essentialsfor studentsPLASTIC SURGERYEDUCATIONAL FOUNDATION plastic surgeryEssentialsThe American Society of Plastic Surgeons (ASPS ) is thelargest organization of board-certified plastic surgeonsin the world. With over 6,000 members, the society isrecognized as a leading authority and informationsource on cosmetic and reconstructive plastic comprises 94 percent of all board-certified plasticsurgeons in the United States. Founded in 1931, thesociety represents physicians certified by The AmericanBoard of Plastic Surgery, Inc. or The Royal College ofPhysicians and Surgeons of is recognized as the voice of plastic surgery by thepublic, organized medicine, industry, and governmentand works to position its members for success in ahighly competitive environment through educationalforums and the development of guidelines and productsto enhance the studentsplastic surgeryINTRODUCTIONThis book has been written primarily for medical students , withconstant attention to the thought, Is this something a studentshould know when he or she finishes medical school?

2 It is notdesigned to be a comprehensive text, but rather an outline that canbe read in the limited time available in a burgeoning curriculum. It isdesigned to be read from beginning to surgery had its beginning thousands of years ago, whenclever surgeons in India reconstructed the nose by transferring aflap of cheek and then forehead skin. It is a modern field, stimulatedby the challenging reconstructive problems of the unfortunatevictims of the World Wars. The advent of the operating microscopehas thrust the plastic surgeon of today into the forefront of advancesin small vessel and nerve repair, culminating in the successfulreplantation of amputated parts as small as distal fingers. Further,these techniques have been utilized to perform the first compositetissue transplantations of both hands and partial faces.

3 The field isbroad and varied and this book covers the many areas ofinvolvement and training of today s plastic surgeons. The American Society of Plastic Surgeons is proud to providecomplimentary copies of the Plastic Surgery Essentials for Studentshandbook to all third year medical students in the United States updated information about variousprocedures in plastic surgery and other medicalinformation of use to medical students and otherphysicians can be found at the ASPS/PSEF website PLASTIC SURGEONS COMMITTEEAdam Lowenstein, ChairDavid H. Song, MD, Vice ChairSeventh Edition 2007 Essentials for students WorkgroupDavid H. Song, MDGinard Henry, MDRussell R. Reid, MD, PhDLiza C. Wu, MDGarrett Wirth, MDAmir H. Dorafshar, MBChBUNDERGRADUATE EDUCATION COMMITTEE OF THEPLASTIC SURGERY EDUCATIONAL FOUNDATIONF irst Edition 1979 Ruedi P.

4 Gingrass, MD, ChairmanMartin C. Robson, MDLewis W. Thompson, MDJohn E. Woods, MDElvin G. Zook, MDCopyright 2007 by thePlastic Surgery Educational Foundation444 East Algonquin RoadArlington Heights, IL 6000514th Printing 2007 All rights in the United States of AmericaTABLE OF CONTENTSP reface:A Career in Plastic Surgery .. iChapter 1: Wounds .. 1 Chapter 2: Grafts and Flaps .. 10 Chapter 3: Skin and Subcutaneous Lesions.. 18 Chapter 4: Head and Neck .. 32 Chapter 5: Breast, Trunk and External Genitalia .. 53 Chapter 6: Upper Extremity .. 68 Chapter 7: Lower Extremity .. 81 Chapter 8: Thermal Injuries.. 89 Chapter 9: Aesthetic Surgery .. 107 Chapter 10: Body Contouring .. 113iPREFACEA CAREER IN PLASTIC SURGERYO riginally derived from the Greek plastikos meaning to mold andreshape, plastic surgery is a specialty which adapts surgicalprinciples and thought processes to the unique needs of eachindividual patient by remolding, reshaping and manipulating bone,cartilage and all soft tissues.

5 Not concerned with a given organsystem, region of the body, or age group, it is best described as aspecialty devoted to the solution of difficult wound healing andsurgical problems, having as its ultimate goal the restoration orcreation of the best function, form and structure of the body with asuperior aesthetic appearance ultimately enhancing a patientsquality of surgeons emphasize the importance of treating the patient asa whole. Whether reconstructing patients with injuries,disfigurements or scarring, or performing cosmetic procedures torecontour facial and body features not pleasing to the patient, plasticsurgeons are concerned with the effect of the outcome on theentire patient. Not necessarily concerned with a set and limitedrepertoire of surgical procedures, plastic surgery is more a point ofview with the ultimate goal of solving problems and thus, exposureto a wide variety of surgical problems and disciplines enhance theability of the plastic surgeon to care for all challenge of plastic surgery then is the wedding of thesurgeon s judgment and problem solving abilities to surgicaltechnique at any given moment.

6 Because of this approach, theplastic surgeon often acts as a last resort surgical consultant tosurgeons and physicians in the treatment of many wound problemsand is often called the surgeon s surgeon. Plastic surgery not only restores body function, but helps to renewor improve a patient s body image and sense of self-esteem. Alongwith psychiatrists, plastic surgeons are especially equipped tohandle the patient s problem of body image and to help the patientdeal with either real or perceived with these far reaching goals, the scope of the operationsperformed by plastic surgeons is extremely broad. As outlined byThe American Board of Plastic Surgery, the specialty of plasticsurgery deals with the repair, replacement, and reconstruction ofThe results of the plastic surgeon s expertise and ability are highlyvisible, leading to a high degree of professional and personalsatisfaction.

7 The discipline requires meticulous attention to detail,sound judgment and technical expertise in performing the intricateand complex procedures associated with plastic surgery. In addition,plastic surgeons must possess a flexible approach that will enablethem to work on a daily basis with a tremendous variety of surgicalproblems. Most importantly, the plastic surgeon must have creativity,curiosity, insight, and an understanding of human of the breadth of the specialty and its ever changingcontent, opportunities for individuals with varied backgrounds isparticularly important. Individuals with undergraduate majorsranging from art to engineering find their skills useful in variousareas of plastic surgery. This need for a broad education continuesinto medical should use elective time to acquire the broadest base ofmedical knowledge.

8 Experience in surgery and psychiatry are ofparticular value. Clinical rotations in surgical specialties, such asneurosurgery, orthopaedics, otolaryngology, pediatric surgery,transplantation, or urology may prove more valuable than generalsurgery since most of the early residency experience will be ingeneral there are several approved types of prerequisite surgicaleducation, most candidates for the traditional plastic surgeryresidency programs have had from three to five years of training ingeneral surgery after graduating from medical school. Applicants mayalso apply for a plastic surgery residency after completing aresidency in otolaryngology, orthopaedics, neurosurgery, or urologyor oral and maxillofacial surgery (the latter requiring two years ofgeneral surgery training in addition to an MD/DDS).

9 Plastic surgeryresidency in the traditional format is generally for two or threeyears. Another residency model in plastic surgery is the IntegratedResidency. Applicants apply to start immediately followinggraduation from medical school and will have either five or six yearsof training under the leadership of the program director of plasticsurgery. Following residency training, many physicians spend anadditional six to twelve months of fellowship training in a particulararea of plastic surgery such as craniofacial surgery, aesthetic surgery,hand surgery, or defects of form or function involving the skin,musculoskeletal system, craniomaxillofacial structures, hand,extremities, breast and trunk, and external genitalia. It uses aestheticsurgical principles not only to improve undesirable qualities ofnormal structures, but in all reconstructive procedures as well.

10 Among the problems managed by plastic surgeons are congenitalanomalies of the head and neck. Clefts of the lip and palate are themost common, but many other head and neck congenitaldeformities exist. In addition, the plastic surgeon treats injuries tothe face, including fractures of the bone of the jaw and surgery is a discipline developed to reposition andreshape the bones of the face and skull through inconspicuousincisions. Severe deformities of the cranium and face, whichpreviously were uncorrectable or corrected with great difficulty, cannow be better reconstructed employing these new techniques. Suchdeformities may result from a tumor resection, congenital defect,previous surgery, or previous injury. Treatment of tumors of the headand neck and reconstruction of these regions after the removal ofthese tumors is also within the scope of plastic surgery.