The ear is generally not a first choice as a cartilage graft donor site for several reasons, none of which is valid. When the graft is harvested anteriorly, the scar is well-concealed as long as the incision is placed within the rim of the conchal bowl. And, although no site can provide as much cartilage as the rib, the auricle can provide a surprisingly large amount of graft material. There is also characteristically minimal morbidity with the harvest of auricular cartilage. This distinguishes it from rib cartilage harvest, which may be accompanied by significant postoperative pain and occasionally pneumothorax. In addition, septal harvest may cause bleeding, saddling of the nose symptomatic of septal perforation, and other airflow disturbances. The most important and major problem with ear cartilage is the flaccidity inherent in its structure. This makes it a poor choice when significant structural support is mandatory.

Skin grafting is an indispensable technique used in a variety of clinical situations, including acute burns, traumatic wounds, scar contracture release, and oncological and congenital deficiencies. The author’s preferred techniques for harvesting and resurfacing various skin defects using split- and full-thickness skin grafts are described in this chapter, together with the assessment of donor and recipient sites, preoperative preparation and postoperative considerations.

Regional anesthesia, or rendering only a targeted part of the body anesthetized, has numerous benefits for both the surgeon and patient. Local anesthetic agents are essential to create and maintain regional blockades, and detailed knowledge of these agents is essential to providing safe and effective care. This chapter begins with review of the basic pharmacology, indications, and contraindications for the use of regional anesthesia. Numerous specific blockades used to anesthetize distinct regions of the body are reviewed with specific focus on anatomy and technique. When safely performed, regional anesthesia can provide an optimal experience for both surgeon and patient.

Because of their exposed nature during human activities, infections of the hand are common. The anatomy of the hand and fingers also lends itself to unique types of infections that do not occur in other areas of the body, such as paronychia, felons, and fungal infections. Because of these unique types of infections, early surgical intervention is often necessary to prevent long-term functional sequelae. This requires healthcare providers to be knowledgeable of the signs and symptoms of these distinct infections in order to effectively treat these patients. This chapter describes many common hand infections and their treatment options.

Stenosing flexor tenosynovitis of the digits, commonly known as trigger finger, is one of the most common conditions affecting the hand. It is characterized by a painful locking or clicking of the finger during flexion or extension. This can lead to significant pain or eventual flexion deformity. Treatment varies based on the duration, severity, and etiology and can be either conservative or operative. The complication rate of surgical intervention remains low, with the most common being pain at the operative site. Treatment of trigger finger in the patient with rheumatoid disease should be approached with caution. Overall management of trigger finger, whether conservative or operative, is routinely successful with the final result of a satisfied patient.

Successful replantation depends on multiple variables. A coordinated effort of emergency transport services, emergency room personnel, operating room staff, anesthesiologists and postoperative nursing is required for success. The need for this team approach has led to the development of several specialized replantation centers worldwide. The authors discuss the various mechanisms of injury and their chances for successful replantation. This chapter examines the indications and contraindications for appropriate replantation. Also provided are many useful techniques for vessel and nerve repair, bony fixation, tendon repair, and soft tissue coverage. The chapter also discusses postoperative management, rehabilitation, and follow-up.

The disruption and subsequent repair of flexor tendons presents a formidable challenge to the hand surgeon. In an effort to regain excursion of the involved tendons, the definitive outcome depends on a number of variables, including the level of injury, the mechanism of injury, and associated trauma to the skin, pulleys, neurovascular bundles, and bone. The ultimate result, however, is directly proportional to scarring, fibrosis, adhesions, and gap formation that limit the return of normal tendon excursion and the final composite motion of the digit.

Reconstruction of the vagina is usually performed in patients undergoing abdominal-perineal resection or pelvic exenteration for carcinoma of the cervix, vagina, or rectum. Vaginal reconstruction is indicated for both psychological rehabilitation and perineal wound healing. Immediate reconstruction after partial or total vaginal resection facilitates primary healing of the perineal defect, decreases fluid loss from the pelvis, reduces infection rate, prevents herniation of abdominal contents into the perineum, and decreases nutritional demands. Additionally, flap closure provides neovascularization of the remaining pelvic tissue, which is particularly important in successful wound healing for patients who have either had radiation to the area or who are having postoperative radiation therapy. Moreover, even in the sexually inactive patient, this surgery provides patients with faster healing and overall enhanced self-esteem

Abdominal-based free tissue transfer accounts for the majority of autologous breast reconstruction. In situations where abdominal sources are unavailable, other donor sites should be considered. In this chapter, alternative donor sites for autologous breast reconstruction are discussed, specifically, gluteal- and thigh-based flaps. The superior gluteal artery perforator (SGAP) and inferior gluteal artery perforator (IGAP) flaps are discussed from the gluteal donor site, and the transverse upper gracilis (TUG), profunda artery perforator (PAP), and the lateral thigh perforator (LTP) flaps are discussed from the thigh donor site. Relevant anatomy and surgical technique are discussed for each flap in order to enhance awareness of secondary flap options in the plastic surgeon’s armamentarium for breast reconstruction.

This chapter summarizes the various surgical treatment options that can be used to restore the integrity of the chest wall after trauma or tumor resection and to assist with wound healing problems associated with infection and radiation therapy. Emphasis is placed on several considerations for patients undergoing chest wall reconstruction. The authors discuss the indications, contraindications, limitations, surgical anatomy, and technique of each flap type and the effective postoperative care and rehabilitation needed in order to prevent postoperative pulmonary problems. This chapter reviews some of the commonly used flaps for chest wall reconstruction. These flaps include the latissimus dorsi, rectus abdominis, and pectoralis major myocutaneous flaps and the omental flap.