Grabb and Smith's Plastic Surgery

1. Introduction - p. 32 2. History - p. 32 3. Applications of Microsurgery - p. 32 4. Preoperative Planning - p. 33 5. Technical Considerations - p. 35 6. Microsurgical Techniques - p. 36 7. Postoperative Management - p. 39 8. Flap Take Back - p. 41 9. Conclusion - p. 41 10. Interactive Questions - p. 43 11. Chapter 6. Concepts of Skin Grafts and Skin Substitutes - p. 44 12. Introduction - p. 44 13. Definitions - p. 44 14. Historical Perspectives - p. 44 15. Fundamentals of Skin Graft Biology - p. 45 16. Indications - p. 45 17. Techniques - p. 46 18. Outcomes - p. 49 19. Skin Substitutes - p. 49 20. Interactive Questions - p. 51 21. Chapter 7. Principles of Flap Reconstruction: Muscle Flaps, Myocutaneous Flaps, and Fasciocutaneous Flaps - p. 52 22. Introduction - p. 52 23. Preoperative Assessment - p. 52 24. Delay Phenomenon - p. 52 25. Muscle Flaps - p. 52 26. Myocutaneous Flaps - p. 53 27. Fasciocutaneous and Perforator Flaps - p. 53 28. Freestyle Flaps - p. 54 29. Supermicrosurgery - p. 54 30. Clinical Examples - p. 54 31. Conclusions - p. 57 32. Interactive Questions - p. 58 33. Chapter 8. Principles of Nerve Repair and Reconstruction and Neuroma Management - p. 59 34. Principles of Nerve Injury - p. 59 35. Biology of Nerve Injury - p. 59 36. Diagnostic Workup for Nerve Injury, Nerve Compression, and Neuroma - p. 59 37. Timing of Nerve Reconstruction for Functional Deficits and Neuropathic Pain - p. 61 38. Nerve Reconstruction - p. 61 39. Treatment of Neuropathic Pain - p. 62 40. Perioperative Care - p. 63 41. Acknowledgments - p. 63 42. Interactive Questions - p. 64 43. Chapter 9. Management of Neuroma Pain - p. 65 44. Introduction - p. 65 45. Evaluation and Diagnosis - p. 65 46. Principles of Symptomatic Neuroma Management - p. 65 47. Surgical Techniques - p. 65 48. Symptomatic Neuroma Prevention - p. 73 49. Conclusion - p. 74 50. Video Legends - p. 74 51. Interactive Questions - p. 76 52. Chapter 10. Principles of Tissue Expansion - p. 77 53. Introduction - p. 77 54. History - p. 77 55. Physiology - p. 77 56. Types of Tissue Expanders - p. 77 57. Principles Regarding Expander Placement - p. 78 58. Principles of Expansion Process - p. 78 59. Complications - p. 79 60. Use of Tissue Expanders - p. 79 61. Conclusion and Future Directions - p. 80 62. Interactive Questions - p. 82 63. Chapter 11. Principles of Local and Regional Anesthesia and Procedural Sedation - p. 83 64. Local Anesthesia - p. 83 65. Minor Nerve Blocks - p. 86 66. Regional Blocks - p. 89 67. Procedural Sedation - p. 89 68. Interactive Questions - p. 92 69. Chapter 12. Concepts of Tissue Engineering - p. 93 70. Biomaterials - p. 93 71. Cell Sources - p. 95 72. Morphogenic Instruction - p. 96 73. Manufacturing - p. 97 74. Examples - p. 97 75. Skin - p. 97 76. Breast - p. 98 77. Nerve - p. 98 78. Bone - p. 98 79. Cartilage - p. 99 80. Challenges and Future Directions - p. 99 81. Conclusion - p. 100 82. Interactive Questions - p. 102 83. Chapter 13. Patient Safety in Plastic Surgery - p. 103 84. Introduction - p. 103 85. Preoperative Assessment - p. 103 86. Venous Thromboembolism - p. 105 87. Pain Management - p. 107 88. Antibiotic Stewardship - p. 107 89. Intraoperative Safety - p. 108 90. Preventing Human Error - p. 108 91. Culture of Safety - p. 108 92. Conclusion - p. 109 93. Interactive Questions - p. 110 94. Chapter 14. Ethics of Plastic Surgery - p. 111 95. Introduction - p. 111 96. Definitions - p. 111 97. Ethical Principles - p. 111 98. Ethics and Evidence-Based Medicine - p. 112 99. Ethical Issues at the Intersection of Plastic Surgery and the Larger Medical System - p. 112 100. Social Media - p. 114 101. Innovation - p. 114 102. Conclusion - p. 115 103. Interactive Questions - p. 116 104. Chapter 15. Principles of Research Designs and Outcomes Research - p. 117 105. Introduction - p. 117 106. A Case-Based Overview - p. 117 107. Developing the Clinical Problem Into a Strong Research Question - p. 119 108. Selecting the Best Design - p. 120 109. Analytic Plan - p. 122 110. Considering Limitations and Bias - p. 123 111. Taking the So What? To Now What? - p. 123 112. Interactive Questions - p. 125 113. Chapter 16. Basic Statistics for the Practicing Physician - p. 126 114. Introduction - p. 126 115. Types of Data - p. 126 116. Summary Measures - p. 126 117. Data Distributions - p. 127 118. Measures of Effect - p. 127 119. Confounding, Bias, and Imprecision - p. 130 120. Inferential Statistics - p. 131 121. Which Test Should We Use? - p. 132 122. Diagnostic Test Performance - p. 135 123. Meta-Analysis - p. 136 124. Acknowledgments - p. 136 125. Interactive Questions - p. 138 126. Part II: Skin and Soft Tissue - p. 138 127. Chapter 17. Benign and Malignant Dermatologic Conditions - p. 139 128. Embryology - p. 139 129. Anatomy - p. 140 130. Common Benign Cutaneous Tumors - p. 140 131. Nonmelanoma Skin Cancers - p. 141 132. Basal Cell Carcinoma - p. 141 133. Squamous Cell Carcinoma - p. 143 134. Melanoma - p. 144 135. Merkel Cell Carcinoma - p. 145 136. Dermatofibrosarcoma Protuberans - p. 145 137. Interactive Questions - p. 146 138. Chapter 18. Thermal, Chemical, and Electrical Injuries - p. 147 139. Thermal, Chemical, and Electrical Injuries - p. 147 140. Interactive Questions - p. 156 141. Chapter 19. Principles of Burn Reconstruction - p. 157 142. Introduction - p. 157 143. Pathophysiology - p. 157 144. Initial Management of the Patient - p. 157 145. Surgical Management of Burns - p. 162 146. Special Anatomic Considerations - p. 163 147. Other Burns - p. 164 148. Interactive Questions - p. 166 149. Chapter 20. Radiation and Radiation Injury - p. 167 150. Introduction - p. 167 151. Pathophysiology - p. 167 152. Oncoplastic Breast Reconstruction - p. 167 153. Mastectomy Reconstruction - p. 167 154. Breast Cancer–Related Lymphedema - p. 168 155. Head and Neck Reconstruction - p. 168 156. Sarcoma Reconstruction - p. 168 157. Radiation Treatment - p. 169 158. Summary - p. 169 159. Interactive Questions - p. 171 160. Chapter 21. Lasers in Plastic Surgery - p. 172 161. Laser History - p. 172 162. The Science and Physics of Lasers - p. 172 163. Chromophores of the Skin - p. 173 164. Depth of Penetration of Various Lasers - p. 174 165. Laser Use in Clinical Plastic Surgery - p. 174 166. Clinical Considerations: Primarily for Skin Resurfacing - p. 176 167. Laser Safety - p. 179 168. Laser Business Considerations - p. 179 169. Interactive Questions - p. 182 170. Part III: Congenital Anomalies and Pediatric Plastic Surgery - p. 182 171. Chapter 22. Cleft Lip and Palate: Principles and Treatment - p. 183 172. Anatomy - p. 183 173. Phenotypic Spectrum and Classification - p. 183 174. Epidemiology - p. 184 175. Multidisciplinary and Early Care - p. 186 176. Presurgical Infant Orthopedics - p. 187 177. Primary Unilateral Cleft Lip Repair - p. 187 178. Primary Bilateral Cleft Lip Repair - p. 189 179. Primary Cleft Palate Repair - p. 191 180. Secondary Procedures - p. 193 181. Conclusion - p. 194 182. Interactive Questions - p. 196 183. Chapter 23. Cleft Lip and Palate: Embryology and Genetics - p. 197 184. Introduction - p. 197 185. Embryology of the Craniofacial Complex - p. 197 186. Orofacial Clefts and Associated Syndromes - p. 198 187. Cellular and Molecular Mechanisms Involved in Palate Development - p. 203 188. Advances Driving Medicine - p. 206 189. Interactive Questions - p. 208 190. Chapter 24. Congenital Melanocytic Nevi and Other Common Skin Lesions - p. 209 191. Anatomy of the Skin - p. 209 192. Congenital Melanocytic Nevi - p. 209 193. Spitz Nevus - p. 211 194. Halo Nevus - p. 211 195. Dysplastic Nevi - p. 211 196. Epidermal Nevi - p. 211 197. Nevus Sebaceous - p. 212 198. Cysts - p. 212 199. Interactive Questions - p. 216 200. Chapter 25. Vascular Anomalies - p. 217 201. Introduction - p. 217 202. Tumors - p. 217 203. Malformations - p. 219 204. Conclusions - p. 222 205. Interactive Questions - p. 223 206. Chapter 26. Nonsyndromic Craniosynostosis and Deformational Plagiocephaly - p. 224 207. Nonsyndromic Craniosynostosis - p. 224 208. Deformational Plagiocephaly, Brachycephaly, and Scaphocephaly - p. 237 209. Interactive Questions - p. 243 210. Chapter 27. Syndromic Craniosynostosis - p. 244 211. Introduction - p. 244 212. Patient Evaluation - p. 244 213. Genetic Considerations - p. 245 214. Selected Syndromes - p. 245 215. Surgical Management - p. 252 216. Psychosocial Management - p. 266 217. Conclusion - p. 266 218. Interactive Questions - p. 268 219. Chapter 28. Craniofacial Microsomia and Principles of Craniofacial Distraction - p. 269 220. Craniofacial Microsomia - p. 269 221. Craniofacial Distraction - p. 276 222. Interactive Questions - p. 284 223. Chapter 29. Orthognathic Surgery - p. 285 224. Orthognathic Surgery: Definition and Goals - p. 285 225. Presurgical Orthodontic Requirements - p. 285 226. Postoperative Care - p. 285 227. Adult and Pediatric Dental Primer - p. 286 228. Common Dental Terms - p. 286 229. Diagnosing Common Dentofacial Deformities - p. 286 230. History - p. 286 231. Physical Exam: The Facial Examination - p. 287 232. Cephalometrics - p. 288 233. Collaborating With Your Orthodontist - p. 289 234. Surgical Planning - p. 289 235. Routine Orthognathic Procedures - p. 290 236. Le Fort I Maxillary Osteotomy - p. 290 237. Surgically Assisted Rapid Palatal Expansion - p. 293 238. Mandibular Sagittal Split Osteotomy - p. 294 239. Vertical Ramus Osteotomy - p. 295 240. Genioplasty - p. 295 241. Intraoperative Complications - p. 296 242. Postoperative Complications - p. 296 243. Conclusion - p. 297 244. Interactive Questions - p. 298 245. Chapter 30. Craniofacial Clefts and Orbital Hypertelorism - p. 299 246. Cleft 0 and 14 - p. 299 247. Cleft Number 1 - p. 302 248. Cleft Number 2 - p. 303 249. Cleft Number 3 - p. 303 250. Cleft Number 4 - p. 303 251. Cleft Number 5 - p. 305 252. Cleft Number 6 - p. 306 253. Cleft Number 7 - p. 306 254. Cleft Number 8 - p. 306 255. Cleft Number 9 - p. 306 256. Cleft Number 10 - p. 307 257. Cleft Number 11 - p. 307 258. Cleft Number 12 - p. 308 259. Cleft Number 13 - p. 309 260. Cleft Number 14 - p. 309 261. Cleft Number 30 - p. 310 262. Cleft Numbers 31 to 33 - p. 310 263. Hypertelorism - p. 311 264. Surgical Considerations - p. 311 265. Interactive Questions - p. 313 266. Chapter 31. Ear Reconstruction - p. 314 267. Epidemiology and Embryology - p. 314 268. Anatomy and Orientation - p. 314 269. Congenital Ear Malformations and Deformations - p. 314 270. Microtia - p. 316 271. Comparative Outcomes, Technical Considerations, and Complications - p. 320 272. Technical Considerations in Comorbid Conditions - p. 321 273. Partial Auricle Defects - p. 321 274. Atresia Repair - p. 321 275. Conclusions - p. 322 276. Interactive Questions - p. 323 277. Chapter 32. Management of Velopharyngeal Dysfunction - p. 324 278. Velopharyngeal Apparatus - p. 324 279. Diagnosis - p. 326 280. Management - p. 328 281. Special Considerations - p. 331 282. Conclusion - p. 335 283. Interactive Questions - p. 337 284. Chapter 33. Craniofacial Tumors and Conditions - p. 338 285. Fibrous Dysplasia - p. 338 286. Parry-Romberg Syndrome - p. 339 287. Treacher Collins Syndrome - p. 341 288. Neurofibromatosis - p. 342 289. Robin Sequence - p. 343 290. Moebius Syndrome - p. 345 291. Dermoid Cyst - p. 346 292. Interactive Questions - p. 348 293. Chapter 34. Pediatric Brachial Plexus Reconstruction - p. 349 294. Introduction - p. 349 295. History - p. 349 296. Anatomy - p. 349 297. Epidemiology - p. 351 298. Risk Factors - p. 351 299. Clinical Evaluation - p. 351 300. Motor Examination - p. 351 301. Neuroma Excision and Grafting - p. 353 302. Nerve Transfers - p. 354 303. Uncommon Nerve Transfers - p. 354 304. Shoulder Management - p. 355 305. Innovations - p. 355 306. Interactive Questions - p. 358 307. Part IV: Head and Neck - p. 358 308. Chapter 35. Skeletal and Soft Tissue Injuries of the Face - p. 359 309. Evaluation of Facial Trauma - p. 359 310. Skeletal Injuries of the Face - p. 360 311. Soft Tissue Injuries of the Face - p. 367 312. Interactive Questions - p. 371 313. Chapter 36. Head and Neck Cancer and Salivary Gland Tumors - p. 372 314. Epidemiologic Trends and Risk Factors - p. 372 315. Preoperative Considerations - p. 372 316. Staging - p. 373 317. Treatment - p. 374 318. Radiation Therapy - p. 376 319. Systemic Therapy - p. 376 320. Salivary Tumors - p. 377 321. Interactive Questions - p. 381 322. Chapter 37. Neuroplastic and Reconstructive Surgery: Management of Complex Scalp and Skull Defects - p. 382 323. Introduction to Neuroplastic Surgery - p. 382 324. Anatomy of the Scalp and Skull - p. 384 325. Scalp - p. 384 326. Calvarium - p. 388 327. Anterior Skull Base Reconstruction - p. 390 328. Temporal Midfacial Reconstruction - p. 391 329. Summary - p. 393 330. Acknowledgments - p. 393 331. Interactive Questions - p. 395 332. Chapter 38. Reconstruction of the Eyelids, Correction of Ptosis, and Canthoplasty - p. 396 333. Anatomy - p. 396 334. Eyelid Reconstruction - p. 397 335. Eyelid Ptosis Reconstruction - p. 400 336. Canthoplasty - p. 405 337. Interactive Questions - p. 410 338. Chapter 39. Nasal Reconstruction - p. 411 339. Introduction - p. 411 340. Anatomical Considerations - p. 411 341. Aesthetic Subunits and Proportions - p. 411 342. Reconstruction Basics - p. 412 343. Biological Agents - p. 412 344. Local Flap Specifics - p. 413 345. Linear Closure - p. 414 346. Melolabial Transposition Flap - p. 414 347. Bilobed Flap - p. 414 348. Dorsonasal Flap - p. 415 349. Nasolabial Flap - p. 415 350. Paramedian Forehead Flap - p. 415 351. Framework Support - p. 417 352. Nasal Lining Options - p. 418 353. Complications - p. 421 354. Conclusions and Future Directions - p. 421 355. Interactive Questions - p. 423 356. Chapter 40. Reconstruction of Acquired Lip and Cheek Deformities - p. 424 357. Lip Reconstruction - p. 424 358. Cheek Reconstruction - p. 430 359. Interactive Questions - p. 433 360. Chapter 41. Facial Paralysis - p. 434 361. The Facial Nerve - p. 434 362. What Is Facial Paralysis? - p. 435 363. Types of Facial Paralysis—Flaccid Versus Postparetic Facial Synkinesis - p. 437 364. Grading Systems for Facial Paralysis - p. 437 365. Flaccid Facial Paralysis - p. 438 366. Synkinesis—Postparetic Synkinesis - p. 448 367. Summary - p. 452 368. Interactive Questions - p. 453 369. Chapter 42. Mandible Reconstruction - p. 454 370. Indications - p. 454 371. Classifications - p. 455 372. Reconstructive Decision-Making - p. 455 373. Flap Selection - p. 456 374. Planning - p. 458 375. Surgical Technique - p. 462 376. Postoperative Management - p. 462 377. Complications - p. 465 378. Conclusion - p. 467 379. Interactive Questions - p. 469 380. Chapter 43. Reconstruction of the Oral Cavity, Pharynx, and Esophagus - p. 470 381. Anatomy - p. 470 382. Oral Cavity - p. 470 383. Pharynx - p. 474 384. Esophagus - p. 476 385. Recipient Vessel Dissection - p. 477 386. Postoperative Care - p. 478 387. Complications - p. 478 388. Interactive Questions - p. 480 389. Chapter 44. Facial Gender-Affirming Surgery - p. 481 390. Introduction and Access to Care Under Health Insurance - p. 481 391. Surgical Consultation - p. 481 392. Facial Analysis and Physical Examination - p. 482 393. Surgical Planning of Osteotomies - p. 482 394. Feminizing Operative Technique and Considerations - p. 483 395. Masculinizing Procedures - p. 489 396. Nonbinary Considerations - p. 489 397. Postoperative Care and Surgical Outcomes - p. 489 398. Mental Health Quality-of-Life Outcomes - p. 491 399. Interactive Questions - p. 492 400. Chapter 45. Migraine Surgery - p. 493 401. Introduction - p. 493 402. Background - p. 493 403. Evaluation - p. 493 404. Conclusions - p. 495 405. Interactive Questions - p. 498 406. Part V: Aesthetic Surgery - p. 498 407. Chapter 46. Nonsurgical Facial Rejuvenation and Skin Resurfacing - p. 499 408. Introduction - p. 499 409. Normal Skin Anatomy - p. 499 410. Epidermis - p. 499 411. Patient Selection - p. 500 412. Biology of Wound Healing From Resurfacing Procedure - p. 501 413. Overview of Treatments - p. 501 414. Nonthermal Procedures - p. 501 415. Deep Peels - p. 502 416. Thermal Procedures - p. 502 417. Types of Lasers - p. 504 418. Skin Resurfacing - p. 505 419. Treatment of Vascular Lesions - p. 505 420. Treatment of Pigmented Lesions - p. 505 421. Complications of Lasers - p. 505 422. Plasma Skin Resurfacing - p. 506 423. Emerging Technologies - p. 506 424. Conclusion - p. 506 425. Interactive Questions - p. 511 426. Chapter 47. Dermal and Soft-Tissue Fillers: Principles, Materials, and Techniques - p. 512 427. Indications - p. 512 428. Types of Filler - p. 513 429. Technique - p. 514 430. Complications and Adverse Events - p. 520 431. Conclusion - p. 522 432. Interactive Questions - p. 523 433. Chapter 48. Botulinum Toxin - p. 524 434. Pharmacology and Commercial Preparation - p. 524 435. Contraindications and Adverse Effects - p. 524 436. Clinical Applications - p. 524 437. Posttreatment Care and Follow-Up - p. 528 438. Acknowledgments and Disclosures - p. 530 439. Interactive Questions - p. 532 440. Chapter 49. Fat Grafting in Plastic Surgery - p. 533 441. Introduction - p. 533 442. Indications and Preoperative Optimization - p. 533 443. Harvesting - p. 533 444. Preparation - p. 534 445. Engraftment/Infiltration - p. 535 446. Fat Grafting as Regenerative Surgery - p. 536 447. Postoperative Outcomes and Adverse Events - p. 536 448. Conclusion and Future Considerations - p. 537 449. Interactive Questions - p. 539 450. Chapter 50. Forehead and Brow Rejuvenation - p. 540 451. History - p. 540 452. Anatomy - p. 540 453. Clinical Evaluation - p. 542 454. Management of the Aging Forehead - p. 542 455. Complications - p. 549 456. Summary - p. 550 457. Interactive Questions - p. 552 458. Chapter 51. Blepharoplasty - p. 553 459. Introduction - p. 553 460. Anatomy - p. 553 461. Preoperative Evaluation - p. 554 462. Upper Blepharoplasty - p. 555 463. Lower Blepharoplasty - p. 557 464. Postoperative Care - p. 558 465. Management of Complications - p. 558 466. Conclusion - p. 558 467. Interactive Questions - p. 559 468. Chapter 52. Eyelid Ptosis and Repair - p. 560 469. Definitions - p. 560 470. Surgical Anatomy of Blepharoptosis - p. 560 471. Classification of Blepharoptosis - p. 561 472. Preoperative Assessment - p. 561 473. Photography and Videography - p. 562 474. Ophthalmology Consultation - p. 563 475. Treatment Principles and Considerations - p. 563 476. Congenital Ptosis - p. 563 477. Frontalis Suspension - p. 563 478. Frontalis Orbicularis Oculi Muscle Flap - p. 564 479. Acquired Ptosis - p. 565 480. Tarso-Mullerectomy (Fasanella-Servat Procedure) - p. 565 481. Muller Muscle-Conjunctival Resection - p. 565 482. Levator Advancement - p. 566 483. Preoperative Determination of Fixation Locations for the Levator Advancement - p. 567 484. Surgical Technique - p. 568 485. Postoperative Outcomes - p. 570 486. Complications - p. 572 487. Conclusion - p. 573 488. Interactive Questions - p. 575 489. Chapter 53. Facelift and Necklift - p. 576 490. Historical Perspective - p. 576 491. Nomenclature - p. 576 492. Science of Facial Aging - p. 576 493. The Facelift Consult - p. 577 494. Facelift Anatomy - p. 577 495. Marking the Patient and Operating Room Setup - p. 578 496. Surgical Steps - p. 578 497. Complications - p. 581 498. Conclusion - p. 581 499. Interactive Questions - p. 583 500. Chapter 54. Functional Considerations in Esthetic Rhinoplasty - p. 584 501. Introduction - p. 584 502. The Pathophysiology of Breathing and Airflow - p. 584 503. Nasal Resistance - p. 584 504. Preoperative Analysis - p. 585 505. Surgical Techniques for the Prevention and Treatment of Nasal Obstruction - p. 586 506. Conclusion - p. 589 507. Interactive Questions - p. 590 508. Chapter 55. Aesthetic Rhinoplasty - p. 591 509. Introduction - p. 591 510. Aesthetic Evaluation of the Rhinoplasty Patient - p. 591 511. Surgical Management in Rhinoplasty - p. 595 512. The Dorsum - p. 597 513. The Nasal Tip - p. 602 514. Summary - p. 609 515. Interactive Questions - p. 611 516. Chapter 56. Otoplasty - p. 612 517. Diagnosis - p. 612 518. Nonoperative Treatment - p. 613 519. Timing of Operative Treatment - p. 613 520. Prominent Ear - p. 613 521. Constricted Ear - p. 615 522. Cryptotia - p. 615 523. Stahl Deformity - p. 615 524. Accessory Cartilage - p. 615 525. Lobule Abnormalities - p. 615 526. Complications - p. 617 527. Summary - p. 617 528. Interactive Questions - p. 618 529. Chapter 57. Technical Refinement in Treating Prominent Ears - p. 619 530. Introduction - p. 619 531. Prominent Ears - p. 619 532. Initial Consultation - p. 619 533. Examination and Anatomy - p. 619 534. Surgical Timing - p. 620 535. Operative Techniques - p. 620 536. Postoperative Care - p. 623 537. Complications - p. 623 538. Conclusion - p. 624 539. Interactive Questions - p. 625 540. Chapter 58. Alloplastic Augmentation of the Facial Skeleton - p. 626 541. Introduction - p. 626 542. Options for Facial Contouring - p. 626 543. Materials - p. 626 544. Author’s Preferred Implant Materials - p. 628 545. Indications for Alloplastic Facial Implants - p. 628 546. Preoperative Planning - p. 629 547. CAD/CAM - p. 629 548. Operative Principles - p. 629 549. Areas for Augmentation - p. 631 550. Chin Augmentation With Implants - p. 632 551. Outcomes - p. 636 552. Interactive Questions - p. 638 553. Chapter 59. Labiaplasty and Vaginal Rejuvenation - p. 639 554. Introduction - p. 639 555. Patient Motivations - p. 639 556. Surgical Anatomy - p. 640 557. Patient Evaluation - p. 642 558. Anesthesia, Positioning, Prepping, and Draping - p. 642 559. Surgical Procedures - p. 643 560. Nonoperative Vulvovaginal Treatments - p. 649 561. Energy Devices - p. 650 562. Conclusion - p. 650 563. Interactive Questions - p. 651 564. Chapter 60. Hair Restoration - p. 652 565. Introduction - p. 652 566. History of Hair Transplantation - p. 652 567. Hair Anatomy and Physiology - p. 652 568. Hair Disorders and Classification Systems - p. 652 569. Indications for Hair Transplantation - p. 653 570. Hairline Esthetics - p. 653 571. Surgical Techniques - p. 654 572. Expectations and Complications - p. 655 573. Medical and Adjunct Treatment Options - p. 655 574. Conclusion - p. 656 575. Interactive Questions - p. 657 576. Chapter 61. Buttock Augmentation - p. 658 577. Introduction/Historical Perspective - p. 658 578. Ideal Proportions - p. 658 579. Anatomical Considerations - p. 658 580. Buttock Ptosis - p. 659 581. Neurovascular Anatomy - p. 659 582. Preoperative Evaluation/Patient Selection - p. 660 583. Markings - p. 660 584. Surgical Technique - p. 661 585. Surgical Procedure - p. 661 586. Fat Collection and Injection - p. 663 587. Fat Grafting - p. 663 588. Postoperative Care - p. 663 589. Buttock Implants - p. 664 590. Expectations - p. 665 591. Complications - p. 665 592. Interactive Questions - p. 668 593. Part VI: Breast - p. 668 594. Chapter 62. Augmentation Mammoplasty, Mastopexy, and Augmentation Mastopexy - p. 669 595. Introduction to Aesthetic Breast Surgery - p. 669 596. Preoperative Assessment of the Aesthetic Breast Patient - p. 669 597. Breast Augmentation - p. 670 598. Management of Breast Ptosis - p. 671 599. Mastopexy - p. 671 600. Augmentation Mastopexy - p. 672 601. Complications in Aesthetic Breast Surgery - p. 674 602. Conclusion - p. 675 603. Interactive Questions - p. 677 604. Chapter 63. Breast Reduction - p. 678 605. Introduction - p. 678 606. Anatomy - p. 678 607. Epidemiology - p. 678 608. Initial Patient Evaluation - p. 678 609. Techniques - p. 680 610. Complications (Figure 63.13) - p. 685 611. Special Considerations - p. 686 612. Conclusion - p. 686 613. Interactive Questions - p. 687 614. Chapter 64. Gynecomastia - p. 688 615. Pathophysiology - p. 688 616. Natural History - p. 689 617. Classification - p. 689 618. Investigations - p. 689 619. Management - p. 690 620. Interactive Questions - p. 694 621. Chapter 65. Breast Cancer: Current Trends in Screening, Patient Evaluation, and Treatment - p. 695 622. Introduction - p. 695 623. Risk Factors - p. 695 624. Types of Breast Cancer - p. 695 625. Screening - p. 697 626. Staging - p. 697 627. Workup - p. 697 628. Neoadjuvant Systemic Therapy - p. 698 629. Surgical Treatment - p. 698 630. Management of the Axilla - p. 699 631. Systemic Therapy - p. 699 632. Radiation Therapy - p. 700 633. Emerging Breast Implant Associated Malignancies: BIA-ALCL, BCL, and SCC - p. 700 634. Conclusions - p. 700 635. Interactive Questions - p. 703 636. Chapter 66. Breast Reconstruction—Prosthetic Techniques - p. 704 637. Introduction - p. 704 638. General Considerations - p. 704 639. Two-Stage Tissue Expander Reconstruction - p. 708 640. Immediate Implant Reconstruction - p. 710 641. Conclusions - p. 711 642. Interactive Questions - p. 713 643. Chapter 67. Concepts in Optimizing Breast Reconstruction Using Autologous Tissue - p. 714 644. Preoperative Evaluation - p. 714 645. Donor Sites - p. 715 646. Autologous Reconstruction in the Setting of Chemotherapy and Radiation Therapy - p. 716 647. Interactive Questions - p. 721 648. Chapter 68. Options in Autologous Breast Reconstruction - p. 722 649. Introduction - p. 722 650. Pedicle Flaps - p. 722 651. Latissimus Dorsi Flap - p. 722 652. Transverse Rectus Abdominis Myocutaneous Flap - p. 723 653. Microvascular Free Flaps - p. 723 654. Recipient Vessels - p. 723 655. Deep Inferior Epigastric Perforator Flap - p. 724 656. Profunda Artery Perforator Flap - p. 725 657. Transverse Upper Gracilis Flap - p. 725 658. Gluteal Flaps - p. 725 659. Lumbar Artery Perforator Flap - p. 726 660. Neurotization and Sensate Flaps - p. 726 661. Summary - p. 727 662. Interactive Questions - p. 729 663. Chapter 69. Oncoplastic Techniques for Breast Reconstruction - p. 730 664. Standardized Terminology - p. 730 665. Preoperative Considerations - p. 730 666. Patient-Related Factors - p. 730 667. Tumor-Related Factors - p. 730 668. Timing of Oncoplastic Reconstruction - p. 730 669. Techniques for Oncoplastic Breast Reconstruction - p. 731 670. Volume Displacement Techniques - p. 731 671. Volume Replacement Techniques - p. 731 672. Postoperative Complications - p. 734 673. Oncologic Surveillance - p. 736 674. Conclusions - p. 736 675. Interactive Questions - p. 737 676. Chapter 70. Management of Breast Cancer–Related Lymphedema - p. 738 677. Background - p. 738 678. Clinical Assessment - p. 738 679. Conservative Management - p. 739 680. Surgical Method for Lymphedema Prevention at Time of Axillary Dissection - p. 740 681. Surgical Management of Upper Extremity Lymphedema - p. 741 682. Reconstructive Lymphatic Surgery - p. 741 683. Reductive/Debulking Surgery - p. 744 684. Conclusion - p. 745 685. Interactive Questions - p. 747 686. Chapter 71. Secondary Procedures for Breast Reconstruction: Fat Grafting - p. 748 687. Introduction - p. 748 688. Background - p. 748 689. Lipoaspirate Harvest - p. 748 690. Delivery Techniques and Distribution of Fat - p. 749 691. Indications for Fat Grafting and Types of Defects - p. 750 692. Fat Grafting in Implant-Based Breast Reconstruction - p. 750 693. Fat Grafting in the Autologous Reconstructed Breast - p. 752 694. Safety in Breast Reconstruction - p. 752 695. Conclusion - p. 753 696. Interactive Questions - p. 756 697. Chapter 72. Reconstruction of the Nipple-Areolar Complex - p. 757 698. Introduction - p. 757 699. Goals - p. 757 700. Markings - p. 757 701. Techniques - p. 757 702. Nipple and Areolar Reconstruction Revisions - p. 760 703. Postoperative Care - p. 762 704. Pitfalls and Complications - p. 762 705. Conclusions - p. 762 706. Interactive Questions - p. 764 707. Chapter 73. Congenital Anomalies of the Breast: Tuberous Breasts, Poland Syndrome, and Asymmetry - p. 765 708. Introduction - p. 765 709. Breast Embryology - p. 766 710. Health-Related Quality of Life Considerations - p. 767 711. Nonoperative Management - p. 768 712. Surgical Treatment - p. 768 713. Postoperative Complications and Outcomes - p. 770 714. Conclusion - p. 770 715. Interactive Questions - p. 772 716. Part VII: Body Contouring - p. 772 717. Chapter 74. Principles of Plastic Surgery After Massive Weight Loss - p. 773 718. Introduction - p. 773 719. Preoperative Assessment - p. 773 720. Type of MWL Surgery - p. 774 721. Identifying and Optimizing Comorbidities - p. 775 722. Physical Examination - p. 775 723. Staging and Timing of Procedures - p. 775 724. Operative Tips - p. 776 725. Complications - p. 777 726. Outcomes - p. 777 727. Interactive Questions - p. 779 728. Chapter 75. Liposuction, Abdominoplasty, and Belt Lipectomy - p. 780 729. Liposuction - p. 780 730. Abdominoplasty - p. 782 731. Belt Lipectomy - p. 784 732. Conclusions - p. 785 733. Interactive Questions - p. 786 734. Chapter 76. Lower Body Lift and Thighplasty - p. 787 735. Lower Body Lift - p. 787 736. Thighplasty - p. 790 737. Interactive Questions - p. 793 738. Chapter 77. Brachioplasty - p. 794 739. Introduction - p. 794 740. Applied Anatomy - p. 794 741. Classification Systems - p. 794 742. Evolution of Brachioplasty Techniques - p. 795 743. Scar Placement - p. 797 744. Liposuction - p. 799 745. Complications and Outcomes - p. 799 746. Interactive Questions - p. 802 747. Part VIII: Hand - p. 802 748. Chapter 78. Functional Anatomy and Principles of Upper Extremity Surgery - p. 803 749. Surface Anatomy - p. 803 750. Functional Anatomy - p. 804 751. Musculotendinous System - p. 805 752. Neurovascular and Lymphatic Systems - p. 807 753. Principles of Upper Extremity Surgery - p. 808 754. Interactive Questions - p. 811 755. Chapter 79. Principles of Bone Fixation - p. 812 756. Summary of Principles - p. 812 757. Definitions - p. 812 758. Biomechanics of Bone Healing - p. 813 759. Biomechanics of Fracture Fixation - p. 813 760. Preoperative Considerations, Decision Making, and Planning - p. 814 761. Intraoperative Approaches, Reductions, and Fixation Techniques - p. 815 762. Postoperative Considerations: Dressing, Fixation Techniques, and Their Effect on Rehabilitation and Bone Healing - p. 816 763. Complications of Poor Reduction or Fixation Techniques - p. 817 764. Interactive Questions - p. 819 765. Chapter 80. Hand Infections - p. 820 766. Introduction - p. 820 767. Paronychia - p. 820 768. Onychomycosis - p. 821 769. Felon - p. 821 770. Infectious Flexor Tenosynovitis - p. 821 771. Subfascial Infections - p. 823 772. Viral Infections - p. 823 773. Septic Arthritis - p. 824 774. Necrotizing Fasciitis - p. 825 775. Aquatic Infections - p. 826 776. Fungal Hand Infections - p. 826 777. Infection Mimickers - p. 826 778. Interactive Questions - p. 828 779. Chapter 81. Soft-Tissue Reconstruction of the Upper Extremity and Management of Fingertip and Nail Bed Injuries - p. 829 780. Principle of Soft-Tissue Reconstruction in the Upper Extremity - p. 829 781. Special Characteristics of Hand and Digits Reconstruction - p. 830 782. Decision-Making Process for Optimal Flap Selection - p. 830 783. Classification of Soft-Tissue Defects - p. 831 784. Flap Selection Based on Defect Location and Size in Hand and Digits - p. 832 785. Flap Selection Based on Defect Size in Upper Extremity Except for Hand and Digits - p. 843 786. Conclusions - p. 848 787. Interactive Questions - p. 850 788. Chapter 82. Management of Compression Neuropathies of the Upper Extremity - p. 851 789. Introduction - p. 851 790. Pathophysiology - p. 851 791. Classification of Nerve Injury - p. 851 792. Diagnosis - p. 851 793. Surgical Principles - p. 853 794. Median Nerve Compression - p. 853 795. Ulnar Nerve Compression - p. 857 796. Radial Nerve Compression - p. 859 797. Conclusion - p. 861 798. Interactive Questions - p. 863 799. Chapter 83. Principles and Applications of Nerve Transfers - p. 864 800. Introduction - p. 864 801. Principles and Indications - p. 864 802. Technical Considerations (Figure 83.1) - p. 865 803. Multidisciplinary Approach and Workup - p. 866 804. Applications - p. 866 805. Multidisciplinary Evaluation and Postoperative Care - p. 871 806. Interactive Questions - p. 873 807. Chapter 84. Management of Brachial Plexus Injuries - p. 874 808. Surgical Anatomy - p. 874 809. Classification of Brachial Plexus Injury - p. 875 810. Patient Evaluation - p. 877 811. Management - p. 878 812. Reconstruction by Injury Pattern - p. 880 813. Multidisciplinary Approach - p. 882 814. Postoperative Care - p. 882 815. Outcomes - p. 882 816. Conclusions - p. 882 817. Interactive Questions - p. 885 818. Chapter 85. Tetraplegia - p. 886 819. Introduction - p. 886 820. Pathophysiology of Injury - p. 886 821. Clinical Evaluation - p. 886 822. Management of Tetraplegia - p. 886 823. Surgical Treatment - p. 887 824. Postoperative Care and Rehabilitation - p. 891 825. Outcomes - p. 891 826. Complications - p. 891 827. Conclusion - p. 892 828. Interactive Questions - p. 893 829. Chapter 86. Management of Hand Fractures and Fracture Dislocations - p. 894 830. Introduction - p. 894 831. Clinical Evaluation - p. 894 832. Principles of Management - p. 894 833. Phalangeal Fractures - p. 895 834. Metacarpal Fractures - p. 897 835. Interactive Questions - p. 902 836. Chapter 87. Management of Wrist Fractures and Dislocations - p. 903 837. Introduction - p. 903 838. Anatomy and Biomechanics - p. 903 839. Diagnosis - p. 903 840. Wrist Fractures - p. 904 841. Wrist Dislocations - p. 908 842. Interactive Questions - p. 913 843. Chapter 88. Distal Radius and Forearm Fractures - p. 914 844. Distal Radius Fractures - p. 914 845. Forearm Fractures - p. 922 846. Interactive Questions - p. 929 847. Chapter 89. Flexor Tendon Repair and Reconstruction - p. 930 848. Introduction - p. 930 849. Anatomy - p. 930 850. Basic Science - p. 930 851. Clinical Evaluation - p. 931 852. Primary Tendon Repair - p. 932 853. Postoperative Rehabilitation - p. 934 854. Flexor Tendon Reconstruction - p. 934 855. Complications - p. 935 856. Conclusion - p. 935 857. Interactive Questions - p. 936 858. Chapter 90. Extensor Tendon Repair and Reconstruction - p. 937 859. Introduction - p. 937 860. Anatomy - p. 937 861. Extensor Tendon Injuries - p. 937 862. Acute Injuries With Loss or Degloving - p. 940 863. Interactive Questions - p. 942 864. Chapter 91. Tendinopathies of the Upper Extremity - p. 943 865. Introduction - p. 943 866. Lateral and Medial Epicondylitis of the Elbow - p. 943 867. Trigger Digits - p. 944 868. De Quervain Tenosynovitis - p. 946 869. Other Tendinopathies - p. 947 870. Conclusion - p. 948 871. Interactive Questions - p. 949 872. Chapter 92. Principles and Applications of Tendon Transfers - p. 950 873. Introduction - p. 950 874. Principles of Tendon Transfer - p. 950 875. Preoperative Evaluation - p. 952 876. Tenorrhaphy Technique - p. 952 877. Radial Nerve Palsy - p. 952 878. Median Nerve Palsy - p. 954 879. Ulnar Nerve Palsy - p. 955 880. Combined Palsies and Other Injuries - p. 957 881. Postoperative Management - p. 958 882. Interactive Questions - p. 961 883. Chapter 93. Ligamentous Injuries in the Hand - p. 962 884. Introduction - p. 962 885. Normal Ligament Anatomy and Function - p. 962 886. Ligamentous Injury - p. 964 887. Diagnosis - p. 965 888. Treatment - p. 966 889. Conclusion - p. 970 890. Interactive Questions - p. 972 891. Chapter 94. Ligament Injuries of the Wrist - p. 973 892. Anatomy - p. 973 893. Kinematics - p. 973 894. Instability - p. 974 895. Wrist Examination - p. 975 896. Imaging Modalities - p. 975 897. Scapholunate Ligament Injury - p. 976 898. Lunotriquetral Ligament Injury - p. 979 899. Perilunate Dislocation - p. 980 900. Triangulofibrocartilage Complex Injury - p. 981 901. Conclusion - p. 981 902. Interactive Questions - p. 983 903. Chapter 95. Management of Mutilating Upper Extremity Injuries - p. 984 904. Introduction - p. 984 905. Evaluation and Initial Resuscitation - p. 984 906. Amputation Versus Salvage - p. 984 907. Preparation for the Operating Room - p. 985 908. Management of Vascular Compromise - p. 986 909. Skeletal Fixation - p. 986 910. Vascular Repair - p. 987 911. Tendon and Muscle Repair - p. 988 912. Nerve Repair - p. 988 913. Soft-Tissue Coverage - p. 988 914. Use of “Spare Parts” - p. 990 915. Fasciotomy - p. 990 916. Special Situations - p. 990 917. CONCLUSION - p. 993 918. Interactive Questions - p. 995 919. Chapter 96. Replantation Strategies of the Hand and Upper Extremity - p. 996 920. History - p. 996 921. Indications - p. 996 922. Preoperative Management - p. 997 923. Benchwork - p. 998 924. Anesthesia - p. 998 925. Single Digital Replantation - p. 998 926. Distal Digital Replantation - p. 1000 927. Ring Avulsion Replantation - p. 1001 928. Thumb - p. 1003 929. Transmetacarpal Replantation - p. 1003 930. Multiple Digit Replantation - p. 1003 931. Major Limb Replantation - p. 1004 932. Postoperative Care - p. 1005 933. Salvaging the Troubled Replant - p. 1006 934. Rehabilitation - p. 1007 935. Outcomes - p. 1007 936. Interactive Questions - p. 1008 937. Chapter 97. Thumb Reconstruction - p. 1009 938. Overall Function - p. 1009 939. Anatomy and Mechanics of the Thumb - p. 1009 940. Patient Evaluation - p. 1009 941. History of Thumb Reconstruction - p. 1010 942. Reconstructive Goals - p. 1010 943. Thumb Replantation - p. 1010 944. Thumb Reconstruction - p. 1011 945. Conclusion - p. 1019 946. Interactive Questions - p. 1021 947. Chapter 98. Dupuytren Disease - p. 1022 948. Basic Science - p. 1022 949. Epidemiology - p. 1022 950. Anatomy and Pathophysiology - p. 1023 951. Evaluation - p. 1024 952. Treatment - p. 1025 953. Adjuncts to Surgical Treatment - p. 1027 954. Outcomes - p. 1027 955. Interactive Questions - p. 1029 956. Chapter 99. Hand Tumors - p. 1030 957. Clinical Assessment - p. 1030 958. Investigations - p. 1030 959. Differentiating Benign and Malignant Tumors - p. 1031 960. Principles of Biopsy for Suspected Malignant Tumors - p. 1031 961. Management - p. 1031 962. Specific Considerations for Common Hand Tumors - p. 1032 963. Surgery for Malignant Hand Tumors - p. 1034 964. Interactive Questions - p. 1037 965. Chapter 100. Vascular Disorders of the Upper Extremity - p. 1038 966. Anatomy - p. 1038 967. Evaluation - p. 1038 968. Acute Ischemia - p. 1039 969. Chronic Ischemia - p. 1040 970. Vascular Anomalies - p. 1041 971. Interactive Questions - p. 1044 972. Chapter 101. Comprehensive Management of the Burned Hand - p. 1045 973. Introduction - p. 1045 974. Anatomy and Pathophysiology - p. 1045 975. General Principles of Management of Acutely Burned Hand - p. 1045 976. General Principles of Management of Postburn Contractures - p. 1050 977. Conclusion - p. 1054 978. Interactive Questions - p. 1056 979. Chapter 102. Compartment Syndrome of the Upper Extremity - p. 1057 980. Introduction - p. 1057 981. Rationale and Basic Science - p. 1057 982. Diagnosis - p. 1057 983. Surgical Intervention - p. 1060 984. Complications - p. 1062 985. Clinical Results - p. 1063 986. Interactive Questions - p. 1065 987. Chapter 103. Congenital Hand Anomalies - p. 1066 988. Introduction - p. 1066 989. Embryology - p. 1066 990. The Hypoplastic or Absent Thumb - p. 1067 991. Trigger Thumb - p. 1069 992. Clasped Thumb - p. 1070 993. Polydactyly - p. 1070 994. Clinodactyly - p. 1071 995. Camptodactyly - p. 1072 996. Syndactyly - p. 1072 997. Constriction Ring Syndrome - p. 1074 998. Cleft Hand - p. 1075 999. Interactive Questions - p. 1077 1000. Chapter 104. Upper Limb Amputations and Prosthetics - p. 1078 1001. Introduction - p. 1078 1002. General Principles - p. 1078 1003. Amputation Techniques by Level - p. 1078 1004. Rehabilitation After Amputation - p. 1082 1005. Prosthetic Options - p. 1083 1006. Nerve Management - p. 1085 1007. Limitations of Prosthetics - p. 1089 1008. Conclusions - p. 1089 1009. Interactive Questions - p. 1090 1010. Chapter 105. Rheumatoid Arthritis and Inflammatory Arthropathies - p. 1091 1011. Diagnosis and Pathophysiology - p. 1091 1012. Medical Management and Optimization - p. 1091 1013. Surgical Indications and Timing - p. 1091 1014. Disease Progression and Surgical Treatment - p. 1091 1015. Carpal Tunnel Syndrome - p. 1099 1016. Interactive Questions - p. 1100 1017. Chapter 106. Osteoarthritis of the Hand and Wrist - p. 1101 1018. Overview - p. 1101 1019. Interphalangeal Joint Arthritis - p. 1101 1020. MCP Joint OA - p. 1102 1021. Thumb CMC (Basilar) Joint Arthritis - p. 1104 1022. Wrist Arthritis - p. 1109 1023. Conclusion - p. 1114 1024. Acknowledgments - p. 1114 1025. Interactive Questions - p. 1116 1026. Chapter 107. Bony Reconstruction of the Upper Extremity - p. 1117 1027. Basic Science of Bone Healing - p. 1117 1028. Techniques for Reconstruction of Bone Defects in the Upper Extremity - p. 1117 1029. Clinical Considerations in Bony Reconstruction - p. 1120 1030. Approaching Upper Extremity Bony Reconstruction - p. 1122 1031. Conclusions - p. 1126 1032. Interactive Questions - p. 1128 1033. Part IX: Trunk and Lower Extremity - p. 1128 1034. Chapter 108. Reconstruction of the Chest, Sternum, and Posterior Trunk - p. 1129 1035. Anatomy and Physiology - p. 1129 1036. Etiology of Chest Wall Defects - p. 1129 1037. Clinical Evaluation - p. 1130 1038. Algorithm for Chest Wall Reconstruction - p. 1130 1039. Posterior Trunk Reconstruction - p. 1133 1040. Conclusion - p. 1136 1041. Interactive Questions - p. 1138 1042. Chapter 109. Abdominal Wall Reconstruction - p. 1139 1043. Anatomy of the Abdominal Wall - p. 1139 1044. Causes and Symptoms of Abdominal Wall Defects - p. 1139 1045. Preoperative Optimization of Modifiable Risk Factors - p. 1140 1046. Complex Open Hernia Repair - p. 1141 1047. Management of Skin and Subcutaneous Tissue - p. 1145 1048. Conclusion - p. 1146 1049. Interactive Questions - p. 1149 1050. Chapter 110. Lower Extremity, Foot, and Ankle Reconstruction - p. 1150 1051. Anatomy - p. 1150 1052. Fracture Classification - p. 1153 1053. Preoperative Considerations and Workup - p. 1153 1054. Reconstructive and Intraoperative Decisions - p. 1154 1055. Postoperative Care and Complications - p. 1158 1056. Conclusion - p. 1159 1057. Interactive Questions - p. 1162 1058. Chapter 111. Perineal Reconstruction - p. 1163 1059. Anatomy - p. 1163 1060. Considerations by Etiology - p. 1163 1061. Factors Affecting Outcomes - p. 1166 1062. Approach to Reconstruction - p. 1166 1063. Postoperative Considerations - p. 1169 1064. Interactive Questions - p. 1172 1065. Chapter 112. Diagnosis and Treatment of Lymphedema - p. 1173 1066. Introduction - p. 1173 1067. Primary Lymphedema - p. 1173 1068. Secondary Lymphedema - p. 1174 1069. Diagnosis of Lymphedema - p. 1174 1070. Staging of Lymphedema - p. 1175 1071. Management of Lymphedema - p. 1176 1072. Surgical Treatment of Lymphedema - p. 1178 1073. Prevention of Lymphedema - p. 1180 1074. The Future of Lymphatic Care - p. 1182 1075. Interactive Questions - p. 1184 1076. Chapter 113. Pressure Injury Management and Reconstruction - p. 1185 1077. Epidemiology - p. 1185 1078. Pathophysiology - p. 1185 1079. Pressure Injury Staging - p. 1187 1080. Clinical Management - p. 1187 1081. Conclusions - p. 1191 1082. Interactive Questions - p. 1193 1083. Chapter 114. Gender-Affirming Chest Surgery - p. 1194 1084. Introduction - p. 1194 1085. History - p. 1194 1086. Embryology and Staging - p. 1194 1087. Postoperative Care - p. 1202 1088. Conclusions - p. 1204 1089. Interactive Questions - p. 1205 1090. Chapter 115. Gender-Affirming Phalloplasty and Vaginoplasty - p. 1206 1091. Introduction - p. 1206 1092. Demographics - p. 1206 1093. Standards of Care and Insurance Coverage Considerations - p. 1206 1094. Preoperative Workup and Special Considerations - p. 1206 1095. Genital Feminization: Vaginoplasty - p. 1208 1096. Phalloplasty and Metoidioplasty - p. 1211 1097. Comments - p. 1218 1098. Interactive Questions - p. 1220 1099. Index - p. 1221