Lower Extremity Soft Tissue and Cutaneous Plastic Surgery PDF
Preview Lower Extremity Soft Tissue and Cutaneous Plastic Surgery
Lower Extremity Soft Tissue & Cutaneous Plastic Surgery Second edition Commissioning Editor: Rita Demetriou-Swanwick Development Editor: Nicola Lally Project Manager: Beula Christopher Designer/Design Direction: Stewart Larking Illustration Manager: Merlyn Harvey Illustrator: Antbits Lower Extremity Soft Tissue & Cutaneous Plastic Surgery Second edition Edited by G. Dock Dockery DPM, FACFAS Fellow and Past Board of Directors, American College of Foot and Ankle Surgeons; Fellow, American College of Foot and Ankle Pediatrics; Fellow, American Society of Podiatric Dermatology; Fellow, American College of Foot and Ankle Orthopedics and Medicine; Board Certified in Foot and Ankle Surgery, American Board of Podiatric Surgery; Board Certified in Podiatric Orthopedics, American Board of Podiatric Orthopedics and Primary Podiatric Medicine; Chairman of the Board and Director of Scientific Affairs, International Foot & Ankle Foundation for Education and Research; Edmonds, Washington, USA Mary E. Crawford DPM, FACFAS Fellow, Past Board of Director and President, American College of Foot and Ankle Surgeons; Fellow, American College of Foot and Ankle Pediatrics; Board Certified in Foot Surgery and Reconstructive Rearfoot and Ankle Surgery, American Board of Podiatric Surgery; Instructor, Department of Foot and Ankle Surgery, Swedish Podiatric Surgical Residency Program, Swedish Medical Center, First Hill Campus, Seattle, Washington; Chair, Board of Medical Advisors, International Foot & Ankle Foundation for Education and Research, Edmonds, Washington; Private Practice, Ankle and Foot Clinic of Everett, Everett, Washington, USA Forewords by Michael J. Coughlin, MD Director, Coughlin Foot and Ankle Clinic, St. Alponsus Regional Medical Center, Boise, Idaho; Past President, International Federation of Foot and Ankle Societies, Rosemont, Illinois, USA Sigvard T. Hansen, Jr. MD Professor Emeritus, Department of Orthopaedics and Sports Medicine, University of Washington; Formerly, Director of S.T. Hansen Jr. MD Foot and Ankle Institute and Foot and Ankle Fellowship Program, Harborview Medical Center, Seattle, Washington, USA Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012 Contributors Contributors Christopher E. Attinger, MD, FACS Lawrence B. Colen, MD, FACS Professor Professor of Surgery Department of Plastic Surgery Department of Plastic and Reconstructive Surgery Georgetown University; Eastern Virginia Medical School; Director Attending Surgeon Wound Healing Center Norfolk Plastic Surgery Georgetown University Hospital Norfolk, Virginia Washington, District of Columbia Mary E. Crawford, DPM, FACFAS, ABPS Bradley W. Bakotic, DPM, DO, FCAP Instructor in Foot and Ankle Surgery Assistant Clinical Professor Swedish Medical Center Barry University School of Podiatric Medicine Seattle, WA; Departments of Dermatology and Pathology Chair Miami Shores, Florida; Board of Medical Advisors Chief Dermatopathologist International Foot & Ankle Foundation Bako Pathology Services Edmonds, Washington; Alpharetta, Georgia Private Practice, Ankle and Foot Clinic Everett, Washington Neal M. Blitz, DPM, FACFAS, ABPS Chief of Foot Surgery G. Dock Dockery, DPM, FACFAS, ABPS Department of Orthopedic Surgery Chairman of the Board and Director of Scientific Affairs Bronx-Lebanon Hospital Center International Foot & Ankle Foundation Bronx, New York Edmonds, Washington Peter A. Blume, DPM, FACFAS, ABPS Ivica Ducic, MD, PhD, FACS Assistant Clinical Professor Professor Department of Orthopedics and Rehabilitation Division of Plastic Surgery; Yale School of Medicine Research Associate New Haven, Connecticut Department of Surgery; Director Carlos A. Charles, MD Peripheral Nerve Surgery Institute Department of Dermatology and Cutaneous Surgery Georgetown University Medical Center University of Miami School of Medicine Washington, District of Columbia Miami, Florida Anna F. Falabella, MD, CWS Mark W. Clemens, MD Department of Dermatology and Cutaneous Surgery Assistant Professor University of Miami School of Medicine Department of Plastic Surgery VA Medical Center MD Anderson Cancer Center Miami, Florida University of Texas Houston, Texas vii Contributors Adolfo C. Fernandez-Obregon, MD Tania J. Phillips, MD, FRCPC Assistant Clinical Professor Professor of Dermatology Department of Dermatology Department of Dermatology New York Medical College Boston University School of Medicine; Valhalla, New York Director Wound Healing Clinic Dennis N. Gusman, DPM, FACFAS, ABPS Boston Medical Center Instructor in Foot and Ankle Surgery Boston, Massachusetts Swedish Medical Center Seattle, WA; John S. Steinberg, DPM, FACFAS, ABPS Private Practice, Auburn Ankle and Foot Clinic Associate Professor Auburn, Washington Department of Plastic Surgery Georgetown University School of Medicine Gary P. Jolly, DPM, FACFAS, ABPS (Deceased 2010) Georgetown University Hospital Director Washington, District of Columbia Graduate Podiatric Medical Education Director Eric B. Unger, MD Fellowship Program in Reconstructive Foot Surgery (PGY-IV) Department of Plastic Surgery New Britain General Hospital Georgetown University Medical Center New Britain, Connecticut Washington, District of Columbia Christopher J. Lamy, DPM, FACFAS, ABPS Charles Zelen, DPM, FACFAS, ABPS Assistant Clinical Professor Assistant Clinical Professor of Medicine Oregon Health Sciences University University of Virginia School of Medicine Portland, Oregon Staff Physician Department of Podiatry and Foot Surgery Mark M. Levin, MD Lewis-Gale Clinic Department of Plastic Surgery Roanoke, Virginia Georgetown University Medical Center Washington, District of Columbia Thomas Zgonis, DPM, FACFAS, ABPS Associate Professor May Leveriza-Oh, MD Department of Orthopedic Surgery Dermatology Fellow, Wound Healing Director Department of Dermatology Reconstructive Foot and Ankle Fellowship Boston University School of Medicine University of Texas Health Science Center Boston, Massachusetts San Antonio, Texas Andrew J. Meyr, DPM, AACFAS Assistant Professor Department of Podiatric Surgery Temple University School of Podiatric Medicine Philadelphia, Pennsylvania viii Foreword Foreword Michael J. Coughlin Lower Extremity Soft Tissue & Cutaneous Plastic Surgery, second techniques receive little attention in routine podiatric and orthopedic edition, is a thorough review of the principles of operative inter training, and this textbook fills a noted void in this area of vention of the lower extremity. Editors, G. Dock Dockery, DPM and education. Mary E. Crawford, DPM have completely updated this textbook, but In all cases, the techniques are discussed, illustrated, and explained have retained the thoughtful approach used in the prior edition, to in a fashion that is simple and straightforward, making it an excellent patient evaluation and treatment with a special emphasis on the reference textbook for not only the podiatric and orthopedic surgeon, anatomy of the foot and ankle, and specific surgical techniques for but for anyone dealing with complex surgical coverage issues. skin grafts, flaps and soft tissue coverage. These techniques whether I found this to be a delightful contribution to our foot and ankle used in a primary operative procedure, or in the case of a revision literature, and the stepbystep manner in which different procedures surgery are explained in a very understandable fashion using both are explained, makes it so incredibly easy to read and to understand. simple drawings and intraoperative photographs. I highly recommend it as a primary reference source for all foot and I found the principles elaborated for surgical instrumentation, ankle surgeons. dressings, and techniques were applicable for the student and resident in training; the flaps and soft tissue sections, I believe, are advanta Michael J. Coughlin, MD geous for the surgeon in practice as well. In many cases, these ix Foreword Foreword Sigvard T. Hansen Jr. I am very pleased to have been asked to write a foreword for the more important, as larger numbers of patients with numerous skin second edition of this book edited by Drs. Dockery and Crawford. I and digit-related problems present for treatment. have practiced foot and ankle surgery in the same community with A potential problem with both orthopedic and podiatric practition- these authors and have long recognized that they have special interests ers is the tendency to get overly excited about major new reconstruc- and skills in this area and in these topics. tion options and implants and never really adequately learn, or just The fine points of cutaneous diagnosis and treatment are not of ignore, the very important basic principles and techniques of manag- foremost interest to most foot and ankle surgeons, particularly those ing skin wounds. This book can help remedy that problem. The who are orthopedically trained. Our skills are focused more on the second edition has been significantly improved over the first with musculoskeletal structures. Knowledge about the foot and ankle, as more extensive illustrations, references and added detail. Additional well as the levels of skill required to manage serious problems, have chapters, some written by MD plastic surgeons and dermatologists, increased greatly both in orthopedic and podiatric groups in the past expand the book’s scope and sophistication. 30 years. Increased interaction between the two groups has helped fuel I would recommend this as required reading for all surgeons doing this growth, as each has much to offer the other. any level of work in the foot and ankle area. I believe it should be Podiatry has long had a greater interest in the skills required to treat recommended, if not required, reading in training programs in the skin-related problems, which are a major part of foot and ankle care. foot and ankle, possibly even in plastic surgery. As noted in this book, the number of diabetic patients is projected to markedly increase in the near future. These skills will become even Sigvard T. Hansen, Jr., MD xi Preface Preface As with the first edition, this edition of Lower Extremity Soft Tissue attainment of precise knowledge and skills in reconstructive and & Cutaneous Plastic Surgery is intended to provide a comprehensive plastic surgery techniques by all physician specialists. Additionally, and practical manual of the most commonly performed lower extrem there has been an increase in the cooperative relationships and referral ity soft tissue and cutaneous surgical procedures. The text moves patterns among plastic surgeons, dermatologic surgeons, podiatric from basic, but very important, information to complex cutaneous foot and ankle surgeons, surgical oncologists, orthopedic surgeons and techniques and reconstructive surgeries. The process starts with pre general practitioners. This process has helped to promote the sharing operative considerations, cutaneous and microvascular anatomy, of knowledge, training, and information regarding the performance of instrumentation and tissue handling, and works its way through simple and complex cutaneous procedures for the lower extremities. anesthesia, hemostasis and suture materials, woundhealing proper The ultimate goal is to allow the reader the ability to develop ties and techniques. Next, attention is directed toward understanding increased selfconfidence in approaching lower extremity cutaneous and utilizing medical photography and, finally, into the heart of the problems. This book is designed to be thorough in scope by providing subject with specific procedures, each chapter illustrated with color specific and practical information for both the new cutaneous surgeon photography and beautiful drawings. and the more experienced practitioner. There has been a tremendous increase in the scope and complexity of cutaneous surgical procedures performed by lower extremity sur G. Dock Dockery DPM FACFAS geons in the past two decades. This is partly due to increased patient Mary E. Crawford DPM FACFAS acceptance of outpatient skin procedures, along with the continued Seattle, 2012 xiii Abbreviations Abbreviations ADM – abductor digiti minimi LME – lines of maximum extensibility AHB – abductor hallucis brevis LMM – lines of minimal movement AHL – abductor hallucis longus MCT – medial calcaneal tubercle APTT – activated, partial thromboplastin time MCTD – mixed connective tissue disease CAT – computerized axial tomography MRI – magnetic resonance imaging CCD – charge-coupled device MTPJ – metatarsophalangeal joint CHF – congestive heart failure NSAIDS – non-steroidal antiinflammatory drugs CT – computerized tomography PAS – periodic-Acid Schiff DIC – disseminated intravascular coagulation PB – peroneus brevis DTM – dermatophyte test medium PVD – peripheral vascular disease EDB – extensor digitorum brevis PVNS – pigmented villonodular synovitis EDL – extensor digitorum longus PVNT – pigmented villonodular tenosynovitis EHL – extensor hallucis longus RSTL – relaxed skin tension lines FDB – flexor digitorum brevis SCC – subcuticular closure FDL – flexor digitorum longus SFA – superficial femoral artery FDM – flexor digiti minimi SLE – systemic lupus erythematosus FHB – flexor hallucis brevis SLR – single lens reflex FHL – flexor hallucis longus SWC – standard wound closure H&E – hematoxylin and eosin TA – tissue adhesives IPJ – interphalangeal joint TAC – tetracaine, adrenaline or epinephrine and cocaine LEPS – lower extremity plastic surgery TMA – transmetatarsal amputations LET – lidocaine, epinephrine and tetracaine USP – United States Pharmacopeia xv
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