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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_813_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Contents
- •Foreword
- •Preface
- •Acknowledgments
- •Contributors
- •1. The Aesthetic Surgery Patient
- •2. The Artistry of Plastic Surgery
- •3. Photography for the Aesthetic Surgeon
- •4. Medicolegal Considerations in Aesthetic Surgery
- •6. Perioperative Anesthesia Considerations for the Aesthetic Surgery Patient
- •7. Procedure-Specific Anesthesia Guidelines for the Aesthetic Surgery Patient
- •8. Multimodal Analgesia for the Aesthetic Surgery Patient
- •9. Safety Considerations in Aesthetic Surgery
- •10. Decreasing Complications in Aesthetic Surgery
- •11. Venous Thromboembolism and the Aesthetic
- •12. The Medi Spa and Other Practice Considerations
- •13. Anatomy, Physiology, and Disorders of the Skin
- •14. Cosmeceuticals and Other Office Products
- •15. Ethnic Skin Care
- •16. Basics of Laser Therapy
- •17. Ablative Laser Resurfacing
- •18. Nonablative Laser Resurfacing
- •19. Chemical Peels
- •20. Dermabrasion
- •21. Botulinum Toxin
- •22. Soft Tissue Fillers
- •23. Fat Grafting
- •24. Treatment of Prominent Veins
- •25. Tissue Glues
- •26. Fixation Devices
- •27. Implants and Alloplasts (Nonbreast)
- •28. Progressive Tension Sutures
- •29. Periorbital Anatomy
- •30. Face and Neck Anatomy
- •31. Facial Analysis
- •32. Hair Transplantation
- •33. Browlift
- •34. Upper Blepharoplasty
- •35. Lower Blepharoplasty
- •36. Asian Blepharoplasty
- •37. Correction of the Tear Trough Deformity
- •38. Lateral Canthopexy
- •39. Blepharoptosis
- •40. Midface Rejuvenation
- •41. Perioral Rejuvenation
- •42. Facelift
- •43. The Nasolabial Fold
- •44. Necklift
- •45. Rhinoplasty
- •46. Secondary Rhinoplasty
- •47. Ethnic Rhinoplasty
- •48. Lip Augmentation
- •49. Genioplasty
- •50. Otoplasty
- •51. Breast Anatomy
- •52. Breast Augmentation
- •53. Mastopexy
- •54. Augmentation-Mastopexy
- •55. Breast Reduction
- •56. Gynecomastia
- •57. Liposuction
- •58. Brachioplasty
- •59. Buttock Augmentation
- •60. Abdominoplasty
- •61. Medial Thigh Lift
- •62. Body Contouring in Massive-Weight-Loss Patients
- •63. Female Aesthetic Genital Surgery
- •64. Noninvasive Body Contouring
- •65. Aesthetics of Gender Affirmation Surgery

378 Part VII&Facial Surgery
REFERENCES
1. Adamson JE, Horton CE, Crawford HH. The growth pattern of the external ear. Plast Reconstr Surg 1965;36:466
2. Macgregor FC. Ear deformities: social and psychological implications. Clin Plast Surg 19785:347
3. Hao W, Chorney JM, Bezuhly M, et al. Analysis of health-related quality-of-life outcomes and their predictive
factors in pediatric patients who undergo otoplasty. Plast Reconstr Surg 2013;132:811e
4. McDowell AJ. Goals in otoplasty for protruding ears. Plast Reconstr Surg 1968;41:17
5. Bradbury ET, Hewison J, Timmons MJ. Psychological and social outcome of prominent ear correction in children.
Br J Plast Surg 1992;45:97
6. Balogh B, Millesi H. Are growth alterations a consequence of surgery for prominent ears? Plast Reconstr Surg
1992;89:623
SURGICAL TECHNIQUE
11. Mustardé technique refers to which of the following?
A. Mattress suturing to better define the antihelix.
Mustardé technique refers to a cartilage-shaping technique using mattress suturing to correct a poorly
defined antihelical fold. This helps better shape the upper third of the ear. Of note, this technique is
almost never performed in isolation (Fig. 50.3).
1
Press medially
on ear
Ink marks
Poorly defined
antihelical fold
Incision
Ink marks
ab
Mastoid bone
Mastoid bone
Mattress suture
cd
Mattress suture
Subcuticular
suture
Fig. 50.3 The Mustardé technique. (a) Several pairs of ink marks are made on the concha and outer aspect of
the antihelix. (b) Several 25-gauge needles dipped in ink are used to transfer the ink marks to the postauricular
skin. (c) The skin excision is carried down to cartilage. After hemostasis is obtained, several sutures are placed
through the full thickness of cartilage. Usually only two or three well-placed sutures are required. (d) The
sutures are tied simultaneously. A subcuticular 4-0 nylon suture is used for closure.
In: Janis J, ed. Essentials of Aesthetic Surgery. 1st Edition. New York: Thieme; 2018.)
(Source: Mustardé technique.
REFERENCE
1. Mustardé JC. The correction of prominent ears using mattress sutures. Br J Plast Surg 1963;16:170

Chapter 50&Otoplasty 379
SURGICAL TECHNIQUE
12. The Furnas technique refers to which of the following?
B. Suture fixation of the conchal cartilage to mastoid fascia.
The Furnas technique is used to correct deformities of the superior two-thirds of the ear by addressing
conchal excess. In general, an ellipse of skin is excised in the postauricular sulcus in the upper twothirds of the ear, not the lower one-third. This will then expose the posterior auricular muscles and
ligaments which are then divided and resected. Several mattress sutures are then used to attach
conchal cartilage to the mastoid fascia (Fig. 50.4). Another conchal shaping maneuver is the Mustardé
technique which is used to correct the prominent ear deformity with a poorly defined antihelical fold
by creating and securing an antihelical fold with two to four horizontal mattress fixation sutures. A posterior skin excision is made once again, exposing the cartilage at which point full-thickness sutures are
placed in order to better define the antihelical fold. This maneuver is almost never performed in isolation (Fig. 50.5).
1
Mastoid bone
Prominent
Enlarged
conchal
cartilage
a
Incision
c
Normal
Mastoid bone
Mattress suture
d
b
e
Subcuticular
Mastoid bone
Mattress suture
suture
Fig. 50.4 The Furnas technique. (a) The Furnas technique is best used for patients with prominence of the
superior two thirds of the ear. (b) The deeply cupped and enlarged conchal cartilage of the prominent ear is
contrasted with normal conchal cartilage in cross section. (c) An ellipse of skin is excised in the postauricular
sulcus, exposing the posterior auricular muscles and ligaments. These are divided and resected. (d, e) Several
mattress sutures are used to attach conchal cartilage to the mastoid fascia. The mattress sutures should be
placed through the full thickness of the conchal cartilage. The sutures are tied simultaneously. Enlarged conchal.
(Source: Furnas technique. In: Janis J, ed. Essentials of Aesthetic Surgery. 1st Edition. New York: Thieme; 2018.)

380 Part VII&Facial Surgery
ab
Mastoid bone
Mattress suture
cd
Press medially
on ear
Ink marks
Poorly defined
antihelical
fold
Incision
Ink marks
Mastoid bone
Mattress suture
Subcuticular
suture
Fig. 50.5 The Mustardé technique. (a) Several pairs of ink marks are made on the concha and outer aspect of
the antihelix. (b) Several 25-gauge needles dipped in ink are used to transfer the ink marks to the postauricular
skin. (c) The skin excision is carried down to cartilage. After hemostasis is obtained, several sutures are placed
through the full thickness of cartilage. Usually only two or three well-placed sutures are required. (d) The
sutures are tied simultaneously. A subcuticular 4-0 nylon suture is used for closure.
In: Janis J, ed. Essentials of Aesthetic Surgery. 1st Edition. New York: Thieme; 2018.)
(Source: Mustardé technique.
REFERENCE
1. Furnas DW. Correction of prominent ears by conchamastoid sutures. Plast Reconstr Surg 1968;42:189
SURGICAL TECHNIQUE
13. The Converse-Wood-Smith technique refers to which of the following?
C. Cartilage-breaking technique for severe prominent ear deformities.
The Converse-Wood-Smith technique refers a cartilage-breaking technique for severe prominent ear
deformities and involves an incision along the entire posterior ear with cartilage removal and
resuspension to correct the prominent ear. The pinna is folded back to define the superior
crus of the antihelix, as well as the crural junction. Although this is a powerful technique, one of the
drawbacks is that it may cause cartilaginous ridging and sharp edges leading to a “postoperative” appearance (Fig. 50.6).
techniques which are used for contour shaping of the upper two-thirds of the ear. Both techniques
involve a posterior skin excision with mattress sutures being taken from the cartilage to the mastoid fascia in the setting of Furnas sutures which corresponds to answer B. The Mustardé technique involves
horizontal mattress sutures being performed along the posterior ear cartilage to better def ine the antihelical fold. A posterior lower third skin resection is used for lobule prominence correction. Proper
auricular cartilage harvesting is by placing an incision along the posterior or anterior mid conchal edge;
cartilage resuspensionisnot always required nor is skin excision.
1
This is in contrast to the cartilage-molding techniques like the Mustardé or Furnas

Chapter 50&Otoplasty 381
abc
d e f
gh i
Fig. 50.6 The Converse–Wood-Smith technique. (a) The pinna is folded back to define the superior crus of the
antihelix, as well as the crural junction. (b) The anterior and posterior borders of the antihelix, the superior border of the superior crus, and the conchal rim are outlined with ink. (c,d) The planned cartilaginous incisions.
(e) Conchal rim definition may be facilitated with pressure applied to the scapha. (f,g) The center line of the
superior crus and antihelix is marked by 25-gauge needles. An ellipse of skin is fashioned to incorporate these
and excised. (h) The skin is undermined in a subperichondrial plane and the cartilaginous segments marked
with needles. The cartilage is incised full thickness, without merging the incisions. (i) If necessary, a wire brush
may be used to thin thick and rigid cartilage. (Continued)

382 Part VII&Facial Surgery
J
j
mn
k
N
l
Fig. 50.6 (Continued) (j) Mattress sutures are placed to form the superior crus and body of the antihelix. (k) The
conchal rim is incised. (l) Digital pressure is used to assess the amount of conchal excess. (m,n) The appropriate
amount of conchal cartilage is excised, and the antihelix and conchal rim are approximated with a single
suture.
York: Thieme; 2018.)
(Source: Converse–Wood-Smith technique. In: Janis J, ed. Essentials of Aesthetic Surgery. 1st Edition. New
REFERENCE
1. Converse JM, Wood-Smith D. Technical details in the surgical correction of the lop ear deformity. Plast Reconstr
Surg 1963;31:118
SURGICAL TECHNIQUE
14. The Modified fishtail excision refers to which of the following?
D. Posterior lower 1/3 skin resection.
The modified fishtail excision is a posterior excision for the correction of a prominent lobule. A “V
extension” is added inferior to the posterior skin excision and this is pressed against the mastoid fascia
to give a mirror image. This segment is then removed bringing the lower third and the lobule closer to
the mastoid (Fig. 50.7).
technique. Suture fixation of the conchal cartilage to the mastoid fascia refers to the Furnas technique.
Cartilage-breaking technique for severe prominent ears refers to the Converse-Wood-Smith technique.
Finally, the technique for proper harvesting of auricular cartilage would not be best performed through
modified fishtail excision but rather a posterior or anterior conchal skin incision to expose the cartilage.
1
Mattress suturing to better define the antihelical fold refers to the Mustardé

Chapter 50&Otoplasty 383
A
abcd
Fig. 50.7 Correction of a prominent lobule using a modified fishtail excision. (a) A V extension of the posterior
auricular incision is drawn on the posterior surface of the lobule. (b) While the ink is still wet, the lobule is
pressed against the mastoid skin. (c) The mirror impression of the V is transposed to the mastoid skin. All skin
within the borders of the modified fishtail design is excised. (d) Closure is performed with a running 4-0 nylon
suture.
Edition. New York: Thieme; 2018.)
(Source: Correction of lobule prominence (lower third). In: Janis J, ed. Essentials of Aesthetic Surgery. 1st
REFERENCE
1. Wood-Smith D. Otoplasty. In Rees T, ed. Aesthetic Plastic Surgery. Philadelphia: Saunders; 1980
COMPLICATIONS
15. An 18-year-old male patient who had an otoplasty performed yesterday calls the office complaining of sud-
den onset of persistent, unilateral pain. What is the appropriate next step?
D. Have the patient come to the ED or office to be evaluated.
The most immediate and pressing postoperative complication is hematoma. This presents as a suddenonset, persistent, unilateral pain. The patient should be seen as soon as possible, the dressing should be
removed, sutures should be removed, the clot should be evacuated, and reapplication of a dressing
should be done with mild compression. Hematoma that is not managed quickly and appropriately will
jeopardize the patient's result.
1
REFERENCE
1. Spira M. Otoplasty: what I do now—a 30-year perspective. Plast Reconstr Surg 1999;104:834
COMPLICATIONS
16. A 20-year-old female patient who had an otoplasty performed 4 days ago calls the office complaining of sud-
den onset of persistent, unilateral pain. What complication do you suspect based on timing?
B. Infection.
If a patient has sudden increased unilateral pain on postoperative day 3 or 4, infection should be
suspected. This is usually from Staphylococcus or Streptococcus, and occasionally Pseudomonas. Some
advocate liberal use of hospital admission and IV antibiotics for purulent infections to prevent progression to chondritis. Sulfamylon can be useful in preventing spread of infection and chondritis.
1
REFERENCE
1. Spira M. Otoplasty: what I do now—a 30-year perspective. Plast Reconstr Surg 1999;104:834


PART VIII
Breast Surgery


51. Breast Anatomy
Ara A. Salibian, Anmol Chattha
See Essentials of Aesthetic Surgery, pp. 711–722
EMBRYOLOGY, DEVELOPMENT, AND PHYSIOLOGY
1. The mammary gland is derived from which of the following cell lines?
A. Endoderm.
B. Mesoderm.
C. Ectoderm.
D. Neuroectoderm.
E. Neural crest origin.
EMBRYOLOGY, DEVELOPMENT, AND PHYSIOLOGY
2. A 19-year-old female presents with complete absence of the right breast and nipple. She has no abnormalities
of her extremities or pectoralis muscle. Her chest wall is in good position and size. Which of the following
terms best describes the anatomic variation?
A. Amastia.
B. Amazia.
C. Athelia.
D. Poland syndrome.
E. Anterior thoracic hypoplasia.
EMBRYOLOGY, DEVELOPMENT, AND PHYSIOLOGY
3. A 20-year-old female presents with complaints of polymastia. Which is the most likely area of accessory breast
tissue found on examination?
A. Shoulder.
B. Overlying the sternum.
C. Lower lateral chest wall.
D. On the back overlying the latissimus dorsi muscle.
E. Thigh.
EMBRYOLOGY, DEVELOPMENT, AND PHYSIOLOGY
4. A young female patient is brought in by her parents regarding concerns of breast asymmetry. She has absence
of any breast tissue but presence of the nipple of one side of her chest. On the contralateral chest, she has
presence of glandular tissue and areolar pigmentation with a secondary mound formed by the nipple above
the level of the breast. What stage of breast development is this patient by the Tanner classification?
A. 1.
B. 2.
C. 3.
D. 4.
E. 5.
EMBRYOLOGY, DEVELOPMENT, AND PHYSIOLOGY
5. A 5-year-old girl's parents are concerned as their daughter has started to develop breasts. Upon examination,
the patient has bilateral stage 4 Tanner breast development but no other signs of puberty or skeletal maturation. This patient's condition is best represented by which of the following?
A. Premature thelarche.
B. Poland syndrome.
C. Jeune syndrome.
D. Supernumerary breast.
E. Delayed maturation.
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