SELECTED TOPICS IN PLASTIC RECONSTRUCTIVE SURGERY Edited by Stefan Danilla           Selected Topics in Plastic Reconstructive Surgery Edited by Stefan Danilla Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Ivana Zec Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published January, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Selected Topics in Plastic Reconstructive Surgery, Edited by Stefan Danilla p. cm. ISBN 978-953-307-836-6 free online editions of InTech Books and Journals can be found at www.intechopen.com   Contents  Preface IX Part 1 Basic Topics in Reconstructive Surgery 1 Chapter 1 Scar Revision and Secondary Reconstruction for Skin Cancer 3 Michael J. Brenner and Jennifer L. Nelson Chapter 2 Local Antibiotic Therapy in the Treatment of Bone and Soft Tissue Infections 17 Stefanos Tsourvakas Chapter 3 The Social Limits of Reconstructive Surgery: Stigma in Facially Disfigured Cancer Patients 45 Alessandro Bonanno Part 2 Topographic Reconstruction Strategies 59 Chapter 4 Head and Neck Reconstructive Surgery 61 J.J. Vranckx and P. Delaere Chapter 5 Acellular Dermal Matrix for Optimizing Outcomes in Implant-Based Breast Reconstruction: Primary and Revisionary Procedures 93 Ron Israeli Chapter 6 Consequences of Radiotherapy for Breast Reconstruction 113 Nicola S. Russell, Marion Scharpfenecker, Saske Hoving and Leonie A.E. Woerdeman Chapter 7 Reconstruction of Perineum and Abdominal Wall 141 J.J. Vranckx and A. D’Hoore VI Contents Part 3 New Technologies and Future Scope in Plastic Surgery 161 Chapter 8 Stem Cell Research: A New Era for Reconstructive Surgery 163 Qingfeng Li and Mei Yang Chapter 9 Three Dimensional Tissue Models for Research in Oncology 175 Sarah Nietzer, Gudrun Dandekar, Milena Wasik and Heike Walles Chapter 10 Mathematical Modeling in Rehabilitation of Cleft Lip and Palate 191 Martha R. Ortiz-Posadas and Leticia Vega-Alvarado Chapter 11 Advanced 3-D Biomodelling Technology for Complex Mandibular Reconstruction 217 Horácio Zenha, Maria da Luz Barroso and Horácio Costa   Preface  Plastic Surgery is a fast evolving surgical specialty. Although best known for cosmetic procedures, plastic surgery also involves reconstructive and aesthetic procedures, which very often overlap, aiming to restore functionality and normal appearance of organs damaged due to trauma, neoplasm, ageing tissue or iatrogenesis. First reconstructive procedures were described more than 3000 years ago by Indian surgeons that reconstructed nasal deformities caused by nose amputation as a form of punishment. Nowadays, many ancient procedures are still used like the Indian forehead flap for nasal reconstruction, but as with all fields of medicine, the advances in technology and research have dramatically affected reconstructive surgery. Recent developments and discoveries in vascular anatomy, imaging, advanced wound dressing, tissue engineering and robotic prosthetics have lead to moving frontiers in reconstructive surgery. These developments expand the limits of reconstruction and lead to achieving outcomes that would not have been possible ten years ago. This book comprises three sections. First section is dedicated to general concepts of plastic surgery such as infection control, local flaps and sociological perspective of plastic surgery. The second section consists of highly detailed and reproducible reconstructive strategies used in several surgical problems. The final section provides the surgeons with easy-to-read articles about new technologies than can be applied in practically any field of plastic surgery. I sincerely hope that this book will help plastic surgeons, residents and researchers to provide the best care for their patients worldwide.  Dr Stefan Danilla Plastic Surgeon Master of Science (Clinical Epidemiology) Hospital Clinic University of Chile Hospital Clínica Alemana de Santiago Santiago Chile [...]... loss The underlying mechanism involves the melding of superficial and deep scar, resulting in tethering and visible depression Multiple depths of injury will multiply the extent of scaring, with stellate or crushing injuries resulting in worse injury Avulsion of tissue will further complicate healing, making it impossible to align skin edges at time of initial injury Deep, beveled injuries maximize... many in- vitro studies on the diffusion or elution of antibiotics from polymethylmethacrylate bone cement Several different antimicrobial agents have been studied, including the aminoglycosides, primarily gentamicin but also tobramycin, amikacin and streptomycin (Greene et al, 1998; Masri et al, 1995; Wahlig et al, 1978), 24 Selected Topics in Plastic Reconstructive Surgery cephalosporins including cefazoline,... rotation and the lengthening both diminish with tighter Z-plasty configurations, as shown in Figure 3 The lengthening in one axis corresponds to shortening in the other axis with associated tissue distortion As shown, a 30 degree Zplasty results in a 25% increase in length; a 45 degree Z-plasty results in a 50% increase in length; and a 60 degree Z-plasty results in a 75% increase in length A Z-plasty... line closure; resurfacing with dermabrasion and lasers; minimally invasive approaches such as fillers and paralytic agents; and adjunctive techniques involving steroids, silicone sheeting, and cosmetics.(9) Each of these approaches is discussed in detail in the following section 4.1 General principles Atraumatic tissue handling, always important in surgery, assumes critical importance in revision surgery, ... baseline vascular compromise Toothed tissue forceps should be used, and tissue handling should be minimized Use of skin hooks may diminish the need for traumatic tissue manipulation Damp sponges may be used to help hydrate the skin edges, an approach that is of special value when using more 8 Selected Topics in Plastic Reconstructive Surgery labor intensive approaches, such as geometric broken line... Z-plasty involves use of overlying Z- 10 Selected Topics in Plastic Reconstructive Surgery plasties in reverse orientation This method can be used to redistribute volume and avoid placing multiple layers of closure over a single line of tension This approach has been most widely applied in cleft palate surgery, although it has also found application for treatment of cervical webs, using the platysma for the... countries to minimize the post-operative risk of infection, e.g in dirty abdominal wounds or in trauma patients 20 Selected Topics in Plastic Reconstructive Surgery Although the ideal local antibiotic delivery system has not been discovered, several promising materials are present in modern research The most common carrier systems of antibiotics that successfully release the drug according to prescribed... Fibrin-sealant 4 Hydroxyapatite blocks 5 Polylactide/polyglycolide implants Gentamicin Santschi & McGarvey, 2003 Teicoplanin Gentamicin Cefazolin Ciprofloxacin Vancomycin Gentamicin Ciprofloxacin Vancomycin 6 Dilactate polymers 7 Cancellous bone 8 Calcium Sulfate 9 Calcium phosphate cement Miscellaneous 1 Fibres 2 Chitosan 3 Biomedical polyourethanes Fluoroquinolones Vancomycin, Ciprofloxacin Tobramycin... 1 Basic Topics in Reconstructive Surgery 1 Scar Revision and Secondary Reconstruction for Skin Cancer Michael J Brenner1,2 and Jennifer L Nelson2 1Director of Facial Plastic & Reconstructive Surgery of Otolaryngology, Department of Surgery Southern Illinois University School of Medicine USA 2Division 1 Introduction Late wound management requires not only mastery of the techniques involved in scar revision,... by osseous reconstructive surgery The need for removal is the major disadvantage of the beads, although in some patients small chains of beads be removed in the ward via a small skin incision (Walenkamp, 1997) Antibiotic-loaded bone cement can be applied either in infected arthroplasties or as surgical prophylaxis during joint arthroplasties Cumulative results of clinical studies involving its application . SELECTED TOPICS IN PLASTIC RECONSTRUCTIVE SURGERY Edited by Stefan Danilla           Selected Topics in Plastic Reconstructive Surgery Edited by Stefan. marionette lines. The facial marginal line Selected Topics in Plastic Reconstructive Surgery 6 starts at the hairline, travels anterior to the tragus, and descends along the posterior margin of. deep scar, resulting in tethering and visible depression. Multiple depths of injury will multiply the extent of scaring, with stellate or crushing injuries resulting in worse injury. Avulsion