重建整形外科.ppt

重建整形外科 整形外科 助理教授 張高評 醫師 參考資料 SABINSTON, TEXTBOOK OF SURGERY, 17th edition, Section XIII Plastic Surgery, Chapter 72 SCHWARTZ’S, PRINCIPLES OF SURGERY, 8th edition, Chapter 44 SECTION General Plastic Surgical Principles and Techniques Head and Neck Trunk and External Genitalia Lower Extremity Breast and Aesthetic Surgery SECTION General Plastic Surgical Principles and Techniques Head and Neck Trunk and External Genitalia Lower Extremity Breast and Aesthetic Surgery Skin Incisions and Excisions Carefully planning of skin incisions so as to avoid an obvious scar “Langer’s lines” Diminish tension Incisions perpendicular to the long axis of underlying muscle RSTLs (relaxed skin tension lines) Not favored areas: weight-bearing or high-use surfaces Linear scars contracted up to 20% in longitudinal direction. Open Wounds Types of Wound Closure Primary or First-intention closure Secondary or Spontaneous intention By biologic process of contracture Tertiary or Delayed primary closure For prevention of infection in a contaminated wound Debridement and Irrigation Debridement Removal of devitalized and contaminated tissues while preserving critical structures such as nerves, blood vessels, tendons, and bone Open wound should be kept moist after debridement. Grafts and Flaps Based on thickness Full-thickness skin grafts (FTSGs) Split-thickness skin grafts (STSGs) FTSG Epidermis with entirety of dermis Donor sites can be closed primarily STSG Vary in the amount of dermis Donor sites re-epithelize spontaneously Grafts and Flaps Flaps Partially or completely isolated segment of tissue perfused with its own blood supply Defined by the source of blood supply Random: not a named blood vessel Axial: comprising of named vessel Free: with the use of microsurgery Grafts and Flaps Z-plasty Redirect and lengthen an existing scar More angles, greater length 60-degree angle to lengthen 75% more SECTION General Plastic Surgical Principles and Techniques Head and Neck Trunk and External Ge