Atlas of Reconstructive Surgery.pdf
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Pobierz
Hiko Hyakusoku · Dennis P. Orgill
Luc Téot · Julian J. Pribaz
Rei Ogawa (Eds.)
Color Atlas of
Burn Reconstructive
Surgery
Prefaces
Reconstructive surgery of burns, especially of extensive burns, is a topic that requires
the ideas and inspiration of plastic surgeons. Traditionally, it is considered that almost
all burn wounds can be reconstructed using simple skin grafting. However, sophisti-
cated reconstructive surgery based on knowledge of various surgical methods is
needed to accomplish both functionally and cosmetically acceptable long-term
results. The contents of this book represent ideal
guidelines
for burn reconstructive
surgery and were provided by authors from 14 different countries. In other words,
this book is the grand sum of the newest surgical technologies and strategies pro-
posed by plastic surgeons.
I have been involved in reconstruction surgery for extensive burns since I became
a plastic surgeon. I have developed many reconstructive procedures and have been
able to apply these methods clinically. Burn reconstruction has brought many thoughts
to develop lap surgical methods to me. Moreover, I have realized that burn recon-
struction should be accomplished via an all-out mobilization of knowledge on lap
surgery and that this is an area that requires continual development of surgical meth-
ods. However, I have met many plastic surgeons who are performing novel and inno-
vative methods. This book is a collection of these worldwide experiences. I hope that
this book will provide great beneits for burn patients worldwide.
Tokyo, Japan
Hiko Hyakusoku, MD, PhD
v
vi
Prefaces
Damage to skin from thermal, electrical or chemical injury has devastating effects on
aesthetic and functional outcomes of burn victims. The stigmata of burn patients
remains one of the most devastating injuries that man can survive. Fortunately, over
the last 30 years, there have been simultaneous advances in scar biology, materials
science and knowledge of microanatomy, surgical techniques, transplantation and cell
culture. As a result there are now many treatment options available that give greater
hope to our patients restoring function and improving their societal interactions.
In this atlas, Dr. Ogawa has brought together the world’s experts to review the impor-
tant topics of super-thin laps, pre-fabricated laps, dermal and epidermal replacements
as well as vacuum-assisted closure technologies. This atlas will be an important resource
for practicing plastic surgeons as well as students and residents in training. Examples in
the atlas will also be valuable for patient education of these varied techniques.
Boston, MA, USA
Julian J. Pribaz, MD
Dennis P. Orgill, MD, PhD
Prefaces
vii
Burns represent a pathology remaining among the hardest to heal wounds. Even if
important progresses in rescucitation allowed life-threatening body surfaces to regress
during the last 50 years, force is to recognize that restoring the original function after
extensive and deep burns requires a long period of ight against contractures, hyper-
trophy and tissue shortening. A multi-disciplinarity approach is mandatory to obtain
a return to the social and working life, but skin has changed for the rest of the life of
the patient.
The development of microsurgery in the 80s, followed by an intense activity in
anatomical studies could evidence the angiosomes and the skin, muscle, tendon and
bone vascular cartographies. From this era, all types of laps were proposed, includ-
ing pre-fabricated and perforator laps, a founding melting pot and a source of intense
activity for the new plastic and reconstructive surgery. This atlas details how to use
them in burn reconstructive surgery.
During the last decade, the surgical possibilities of dermal replacement becomes
more and more eficient. The recent development of tissue engineering, leading to
added biological similarities with the normal skin, opens a new space for relexion
and trials, based on cell–extracellular matrix interactions via cytokines and growth
factors.
The need for repairing the cosmetic outcome of facial burns remains a social
challenge and will certainly be a long-term contract for the new generation of burns
specialists and plastic surgeons.
Montpellier, France
Luc Téot, MD, PhD
viii
Prefaces
Every reconstructive surgeon thinks that evidence-based burn reconstruction is an
ideal method; however, it is yet to be established. The reason for this may be that
every single wound or scar is unique. Moreover, the color, texture, thickness and
hardness of the skin vary according to human race, age, sex and body site. Thus, we
are forced to select treatment methods on a case-by-case basis according to the lim-
ited experience of each surgeon.
Meanwhile, during the inishing stage of reconstruction, large parts of the surgical
procedure should include elements of aesthetic surgery. In this stage, it may not be an
exaggeration to state that evidence-based surgery is not beneicial. Treatment meth-
ods should be selected and performed based on the aesthetic sense and cultivated
sensitivity of each surgeon. Evidence-based surgery and artistic reconstruction repre-
sent a big dilemma that is posed to every burn reconstructive surgeon.
I believe this book, which is entitled
Color
Atlas of Burn Reconstructive Surgery
provides an answer for this particular dilemma. This answer may be the fusion of
evidence-based surgery and artistic reconstruction. After reading this book, the sur-
geon will recognize what part of the reconstruction should be carried out using evi-
dence-based surgery and what part should be performed artistically. We should not
give up on the generation of evidence-based standardized protocols for patient safety
or on the education of younger-generation surgeons. In addition, we should not
neglect artistic reconstruction at any time.
In this book, international authors who have wide perspectives in burn reconstruc-
tive surgery shared their own valuable experiences and concepts about the character-
istics and indications of their methods. The contents include wound management,
classiication and evaluation of wounds/scars, various artistic and geometric methods
and future treatment strategies from a “regenerative medicine” standpoint. I hope that
this book will enhance the work of burn reconstructive surgeons and confer tremen-
dous beneits to burn patients.
Finally, I thank all authors and coeditors who have taken time from their busy
schedules to assemble this book. In addition, I appreciate the tremendous help of Ms.
Ellen Blasig at Springer in Germany. Her contribution was essential for the accomp-
lishment of this project. Moreover, I thank the illustrator Mr. Kazuyuki Sugiu from
Studio Sugi’s for preparing the igures.
Tokyo, Japan
Rei Ogawa, MD, PhD
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