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1、CHAPTER69PLASTICSURGERYMaryH.McGrathandJasonPomerantzregionisneeded.Microvascularfreetissuetransferrepresentsthereconstructivetechniquesmostcomplexflapoptionandisusuallythetoprungonthepediatricplasticsurgeryreconstructiveladder.plasticsurgeryoftheheadandneckWhenus
2、ingtheconceptofthereconstructiveladder,theplasticsurgeryofthetrunktriadofform,function,andsafetyisthebasisforsettingthepressuresoresreconstructivegoalsforanygivendefect.Forexample,whenreconstructionofthelowerextremityreconstructingtheface,awarenessofformwouldsugge
3、stamorebodycontouringcomplextechnique,suchastissueexpansion,insteadoftheconclusionssimplertechniqueofskingraftingbecauseitisoptimaltorestorewithskinandsofttissueofthesamethickness,texture,andcolor.Foranyspecificreconstructivesituation,thismatrixofgoingfromsimpleto
4、complex,consideringformandfunction,andkeepingsafetyparamountprovidesdirection.Challengedbycomplexclinicalproblems,thepaceofinnova-tioninplasticsurgeryhasacceleratedsteadilyoverthepast30PrimaryWoundClosureyears.ThespecialtybenefitsfromtheabsenceofanatomicorGoodsutu
5、retechniquestartswithanincisionwiththescalpelorgansystemboundaries,andfromthecollaborationwithotheratrightanglestotheskinandcontinueswithcarefulhandlingsurgicalspecialistswhoengageplasticsurgeons,asnewrecon-oftissuetoavoiddevitalizingtheskinmargins,débridementofst
6、ructiveandaestheticchallengesaccompanysurgicaladvancesskinedgesifneeded,evertingthewoundmargin,andpreciseinallareas.Withgrowingsophistication,plasticsurgeryhasapproximationwithouttension.Theskinedgesneedtobelinedmaturedintoareasofspecialization,includingcongenital
7、,max-upatthesamelevelandwoundedgesshouldjusttoucheachillofacial,breastsurgery,handsurgery,headandnecksurgery,other.Postoperativeedemaispredictableandwillcreateaddi-skinandsofttissuesurgery,aestheticsurgery,bodycontouring,tionaltension.woundcare,microsurgery,andbur
8、ncare.AsarelativelysmallMinimizingtensionisessentialtoreducescarring.Thiscanspecialty,plasticsurgeonsareabreastofinnovationsineachofbedonebyusingburiedd
