Plastic Surgery Emergencies Principles and Techniques Thieme Plastic Surgery Emergencies Principles and Techniques Jamal M. Bullocks, MD Assistant Professor Division of Plastic Surgery Michael E. Debakey Department of Surgery Baylor College of Medicine Texas Medical Center Houston, Texas Patrick W. Hsu, MD Chief Resident Division of Plastic Surgery University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School Camden, New Jersey Shayan A. Izaddoost, MD, PhD Division of Plastic Surgery Michael E. Debakey Department of Surgery Baylor College of Medicine Texas Medical Center Houston, Texas Larry H. Hollier Jr., MD, FACS Associate Professor Division of Plastic Surgery Michael E. Debakey Department of Surgery Baylor College of Medicine Texas Medical Center Houston, Texas Samuel Stal, MD, FACS Professor and Chief Division of Plastic Surgery Michael E. Debakey Department of Surgery Baylor College of Medicine Texas Medical Center Houston, Texas Thieme New York • Stuttgart Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Vice President, Production and Electronic Publishing: Anne T. Vinnicombe Managing Editor: Owen Zurhellen IV Vice President, International Marketing and Sales: Cornelia Schulze Chief Financial Officer: Peter van Woerden President: Brian D. Scanlan Production Editor: Print Matters Illustrator: Mike de la Flor Cover Illustrator: Cara Ryan Downey, MD Compositor: Thomson Digital Printer: Everbest Printing Company Library of Congress Cataloging-in-Publication Data Plastic surgery emergencies : Jamal M. Bullocks... [et al.]. p.; cm. Includes index. ISBN 978-1-58890-670-0 (Americas : alk. paper) - ISBN 978-3-13-145241-2 (Rest of world : alk. paper) 1. Surgery, Plastic. 2. Surgical emergencies. I. Bullocks, Jamal M. [DNLM: 1. Reconstructive Surgical Procedures-methods. 2. Emergency Treatment-methods. 3. Wounds and Injuries-surgery. WO 600 P7114 2008] RD118.P5363 2008 617.9'52-dc22 2007044537 Copyright ©2008 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher's consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage. Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time of publication. 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Printed in China 54321 ISBN 978-1-58890-670-0 Contents Foreword Melvin Spira, MD, DDS vii Preface ix List of Abbreviations xi 1 Wound Management 1 2 Anesthesia and Wound Closure 7 3 Pressure Sores 15 4 Bite Wounds 19 5 Burns and Frostbite 29 6 The Traumatized Face 54 7 Facial Lacerations 68 8 Orbit and Zygoma Fractures 79 9 Nasal and Nasal-Orbital-Ethmoid (NOE) Fractures 89 10 Frontal Sinus Fractures 100 11 Mandibular Fractures 106 12 Examination of Hand Injuries 118 13 Anesthesia and Splinting of the Hand and Wrist 129 14 Hand and Wrist Fractures and Dislocations 142 15 Hand Infections and Injection Injuries 167 16 Hand and Forearm Tendon Injuries 188 17 Hand Vascular Injuries and Digit Amputations 200 18 Upper Extremity Peripheral Nerve Injuries 218 19 Upper Extremity Compartment Syndrome 224 20 Postoperative Evaluation of Free Flap Reconstructions 232 21 The Postoperative Aesthetic Patient 239 Index 251 Foreword "The man who graduates today and stops learning tomorrow is uneducated the day after." —Newton D. Baker Jr. When I was asked to write a foreword for this book Plastic Surgery Emergencies, I must confess, my first thought was "Is another book truly necessary?" But after reading it, I am both honored and flat­ tered by the request. The browser might first question if this rela­ tively small book fulfills a need, and second ask if it fulfills the need well. The answer to both questions is a resounding "Yes." With the body of medical knowledge doubling every 5 years or so, the information that must either have been learned or be readily available and understandable to both the young as well as the expe­ rienced plastic surgeon continues to increase exponentially. This book distills present knowledge into an easily readable guide to almost any emergency a plastic surgeon might face who is on-call in the emergency room, or responding to a late night/early morning call from the hospital relating to a postoperative patient. The authors, who are general plastic surgeons and specialists from the Division of Plastic Surgery here at the Baylor College of Medicine, have culled information from their own surgical experiences, as well as a wide variety of outside sources. They have condensed this knowledge into a small, handy volume, which could easily be read either at one's leisure or immediately prior to assuming the care of a patient. It would be difficult to find an injury or complication from a plastic surgery operation whose emergency treatment is not covered in this book. The authors have detailed the specifics in terms of dif­ ferential diagnosis and the corrective steps necessary to fulfill the responsibilities of a plastic surgeon answering emergency room call. There are many references to the general principles of treatments— those learned in residency training and in the early years of practice that have stood the test of time. The ability of the surgeon to present an organized treatment plan and then carry it out expeditiously will instill confidence in the patient and the health care personnel in­ volved in the treatment of these patients. The format of the book is conducive to allowing readers to add both personal and technical notes, which will serve them well in the treatment of future patients with similar injuries. I would be remiss if I didn't call special attention to the lead author, Dr. Jamal M. Bullocks, whose ability and youthful enthusiasm has amalgamated the thoughts and experience of the other authors into a volume that will find great value for all plastic surgeons as well as general surgeons and emergency room physicians. To those older plastic surgeons who may believe that they have already learned the answers to most of the problems presenting to the plastic surgeon on call, I respectfully suggest that although the problems that presented a decade or two ago may be the same, the answers (i.e., treatment) today may be different. It is to that difference that we are indebted to the authors of this book d r for their effort and time in providing us with concise and practical o w answers. e r o F Melvin Spira, M.D., D.D.5. Division of Plastic Surgery Department of Surgery Baylor College of Medicine Preface Severe facial trauma, soft tissue and hand injuries, and the postoper­ ative care of plastic surgery patients often present great challenges to the acute care physician. In addition, the method of treatment at the initial time of presentation often dictates the ultimate functional and cosmetic outcome for the patient. The rapid pace of activity in the emergency room or during an on-call night consultation can eas­ ily lead to a delay in patient diagnosis and treatment if extensive research is required on unfamiliar topics. Plastic Surgery Emergencies is designed to provide updated, easy-to-follow instructions and clear illustrations to optimize the effectiveness of treatment of patients with acute plastic surgery issues. This book, through its concisely outlined principles and procedures, will guide medical practitioners in their approach to the patient at this most critical time period. We attempted to include all topics that we ourselves have faced while taking plastic surgery call at the affiliated hospitals in the Texas Medical Center, one of the largest medical centers in the world, which sees over 100,000 patients per day. The included topics are outlined with the information, tools, and pharma­ cotherapy needed for acute patient management. The chapters are designed in an outline format for rapid transfer of erudite and practical information. With more than 100 original drawings and photographs, Plastic Surgery Emergencies, we hope, will serve as a one-step, quick-reference source to aid in the efficient diagnosis and appropriate treatment of patients. Whether used by a resident facing a congested flap, a rural physician facing a hand infection, or an emergency room physician facing a mangled extremity, Plastic Surgery Emergencies will pro­ vide in-depth, easy-to-follow directions that will allow optimized care for the patient and provide confidence for the practitioner.