Table Of ContentR. Hierner, R. Putz, A. T. Bishop, Z. Shen, K. Wilhelm
Flaps in Hand and Upper Limb Reconstruction
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Robert Hierner, Reinhard Putz, Allen T. Bishop,
Zunli Shen, Klaus Wilhelm
Flaps in Hand and
Upper Limb Reconstruction
Surgical Anatomy, Operative Techniques
and Differential Therapy
First Edition
With contributions from
Alexander Y. Shin and Mikko Larsen
Translations provided by
Thomas Lederer, Walla Walla, WA, USA
Edward W. Beese, Munich, Germany
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1. Edition 2014
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Acquisition Editor: Dr. Martina Braun, Dr. Till Meinert, Munich, Germany
Development Editor: Dr. Bernhard Gall, Munich, Germany
Translation: Dr. Thomas Lederer, Walla Walla, WA, USA; Edward W. Beese MD, Munich, Germany
Illustrations: Ulrike Brugger and Luitgard Kellner, Munich, Germany; Henriette Rintelen, Velbert, Germany
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Preface
Treating hand and upper-limb deficiencies is an everyday task in recon- Combining a textbook and a reference guide into one, this work will
structive surgery. This book provides an excellent survey of the immense no doubt contribute significantly to improving the quality of primary
variety of both conventional and microvascular flap reconstructions of and secondary treatment of deficiencies of the hand and the upper limb.
the hand and upper limb, regarding them as complementary rather than We should like to thank the authors for their personal dedication and for
mutually exclusive approaches. a book that stands out for its language, content and artwork.
The authors attach great importance to complying with the basic prin-
ciples of plastic surgery, which often tend to be neglected as hand and
upper limb surgery becomes more and more specialised. Also, physio-
therapy is firmly integrated in each of the therapy regimes suggested,
which is another advantage.
The way anatomic specifics are presented here is unique in the rele-
vant literature. Based on this, the book provides a concise and practical
guide where detailed descriptions of the various therapeutic procedures
are followed by differential therapeutic evaluations. It furnishes both the October 2013
surgeon facing emergency situations and the hand and upper limb Prof. Yong-Dong Gu
s urgery specialist with valuable aids and suggestions. Shanghai Medical University
Foreword
Despite the large number of excellent publications and books on the topic role. So the surgeon must be familiar with the basics of physiotherapy in
of flap surgery of the hand and upper limb, no complete survey has yet order to adequately prepare for and supervise postoperative recovery.
been available that provides an exhaustive description of the numerous The differential therapy options that are reflected in the various tables
possible flap procedures together with an evaluation and ranking of their give a survey of the approaches and procedures performed at various
practical feasibility. It was our desire to fill this gap. large centres across the world. They are based on experimental investiga-
Faced with a plethora of possibilities, we need to concern ourselves tions as well as on many years of clinical experience. We do not seek to
with the functional, aesthetic and social aspects of the hand in order to convey dogmatic factual knowledge but to make rational therapeutic
choose the flap procedure that is the best in a given case. It is not techni- suggestions.
cal feasibility that we seek but the therapy which is appropriate for the This book is directed to all disciplines involved in the fields of hand
indi vidual patient. and upper limb surgery. With its practical decision-making aids, it is
The confidence with which individually appropriate treatment is conceived as a handbook for readers with little or moderate experience.
achieved is what distinguishes the beginner from the experienced sur- For the advanced and the specialist, it proposes to be a stimulating
geon. The aim was to provide a concise and structured overview of the reference work.
procedure and yet offer the key references. To achieve maximum authen-
ticity in the illustrations, the drawings are based not only on surgical October 2103
documentation but also on anatomical latex injection preparations of the Moers, Shanghai, Rochester and Munich
separate steps of flap surgery.
Performing flap surgery demands profound anatomical knowledge Robert Hierner
and a thorough understanding of the basics of tissue perfusion and in- Zunli Shen
nervation. Surgical precision that derives from these foundations is an Allen Bishop
indispensable requirement for the successful healing of the flap. Post- Reinhard Putz
operative treatment, especially physiotherapy, plays an equally important Klaus Wilhelm
Acknowledgements
The authors wish to thank all who have been involved in the making of The authors would also like to extend their gratitude to Bernhard Gall,
this book. Till Meinert and Martina Braun as well as the entire team at Elsevier
The anatomical illustrations are a crucial element. They are based on U rban & Fischer for preparing this edition.
selected specimens prepared by Riccardo Giunta and Robert Hierner. We are aware that it was not an easy decision for the publisher to pro-
The illustrations are the work of Ulrike Brugger and Luitgard Kellner. vide the book with so many detailed (and expensive) high-quality draw-
Both artists have shown high levels of intuitive skill in familiarising ings. Nevertheless these instructive drawings highlighting the main
themselves with the complex subject matter, and their ability to focus on operative steps are the basis of successful teaching and are therefore an
the essentials has given the illustrations a unique technical and artistic essential element of the book. We would like to thank Elsevier for
expression. Thanks are due likewise to Henriette Rintelen, who con- e nabling us to plan and execute such an elaborate project.
tributed many of the icons and additional graphics, and to Horst Ruß We would like to thank Professor Yong-Dong Gu from Shanghai Uni-
(Fig. 4.1). The CT and MRI images have been kindly supplied by Roland versity for writing the preface for this book.
Scheck.
Special thanks are reserved for the translators Thomas Lederer and
Edward W. Beese for their tremendous work. Many helpful comments
were made by Karin Beifuss.
Picture credits
Fig. 1.1 – 1.3, 1.5 a, 1.6, 1.8 a, 1.13, 1.14, 1.16, 1.18, 1.19, 1.21, Ulrike Brugger and Luitgard Kellner, Munich, Germany
1.26 – 1.35, 1.37 – 3.2, 4.2 – 14.1, 14.5, 15.2, 18.1, 18.2, 18.5
Pages 92, 94, 96, 98, 100, 102, 104, 106, 108, 112, 114, 118, 122, 126,
128, 134, 136, 138, 140, 144, 146, 148, 152, 156, 160, 164, 166, 170, 176,
192, 220, 224, 226, 230, 252, 260, 268, 272, 276, 278, 282, 284, 286, 290,
302, 328, 332, 336, 338, 356, 360, 364, 366, 372, 378, 384, 388, 406, 412,
478 – 481, 483 – 522, 550 – 555
Fig. 1.4, 1.7, 1.9, 1.10, 1.15, 1.17, 1.20, 1.24, 1.36 a1, b1, c1 Paulsen F, Waschke J (eds.): Sobotta Atlas of Human Anatomy,
15. English Edition, Elsevier Urban und Fischer, Munich, Germany
Fig. 1.5 b, 1.8 b, 1.11, 1.12, 1.22, 1.23, 1.25 Putz R, Pabst R (eds.): Sobotta Atlas of Human Anatomy, 14. English
Edition, Elsevier Urban und Fischer, Munich, Germany
Fig. 1.36 a2, a3, b2, b3, c2, c3 Roland Scheck, Hausham, Germany
Fig. 4.1 Horst Ruß, Munich, Germany © Reinhard Putz
Fig. 14.2 – 14.4, 14.6, 14.7, 15.1, 17.1, 18.3, 18.4 Henriette Rintelen, Velbert, Germany
Pages 180, 186, 188, 194, 198, 202, 206, 210, 214, 216, 234, 236, 240,
244, 248, 250, 256, 294, 298, 306, 316, 322, 340, 344, 350, 394, 396, 398,
402, 408, 411, 414, 418, 422, 426, 432, 442
Authors
Allen T. Bishop, MD
Chair, Division of Hand Surgery
Department of Orthopedic Surgery
Mayo Clinic
200 1st St. SW
Rochester, MN 55905
USA
Robert Hierner, MD, PhD
Professor and Chair Plastic Surgery
Department of Plastic, Reconstructive, Aesthetic and Hand Surgery
Bethanien Hospital and Foundation Moers
Bethanienstraße 21
47441 Moers
Germany
Reinhard Putz, MD, PhD
Professor Emeritus of Anatomy
Ludwig-Maximilians-University
Pettenkoferstraße 11
80336 München
Germany
Zunli Shen, MD, PhD
Professor and Director
Department of Plastic, Hand and Aesthetic Surgery
Shanghai First Peoples Hospital
Shanghai Jiao Tong University
Wu Jin Road 85
Shanghai 200080
China
Klaus Wilhelm, MD, PhD
Professor Emeritus of Hand Surgery
Ludwig-Maximilians-University Munich
Germany
