Lower Extremity Soft Tissue and Cutaneous Plastic Surgery

495 Pages·2012·129.52 MB·English

by  G. Dock Dockery

Lower Extremity Soft Tissue & Cutaneous Plastic Surgery
Second edition
Commissioning Editor: Rita Demetriou-Swanwick
Development Editor: Nicola Lally
Project Manager: Beula Christopher
Designer/Design Direction: Stewart Larking
Illustration Manager: Merlyn Harvey
Illustrator: Antbits
Lower Extremity Soft
Tissue & Cutaneous
Plastic Surgery
Second edition
Edited by
G. Dock Dockery
DPM, FACFAS
Fellow and Past Board of Directors, American College of Foot and Ankle Surgeons; Fellow, American College of Foot
and Ankle Pediatrics; Fellow, American Society of Podiatric Dermatology; Fellow, American College of Foot and Ankle
Orthopedics and Medicine; Board Certified in Foot and Ankle Surgery, American Board of Podiatric Surgery; Board
Certified in Podiatric Orthopedics, American Board of Podiatric Orthopedics and Primary Podiatric Medicine; Chairman of
the Board and Director of Scientific Affairs, International Foot & Ankle Foundation for Education and Research; Edmonds,
Washington, USA
Mary E. Crawford
DPM, FACFAS
Fellow, Past Board of Director and President, American College of Foot and Ankle Surgeons; Fellow, American College
of Foot and Ankle Pediatrics; Board Certified in Foot Surgery and Reconstructive Rearfoot and Ankle Surgery, American
Board of Podiatric Surgery; Instructor, Department of Foot and Ankle Surgery, Swedish Podiatric Surgical Residency
Program, Swedish Medical Center, First Hill Campus, Seattle, Washington; Chair, Board of Medical Advisors, International
Foot & Ankle Foundation for Education and Research, Edmonds, Washington; Private Practice, Ankle and Foot Clinic of
Everett, Everett, Washington, USA
Forewords by
Michael J. Coughlin, MD
Director, Coughlin Foot and Ankle Clinic, St. Alponsus Regional Medical Center, Boise, Idaho; Past President, International Federation of Foot and Ankle
Societies, Rosemont, Illinois, USA
Sigvard T. Hansen, Jr. MD
Professor Emeritus, Department of Orthopaedics and Sports Medicine, University of Washington; Formerly, Director of S.T. Hansen Jr. MD Foot and
Ankle Institute and Foot and Ankle Fellowship Program, Harborview Medical Center, Seattle, Washington, USA
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012
Contributors
Contributors
Christopher E. Attinger, MD, FACS Lawrence B. Colen, MD, FACS
Professor Professor of Surgery
Department of Plastic Surgery Department of Plastic and Reconstructive Surgery
Georgetown University; Eastern Virginia Medical School;
Director Attending Surgeon
Wound Healing Center Norfolk Plastic Surgery
Georgetown University Hospital Norfolk, Virginia
Washington, District of Columbia
Mary E. Crawford, DPM, FACFAS, ABPS
Bradley W. Bakotic, DPM, DO, FCAP Instructor in Foot and Ankle Surgery
Assistant Clinical Professor Swedish Medical Center
Barry University School of Podiatric Medicine Seattle, WA;
Departments of Dermatology and Pathology Chair
Miami Shores, Florida; Board of Medical Advisors
Chief Dermatopathologist International Foot & Ankle Foundation
Bako Pathology Services Edmonds, Washington;
Alpharetta, Georgia Private Practice, Ankle and Foot Clinic
Everett, Washington
Neal M. Blitz, DPM, FACFAS, ABPS
Chief of Foot Surgery G. Dock Dockery, DPM, FACFAS, ABPS
Department of Orthopedic Surgery Chairman of the Board and Director of Scientific Affairs
Bronx-Lebanon Hospital Center International Foot & Ankle Foundation
Bronx, New York Edmonds, Washington
Peter A. Blume, DPM, FACFAS, ABPS Ivica Ducic, MD, PhD, FACS
Assistant Clinical Professor Professor
Department of Orthopedics and Rehabilitation Division of Plastic Surgery;
Yale School of Medicine Research Associate
New Haven, Connecticut Department of Surgery;
Director
Carlos A. Charles, MD Peripheral Nerve Surgery Institute
Department of Dermatology and Cutaneous Surgery Georgetown University Medical Center
University of Miami School of Medicine Washington, District of Columbia
Miami, Florida
Anna F. Falabella, MD, CWS
Mark W. Clemens, MD Department of Dermatology and Cutaneous Surgery
Assistant Professor University of Miami School of Medicine
Department of Plastic Surgery VA Medical Center
MD Anderson Cancer Center Miami, Florida
University of Texas
Houston, Texas
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Contributors
Adolfo C. Fernandez-Obregon, MD Tania J. Phillips, MD, FRCPC
Assistant Clinical Professor Professor of Dermatology
Department of Dermatology Department of Dermatology
New York Medical College Boston University School of Medicine;
Valhalla, New York Director
Wound Healing Clinic
Dennis N. Gusman, DPM, FACFAS, ABPS Boston Medical Center
Instructor in Foot and Ankle Surgery Boston, Massachusetts
Swedish Medical Center
Seattle, WA; John S. Steinberg, DPM, FACFAS, ABPS
Private Practice, Auburn Ankle and Foot Clinic Associate Professor
Auburn, Washington Department of Plastic Surgery
Georgetown University School of Medicine
Gary P. Jolly, DPM, FACFAS, ABPS (Deceased 2010) Georgetown University Hospital
Director Washington, District of Columbia
Graduate Podiatric Medical Education
Director Eric B. Unger, MD
Fellowship Program in Reconstructive Foot Surgery (PGY-IV) Department of Plastic Surgery
New Britain General Hospital Georgetown University Medical Center
New Britain, Connecticut Washington, District of Columbia
Christopher J. Lamy, DPM, FACFAS, ABPS Charles Zelen, DPM, FACFAS, ABPS
Assistant Clinical Professor Assistant Clinical Professor of Medicine
Oregon Health Sciences University University of Virginia School of Medicine
Portland, Oregon Staff Physician
Department of Podiatry and Foot Surgery
Mark M. Levin, MD Lewis-Gale Clinic
Department of Plastic Surgery Roanoke, Virginia
Georgetown University Medical Center
Washington, District of Columbia Thomas Zgonis, DPM, FACFAS, ABPS
Associate Professor
May Leveriza-Oh, MD Department of Orthopedic Surgery
Dermatology Fellow, Wound Healing Director
Department of Dermatology Reconstructive Foot and Ankle Fellowship
Boston University School of Medicine University of Texas Health Science Center
Boston, Massachusetts San Antonio, Texas
Andrew J. Meyr, DPM, AACFAS
Assistant Professor
Department of Podiatric Surgery
Temple University School of Podiatric Medicine
Philadelphia, Pennsylvania
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Foreword
Foreword
Michael J. Coughlin
Lower Extremity Soft Tissue & Cutaneous Plastic Surgery, second techniques receive little attention in routine podiatric and orthopedic
edition, is a thorough review of the principles of operative inter­ training, and this textbook fills a noted void in this area of
vention of the lower extremity. Editors, G. Dock Dockery, DPM and education.
Mary E. Crawford, DPM have completely updated this textbook, but In all cases, the techniques are discussed, illustrated, and explained
have retained the thoughtful approach used in the prior edition, to in a fashion that is simple and straightforward, making it an excellent
patient evaluation and treatment with a special emphasis on the reference textbook for not only the podiatric and orthopedic surgeon,
anatomy of the foot and ankle, and specific surgical techniques for but for anyone dealing with complex surgical coverage issues.
skin grafts, flaps and soft tissue coverage. These techniques whether I found this to be a delightful contribution to our foot and ankle
used in a primary operative procedure, or in the case of a revision literature, and the step­by­step manner in which different procedures
surgery are explained in a very understandable fashion using both are explained, makes it so incredibly easy to read and to understand.
simple drawings and intraoperative photographs. I highly recommend it as a primary reference source for all foot and
I found the principles elaborated for surgical instrumentation, ankle surgeons.
dressings, and techniques were applicable for the student and resident
in training; the flaps and soft tissue sections, I believe, are advanta­ Michael J. Coughlin, MD
geous for the surgeon in practice as well. In many cases, these
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Foreword
Foreword
Sigvard T. Hansen Jr.
I am very pleased to have been asked to write a foreword for the more important, as larger numbers of patients with numerous skin
second edition of this book edited by Drs. Dockery and Crawford. I and digit-related problems present for treatment.
have practiced foot and ankle surgery in the same community with A potential problem with both orthopedic and podiatric practition-
these authors and have long recognized that they have special interests ers is the tendency to get overly excited about major new reconstruc-
and skills in this area and in these topics. tion options and implants and never really adequately learn, or just
The fine points of cutaneous diagnosis and treatment are not of ignore, the very important basic principles and techniques of manag-
foremost interest to most foot and ankle surgeons, particularly those ing skin wounds. This book can help remedy that problem. The
who are orthopedically trained. Our skills are focused more on the second edition has been significantly improved over the first with
musculoskeletal structures. Knowledge about the foot and ankle, as more extensive illustrations, references and added detail. Additional
well as the levels of skill required to manage serious problems, have chapters, some written by MD plastic surgeons and dermatologists,
increased greatly both in orthopedic and podiatric groups in the past expand the book’s scope and sophistication.
30 years. Increased interaction between the two groups has helped fuel I would recommend this as required reading for all surgeons doing
this growth, as each has much to offer the other. any level of work in the foot and ankle area. I believe it should be
Podiatry has long had a greater interest in the skills required to treat recommended, if not required, reading in training programs in the
skin-related problems, which are a major part of foot and ankle care. foot and ankle, possibly even in plastic surgery.
As noted in this book, the number of diabetic patients is projected to
markedly increase in the near future. These skills will become even Sigvard T. Hansen, Jr., MD
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Preface
Preface
As with the first edition, this edition of Lower Extremity Soft Tissue attainment of precise knowledge and skills in reconstructive and
& Cutaneous Plastic Surgery is intended to provide a comprehensive plastic surgery techniques by all physician specialists. Additionally,
and practical manual of the most commonly performed lower extrem­ there has been an increase in the cooperative relationships and referral
ity soft tissue and cutaneous surgical procedures. The text moves patterns among plastic surgeons, dermatologic surgeons, podiatric
from basic, but very important, information to complex cutaneous foot and ankle surgeons, surgical oncologists, orthopedic surgeons and
techniques and reconstructive surgeries. The process starts with pre­ general practitioners. This process has helped to promote the sharing
operative considerations, cutaneous and microvascular anatomy, of knowledge, training, and information regarding the performance of
instrumentation and tissue handling, and works its way through simple and complex cutaneous procedures for the lower extremities.
anesthesia, hemostasis and suture materials, wound­healing proper­ The ultimate goal is to allow the reader the ability to develop
ties and techniques. Next, attention is directed toward understanding increased self­confidence in approaching lower extremity cutaneous
and utilizing medical photography and, finally, into the heart of the problems. This book is designed to be thorough in scope by providing
subject with specific procedures, each chapter illustrated with color specific and practical information for both the new cutaneous surgeon
photography and beautiful drawings. and the more experienced practitioner.
There has been a tremendous increase in the scope and complexity
of cutaneous surgical procedures performed by lower extremity sur­ G. Dock Dockery DPM FACFAS
geons in the past two decades. This is partly due to increased patient Mary E. Crawford DPM FACFAS
acceptance of outpatient skin procedures, along with the continued Seattle, 2012
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Abbreviations
Abbreviations
ADM – abductor digiti minimi LME – lines of maximum extensibility
AHB – abductor hallucis brevis LMM – lines of minimal movement
AHL – abductor hallucis longus MCT – medial calcaneal tubercle
APTT – activated, partial thromboplastin time MCTD – mixed connective tissue disease
CAT – computerized axial tomography MRI – magnetic resonance imaging
CCD – charge-coupled device MTPJ – metatarsophalangeal joint
CHF – congestive heart failure NSAIDS – non-steroidal antiinflammatory drugs
CT – computerized tomography PAS – periodic-Acid Schiff
DIC – disseminated intravascular coagulation PB – peroneus brevis
DTM – dermatophyte test medium PVD – peripheral vascular disease
EDB – extensor digitorum brevis PVNS – pigmented villonodular synovitis
EDL – extensor digitorum longus PVNT – pigmented villonodular tenosynovitis
EHL – extensor hallucis longus RSTL – relaxed skin tension lines
FDB – flexor digitorum brevis SCC – subcuticular closure
FDL – flexor digitorum longus SFA – superficial femoral artery
FDM – flexor digiti minimi SLE – systemic lupus erythematosus
FHB – flexor hallucis brevis SLR – single lens reflex
FHL – flexor hallucis longus SWC – standard wound closure
H&E – hematoxylin and eosin TA – tissue adhesives
IPJ – interphalangeal joint TAC – tetracaine, adrenaline or epinephrine and cocaine
LEPS – lower extremity plastic surgery TMA – transmetatarsal amputations
LET – lidocaine, epinephrine and tetracaine USP – United States Pharmacopeia
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