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Master Techniques in Orthopaedic Surgery Soft Tissue Surgery

Master Techniques in Orthopaedic Surgery Soft Tissue Surgery

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02/28/2014

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Editors: Moran, Steven L.; Cooney, William P.

Title: Master Techniques in Orthopaedic Surgery: Soft Tissue Surgery, 1st

Edition

Copyright ©2009 Lippincott Williams & Wilkins

> Front of Book > Editors

Editors

Steven L. Moran

William P. Cooney III

Editor-in-Chief

Bernard F. Morrey MD

Founding Editor

Roby C. Thompson Jr. MD

Volume Editors

Bernard F. Morrey MD

Surgical Exposures

Matthew C. Morrey MD

Surgical Exposures

James Strickland MD

The Hand

Thomas Graham MD

The Hand

Richard H. Gelberman MD

The Wrist

Bernard F. Morrey MD

The Elbow

Edward V. Craig MD

The Shoulder

David S. Bradford MD

The Spine

Thomas L. Zdeblick MD

The Spine

Robert L. Barrack MD

The Hip

Douglas W. Jackson MD

Reconstructive Knee Surgery

Paul A. Lotke MD

Knee Arthroplasty

Jess H. Lonner MD

Knee Arthroplasty

Harold B. Kitaoka MD

The Foot & Anke

Donald A. Wiss MD

Fractures

Vernon T. Tolo MD

Pediatrics

David L. Skaggs MD

Pediatrics

Steven L. Moran MD

Soft Tissue Surgery

William P. Cooney III MD

Soft Tissue Surgery

Contributors

Romney C. Andersen LTC, MC, USA

Assistant Chief

Orthopaedic Surgery Service, Walter Reed National Military Medical Center,

Bethesda, Maryland

Louis C. Argenta MD

Professor and Chairman Emeritus

Department of Plastic and Reconstructive Surgery, Wake Forest Medical Center,

Winston-Salem, North Carolina

Kodi K. Azari MD, FACS

Chief

Mercy Hospital of Pittsburgh Division of Hand Surgery; Director, Hand Surgery

Fellowship, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Alessio Baccarani MD

Fellow

Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Duke University

Medical Center, Durham, North Carolina

Allen T. Bishop MD

Chair

Division of Hand Surgery, Department of Orthopaedic Surgery, Mayo Clinic,

Rochester, Minnesota

William J. Casey III MD

Mayo Clinic Arizona, Phoenix, Arizona

Kuang-Te Chen MD

Attending Surgeon

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital,

Taipei, Taiwan

Emilie Cheung

Orthopaedic Surgery, Stanford University, Stanford, California

Kevin C. Chung MD, MS

Professor

Division of Plastic Surgery, University of Michigan, Ann Arbor, Michigan

Michael P. Clare MD

Director of Fellowship Education, Foot and Ankle Fellowship

Florida Orthopaedic Institute, Tampa, Florida

Henry D. Clarke MD

Assistant Professor of Orthopaedic Surgery

Mayo Clinic College of Medicine, Rochester, Minnesota

Damon Cooney MD

Resident

Department of Plastic Surgery, Southern Illinois University, Springfield, Illinois

William P. Cooney III MD

Professor Emeritus

Department of Orthopaedic Surgery, Mayo Medical School, Rochester, Minnesota

Anthony DeFranzo MD

Wake Forest University School of Medicine, North Carolina Baptist Hospital,

Winston-Salem, North Carolina

Matthew DeOrio MD

Foot and Ankle Fellow

Duke University Medical Center, Durham, North Carolina

Seth D. Dodds MD

Assistant Professor

Hand and Upper Extremity Surgery, Department of Orthopaedics and

Rehabilitation, Yale University School of Medicine, New Haven, Connecticut

Scott F. M. Duncan MD

Assistant Professor

Mayo Medical School; Consultant, Owatonna Clinic, Mayo Health System,

Owatonna, Minnesota

Bassem T. Elhassan MD

Assistant Professor and Consultant of Orthopaedic Surgery

Mayo Clinic, Rochester, Minnesota

David Elliot MA (Oxon), BM, BCh

Consultant and Plastic Hand Surgeon

St. Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, England

Robert Esther MD

Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota

Jeffrey B. Friedrich MD

Assistant Professor of Surgery and Orthopaedics

University of Washington, Children's Hospital and Regional Medical Center, Seattle,

Washington

Günter Germann MD, PhD

Professor of Surgery

Department of Plastic, Hand, and Reconstructive Surgery, University of Heidelberg,

Heidelberg, Germany

Goetz A. Gessler MD

Department of Plastic, Hand, and Reconstructive Surgery, University of Heidelberg,

Heidelberg, Germany

Douglas P. Hanel MD

Professor

Hand and Microvascular Surgery, Department of Orthopaedics and Sports Medicine,

University of Washington, Seattle, Washington

Thomas F. Higgins MD

Assistant Professor

Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Utah

School of Medicine, Salt Lake City, Utah

John B. Hijjawi MD

Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin

Nathan A. Hoekzema

Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota

David J. Jacofsky MD

Chairman

The Core Institute, Sun City West, Arizona

Amir Jamali MD

Assistant Professor

University of California—Davis Department of Orthopaedic Surgery, Sacramento,

California

Mark H. Jensen MD

General Surgery Resident

Mayo Clinic, Rochester, Minnesota

Kenji Kawamura MD, PhD

Assistant Professor

Department of Emergency and Critical Care, Nara Medical University, Nara, Japan

Thomas Kremer

Department of Plastic, Hand, and Reconstructive Surgery, University of Heidelberg,

Heidelberg, Germany

W. P. Andrew Lee MD, FACS

Professor and Chief

Division of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh,

Pennsylvania

Salvatore C. Lettieri MD

Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minnesota

L. Scott Levin MD, FACS

Professor of Surgery

Duke University Medical Center, Durham, North Carolina

Lawrence C. Lin MD

Plastic Surgery Fellow

Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota

Susan E. Mackinnon

Shoenberg Professor and Chief

Division of Plastic and Reconstructive Surgery, Washington University School of

Medicine, St. Louis, Missouri

Samir Mardini MD

Associate Professor of Surgery

Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota

Patricia L. McKay CDR, MC, USN

Residency Director

National Capital Consortium, National Naval Medical Center, Walter Reed Army

Medical Center, Washington, DC

Bradley Medling

Plastic Surgery Institute

Southern Illinois University School of Medicine, Springfield, Illinois

Steven L. Moran MD

Associate Professor of Orthopaedics and Plastic Surgery

Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota

Steven Myerthall BPE, BSC, MD, FRCSC

The Core Institute

John C. Lincoln Deer Valley Hospital, Sun City West, Arizona

George Nanos MD

US Navy, Oak Harbor Naval Hospital, Oak Harbor, Washington

Jason Nascone MD

Assistant Professor

University of Maryland School of Medicine, RA Cowley Shock Trauma Center,

Baltimore, Maryland

Michael W. Neumeister MD

Professor and Chairman

Division of Plastic Surgery, SIU School of Medicine, Springfield, Illinois

Gustavo S. Oderich MD

Assistant Professor of Surgery

Mayo Clinic College of Medicine, Rochester, Minnesota

Katrim Palm-Bröking MD

Department of Plastic, Hand, and Reconstructive Surgery, University of Heidelberg,

Heidelberg, Germany

Marco Rizzo MD

Associate Professor of Orthopaedic Surgery

Mayo Clinic, Rochester, Minnesota

Christopher J. Salgado MD

Assistant Professor of Surgery

Division of Plastic Surgery, Cooper University Hospital, Camden, New Jersey

Roy W. Sanders MD

Chief

Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, Florida

Michael Sauerbier MD, PhD

Associate Professor

University of Heidelberg, Department of Plastic, Hand, and Reconstructive Surgery,

University of Heidelberg, Heidelberg, Germany

S. Andrew Sems MD

Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota

Alex Senchenkov MD

Clinical Instructor

Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati,

Cincinnati, Ohio

Alexander Y. Shin MD

Professor and Consultant

Division of Hand Surgery, Department of Orthopaedic Surgery, Rochester,

Minnesota

Thomas C. Shives

Professor of Orthopaedic Surgery

Mayo Clinic, Rochester, Minnesota

Franklin H. Sim MD

Professor of Orthopaedics

Mayo Clinic, Rochester, Minnesota

Mark J. Spangehl MD

Assistant Professor of Orthopaedics

Mayo Clinic College of Medicine, Mayo Clinic Arizona, Phoenix, Arizona

John W. Sperling MD, MBA

Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota

Scott Steinmann MD

Associate Professor

Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota

Timothy M. Sullivan

Professor of Surgery

Division of Vascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester,

Minnesota

Shian Chao Tay MD, MS

Assistant Professor of Orthopaedics

Mayo Clinic, Rochester, Minnesota

Lam Chuan Teoh FRCS

Clinical Associate Professor

Hand Surgery, Singapore General Hospital, Singapore

Huey Y. Tien

Clinical Instructor of Surgery

University of Louisville School of Medicine, Louisville, Kentucky

Tsu-Min Tsai MD

Clinical Professor of Orthopaedic Surgery

University of Louisville School of Medicine, Louisville, Kentucky

Norman S. Turner MD

Assistant Professor

Mayo Graduate School of Medicine, Rochester, Minnesota

Nicholas B. Vedder MD, FACS

Professor of Surgery and Orthopaedics, Chief

Division of Plastic Surgery, University of Washington, Seattle, Washington

Renata V. Weber MD

Assistant Professor of Plastic and Reconstructive Surgery

Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York

Fu-Chan Wei MD, FACS

Professor

Department of Plastic Surgery, Chang Gung Memorial Hospital; Dean, Medical

College, Chang Gung University, Taipei, Taiwan

Bradon J. Wilhelmi MD

Professor and Chief Program Director

University of Louisville, Louisville, Kentucky

Eduardo A. Zancolli

National Academy of Medicine, Orthopaedics and Traumatology, Buenos Aires,

Argentina

Editors: Moran, Steven L.; Cooney, William P.

Title: Master Techniques in Orthopaedic Surgery: Soft Tissue Surgery, 1st

Edition

Copyright ©2009 Lippincott Williams & Wilkins

> Front of Book > Dedication

Dedication

To my mother and father, Nancy and Albert Lawrence Moran.

—The journey of a thousand miles begins with the first step.—

Steven Moran MD

To my wife Mickey and family. They allowed me to take and shared in taking

“the one less traveled by, and that has made all the difference.―

W P Cooney MD

Editors: Moran, Steven L.; Cooney, William P.

Title: Master Techniques in Orthopaedic Surgery: Soft Tissue Surgery, 1st

Edition

Copyright ©2009 Lippincott Williams & Wilkins

> Front of Book > Preface

Preface

Over the past 30 years options for the soft tissue management of traumatic defects

have increased with an improved understanding of pedicled flaps, the advent of

microsurgery, and the development of negative pressure sponge therapy. Wound

complications have decreased due to advances in antibiotic therapy and better

debridement techniques. Improved knowledge of surgical anatomy has helped

develop surgical incisions which provide better exposure while preserving regional

blood supply. Despite these advances, there is still a need for every surgeon to

know the techniques of debridement, soft tissue management, and proper incision

placement—for these are the foundation of successful surgery.

The educational goal of this text is to demonstrate how to avoid wound problems

and how to cover wound problems if they should occur. Chapters illustrate

pertinent anatomy, indications and contraindications for specific incisions, and

methods for flap coverage in cases of soft tissue loss. Step-by-step accounts of the

technical details are provided to carry out these exposures and procedures so that

readers will feel they are watching over the shoulder of the contributing author in

the operating room. Contributors are experienced in both soft tissue and bony

management. Though all surgeons may not feel comfortable with performing all

procedures presented in this book, they will at least know what they can expect or

request during specialist consultation. This volume of the Master Techniques in

Orthopaedic Surgery series focuses on the management of the soft tissues as they

relate to orthopaedic trauma, but is a text designed for all traumatologists,

orthopaedic surgeons, plastic surgeons, and anyone who has had the pleasure (or

displeasure) of taking care of a difficult wound.

Steven L. Moran MD

William P. Cooney III MD

Editors: Moran, Steven L.; Cooney, William P.

Title: Master Techniques in Orthopaedic Surgery: Soft Tissue Surgery, 1st

Edition

Copyright ©2009 Lippincott Williams & Wilkins

> Front of Book > Acknowledgments

Acknowledgments

The creation of this text was the result of a tremendous effort of many people.

Lippincott, Williams & Wilkins has provided us with incredible resources and a

dedicated and knowledgeable staff. We are deeply indebted to the team of Robert

Hurley, Executive Editor; Dave Murphy, Managing Editor; Keith Donnellan,

Developmental Editor; and Kristen Spina, Editorial Project Manager. We also are

deeply indebted to our medical illustrator Wendy Beth Jackelow, who has provided

countless hours of work bringing the surgeons’sketches to life. We would also

like to thank Dr. Bernard Morrey for giving us the opportunity to write this book.

Finally, we are deeply indebted to our coauthors who have provided insightful,

organized, and beautifully illustrated chapters explaining the techniques involved

in these reconstructive procedures. It is through their hard work that we are able

to provide you with this text.

Steven Moran

William P. Cooney

Editors: Moran, Steven L.; Cooney, William P.

Title: Master Techniques in Orthopaedic Surgery: Soft Tissue Surgery, 1st

Edition

Copyright ©2009 Lippincott Williams & Wilkins

> Table of Contents > Part I - Overview and Foundation > Chapter 1 - Why Wounds Fail to Heal

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