显微外科及手术辅助基础训练 参加本科生的各类门诊手术。协助科室主任或专家完成复杂的重建手术。
DOPS：至少 1 次。
- Plastic Surgery, Mathes(2005)，共 8 冊。
- Plastic Surgery, Grabb and Smith, 6th edition (2006)。
- Plastic and Reconstruction Surgery-indications, operations and outcomes，2000 年共 5 冊。
- Green’s operative hand surgery, 5th edition (2005)。
- Plastic and reconstruction surgery---essentials for students.本書共 10 chapters包括：
- Plastic and reconstructive surgery。
- Selective readings in plastic surgery。
- The journal of hand surgery。
- British journal of plastic surgery。
- Burn。
一医大楼五楼52病区、八楼83病区及六楼烧伤重症中心 门诊四楼整形美容门诊 一医三楼手术室门诊二楼整形门诊 科研楼地下一层手术室 显微外科培训中心 欢迎来到整形科 ▲不要迟到▲请阅读工作手册▲如有疑难问题，请向CR报告。
9.開order請依下列原則
- 休假住院醫師之例行工作由當日值班醫師代理完成。
- 外科住院醫師於非休假日之星期六、星期日早上8:00請準時參加值 班總醫師查房；若該日為非值班日，於完成交辦與例行工作後休息。
- 於休假期間手機請保持可聯絡狀態，以便緊急聯絡或討論病情。
- 實習醫師於每半月至少有四天為星期六、星期日。
- 休假實習醫師之例行工作由當日值班實習醫師或非休假之實習醫師 代理完成。
- 一般常規
- 手術前的準備
- 手術後之照顧
- 手術前的準備
- 手術後的照護
外科住院医师和 PGY1 每月至少有一个周六和周日休息。周六、周日（非节假日）实习生必须在上午8:00到岗。
连接组织：表皮瓣、肌肉瓣、骨皮瓣、断指、其他药物： 1.Rheomacrodex 开始和结束日期。2.Promostan 开始和结束日期。3.其他：。
附 註：
H2 blocker(Zantac, Tagamet)不超過一週，一週後改口服，第二線以上抗生素必 須有w’d culture及會診 infection 記錄。
Inhalation 的病人，視情況會診RT做bronchoscopy。
燒傷病人診斷及discharge note 中，必須註明燒傷種類、嚴重度、TBSA及部位。
Hand Therapy
应该引入一些对患者有益的特殊治疗、技术和方法。这种治疗使用电流刺激腹部肌肉，使其收缩并移动韧带，让患者了解肌肉功能并消除早期粘连。
4-10 天
10-14 天 EPM I 繼續
Claw position （fig42-7）（-）position A.手腕中立
MP 屈曲 C.IP 伸展
首先在受保护的位置积极运动腕骨和指骨区域。逐渐开始通过中心位置进行主动和被动腕骨伸展，如果您可以忍受接收，则继续，并在必要时开始。
第 5-6 週
American Society of Plastic Surgeons 444 East Algonquin Road
Residency Review Committee for Plastic Surgery 515 North State Street, Suite 2000
STAGES OR PHASES OF WOUND HEALING
WOUND CLOSURE
FACTORS INFLUENCING WOUND HEALING
MANAGEMENT OF THE CLEAN WOUND
Depending on how much of the dermis is incorporated, STSGs undergo secondary contraction as they heal. Inosculation – On day 3, the cut ends of the vessels at the base of the dermis begin to form connections with those of the wound bed. c. Hematoma/Seroma - Hematomas and seromas prevent contact of the graft with the bed and inhibit revascularization.
SKIN GRAFTS
This usually requires reanastamosis of the vessels to the recipient vessels in the primary defect. Random pattern flaps do not have a specific or named blood vessel in the base of the flap. They require reanastamosis of the artery and vein to the recipient vessels at the recipient site.
CLASSIFICATION
Deep Inferior Epigastric Perforator Flap — The DIEP flap consists of the skin and fat of the lower abdomen supplied by the perforators of the deep inferior epigastric artery and vein without the rectus abdominis muscle. Anterolateral thigh perforator flap — ALTP consists of skin and fat of the anterolateral thigh supplied by the descending branch of the lateral circumflex artery and perforator veins without the vastus lateralis muscle. Thoracodorsal artery perforator flap — The TAP flap consists of skin and fat of the lateral back supplied by the thoracodorsal artery perforator and veins without the latissimus dorsi muscle.
CHOOSING THE RIGHT FLAP
Perforator — Perforator flaps are flaps composed of skin and/or subcutaneous fat supplied by blood vessels running through or between deep tissues. It is harvested without the deep tissues to minimize donor site morbidity and provide only the necessary amount of dermal and/or subcutaneous fat for transfer. Furthermore, these scars have a high recurrence rate in the setting of the different treatment modalities.
BENIGN A. Scars
Systemic therapy (corticosteroids, 2 mg/kg) is the first-line option; laser therapy may be indicated early. Treatment: surgical excision with appropriate margins or by histological frozen section or by Mohs micrographic surgery followed by reconstruction. Treatment: surgical excision with adequate margins or by frozen section or by Mohs micrographic surgical excision followed by reconstruction.
CONGENITAL
Problems of the head and neck in the practice of plastic surgery include congenital, traumatic, infectious, neoplastic and other conditions. A working knowledge of embryology and anatomy of the head and neck is of crucial importance in the diagnosis and surgical treatment of these diseases. An epithelial-lined duct that frequently appears in the lateral neck along the anterior border of the sternocleidomastoid muscle.
INFECTIONS
NEOPLASTIC (exclusive of skin — see Chapter 3) A. Salivary gland tumors or disorders
Anatomical — malignancies behave differently according to anatomical site and prognosis worsens from anterior to posterior i. Benign — depending on location — fibroma, osteoma, lipoma, cyst, etc. a) Most are squamous cell carcinoma or its variants. Examination — including indirect laryngoscopy and nasopharyngeal endoscopy if indicated b. Biopsy of any lesion that does not heal within 2-4 weeks c. X-ray imaging and imaging according to indications. a) Wide local excision with tumor-free margins.
MISCELLANEOUS A. Disorders of the jaw
Should also examine the vertical height of the midface (vertical maxillary excess, VME versus vertical maxillary deficiency, VMD). Structural pillars of the facial skeleton: an approach to the management of Le Fort fractures. Reconstructive problems of the trunk consist of restoring the structural integrity of the chest and abdominal wall after major trauma or tumor removal.
BREAST
Halsted radical mastectomy: removal of all breast tissue, nipple/areolar complex, pectoralis major and minor muscles, muscular fascia, level I, II and III lymph nodes (this procedure does not improve disease control compared to modified radical mastectomy). DIEP and SIEA flaps are technically more difficult to make as they do not take any muscle from the abdominal wall and require dissection of the blood vessels away from the "carrier". Sternal dehiscence involves separation of the bony sternum and often infection of the deep soft tissue, called mediastinitis.
CHEST WALL RECONSTRUCTION A. Major principles
Rigid fixation of the sternal plate (provides improved chest and respiratory function, as well as cosmetic appearance). Primary rigid sternal plate fixation (instead of circumferential wires) has been shown to reduce complications. Primary wound closure +/- myocutaneous flaps (usually pectoralis major but others have been described: rectus abdominis, latissimus dorsi and omentum).
PRESSURE ULCERS
Closure of the wound with healthy, durable tissue that can provide adequate padding over the bony prominence (myocutaneous vs. fasciocutaneous flap) V. Definitive closure of the infected median sternotomy wound: a treatment algorithm using vacuum-assisted closure followed by rigid plate fixation. Multiple painful, swollen lesions in the armpits, groin, and other parts of the body that contain apocrine glands.
HAND ANATOMY
Color - the nail bed should be pink, blanch on pressure and show capillary refill within a second. Ensure hemostasis with fine staples and cautery 7. Nerve injuries should be repaired with augmentation 8. Tendons are mostly repaired except in special cases. The splint should be in a safe position when possible, but an alternative position may be required to protect tendon or nerve repairs b.
SPECIAL INJURIES
Paronychia – infection of the lateral nail fold. Treatment: If early, elevate the skin over the nail to drain. Most can be treated with closed reduction; open reduction may be necessary if supporting structures enclose the bone (e.g., metacarpal head via extensor mechanism). Try to maintain a controlled, protected movement. 2. Unstable joint – immobilize for 3 weeks. some, e.g. thumb ulnar collateral ligament, may require surgical repair).
CONGENITAL DEFECTS
HAND TUMORS A. Benign
MISCELLANEOUS
ULCERATIONS
Traumatic ulcer Surgical treatment requires excision of the entire area of the ulcer, the scar tissue and the surrounding area. Not all lower extremity ulcers will require surgical intervention if appropriate treatment is followed. Surgical treatment requires excision of the entire area of the ulcer, the scar tissue and the surrounding area of increased pigmentation (hemosiderin deposition).
TRAUMA
Treatment success has been reported with hyperbaric oxygen in conjunction with local wound care.
LYMPHEDEMA
The management of the patient with a major thermal injury requires an understanding of the pathophysiology, diagnosis and treatment not only of the local skin lesion, but also of the haemodynamic, metabolic, nutritional, immunological and disturbances that occur.
BURNS
Inhalation injuries: watch out for indoor burns, burnt nose hairs, carbon particles in throat, hoarseness, conjunctivitis. 1/2 of the first 24-hour fluid requirement should be given within the first eight hours after the burn, and the remaining 1/2 within the next 16 hours. The bacterial colonization status of the burn wound and the effectiveness of topical antibacterial therapy can be monitored by wound biopsies for quantitative and qualitative bacteriology.
CHEMICAL BURNS A. Pathophysiology
Splints are used to prevent joints. keep the elbow and knee in extension, and the MCP joints of the fingers in flexion. Timely closure of the wound with an adequate amount of skin should largely eliminate these problems d. Continuation of postoperative splinting and elastics. pressure supports are important in collagen remodeling by preventing hypertrophic scars. Due to the heat generated when the current flows through the tissue. a) More severe damage in high resistance tissue (ie bone). ii) Daily massage pool and exercise (d) Sympathectomy, anticoagulants and. early amputation of questionable value in controlled studies.
LIGHTNING INJURIES
Aesthetic surgery includes those procedures that provide an improvement in one's appearance to improve one's self-esteem. Unrealistic expectations and/or personality disorders should alert the surgeon to the possibility of refusing to accept the patient or referring the patient for psychiatric evaluation. A teenager might want a more comfortable nose, a young woman might want her breasts enlarged so she is able to wear certain clothes or swimwear, a bald man might want his hair restored, a PR person might want a more youthful appearance with.
FACIAL REJUVENATION A. Facelift
The incisions mark the area of skin to be removed and the new position of the wart. The skin, which was previously located above the nipple, descends and together reshapes the breast.
SKIN REJUVENATION
Body contouring can be considered a component of Aesthetic surgery using techniques and procedures that will clearly enhance and improve one's appearance and possibly one's self-esteem. In addition, body contouring procedures are also used to improve general health, such as the removal of chronically macerated and infected skin and subcutaneous tissues. There has been a dramatic increase in the number of body contouring patients, which correlates well with the increased number of gastric bypass patients.
LIPOSUCTION
EXCISIONAL BODY CONTOURING SURGERY Designed to treat skin quality problems including laxity,
Classic medial thigh lift is plagued by problems such as poor migration and enlargement of the scars, lateral traction deformities of the vulva and early return of ptosis. Results are improved with suspension of the superficial fascial system to Colle's fascia along the pubic ramus E. Excision of inferior tissue may lead to flattening of the buttock and an inferior buttock tear as opposed to folds.
