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Plastics in Practice

A Medicine and Health & Fitness podcast

#38 in Medicine · 🇮🇳

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About the show

All things plastic surgery. One place. High-yield education for every stage of training.

Newest episodes

Penile Reconstruction: Match Anatomy to Function

Oct 18, 2026 21 min

https://plasticsinpractice.com/ Penile reconstruction requires separate plans for coverage, urination, sensation and rigidity. The remaining anatomy and the patient's goals determine which components are needed. In this episode of Plastics in Practice, we review reconstruction after penile tissue loss and gender-affirming options, connecting native tissue preservation, flap selection, urethral design and staged functional goals. Key takeaways: • Define the remaining skin, urethra, erectile tissue and neurovascular structures before selecting reconstruction. • Preserve viable native tissue when possible; suitable acute amputations need urgent assessment for replantation, while selected skin defects may be managed with grafted coverage. • Distinguish metoidioplasty using native erectile tissue from flap phalloplasty, and balance donor-site thickness, blood supply, sensation and morbidity. • Make urethral lengthening an explicit decision. A new urinary channel can develop fistula or stricture even when the outer shaft is viable. • Nerve coaptation can support sensory recovery, but sensation varies and is not guaranteed. • Plan rigidity separately: a soft tissue flap does not recreate native erectile bodies, and later erectile devices add implant risks and possible revision. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. Apple Podcasts: https://podcasts.apple.com/us/podcast/penile-reconstruction-match-anatomy-to-function/id1835564216?i=1000796954678 Amazon Music: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/0bf9d760-c85b-403a-87b3-5638ceee0955/plastics-in-practice-resident-review-penile-reconstruction-match-anatomy-to-function YouTube podcast: https://youtu.be/Dwmb-Xq5UdA YouTube explainer: https://youtu.be/3qJZa2k9QdM YouTube Short: https:/...

Rheumatoid Arthritis: When Finger Extension Fails

Oct 17, 2026 24 min

https://plasticsinpractice.com/ Rheumatoid arthritis can threaten tendons, destabilize joints and change the mechanics of the whole hand. Reconstructive planning begins with the cause of lost function. In this episode of Plastics in Practice, we review the rheumatoid hand, from the inflammatory-arthritis differential and deformity mechanisms to tendon rupture, joint reconstruction and perioperative planning. Key takeaways: • Distinguish rheumatoid arthritis from other inflammatory and degenerative conditions using the clinical pattern, systemic findings and imaging. • Synovitis can weaken joint restraints and damage tendons; the visible finger posture may reflect a deforming force elsewhere in the hand or wrist. • Separate flexible, reducible deformity with preserved joint surfaces from fixed deformity with advanced destruction before choosing reconstruction. • New extension loss warrants prompt assessment. Distinguish tendon rupture from tendon subluxation or nerve dysfunction, and address the attritional source when reconstructing a rupture. • Silicone MCP arthroplasty can improve alignment and patient-reported function without necessarily improving grip or pinch strength. • Balance the pain, stability and motion goals of wrist reconstruction, and coordinate disease control, medications and perioperative assessment with rheumatology and anesthesia. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. Apple Podcasts episode: https://podcasts.apple.com/us/podcast/rheumatoid-arthritis-when-finger-extension-fails/id1835564216?i=1000796831957 Amazon Music episode: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/bb0a03d5-477e-467e-bad9-90fb4dd8837a/plastics-in-practice-resident-review-rheumatoid-arthritis-when-finger-extension-fails YouTube explainer...

Targeted Muscle Reinnervation: Pain and Prosthetic Control

Oct 16, 2026 18 min

https://plasticsinpractice.com/ After upper-limb amputation, a surviving nerve can still carry a useful command. TMR gives that signal a new muscle target. In this episode of Plastics in Practice, we review how targeted muscle reinnervation supports prosthetic control and helps address nerve-related postamputation pain. Key takeaways: • Define the goal before choosing transfers: nerve-related pain, prosthetic control, or both. • TMR connects a residual nerve to a motor branch supplying viable, functionally expendable muscle. • For motor control, the reinnervated muscle amplifies an intended movement into a signal that surface electrodes can detect. • Preserve useful native muscle and existing control sites when planning new targets. • Neuroma-related residual-limb pain and phantom limb pain can coexist and need separate assessment. • TMR can help reduce nerve-related postamputation pain, but relief is not guaranteed. Pain-directed surgery need not depend on prosthesis use. • Coordinate surgery, socket fitting and rehabilitation. Better motor signals do not automatically restore sensation. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. Editorial clarification at approximately 13:55: The French prospective series compared preemptive TMR with conventional treatment at primary amputation (neuroma burial or simple neurectomy), not with delayed TMR. Mathieu et al., 2025, PMID 39853391: https://pubmed.ncbi.nlm.nih.gov/39853391/ YouTube Short: https://youtube.com/shorts/Vc_3CT2Ysc0 Full video explainer: https://www.youtube.com/watch?v=sUN2KmZDnzA Instagram account: https://www.instagram.com/plasticsinpractice/ #TargetedMuscleReinnervation #PeripheralNerveSurgery #UpperLimbAmputation #ProstheticRehabilitation #PlasticSurgeryEducation References: 1. Eberlin et al. A Consensus Ap...

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All episodes

Penile Reconstruction: Match Anatomy to Function

Oct 18, 2026 21 min

Rheumatoid Arthritis: When Finger Extension Fails

Oct 17, 2026 24 min

Targeted Muscle Reinnervation: Pain and Prosthetic Control

Oct 16, 2026 18 min

Common Congenital Hand Anomalies: Function Guides Treatment

Oct 13, 2026 24 min

https://plasticsinpractice.com/ A visible hand difference does not tell you which operation, if any, will improve function. In this episode of Plastics in Practice, we review how examination guides syndactyly timing, thumb duplication reconstruction and camptodactyly treatment. Key takeaways: • Observe reach, grasp and thumb use, then examine the whole limb and look for associated findings. • Describe syndactyly by the digits involved and whether the connection is soft tissue alone or includes bone. • A longer finger joined to a shorter neighbor can become tethered during growth. The anatomy helps determine when separation is needed. • Adjacent-web releases are generally staged to protect the intervening digit’s blood supply. • Thumb duplication needs a plan for stability and tendon balance. Size alone does not determine which tissue is useful. • Test passive correction in camptodactyly. Mild, flexible contractures usually begin with stretching and splinting. • Reassess worsening contracture and functional loss. Surgery can add stiffness, and a residual bend may remain. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. YouTube Short: https://youtube.com/shorts/FtPgkLixl_0 YouTube Explainer: https://youtu.be/U5NRtCU7ZAg Instagram account: https://www.instagram.com/plasticsinpractice/ #CongenitalHand #Syndactyly #ThumbDuplication #Camptodactyly #HandSurgery References: 1. Seattle Children’s. Syndactyly. https://www.seattlechildrens.org/conditions/syndactyly/ 2. Children’s Hospital of Philadelphia. Thumb Duplication. https://www.chop.edu/conditions-diseases/thumb-duplication 3. Boston Children’s Hospital. Camptodactyly. https://www.childrenshospital.org/sites/default/files/2022-04/camptodactyly-factsheet.pdf

Management of the Burned Hand: Preserve Function

Oct 11, 2026 27 min

https://plasticsinpractice.com/ A closed burn wound can still leave a hand that barely moves. In this episode of Plastics in Practice, we review how to recognize threatened circulation, reassess burn depth, and protect hand function while the wound heals. Key takeaways: • After immediate trauma priorities, remove rings and assess circulation, sensation and movement. • Cool fingers, worsening sensation, delayed refill or deteriorating Doppler signals need urgent burn surgical assessment. Do not wait for pulse loss. • Reassess depth and healing progress; a potentially deep hand burn needs early specialist input. • Typical dorsal burns need wrist extension, knuckle flexion, straight interphalangeal joints and an open thumb web. Palmar injuries may need a different position. • Combine edema control with supervised movement when the wound and deeper structures permit; protect vulnerable grafts and tendons. • Follow finger flexion, extension and first web opening alongside wound closure. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. Apple Podcasts: https://podcasts.apple.com/us/podcast/management-of-the-burned-hand-preserve-function/id1835564216?i=1000795827856 Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/4efe33f7-ad92-4404-a609-1a9327ba513c/plastics-in-practice-resident-review-management-of-the-burned-hand-preserve-function YouTube Short: https://www.youtube.com/shorts/OUw3t8iLu-w YouTube Explainer: https://www.youtube.com/watch?v=ACCIT9VLjo8 Instagram account: https://www.instagram.com/plasticsinpractice/ #HandBurns #BurnCare #HandSurgery #BurnRehabilitation #PlasticsInPractice References: 1. American Burn Association. Guidelines for Burn Patient Referral. https://www.ameriburn.org/burn-care-team/resources/guidelines-for-burn-patient-ref...

Management of Vasoconstriction: Look Beyond Spasm

Oct 10, 2026 19 min

https://plasticsinpractice.com/ Poor perfusion needs an explanation beyond the word spasm. In this episode of Plastics in Practice, we review how to distinguish reversible narrowing from structural and mechanical problems, recognize threatened perfusion, and match treatment to the cause. Key takeaways: • Raynaud attacks do not always show the complete white-blue-red sequence; interpret the history, examination and nailfold findings together. • Persistent pain, cold pallor, new sensory loss or tissue injury requires urgent assessment for threatened perfusion. • Consider proximal arterial disease, emboli and trauma-related ulnar injury rather than attributing every ischemic digit to spasm. • For systemic sclerosis-associated Raynaud, calcium channel blockers are first-line; consider PDE5 inhibitors and specialist IV iloprost for appropriate severe or refractory disease. • Do not combine nitrates, including topical nitrate, with PDE5 inhibitors because of serious hypotension risk. • Botulinum toxin has negative randomized trial results for routine SSc-Raynaud treatment; selected severe or refractory ulcer use and sympathectomy need specialist judgment and clear discussion of uncertainty. • In microsurgical compromise, inspect inflow, outflow and the whole pedicle; supportive measures must not delay correction of a mechanical problem. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. YouTube Short: https://www.youtube.com/shorts/mKttuP9TwF4 YouTube explainer: https://www.youtube.com/watch?v=1JRVgx-zJC4 Apple: https://podcasts.apple.com/us/podcast/management-of-vasoconstriction-look-beyond-spasm/id1835564216?i=1000795187132 Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/2e14ba0e-7529-4f03-bba5-8378691e40e6/plastics-in-practice-resident-re...

Hand Tumors: Assessment and Biopsy Planning

Oct 9, 2026 21 min

https://plasticsinpractice.com/ A small, painless hand mass can still need a carefully planned diagnosis before excision. In this episode of Plastics in Practice, we review how imaging and biopsy planning help clarify an unexplained hand mass while protecting later treatment options and hand function. Key takeaways: • Most hand masses are benign, but small size and lack of pain do not exclude sarcoma. • An enlarging, firm, deep or otherwise unexplained mass deserves further assessment rather than an assumed benign diagnosis. • Ultrasound can help distinguish cystic from solid tissue; that distinction alone is not a cancer test. • MRI can define a suspicious lesion’s extent and its relationship to tendons, nerves and vessels. • Involve the team that would treat a sarcoma before biopsy or excision of a suspicious mass. • Plan the biopsy route with definitive surgery in mind. Unplanned dissection can enlarge the later treatment field and put functional structures at risk. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. YouTube explainer: https://www.youtube.com/watch?v=getLckvMB0M Instagram account: https://www.instagram.com/plasticsinpractice/ #HandTumors #HandSurgery #Sarcoma #BiopsyPlanning #PlasticsInPractice References: 1. European Society of Musculoskeletal Radiology. Soft tissue tumor imaging in adults: guidelines 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC11213759/ 2. British Sarcoma Group. UK guidelines for the management of soft tissue sarcomas. https://pmc.ncbi.nlm.nih.gov/articles/PMC11724041/ 3. Early Complications of Planned Resection Versus Unplanned Excision of Sarcomas in the Distal Upper Extremity. 2024. https://pubmed.ncbi.nlm.nih.gov/39166192/

Dupuytren’s Disease: Function, Anatomy and Treatment

Oct 7, 2026 10 min

https://plasticsinpractice.com/ A fascial cord can tether the finger, but releasing it does not resolve every part of the deformity. In this episode of Plastics in Practice, we review assessment of Dupuytren’s disease, secondary joint stiffness, altered neurovascular anatomy, and treatment choices that balance correction, recovery and recurrence. Key takeaways: • Dupuytren’s affects the palmar and digital fascia. The cord is diseased fascia, not a shortened flexor tendon. • Start with function. Consider the patient’s priorities, joint stiffness and perioperative risks before choosing treatment. • Longstanding proximal interphalangeal deformity can leave secondary stiffness after cord release. Full straightening is not guaranteed. • A spiral cord can draw the digital neurovascular bundle toward the finger’s midline and closer to the skin. Anticipate altered anatomy. • Needle fasciotomy divides a cord, collagenase weakens it, and limited fasciectomy removes diseased fascia. Balance recovery demands, risks and durability with the patient’s priorities. • Treatment addresses contracture without eliminating the tendency to form disease. Counsel about recurrence, rehabilitation and useful hand function. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. 🎧 Explore this episode: Instagram account: https://www.instagram.com/plasticsinpractice/ YouTube explainer: https://youtube.com/watch?v=VpB79uxvhXc YouTube Short: https://youtube.com/shorts/btGTqCDy3EE #DupuytrensDisease #HandSurgery #HandAnatomy #PlasticSurgeryEducation #PlasticsInPractice References: 1. American Academy of Orthopaedic Surgeons. Dupuytren’s Disease. OrthoInfo. https://www.orthoinfo.org/diseases--conditions/dupuytrens-disease/ 2. Macey and Thomas. The Serpentine Zone: A Surgeon’s Guide to the Surface Anatomy of the Digital Neurovascular Spiral in Dupuytren’s Contracture. 2018. https://pubmed.ncbi.nlm.nih.gov/297067...

Thumb Reconstruction

Oct 4, 2026 21 min

https://plasticsinpractice.com/ Rebuilding a thumb means restoring useful pinch and grasp. Length is only part of the problem. In this episode of Plastics in Practice, we review functional assessment, sensate coverage, and reconstruction choices after thumb tissue loss or amputation. Key takeaways: • Restore useful pinch and grasp. Assess length, stability, motion and sensation alongside the carpometacarpal joint, thenar function, first web space and remaining fingers. • An acute thumb amputation needs urgent specialist replantation assessment. Feasibility, injury pattern and patient priorities guide the decision. • Distinguish coverage needs from missing structural components. Skin coverage alone cannot replace lost bone, tendon, nerve or joint function. • Durable sensate pulp matters. A Moberg flap can cover selected distal palmar defects, but its reach is limited and joint motion must be considered. • Toe transfer and pollicization offer options for selected major losses. Selection depends on the remaining hand, donor effects and the patient’s goals. • Plan for rehabilitation and the tasks that matter to the patient. Thumb length, appearance and survival do not by themselves guarantee useful function. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. 🎧 Explore this episode: Instagram account: https://www.instagram.com/plasticsinpractice/ Apple: https://podcasts.apple.com/us/podcast/thumb-reconstruction/id1835564216?i=1000793038307 YouTube: https://youtu.be/zSBh7AqWxDo Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/3a0799b8-467e-4c02-a881-ea1a45079e83/plastics-in-practice-resident-review-thumb-reconstruction #ThumbReconstruction #HandSurgery #Microsurgery #PlasticSurgeryEducation #PlasticsInPractice References: 1. British Society for Surgery of the Hand. Revascularisation/Replantation trauma standard. https://www.bssh.ac.uk...

Hand and Upper Extremity Replantation

Sep 21, 2026 22 min

https://plasticsinpractice.com/ A surviving replant is only the beginning. The goal is a hand that can feel, move, and serve the patient’s needs. In this episode of Plastics in Practice, we review patient selection, preservation, injury assessment, reconstruction, monitoring, and rehabilitation after upper-extremity amputation. Key takeaways: • Useful function is the goal. Consider sensation, motion, pain, hand demands, and rehabilitation alongside the likelihood of survival. • Stabilize the patient and seek early specialist assessment. Preserve a detached part in saline-moistened gauze inside a sealed waterproof bag cooled in ice water; prevent direct tissue contact with ice or water. • Thumb loss, multiple-digit loss, and amputations in children merit careful replantation consideration. The final decision remains individualized. • Crush and avulsion can extend vessel injury beyond the visible wound. Debride to healthy tissue and plan a tension-free repair or an appropriate graft. • Arterial inflow and venous drainage are both necessary. A pale, cool digit with delayed refill or a swollen, blue digit with brisk refill needs urgent assessment by the replant team. • Protect the reconstruction while planning hand therapy. Survival, useful motion, sensory recovery, and return to activity are separate outcomes. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. The accompanying Short and explainer use recorded human narration and original AI-assisted teaching animations and anatomical illustrations. These visuals are educational reconstructions, not patient footage. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpra...

Mangled Upper Extremity Salvage

Sep 5, 2026 17 min

https://plasticsinpractice.com/ A mangled upper extremity can look unsalvageable before resuscitation, perfusion, and debridement reveal what function remains. In this episode of Plastics in Practice, we build a practical limb-salvage sequence—from life-threatening priorities and early antibiotics to revascularization, compartment assessment, reconstruction, and rehabilitation. Key takeaways: • Put life before limb. Complete trauma resuscitation, control hemorrhage, and document perfusion, motor function, and sensation before committing to salvage or amputation. • A MESS of seven is a risk signal, not an upper-extremity amputation verdict. A 2024 meta-analysis suggested that at least one in five patients above the included studies’ MESS amputation thresholds underwent limb salvage.[1] • For an open long-bone fracture within BOAST's scope, give intravenous prophylactic antibiotics as soon as possible, ideally within one hour of injury. Hand, wrist, and digit injuries are outside this BOAST’s scope and may be managed locally using similar principles.[2] • If the limb is ischemic, restore flow as soon as possible. When timely definitive vascular repair is not feasible because of patient physiology or skeletal instability, a temporary vascular shunt can rapidly restore perfusion while stabilization proceeds.[6] • In adults with traumatic extremity injury, on repeated or continuous monitoring, delta pressure equals diastolic blood pressure minus intracompartmental pressure. A value above thirty millimeters of mercury may assist in ruling out acute compartment syndrome; thirty or less is concerning but not diagnostic and must be integrated with serial examination.[3] • Functional salvage requires meticulous debridement, stable bone, vascular repair, coordinated tendon and nerve reconstruction, durable soft-tissue coverage, and rehabilitation planned from the beginning.[4,5] This content is for educational purposes only and is not medical advice. 🎧 Full episodes avail...

Ligament Injuries of the Hand and Wrist

Aug 22, 2026 24 min

https://plasticsinpractice.com/ A normal-looking radiograph can hide a ligament injury that becomes stiffness, deformity, or arthritis if it is missed.In this episode of Plastics in Practice, we connect reduction, stability testing, imaging, early motion, and operative decision points across finger, thumb, carpal, and distal radioulnar joint injuries.Key takeaways:• Treat the PIP joint as a motion emergency: permanent stiffness can develop within about two weeks. After reduction, confirm congruity and stability, then begin early protected motion when the joint is stable.[1]• Use the thirty-fifty rule as a guide for dorsal PIP fracture-dislocations: less than thirty percent articular involvement is usually stable, thirty to fifty percent is tenuous, and more than fifty percent is usually unstable. Clinical stability still overrides fragment size.[1]• Avoid axial traction during reduction of a dorsal finger MCP dislocation. Traction can pull the volar plate into the joint and convert a simple injury into an irreducible complex dislocation.• For a thumb UCL injury, no firm endpoint is the strongest red flag for a complete tear; angle thresholds vary. A Stener lesion places the adductor aponeurosis between the ligament and bone, blocking anatomic healing.[2,3]• A scapholunate gap around three millimeters or more, an angle above seventy degrees, or dorsal lunate tilt above fifteen degrees supports instability, but normal static films do not exclude a dynamic injury.[4]• On the lateral wrist radiograph, trace the radius, lunate, and capitate. Loss of collinearity plus median nerve symptoms is the perilunate warning pattern; outcomes are better when treatment begins within seven days than after delay.[5]This content is for educational purposes only and is not medical advice.🎧 Full episodes available now:Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.ap...

Principles of Tendon Transfers

Aug 17, 2026 20 min

https://plasticsinpractice.com/ A tendon transfer can be perfectly woven and still fail if the joint is stiff, the tissue bed is scarred, or the donor cannot match the lost motion. In this episode of Plastics in Practice, we build a practical framework for tendon transfers—from donor selection and tensioning to radial, median, and ulnar nerve palsy reconstruction and postoperative retraining. Key takeaways: • Make the hand ready first: joints must be supple, and the transfer must glide through a quiet soft-tissue bed. A contracture release and tendon transfer require incompatible rehabilitation and should not be combined. • Match excursion and power: finger flexors provide about seventy millimeters of excursion, finger extensors fifty, and wrist motors thirty; a donor can lose up to one motor grade after transfer.[1,4] • Favor an expendable donor, a direct line of pull, synergistic motion, one donor for one function, and tension near the donor's working length.[1,4] • For high radial palsy, the classic FCR set restores wrist extension with PT to ECRB, finger MCP extension with FCR to EDC, and thumb extension with PL to a rerouted EPL. A fused wrist favors an FDS donor because tenodesis cannot supplement FCR excursion.[1,2] • Median palsy opponensplasty commonly uses FDS or EIP; the donor and pulley must recreate palmar abduction, flexion, and pronation rather than abduction alone.[3] • In ulnar palsy, a positive Bouvier test identifies simple clawing that may accept a static MCP block; a negative test signals complex clawing that needs dynamic intrinsic replacement. • Protect the transfer for four weeks, add passive stretching around week six, begin strengthening around week eight, and progress toward unrestricted activity at three months.[1] This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3...

Upper Extremity Tenosynovitis and Tendinopathy

Aug 15, 2026 23 min

https://plasticsinpractice.com/ Radial wrist pain, a locking digit, and lateral elbow pain can all be called overuse—but a few centimeters can change the diagnosis, treatment, and surgical target. In this episode of Plastics in Practice, we map de Quervain tenosynovitis, intersection syndrome, trigger finger, and lateral elbow tendinopathy from focused examination through splinting, injection, rehabilitation, and surgical release. Key takeaways: • Map radial-sided symptoms by location: de Quervain disease localizes at the radial styloid, while intersection syndrome produces dorsoradial pain and often crepitus four to six centimeters proximal to Lister tubercle. • De Quervain disease involves the APL and EPB in the first dorsal compartment; a separate EPB subcompartment can explain incomplete response after injection or release. • Current evidence supports considering corticosteroid injection plus three to four weeks of thumb-spica immobilization as first-line management for de Quervain disease; ultrasonography can help target anatomic subcompartments.[1,2] • Trigger finger localizes to the A1 pulley near the volar metacarpal head—even when the patient feels the click at the PIP joint. • Corticosteroid injection succeeds in roughly two thirds of trigger digits in pooled randomized trials; persistent locking, fixed contracture, or failed conservative care should prompt evaluation for A1 pulley release.[3] • Lateral epicondylitis is better framed as lateral elbow tendinopathy: confirm focal pain with grip or resisted wrist extension, consider radial tunnel symptoms, and avoid promising a rapid cure from any single intervention.[4] This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835...

Extensor Tendon Surgery: Zones, Traps, and Early Motion

Aug 15, 2026 27 min

https://plasticsinpractice.com/ Extensor tendon injuries are easy to underestimate: a small dorsal wound can conceal a complete laceration, a contaminated MCP joint, or a central slip injury that declares itself later. In this episode of Plastics in Practice, we review the examination, zone-based repair strategy, rehabilitation, complications, and reconstruction of extensor tendon injuries. Key takeaways: • Use the eight-zone map to localize injury and choose a repair and rehabilitation plan; odd-numbered zones lie over joints. • Test beyond simple active extension: juncturae can mask a complete zone-six EDC laceration, the Elson test assesses the central slip, and table-top thumb lift helps isolate EPL function. • Repair lacerations involving more than half of the tendon in zone two, the zone-three central slip, and zone four; avoid unnecessary bulk or shortening in the thin distal mechanism. • Treat a zone-five fight bite as a contaminated joint injury—explore the capsule, debride and irrigate, and defer tendon repair until the wound is clean. • Match rehabilitation to repair strength: zones one and two usually need continuous extension protection for six to eight weeks, while stronger repairs in zones four through eight can support protected early motion. Recent randomized trials support relative-motion extension protocols for selected zone-four to zone-six repairs.[1,2] • Anticipate extensor lag, loss of flexion, adhesions, and tendon rupture; consider tenolysis only after a sustained therapy plateau and use grafts or tendon transfers selectively. This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO...

Flexor Tendon Repair: Strength, Glide, and Early Motion

Aug 13, 2026 28 min

https://plasticsinpractice.com/ Flexor tendon repair succeeds only when construct strength, tendon glide, pulley preservation, and rehabilitation are planned as one system. In this episode of Plastics in Practice, we review the evaluation, zone-based strategy, repair principles, rehabilitation, complications, and salvage of flexor tendon injuries. Key takeaways: • Detect loss of the normal cascade or tenodesis effect, test flexor digitorum profundus and superficialis independently, and document neurovascular status. • Let the injury zone drive exposure and repair; zone II demands especially careful sheath and pulley management. • Build a strong, smooth multistrand repair with accurate tendon-end coaptation and no obstructive bulk at the repair interface.[1,2] • Preserve the critical A2 and A4 pulleys when possible, and vent judiciously when needed to restore free tendon glide.[1,2] • Begin therapist-directed protected motion early when the construct, associated injuries, and patient factors permit. The 2026 IFSSH consensus favors true early active flexion, whereas a 2024 randomized trial found better five-year motion after passive mobilization with place-and-hold; protocol choice remains debated and should be individualized.[1-3] • Recognize adhesions, gapping or rupture, bowstringing, quadriga, lumbrical-plus, and the situations that require grafting or staged reconstruction. This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #FlexorTendonRepair #HandSurgery #TendonRepair #PlasticSurgeryEducation #SurgicalPearls #Plastic...

Wrist Fractures: Distal Radius and Scaphoid Decision Points

Aug 12, 2026 17 min

https://plasticsinpractice.com/ Wrist fracture decisions turn on a few measurements, but the right threshold depends on the patient, the image, and the bone. In this episode of Plastics in Practice, we review distal radius and carpal fractures with an emphasis on reduction, fixation, and the diagnostic traps that change management. Key takeaways: • Document median nerve function and distal radioulnar joint stability before and after distal radius reduction. • In study-defined non-geriatric adults, post-reduction radial shortening greater than three millimeters, dorsal tilt greater than ten degrees, or intra-articular displacement or step-off greater than two millimeters supports operative fixation.¹ • Age sixty-five is a study proxy, not a biologic cutoff. Functional demand and patient priorities still matter, and routine fixation has not improved long-term patient-reported outcomes in geriatric cohorts.¹ • Fixation constructs have similar long-term outcomes; volar locking plates mainly offer earlier functional recovery.¹ • A negative scaphoid radiograph does not close the case. Immobilize a clinically suspicious wrist, obtain early MRI for an occult fracture, and use long-axis CT when a fracture is visible.² • Initial below-elbow casting is appropriate for bicortical scaphoid waist fractures displaced two millimeters or less, with prompt fixation if nonunion is confirmed.²˒³ • Fixation is favored beyond two millimeters of scaphoid waist displacement, for any displaced proximal-pole fracture, or with an unstable carpal injury. Confirm union before discharge.² This content is for education only and does not replace clinical judgment, institutional protocols, or individualized patient care. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 You...

Hand Fractures: Reduction, Fixation, and Early Motion

Aug 9, 2026 18 min

https://plasticsinpractice.com/ Hand fracture outcomes often hinge on what radiographs miss — rotation, post-reduction stability, and whether fixation permits early motion. In this episode of Plastics in Practice, we review metacarpal and phalangeal fracture management — rotational alignment, stability, fixation strategy, early motion, thumb-base injuries, proximal interphalangeal joint fracture-dislocations, and complications. Key takeaways: • Examine each injured digit in maximal extension and flexion. Scissoring reveals malrotation; persistent rotation after reduction is operative.³ • Stable, nondisplaced closed fractures usually need splinting or buddy taping, early motion, and radiographs at seven to ten days. Clinical union commonly takes three to four weeks.¹ • Open hand fractures except tuft fractures need same-day review and antibiotics. Treat definitively — or wash out and close — within twenty-four hours; stop antibiotics after closure or by seventy-two hours, whichever comes first.² • Selected isolated, closed fifth-metacarpal neck fractures with less than seventy degrees of volar angulation and no rotation can do well with buddy taping and early motion. Open, complex, displaced, rotational, or occupation-limiting patterns need separate judgment.³,⁴ • Choose the least invasive construct that holds reduction and permits motion. Use at least two K-wires in different planes for rotational control; plates add rigidity but also dissection and tendon-adhesion risk.¹,⁷ • For a Bennett fracture, restore a stable, concentric thumb carpometacarpal joint. Less than one millimeter of step-off is a target, not an absolute cutoff; congruity and stability drive treatment.⁶ • For a dorsal proximal interphalangeal joint fracture-dislocation, less than thirty percent involvement is usually stable, thirty to fifty percent is tenuous, and more than fifty percent is usually unstable. Confirm dynamically after reduction.⁵ This content is for educational purposes only and is n...

Upper Extremity Nerve Injuries and Compression Neuropathies

Aug 8, 2026 23 min

https://plasticsinpractice.com/ Peripheral nerve deficits are a race against irreversibledenervation — misclassify the lesion or miss the level of compression, and observation becomes lost recovery time. In this episode of Plastics in Practice, we review traumaticperipheral nerve injury and the compression neuropathies that matter across the median, ulnar, and radial nerves — how to classify the lesion, time electrodiagnostic testing, recognize localization traps, and choose observation versus decompression or repair. Key takeaways: · Neurapraxia is a conduction block with intactaxons and expected recovery within two to three months; axonotmesis regeneratesat roughly one millimeter per day under ideal conditions; neurotmesis requiressurgical coaptation. · Neurologic deficits after penetrating trauma arepresumed neurotmetic and warrant early exploration. Primary repair is ideallyperformed within seventy-two hours for a sharp, clean laceration, while mostgunshot deficits are concussive and initially observed. · After axonal injury, distal nerve-conductionabnormalities develop over one to two weeks and EMG fibrillations appear at three to four weeks; electrodiagnostic testing is traditionally repeated at four to six weeks. · If a closed deficit shows no clinical orelectrodiagnostic recovery by three to six months, exploration is generally recommended. Denervated muscle loses an estimated one percent per week, and significant motor recovery is unlikely beyond twelve to eighteen months. · Nocturnal radial-digit paresthesias with sparedthenar-eminence sensation support carpal tunnel syndrome; activity-related symptoms involving the thenar eminence suggest pronator syndrome; an isolatedfailed “OK” sign without sensory loss suggests anterior interosseous syndrome. · Dorsoulnar sensory loss localizes ulnarcompression to the elbow rather than Guyon canal. Within Guyon canal, Zone I produces mixed deficits, Zone II motor deficits, and Zone III sensory deficits. · ...

Hand Infections: Diagnosis and Management

May 31, 2026 23 min

https://plasticsinpractice.com/ Hand infections deteriorate fast — the same anatomy that gives the hand its function turns ordinary swelling into ischemia, tendon necrosis, and permanent loss of motion. This episode walks through how to recognize and manage everything from paronychia and felon to pyogenic flexor tenosynovitis, deep space infections, bite injuries, and necrotizing fasciitis — with the surgical pitfalls every resident needs to know cold. In this episode of Plastics in Practice, we cover the anatomy that makes the hand vulnerable, when to splint and when to cut, the Kanavel signs you'll be quizzed on, the herpetic whitlow trap, the high-mortality red flags of nec fasc, and how rising community-acquired MRSA changes empiric antibiotic selection. Key takeaways: • Drainage is non-negotiable for any abscess. Antibiotics are an adjunct, not a substitute. • Never infiltrate local anesthesia into cellulitis — it spreads the infection. Use regional blocks for deep space infections. • Herpetic whitlow is medical, not surgical. Cutting risks systemic viral spread. Confirm with Tzanck smear. • Kanavel's four signs of pyogenic flexor tenosynovitis: semi-flexed digit, fusiform swelling, tenderness along the sheath, pain on passive extension. • Clenched-fist bite injuries seed the MCP joint. Polymicrobial with Eikenella — admit, x-ray, tetanus, and explore in the OR if the extensor mechanism is breached. • Necrotizing fasciitis carries up to 40% mortality. Bright shiny skin, nonpitting edema, violaceous patches — broad-spectrum antibiotics and aggressive debridement now. • Community-acquired MRSA is rising. Culture before empiric antibiotics whenever possible. This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-...

Upper Extremity Anesthesia Essentials

May 28, 2026 17 min

https://plasticsinpractice.com/ Upper extremity surgery is, at its core, a regional anesthesia specialty. Choose the right block in the right place and most hand and arm cases never need general anesthesia. In this episode of Plastics in Practice, we work through the practical anesthesia decision tree for the upper extremity: brachial plexus block locations and their trade-offs, peripheral nerve blocks at the elbow and wrist, the Bier block, digital block techniques, and the modern, evidence-based truth about epinephrine in the finger. Key takeaways: - Severe systemic toxicity is almost always an intravascular accident - aspirate before every injection, and never trust pain as a safety signal in a sedated or proximally blocked patient. - Interscalene for the shoulder, supraclavicular for fast complete arm anesthesia, infraclavicular for elbow and distal, axillary for the hand. - Brachial plexus blocks take 15-25 minutes to mature - perform them in a dedicated block area about 30 minutes before incision. - Bier blocks fit cases under 60 minutes. Keep the tourniquet up for 30 minutes minimum and cycle it down in three releases. - Epinephrine 1:200,000 is safe in fingers and hands - the necrosis fears come from pre-1950s procaine and cocaine reports. - Single subcutaneous volar digital block beats the transthecal block on onset and pain. This content is for educational purposes only and is not medical advice. Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #PlasticSurgery #Residency #HandSurgery #UpperExtremity #RegionalAnesthesia #BrachialPlexus #SurgicalEducation #PlasticsInPractice

Functional Anatomy and Principles of Upper Extremity Surgery

May 25, 2026 17 min

https://plasticsinpractice.com/ Every hand case rests on the same foundation: knowing which joints need mobility, which need stability, and how to run an acute hand with a trauma-first mindset. Get this layer right, and every chapter after it makes sense. In this episode of Plastics in Practice, we cover the foundational anatomy and operative principles of the upper extremity: how the thumb, finger, and wrist joints differ in their tolerance for stiffness and instability; the classic deformities (swan-neck, boutonniere, DISI, VISI) and the ligaments that produce them; the acute hand workup from "life over limb" through ER reduction; how to image and describe fractures in anatomic terms rather than eponyms; intrinsic plus splinting; safe tourniquet use; Bruner incisions; and why elevation is the single most important postoperative instruction you'll ever give. Key takeaways: MCP joints have low tolerance for stiffness; the DIP tolerates it well - stability matters more there than motion.Volar plate disruption at the PIP causes swan-neck; central slip rupture causes boutonniere - opposite mechanisms, opposite deformities.Scapholunate ligament tear leads to DISI; lunotriquetral tear leads to VISI. The lunate follows the ligament that's still intact.Tourniquet time should be 90 to 120 minutes max to avoid ischemic reperfusion injury; pressure about 100 mmHg above systolic.Splint in the intrinsic plus position: wrist in slight extension, MCPs flexed, IPs extended.Routine soft-tissue cases under 2 hours: postop antibiotics show no clear benefit. Open fractures and bony work: 24 hours of perioperative IV coverage.Bruner zigzag incisions across the volar finger and palm prevent contracture; never cross flexion creases perpendicularly.This content is for educational purposes only and is not medical advice. Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z Apple: https://podca...

Lymphedema: Diagnosis and Treatment

May 24, 2026 23 min

https://plasticsinpractice.com/ Lymphedema is the chronic disease plastic surgeons are best positioned to treat — and the most commonly mismanaged. After axillary node dissection, up to 50% of breast cancer patients develop it, and most never get the early, disciplined care that prevents progression to fibrofatty disease. In this episode of Plastics in Practice, we review the essentials of lymphedema management — from how the lymphatic system fails to the diagnostic threshold (2 cm or 200 ml difference), staging by the International Society of Lymphology, the role of Complex Decongestive Therapy as the gold-standard nonsurgical approach, and how to think about surgery: physiologic methods like lymphaticovenous bypass and vascularized lymph node transfer, versus reductive options like liposuction and direct excision. We also cover the late complications residents should not miss — recurrent cellulitis, and the rare but devastating Stewart-Treves lymphangiosarcoma. Key Takeaways: Diagnostic threshold: limb circumference difference > 2 cm or volume increase > 200 ml is clinically significant.Up to 50% of patients with axillary lymph node dissection develop lymphedema; only 4–7% after sentinel node biopsy.Complex Decongestive Therapy (CDT) is the gold-standard nonsurgical management — Phase 1 intensive (4–6 weeks), Phase 2 maintenance for life.ISL staging: Stage 0 latent → Stage I pitting → Stage II non-pitting fibrofatty → Stage III lymphostatic elephantiasis.Physiologic surgery (lymphaticovenous bypass, vascularized lymph node transfer) can reduce limb volume ~35% at 12 months in selected patients.Liposuction is the workhorse for non-pitting, fibrofatty lymphedema — requires ≥ 600 ml volume difference, failed 3 months of CDT, and lifelong compression after surgery.Stewart-Treves lymphangiosarcoma: rare but aggressive — 5-year survival 10%, average survival 19 months after diagnosis. Always biopsy suspicious nodules in a long-standing lymphedematous limb. This conte...

Pressure Sore Fundamentals

May 19, 2026 24 min

https://plasticsinpractice.com/ Pressure sores are the wound the plastic surgeon gets consulted on after everything else has gone wrong — and the recurrence rate is brutal if you skip the basics. The lesson nobody teaches you in residency is that the surgery is the easy part. In this episode of Plastics in Practice, we review the basics of pressure sore management: the pathophysiology of pressure-time injury, the six-stage NPUAP system, what you absolutely have to optimize preoperatively (albumin, A1c, spasm, contractures, osteomyelitis), how to choose between fasciocutaneous and musculocutaneous flaps for ischial, sacral, and trochanteric defects, and why the recurrence numbers stay high no matter what flap you pick. Key takeaways: - Tissue injury starts deep — muscle over bone fails first, the skin lesion is just the tip of the iceberg. - Capillary perfusion fails above ~32 mm Hg; five minutes of off-loading every two hours is enough to prevent breakdown even at high pressures. - Pressure x time is parabolic: 500 mm Hg for 2 hours or 100 mm Hg for 10 hours both kill muscle. Skin ulcerates last. - Optimize before you operate: albumin >2.0 g/dL, A1c 6%, control spasm (baclofen, dantrolene, botulinum toxin), treat osteomyelitis surgically — not medically. - Avoid primary closure and skin grafts — these wounds have a true tissue deficit. Use flaps. - Fasciocutaneous vs. myocutaneous: in a 94-patient series there was no difference in recurrence, complications, or morbidity — pick the flap that preserves future options. - Avoid radical ostectomy — total ischiectomy redistributes pressure and creates the next ulcer. - Recurrence after flap closure runs ~39%; the most vulnerable window is the first 15–22 months. - Watch for Marjolin ulcer in long-standing wounds — aggressive SCC with metastatic rates over 60%; wide excision is the answer. This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.ins...

Perineal Reconstruction: Principles and Flap Selection

May 17, 2026 20 min

https://plasticsinpractice.com/ Few regions punish poor planning like the perineum — the pelvic outlet sits at the crossroads of the urinary, gynecologic, and GI tracts, and the wrong flap choice in an irradiated or contaminated field gets you back in the OR fast. In this episode of Plastics in Practice, we walk through the core principles of perineal reconstruction: anatomy and vascular supply, the reconstructive ladder, pelvic dead-space management, and the workhorse flaps you actually need to know — VRAM, gracilis, posterior thigh, Singapore, and the greater omentum. We finish with functional restoration in both female and male patients, including the Cordeiro classification for acquired vaginal defects, scrotal reconstruction after Fournier's, and the basics of microsurgical penile replantation. Key takeaways: The perineum is a diamond between the pubic symphysis, ischial tuberosities, and coccyx — anterior urogenital triangle and posterior anal triangle.¹Pelvic dead space after APR or exenteration is dangerous — fill it with a well-vascularized flap to cut abscess, dehiscence, and bowel-obstruction risk.²VRAM is the workhorse for combined pelvic and perineal defects; it beats thigh flaps on major complications in this setting.³Gracilis is the workhorse when you don't want a laparotomy — versatile, low donor morbidity, but watch the short pedicle and unreliable skin paddle for large defects.⁴Singapore flap is the go-to for vaginal reconstruction — sensate, axial, and preserved by the superficial perineal artery.Use the Cordeiro classification for acquired vaginal defects: IA → Singapore, IB → VRAM, IIA → rolled rectus, IIB → bilateral gracilis.⁵Scrotal reconstruction after Fournier's: up to 50% primary closure; otherwise meshed STSG with tunica vaginalis intact and spermatic cords sewn together first.⁶Penile replantation: microsurgical repair within 6 h warm or 16 h cold ischemia — urethra, tunica albuginea, dorsal artery and vein, dorsal nerve, plus suprapubic...

Foot and Ankle Reconstruction: Core Principles

May 15, 2026 21 min

https://plasticsinpractice.com/ Saving a foot is rarely about the flap. It's about the angiosome you re-perfuse, the millimeters of debridement you take, and whether you lengthen a tight Achilles before you ever think about closure. In this episode of Plastics in Practice, we cover the principles of foot and ankle reconstruction: the six angiosomes and how they should drive every revascularization, incision, and flap design; the role of the multidisciplinary team in salvaging a limb that traditionally would have been amputated; and the practical algorithm for moving a chronic wound to closure — debridement, NPWT, dermal templates, and the simple techniques that resolve roughly 90% of these wounds without ever needing a microsurgical free flap. We finish with a location-by-location reconstructive playbook from forefoot to hindfoot, including why Achilles tendon lengthening is the single highest-yield biomechanical move in the diabetic forefoot. Key takeaways: - The 5-year mortality after major lower-limb amputation in diabetics exceeds 50% — higher than colon or breast cancer. - The angiosome concept divides the foot into six vascular territories; direct revascularization of the affected angiosome increases healing 50% and decreases major amputation fourfold. - Biofilm exists in >90% of chronic wounds and penetrates up to 4 mm — debridement, not coverage, is the rate-limiting step. - Achilles tendon lengthening cuts diabetic forefoot ulcer recurrence in half at 2 years and is the single highest-yield biomechanical intervention. - Roughly 90% of foot and ankle wounds heal with simple techniques; only ~10% require flap reconstruction. - For plantar coverage, the medial plantar fasciocutaneous flap remains the workhorse — sensate, durable, glabrous skin with a wide arc of rotation. - Free flaps to the foot have the highest failure rate of any anatomic location; anastomose outside the zone of injury and use end-to-side to spare a major vessel. This content is for educ...

Lower Extremity Reconstruction: Core Principles

May 14, 2026 25 min

https://plasticsinpractice.com/ Lower extremity reconstruction is the most unforgiving testing ground in plastic surgery — every decision is graded by whether the patient can bear weight, walk, and protect a sensate foot for the rest of their life. In this episode of Plastics in Practice, we walk through the core principles of lower extremity salvage: the zone-of-injury concept, when to fix vs. amputate, fracture management, soft-tissue coverage by leg third, and the trade-offs between limb salvage and a well-fit below-knee amputation. Key takeaways Salvage is judged against amputation, not “normal.” The goal is a limb more functional than a prosthesis — loss of the tibial nerve and plantar sensibility is a relative contraindication.Stabilize the skeleton first. Vascular and nerve repairs done before fixation are routinely disrupted during fracture reduction; external fixation is the workhorse for grade IIIB / IIIC injuries.Early soft-tissue coverage wins. Closure within 72 hours of injury carries the lowest complication rate; delayed closure (1–6 weeks) climbs to ~50%.Match the flap to the leg third: gastrocnemius proximal, soleus middle, free tissue distal.Bone gaps have a tiered answer: cancellous graft for short defects, Ilizarov distraction for 4–8 cm gaps, vascularized fibula up to ~24 cm.VAC therapy buys time, not closure. It improves the bed and reduces flap size, but use beyond 7 days is associated with higher infection and amputation rates in IIIB tibias.BKA is a reconstructive choice, not a failure. It adds ~25% to the energy cost of ambulation vs. ~65% for AKA; preserve the knee whenever possible, including with a foot-fillet free flap from the amputated part.This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plast...

Abdominal Wall Reconstruction: Core Principles

May 13, 2026 22 min

https://plasticsinpractice.com/ Abdominal wall reconstruction is where plastic surgery principles get tested in real time — and it's where most failures start with one wrong assumption about force distribution. In this episode of Plastics in Practice, we review the basics of abdominal wall reconstruction: how to think about the abdomen as a pressurized cylinder, why supported repairs beat bridged repairs almost every time, how to read the components separation technique like a physiology problem instead of a memorization problem, and how to choose between synthetic and bioprosthetic mesh in a contaminated field. We close with soft tissue strategy — when to skin graft early, when to reach for a perforator flap, and how to decide between rebuilding the wall first or rebuilding the cover first. Key takeaways: Hernias expand because sutures cut through tissue like a wire through ice — load-sharing supported repairs are the answer, not bigger primary sutures.Large hernias convert isometric abdominal contraction into isotonic shortening, derailing diaphragm function and torso mechanics — repair restores physiology, not just anatomy.Components separation can move each rectus 8–10 cm to the midline through external oblique release alone; preserving periumbilical perforators is what keeps the skin alive.Synthetic mesh is for clean fields. Bioprosthetic mesh is for contamination, radiation, bowel suture lines, or any field where the soft tissue cover might fail.In the open abdomen, early skin grafting over granulated bowel is your friend — it heals in two dimensions and tolerates poor nutrition far better than flaps.If the hernia is expanding, it's ready to repair — that means the adhesions have softened enough to dissect cleanly.This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA...

Chest Wall Reconstruction Essentials

May 12, 2026 28 min

https://plasticsinpractice.com/ Chest wall reconstruction is where rigid skeletal support and versatile soft tissue coverage meet — and where a wrong flap choice or a missed debridement step turns a small defect into a respiratory disaster. In this episode of Plastics in Practice, we review the basics of chest wall reconstruction: the anatomy that drives every decision, when you actually need to rebuild the skeleton, how to classify and treat sternal wound infections, and how to pick the right flap based on the location and depth of the defect. Key takeaways: Skeletal reconstruction is classically indicated for defects involving four or more ribs or greater than 5 cm in diameter — but posterior and superior defects often tolerate soft tissue coverage alone.¹Methylmethacrylate–mesh "sandwich" gives you rigid protection for large anterior defects, but its rigidity can cost you respiratory comfort.¹Pectoralis major is the workhorse for the upper and middle sternum; for the lower sternum, think IMA-perforator turnover flap or rectus abdominis (VRAM/TRAM).²Omentum is your bailout when local flaps fail — large surface area, thin, perfect for wrapping vascular grafts — but you're paying for it with a laparotomy.³Bilateral IMA harvest strips the sternum of its segmental blood supply and dramatically raises mediastinitis risk; sternal plating is reserved for high-risk re-operative patients.⁴Sternal wound infections are classified by timing: Class 1 (early, sterile), Class 2 (1–3 weeks, purulent mediastinitis), Class 3 (chronic draining sinus). Class 2 and 3 demand thorough debridement plus flap coverage.⁵Single-stage radical debridement with concurrent flap coverage has comparable success to staged debridement — pick based on the patient and the wound, not dogma.⁵This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJi...

Hair Transplantation Essentials

May 10, 2026 22 min

https://plasticsinpractice.com/ Hair restoration is one of the most planning-dependent procedures in plastic surgery — a single wrong call on the hairline or the donor strip can show up for the rest of the patient's life. In this episode of Plastics in Practice we walk through what residents actually need to know about modern hair transplantation: how to evaluate the donor area, how to think about lifetime donor yield, the trade-offs between strip excision and FUE, graft preparation and the out-of-body clock, recipient site design (hairline placement, angle and direction, ethnic and gender variations), postoperative management, and where finasteride, minoxidil, and PRP fit in. Key takeaways: The Safe Donor Area (SDA) defines what is truly permanent — and a 30-year-old destined for Norwood V/VI averages roughly 5,393–6,404 lifetime FUs from average-density donor scalp.¹ Strip excision still dominates (~88.5% of cases) vs. FUE (~11.5%); transection rates can be pushed below 10–15% with tumescent solutions and skin-hook technique.² Graft survival drops about 1% per hour out of body — chilled saline gives ~88% survival at 8 hours; pear-shaped grafts under 6× magnification protect the bulb, sebaceous glands, and dermal papilla.³ Hairline placement: never too low. The mid-frontal point lives where the vertical forehead transitions to the horizontal scalp, ~7–10 cm above the glabella. Build in micro- and macro-irregularities so it never reads as a wall.⁴ Density target for natural long-term coverage in younger patients is 25–30 FU/cm²; high-density "dense packing" >30 FU/cm² is reserved for ideal donor/recipient profiles.⁴ Adjuncts matter: finasteride 1 mg is ~87% effective at slowing AGA progression; topical minoxidil reduces postoperative effluvium and is encouraged 5–12 weeks post-op.⁵,⁶ Cicatricial alopecia (post-facelift, burn, traction): keep recipient density conservative at 15–20 FU/cm² to avoid overwhelming a compromised blood supply.⁷ This content is for educatio...

Osseous Genioplasty

May 10, 2026 17 min

https://plasticsinpractice.com/ Osseous genioplasty is the most versatile tool the plastic surgeon has for the lower face — and the most commonly mis-planned. In this episode of Plastics in Practice, we review the basics of chin surgery: when to pick the osteotomy over an implant, the five-pillar physical exam, the technical steps that decide your aesthetic result, and the pitfalls that cause the bizarre "overadvanced" chin we've all seen on revision.Key takeaways:• The lower lip rule: never advance the chin past a vertical line dropped from the lower lip. Cross it, and the result looks artificial every time.¹• 3-D versatility: implants only correct mild sagittal deficiency. Vertical excess, asymmetry, deep folds, or revisions belong to osseous genioplasty.²• Soft-tissue ratios: ~1:1 for advancement and lengthening; only ~0.5:1 for posterior repositioning.³• The 4 mm rule: keep the horizontal cut ≥ 4 mm below the mental foramina to protect the inferior alveolar nerve.⁴• Carry the cut posteriorly to the molars — the most common technical error is too short a cut, which produces an hourglass deformity.⁴• Mentalis discipline at closure prevents witch's chin (soft-tissue ptosis).⁵Disclaimer: This content is for educational purposes only and is not medical advice.🎧 Full episodes available now:Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #PlasticSurgery #Residency #Genioplasty #Craniofacial #SurgicalEducation #PlasticsInPractice #FacialAesthetics #ChinSurgeryReferences (AMA):1. Rosen HM. Aesthetic guidelines in genioplasty: the role of facial disproportion. Plast Reconstr Surg. 1995;95(3):463-469.2. Converse JM, Wood-Smith D. Horizon...

Facial Implants

Apr 8, 2026 23 min

https://plasticsinpractice.com/ Facial implants can dramatically change facial balance, but the difference between a natural result and an operated look comes down to planning, positioning, and fixation. In this episode, we break down the core principles of facial skeletal augmentation with implants for the plastic surgery resident. We review the major implant materials, the anatomic targets across the midface and mandible, and the operative concepts that matter most in real cases. This includes why subperiosteal placement is preferred, why screw fixation remains a key technical principle, and how to think through chin augmentation versus sliding genioplasty. We also cover common causes of poor outcomes, including malposition, asymmetry, poor transition zones, and technique-related complications rather than material toxicity. Key takeaways: Facial skeletal morphology is a major determinant of facial aestheticsAnthropometric normals are more useful than rigid neoclassical canons for planning Subperiosteal dissection improves visualization, precision, and safety during implant placement Screw fixation helps eliminate implant-bone gaps and reduces migration risk Infraorbital rim and paranasal implants can be powerful tools in midface deficiency Chin implants and sliding genioplasty each have distinct advantages and tradeoffs 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ References Farkas LG, Hreczko TA, Kolar JC, Munro IR. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg. 1985;75(3):328-338. doi:10....

Otoplasty Essentials

Apr 6, 2026 17 min

https://plasticsinpractice.com/ Prominent ears are not one deformity. They are usually a combination problem involving the antihelix, concha, and lobule. In this episode, we break down a practical, anatomy-first approach to otoplasty that helps you create a natural setback without a sharp, overdone, or obviously operated appearance. We review the major causes of auricular prominence, the aesthetic goals of correction, and the core maneuvers every plastic surgery resident should know. The focus is on reliable, cartilage-sparing principles: Mustarde sutures for antihelical recreation, Furnas sutures and selective conchal reduction for conchal excess, and deliberate management of the lobule so you do not leave behind a hockey-stick deformity. We also cover timing, infant ear molding, postoperative care, and complications worth respecting. Key Takeaways Prominent ears usually reflect a combination of underdeveloped antihelical fold, conchal excess, and lobule prominence. The goal is a soft, natural, harmonious setback with visible helical rim from the front and a straight helical contour from behind. Mustarde mattress sutures remain a foundational technique for recreating the antihelix. Furnas concha-mastoid sutures help address middle-third prominence by reducing the concha-mastoid angle. Lobule correction matters; ignoring it can leave a disharmonious result despite an otherwise good otoplasty. Early neonatal ear molding can permanently improve selected deformities without surgery. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ References Thorne CH, Wilkes G. Ear deformities, otoplasty, and e...

Rhinoplasty Fundamentals

Mar 31, 2026 19 min

https://plasticsinpractice.com/ Rhinoplasty is not a reductive operation anymore. Modern rhinoplasty is about precision, preservation, and structure. In this episode, we break down a practical framework for analyzing the rhinoplasty patient, protecting the airway, and executing reproducible tip and dorsal maneuvers with fewer long-term problems. We cover the anatomy that actually matters in the OR: skin/soft tissue envelope behavior, the bony and cartilaginous vaults, the internal nasal valve, and the ligamentous support structures that determine projection, rotation, and long-term stability. We also walk through systematic nasofacial analysis, component dorsal hump reduction, algorithmic tip refinement, spreader graft logic, osteotomy planning, and why revision rhinoplasty remains so technically unforgiving. Key Takeaways Modern rhinoplasty favors conservative, structure-sparing techniques over aggressive resection. Component dorsal hump reduction helps preserve dorsal aesthetic lines and reduce midvault complications. Tip work should follow an algorithmic progression: cephalic trim, sutures, strut support, then grafting as needed. The internal nasal valve is a major determinant of airflow and must be protected throughout dorsal and septal work. Strong outcomes depend on methodical preoperative analysis and matching technique to deformity. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ References Ghavami A, Janis JE, Acikel C, Rohrich RJ. Tip shaping in primary rhinoplasty: an algorithmic approach. Plast Reconstr Surg. 2008;122(4):1229-1241. doi:10.1097/PRS.0b013e31817d5f7d. PMID: 188276...

Facelift Core Principles

Mar 27, 2026 23 min

https://plasticsinpractice.com/ Master the principles behind modern facelifting. This episode breaks down the core concepts of rhytidectomy, focusing on high-yield surgical principles, SMAS manipulation, and complication avoidance. We move beyond outdated skin-tension techniques and focus on what truly matters: volume restoration, anatomic precision, and hemodynamic control. You’ll learn how to think about facelifts like a surgeon—not just perform steps. From SMAS strategies to neck management and hematoma prevention, this is a practical, resident-level deep dive. Volume > tension: Excess skin tension leads to distortion and poor aestheticsSMAS is everything: Extended SMAS provides superior midface + neck correctionHematoma = #1 complication: Strongly linked to perioperative hypertensionAnatomy dictates safety: Stay superficial to the transparent fascia to protect CN VIINeck defines outcome: Platysma management is critical for cervicomental angleLess is more: Over-aggressive surgery → “operated” appearance🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ BibliographyThorne CH. Facelift. Grabb and Smith’s Plastic Surgery. This content is for educational purposes only and is not medical advice. #PlasticSurgery #Facelift #SMAS #SurgicalEducation #PRS #Residency #Aesthetics #MedEd

Blepharoplasty High-Yield Principles

Mar 26, 2026 22 min

https://plasticsinpractice.com/ Blepharoplasty looks simple—but it’s one of the easiest ways to create devastating complications if you don’t respect the anatomy. This episode breaks down the high-yield principles of modern blepharoplasty, focusing on what actually prevents bad outcomes: proper evaluation, conservative technique, and understanding lid support. We cover upper and lower lid strategy, when to preserve vs remove fat, and how to avoid classic complications like ectropion, scleral show, and retrobulbar hematoma. Evaluation is everything: vector analysis, lid laxity, and Schirmer’s test predict complicationsVolume preservation > aggressive excision to avoid hollow “A-frame” deformity Lower lid support is critical: canthopexy/canthoplasty reduces malposition risk Orbitomalar ligament release + fat redraping improves lid–cheek junctionRetrobulbar hematoma = emergency → immediate canthotomy/cantholysisTransconjunctival approach preferred in select patients to minimize complications🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ Codner MA, Burke RM. Blepharoplasty. In: Plastic Surgery Text. Comprehensive Analysis of Modern Blepharoplasty. Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #Blepharoplasty #Aesthetics #SurgicalPearls #PRS #Residency #Oculoplastics #FacialRejuvenation

Forehead and Brow Lift

Mar 24, 2026 18 min

https://plasticsinpractice.com/ The brow lift has evolved. What used to rely on long coronal incisions has shifted toward anatomically precise, minimally invasive endoscopic approaches designed to restore brow position while avoiding the over-elevated, unnatural “surprised” look. In this episode of Plastics in Practice, we break down the modern principles of forehead and brow rejuvenation with a resident-focused review of upper facial aging, brow aesthetics, relevant anatomy, retaining ligaments, and operative strategy. We cover how the frontalis acts as the sole brow elevator, why the corrugator, procerus, orbicularis, and depressor supercilii matter clinically, and how selective ligament release with controlled fixation helps produce more natural results. The frontalis is the only true brow elevator; the corrugator, procerus, orbicularis oculi, and depressor supercilii act as brow depressors.Female brows generally favor lateral elevation and arch, whereas the male brow should remain flatter and closer to the superior orbital rim.Over-elevating the medial brow creates the classic “surprised look” and should usually be avoided.The lateral retinacular ligament must be adequately released for effective lateral brow elevation.Modern endoscopic techniques reduce morbidity associated with traditional coronal approaches, including alopecia and paresthesia.Unicortical bone tunnel fixation provides durable suspension in endoscopic brow rejuvenation. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #PlasticSurgery #BrowLift #ForeheadRejuvenation #EndoscopicBrowLift #AestheticSurgery #PlasticSurgeryResid...

Fat Grafting: From Face to Mega-Volume

Mar 20, 2026 7 min

https://plasticsinpractice.com/ Fat grafting is no longer just filler—it’s a cornerstone of modern plastic surgery. In this episode, we break down the principles that actually determine graft survival, contour outcomes, and safety across facial and mega-volume applications. From the Coleman technique to BRAVA-assisted breast reconstruction, this is a high-yield, resident-focused deep dive into what matters in real cases. Fat graft “take” is ~40–60% → technique + vascularization are everything Small vs large volume = completely different strategies (micro-aliquots vs slurry + expansion) Best facial survival: deep, low-motion compartments (malar, cheek) Golden rule: V/C ratio ≤ 1:1 to avoid graft failure BRAVA pre-expansion ↓ interstitial pressure → ↑ volume capacity (up to ~700 cc) Biggest complications: overgrafting, contour irregularities, rare intravascular injection We cover donor site selection (spoiler: doesn’t matter much), processing methods (centrifugation vs sedimentation), and injection strategies (micro-aliquots vs mapping vs reverse liposuction). We also break down why irradiated tissue fails, how to stage reconstruction, and where stem cell enrichment currently stands (not FDA approved). 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ References Bucky LP, Percec I, Del Vecchio DA. Fat Grafting in Plastic Surgery. Coleman SR. Structural fat grafting. Plast Reconstr Surg. 2006. Coleman SR, Saboeiro AP. Fat grafting to the breast revisited. Plast Reconstr Surg. 2007. This content is for educational purposes only and is not medical advice. #PlasticSurgery #FatGrafting #Surgica...

Botulinum Toxin: Mechanism and Injection Pearls

Mar 18, 2026 21 min

https://plasticsinpractice.com/ Botulinum toxin is simple—until you actually try to use it well. This episode breaks down what most people get wrong: it’s not about units, it’s about functional anatomy and precision. We walk through the true mechanism (SNAP-25 cleavage → presynaptic blockade), why Botox affects nerves—not muscle or skin, and how that translates into real-world injection strategy. From glabella to platysma, this is a high-yield, resident-focused guide to getting consistent results while avoiding classic complications. If you’re still thinking in “standard dosing,” you’re already behind. BoNTA works via SNAP-25 cleavage → blocks acetylcholine release → functional denervation Effects are dose-dependent weakening, not paralysis—precision matters Functional anatomy > fixed dosing (e.g., Mona Lisa vs canine smile patterns) Most complications = toxin diffusion to adjacent muscles High-risk zones: perioral (incompetence), neck (dysphagia), frontalis (ptosis) Used in 300+ conditions beyond aesthetics (hyperhidrosis, migraine, nerve injury) Kane MA. Botulinum toxin. In: Grabb and Smith’s Plastic Surgery. Scott AB, et al. Invest Ophthalmol Vis Sci. 1973. Carruthers JD, Carruthers JA. Dermatol Surg. 1992. Kane MA. Plast Reconstr Surg. Disclaimer: This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #PlasticSurgery #Botox #Neurotoxins #Aesthetics #Residency #MedEd #FacialAnatomy #Injectables #CosmeticMedicine

Dermal Fillers Explained: Rheology, Anatomy, and Technique

Mar 17, 2026 19 min

https://plasticsinpractice.com/ Dermal fillers are more than just wrinkle tools. In this episode, we break down the science that actually drives filler performance: rheology, particle behavior, tissue planes, facial fat compartments, and complication management. This is a high-yield review of dermal and soft-tissue fillers for plastic surgery residents, fellows, and aesthetic surgeons. We cover how G′ (elastic modulus) and viscosity influence lift, spread, and extrusion; why cross-linking matters more than concentration alone for HA longevity; how facial aging reflects compartmentalized volume loss rather than uniform descent; and how these concepts translate into agent selection, injection plane, and technique. We also review the practical differences among HA, CaHA, PLLA, PMMA, collagen-based fillers, and fat, plus the major pearls in avoiding and managing vascular compromise, nodules, granulomas, and biofilm-related complications. This episode is grounded in the uploaded study guide and chapter source material. Key Takeaways High G′ fillers provide more structural support and lift; lower G′ fillers suit more superficial, mobile areas. Cross-linking is a major determinant of HA durability and in vivo stability. Facial aging is compartmentalized, so strategic revolumization can create indirect correction of adjacent deformities. Injection pattern, plane, needle/cannula choice, and dilution should match the filler’s rheology and target anatomy. Complication readiness matters: vascular compromise requires early recognition and aggressive management, especially with HA products. References [1] Kablik J, Monheit GD, Yu L, Chang G, Gershkovich J. Comparative physical properties of hyaluronic acid dermal fillers. Dermatol Surg. 2009;35 Suppl 1:302-312. doi:10.1111/j.1524-4725.2008.01046.x. PMID: 19207319. [2] Sundaram H, Voigts B, Beer K, Meland M. Comparison of the rheological properties of viscosity and elasticity in two categories of soft tissue fillers: calcium h...

Skin Resurfacing: Peels, Lasers, and Dermabrasion

Mar 14, 2026 19 min

https://plasticsinpractice.com/ Skin resurfacing is one of those topics that looks simple on the surface but gets very nuanced once you start thinking about depth, target tissue, endpoint recognition, and complication profile. In this episode, we break down the science of skin resurfacing in a way that actually matters for plastic surgery trainees. We cover the core anatomy behind resurfacing, why the dermal-epidermal junction matters, and how different modalities—chemical peels, dermabrasion, CO2 laser, Erbium:YAG, and fractional photothermolysis—produce different patterns of injury and healing. The real clinical question is not just what device or agent you use, but how deep you go, what problem you are treating, and what tradeoffs you accept. Wrinkle correction generally requires treatment through the DE junction into at least the papillary dermis, while deeper injury also increases the risk of scarring and permanent pigmentary change. Epidermal treatments target dyschromias, keratoses, and superficial actinic change. Wrinkle correction usually requires penetration through the DE junction into the papillary dermis. TCA, phenol/croton oil, dermabrasion, CO2, and Erbium:YAG all differ in mechanism, endpoint, and recovery. Fractionated resurfacing improves healing time by sparing intervening tissue, but may not match full-field CO2 for deep wrinkle effacement. Major complications include HSV reactivation, bacterial/fungal infection, hyperpigmentation, and permanent hypopigmentation. Barton FE. Skin resurfacing. In: Grabb and Smith’s Plastic Surgery. Chapter 41. Study Guide – Analysis of Skin Resurfacing Techniques and Clinical Applications. Uploaded source document. Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34:426. Hetter GP. An examination of the phenol-croton oil peel: Part I. Dissecting the formula. Plast Reconst...

Congenital Breast Anomalies: Tuberous, Poland, Asymmetry

Mar 14, 2026 22 min

https://plasticsinpractice.com/ Congenital breast anomalies are more than aesthetic diagnoses—they carry major psychosocial weight and demand a thoughtful reconstructive plan. In this episode, we break down the high-yield clinical framework for evaluating and surgically correcting congenital breast deformities, with a focus on tuberous breast deformity, developmental asymmetry, and Poland syndrome. This is the resident-level overview you actually want before clinic, consults, or conference: embryology, Tanner staging, classification systems, timing of intervention, and the operative principles that drive reconstruction. We cover why “improvement, not perfection” is the right counseling framework, why bilateral procedures are often necessary for symmetry, and how modern reconstruction increasingly incorporates fat grafting alongside implants, expanders, and autologous tissue transfer. Key Takeaways Breast development begins in utero and matures through Tanner staging, with most definitive reconstruction delayed until breast maturity around ages 16–18. Tuberous breast deformity is defined by base constriction, lower-pole deficiency, high/tight IMF, parenchymal hypoplasia, and possible areolar herniation. Grolleau classification remains the practical system for tuberous breast deformity planning. Poland syndrome classically involves absence of the sternocostal head of pectoralis major with variable breast, chest wall, and upper-extremity anomalies. Reconstruction is individualized: implants, tissue expansion, latissimus flap, free tissue transfer, and adjunctive fat grafting all have a role depending on severity. The surgical goal is balanced form and symmetry—not perfection. References Latham K, Fernandez S, Iteld L, Panthaki Z, Armstrong MB, Thaller S. Pediatric breast deformity. J Craniofac Surg. 2006;17(3):454-467. doi:10.1097/00001665-200605000-00012. PMID: 16770181. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child....

Nipple Reconstruction

Mar 12, 2026 20 min

https://plasticsinpractice.com/ Nipple reconstruction is not the “small final step” of breast reconstruction—it is the focal point. A great breast mound can be undermined by poor nipple position, poor projection, or a mismatch in size and symmetry. In this episode, we break down the high-yield principles that actually matter when planning and performing nipple-areola complex reconstruction. We cover how to mark the nipple thoughtfully rather than relying on rigid measurements alone, why patient input matters more than many residents realize, and how technique selection changes depending on whether the breast mound is autologous or implant-based. We also review local flap options, contralateral composite grafting, cartilage and acellular dermal matrix strategies, and the role of tattooing as both an adjunct and a stand-alone option. Most importantly, we discuss the unavoidable issue of projection loss and why initial overcorrection is often the smarter move. Built from the uploaded chapter and study guide on nipple reconstruction. Key Takeaways Nipple position is the most unforgiving variable in NAC reconstruction and often matters more than the flap design itself. Local flaps remain the workhorse, especially in autologous reconstruction with adequate soft tissue. Expect projection loss over time; deliberate overcorrection is usually necessary. Prosthetic reconstruction often requires alternative strategies such as grafts, cartilage, ADM, or tattoo-only reconstruction. Tattooing is not just cosmetic finishing—it significantly affects final patient satisfaction. References Fuentes PM, Langstein HN. A review of nipple-areola complex reconstruction and tattooing in postmastectomy breast reconstruction. Gland Surg. 2026;15(1):29-43. PMID: 41668920. Paolini G, Amoroso M, Pugliese P, et al. Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm. Aesthetic Plast Surg. 2021;45(3):933-945. doi:10.1007/s00266-020...

Free Flap Breast Reconstruction

Mar 11, 2026 20 min

https://plasticsinpractice.com/ Free flap breast reconstruction is one of the most technically demanding and rewarding procedures in reconstructive microsurgery. In this episode, we break down flap selection, donor-site strategy, recipient vessel choice, perfusion monitoring, and the key complications every plastic surgery resident needs to know. We focus on why the abdomen remains the preferred donor site for most patients, how DIEP, free TRAM, and SIEA differ in muscle preservation and vascular reliability, and when to move to secondary donor sites like SGAP, IGAP, or TUG/TMG. We also review why the internal mammary system is usually the recipient vessel of choice, how CTA/MRA improves preoperative planning, and how NIR spectroscopy and indocyanine green angiography can improve early detection of vascular compromise. Success in these cases is not just about anastomosis—it is about planning, judgment, and flap-specific decision making. Key Takeaways DIEP offers strong abdominal wall preservation but requires meticulous perforator dissection. Free TRAM may improve perfusion while sacrificing more muscle than DIEP. SIEA avoids fascia violation but is anatomically feasible in only a minority of patients. Internal mammary vessels typically provide superior flow and positioning flexibility versus thoracodorsal vessels. CTA/MRA helps identify dominant perforators and streamline operative planning. Postop monitoring is critical, since early detection drives flap salvage. Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #BreastReconstruction #FreeFlap #DIEPFlap #TRAMFlap #Microsurgery #ReconstructiveSurgery #PlasticSurgeryResident #SurgicalEducation #AutologousReconstruction 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-res...

TRAM Flap Breast Reconstruction

Mar 10, 2026 21 min

https://plasticsinpractice.com/ Pedicled or free TRAM? This is one of the classic decision points in autologous breast reconstruction, and it still matters. In this episode, we break down the practical tradeoffs between pedicled TRAM, free TRAM, and DIEP-based thinking: flap perfusion, donor-site morbidity, operative complexity, and patient selection. For residents, this is the real question: when should you preserve muscle, when should you prioritize perfusion, and when is the “simpler” flap actually the smarter flap? We walk through the muscle-sparing classification, high-risk patient considerations, recipient vessel choices, and the aesthetic plus functional consequences that actually drive decision-making in the OR. Key Takeaways Pedicled TRAM prioritizes reliability, speed, and technical simplicity. Free TRAM offers improved perfusion and is often better for obese or heavy-smoking patients. DIEP minimizes muscle sacrifice, but fewer perforators can increase flap-related risk in selected cases. Larger flaps or smaller perforators may push decision-making toward muscle-sparing free TRAM rather than DIEP. Donor-site morbidity tracks closely with muscle and fascia sacrifice, but muscle preservation is not the only variable that matters. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #BreastReconstruction #TRAMFlap #DIEPFlap #Microsurgery #PRS #PlasticSurgeryResident #AutologousBreastReconstruction References Nahabedian MY, Momen B, Galdino G, Manson PN. Breast reconstruction with the free...

Inservice Review - High Yield

Mar 4, 2026 1 hr 10 min

https://plasticsinpractice.com/ This long-form episode is a high-yield, start-to-finish in-service review. We cover the main topics: core principles → wounds/flaps/grafts → burns/skin cancer → CMF trauma + vision threats → hand infections/tendon zones → breast/implants + complications → trunk/LE coverage logic → last-minute algorithms. #PlasticSurgery #PSITE #InService #PlasticsInPractice #SurgeryResident #BoardPrep #Microsurgery #HandSurgery #Craniofacial 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ References: Blumetti J, Hunt JL, Arnoldo BD, et al. The Parkland formula under fire: is the criticism justified? J Burn Care Res. 2008;29(1):180-186. PMID: 18182919. doi:10.1097/BCR.0b013e31815f3876. Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN Consensus Guidelines on the Diagnosis and Treatment of Breast Implant-Associated ALCL. Aesthet Surg J. 2019;39(Suppl_1):S3-S13. PMID: 30715173. doi:10.1093/asj/sjy331. Hopkins PM, Rüffert H, Snoeck MMJ, et al. Malignant hyperthermia 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2021;76(5):655-664. PMID: 33399225. doi:10.1111/anae.15317. Joyce KM, Joyce CW, Jones DP, et al. Surgical Management of Melanoma. In: StatPearls [Internet]. 2017–. PMID: (see NCBI entry). Kennedy CD, Huang JI, Hanel DP. In Brief: Kanavel’s Signs and Pyogenic Flexor Tenosynovitis. Clin Orthop Relat Res. 2016;474(1):280-284. PMID: 26022113. doi:10.1007/s11999-015-4367-x. Safety Committee of Japanese Society of Anesthesiologists. Practical guide for management of systemic toxicity caused by local anesthetics. J Anesth. 2019;33(1):1-8. PMID: 30417244. d...

Latissimus Dorsi Flap Breast Reconstruction

Feb 25, 2026 16 min

https://plasticsinpractice.com/ Autologous reliability with prosthetic precision—the latissimus dorsi flap (LDF) is back for a reason. In this episode we break down how to optimize LD flap breast reconstruction using “volume-added” harvest and smart expander/implant strategy. We cover the operative setup from markings and skin paddle design to subfascial dissection to capture deep fat, high axillary tunneling, and inset strategies that improve contour while protecting the pedicle. We also clarify when to use expander as an intelligent spacer vs. immediate implant—and how Stage 2 refinement (4–6 months) improves final implant selection and symmetry. Key Takeaways: Markings: center the skin island on the muscle; align to relaxed skin tension lines to reduce ugly scars. Volume-added harvest: stay just under thoracic fascia to bring deep fat for better mastectomy-edge camouflage. Preserve lateral contour: respect the upper anterior “zone of adherence;” tunnel high in the axilla. Protect perfusion: keep serratus branch intact—critical collateral if thoracodorsal is compromised. Seroma is the enemy: quilting/progressive tension sutures + drains can reduce chronic drainage. Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #BreastReconstruction #LatissimusDorsiFlap #Microsurgery #PRS #Residency Links:🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ References : Hammond DC, Loffredo MA. Latissimus Dorsi Flap Breast Reconstruction. In: [Chapter 60]. Rios J, Adams WP, Pollock T. Progressive tension sutures to decrease latissimus donor site serom...

Prosthetic Breast Reconstruction

Feb 19, 2026 13 min

https://plasticsinpractice.com/ Prosthetic breast reconstruction looks “simple” until you chase symmetry, fight the inframammary fold, and add radiation into the mix. This episode is a practical walkthrough of the two-stage expander–implant pathway—what actually matters, what fails, and how to plan it cleanly. Episode overview We cover patient selection, immediate vs delayed timing, modern biodimensional expanders, the expansion protocol, and the exchange operation with an emphasis on IMF positioning, inferior pole projection/ptosis, and strategies to optimize symmetry. We also break down ADM use (what it helps, what it costs), and why radiation changes complication risk and revision rates. Key takeaways: Ideal implant candidates: thin, bilateral, or thin unilateral with a nonptotic contralateral breast. Expansion pearls: start ~10–14 days, fill 30–120 mL per visit; overexpand ~25–30% to build skin for ptosis/projection. ADM: enables larger initial fills and pocket control, but can increase seroma and infection-related failure. Exchange: measure base width/height/projection; IMF definition is the highest-leverage step. Radiation: higher capsular contracture/complication rates—plan sequencing and counsel hard. Links Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Apple: https://podcasts.apple.com/us/podcast/plastics-in-prac Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #PlasticSurgery #BreastReconstruction #Microsurgery #SurgicalEducation #Residency #TissueExpander #ImplantReconstruction #ADM #Oncoplastic #PRS References: Antony AK, McCarthy CM, Cordeiro PG, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions. Plast Reconstr Surg. 2010;125(6):1606-1614. PMID: 20517083. Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant...

Management of Breast Cancer

Feb 15, 2026 15 min

https://plasticsinpractice.com/ Breast cancer management isn’t “mastectomy vs lumpectomy.” It’s risk → imaging → tissue diagnosis → staging → locoregional control → systemic therapy, all tailored to tumor biology and patient goals. In this episode, we walk through the modern evidence base that moved us from Halsted-era radical surgery to breast-conserving therapy + targeted systemic therapy, while keeping oncologic safety front and center. Key takeaways: Screening: Average risk = annual mammography starting at 40; high-risk patients may add MRI starting ~30. Pathology framework: DCIS (basement membrane) vs LCIS (risk marker) vs invasive (ductal most common; lobular often occult on mammo). Breast conservation: Lumpectomy with negative margins + RT achieves survival comparable to mastectomy; RT dramatically improves local control. Axilla: SLNB is standard staging in early disease with lower morbidity; many patients avoid completion ALND depending on criteria + adjuvant RT. Systemic therapy: Endocrine therapy and targeted agents reduce recurrence risk—selection is tumor-marker driven. Disclaimer: This content is for educational purposes only and is not medical advice. #BreastCancer #BreastSurgery #PlasticSurgery #GeneralSurgery #Oncoplastic #SurgicalOncology #Residency #SLNB #DCIS #Mastectomy Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Apple: https://podcasts.apple.com/us/podcast/plastics-in-prac Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ Citations (AMA): Saslow D, Boetes C, Burke W, et al. CA Cancer J Clin. 2007;57(2):75-89. doi:10.3322/canjclin.57.2.75. PMID:17392385. Fisher B, Redmond C, Poisson R, et al. N Engl J Med. 1989;320(13):822-828. PMID:2927449. Clarke M, Collins R, Darby S, et al. Lancet. 2005;366(9503):2087-2106. doi:10.1016/S0140-6736(05)67887-7. PMID:16360786. Giuliano AE, Hunt KK, Ballman KV, et al....

Gynecomastia Management

Feb 11, 2026 13 min

https://plasticsinpractice.com/ Gynecomastia isn’t “just fat.” It’s a spectrum—ductal tissue, stroma, and fat—driven by hormonal shifts across life stages. In this episode, we walk through a clean clinical framework: etiology → pathology timeline → exam/workup → severity grading → surgical plan, with pearls that prevent the most common aesthetic failures. We cover when you can stop the workup, how to interpret florid vs fibrous disease by duration, and how Simon grading dictates whether you’re doing lipo, excision, pull-through, or formal skin resection. Then we get practical: incision placement, contour strategy, compression, drains, and how to avoid the nightmare complications—hematoma, under-resection, and the classic subareolar “saucer” deformity. Key takeaways Gynecomastia peaks in neonatal, adolescent, and >65 age groups—think T:E ratio shift. Pathology tracks duration: florid 1 yr. Simon grade guides skin management—2b often deserves time + compression before skin excision. Preserve a 1–1.5 cm subareolar cuff to prevent NAC adherence/depression. If lipo leaves a residual “bud,” add pull-through (don’t accept under-resection). Citations (AMA) Rohrich RJ, Ha RY, Kenkel JM, Adams Wand management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. 2003;111(2):909-923. doi:10.1097/01.PRS.0000042146.40379.25. PMID:12560721. Hammond DC. Surgical correction of gynecomastia. Plast Reconstr Surg. 2009;124(1 Suppl):61e-68e. doi:10.1097/PRS.0b013e3181aa2dc7. PMID:19568140. Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973;51(1):48-52. doi:10.1097/00006534-197301000-00009. PMID:4687568. Hammond DC, Arnold JF, Simon AM, Capraro PA. Combined use of ultrasonic liposuction with the pull-through technique for the treatment of gynecomastia. Plast Reconstr Surg. 2003;112(3):891-895. doi:10.1097/01.PRS.0000072254.75067.F7. PMID:12960873. Disclaimer: This content is for ed...

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Podcast details

Created by: Plastics in Practice
Status: Active
Latest episode: Oct 18, 2026
Episodes: 75
Release period: Several times a week
Avg. episode length: 20 min
Explicit: No
Language: English

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