Plastics in Practice (Resident Review)

In this episode of Plastics in Practice, we break down one of the most enduring debates in reconstructive microsurgery: Muscle vs. Fasciocutaneous (FC) flaps for lower limb trauma. For decades, residents were taught that muscle was mandatory for open fractures and osteomyelitis due to its superior vascularity and dead-space obliteration. But does the modern evidence support this?We analyze...

Foot and ankle reconstruction is a battlefield of function and form. Every subunit has its own demands — the dorsum needs thin, pliable coverage; the heel demands durable, glabrous-like skin. In this landmark PRS 2010 paper, Hollenbeck et al. applied the subunit principle to 165 free flaps, giving surgeons a blueprint for tailored, long-term reconstruction success.Summary:This episode breaks down...

Orbital floor fractures are among the most common midfacial injuries—and understanding when and how to operate is key for every resident. In this episode, we break down the anatomy, evaluation, and evidence-based management of orbital blowout fractures, based on Gart & Gosain’s Plastic and Reconstructive Surgery 2014 review.We cover:Mechanisms — buckling vs. hydraulic theory, and why both...

Mandible fractures are the most common indication for surgical repair of facial fractures, and their management continues to evolve with modern plating systems and imaging. In this episode of Plastics in Practice, we break down the key anatomy, causes, diagnostic pearls, and surgical strategies you need to know for the boards and the operating room.We start with the anatomy of the mandible — from...

Frontal sinus fractures are among the most challenging maxillofacial injuries — rare but high-stakes, with potential for meningitis, brain abscess, and lifelong sinus complications if mismanaged. In this episode of Plastics in Practice, we break down the stepwise algorithm for diagnosis and management of frontal sinus trauma.We’ll walk through the embryology and anatomy that make these fractures...

Zygoma fractures are among the most common midfacial injuries, directly impacting both function and aesthetics. For plastic surgery residents, mastering the anatomy, evaluation, and surgical management of these fractures is essential.In this episode of Plastics in Practice, we break down the essentials of zygoma fractures. From the quadripod anatomy of the zygomaticomaxillary complex to the...

Middle and distal leg defects can be among the most challenging reconstructive problems in plastic surgery. But what if you could avoid microsurgery and still achieve reliable “like-with-like” coverage?In this episode, we break down the principles, technique, and outcomes of perforator propeller flaps for lower extremity reconstruction. Drawing from the landmark PRS Global Open article by...

When faced with high-energy lower extremity trauma, the question of salvage versus amputation is one of the toughest decisions in reconstructive surgery. This episode breaks down the evidence and provides practical pearls for plastic surgery residents and trainees.We walk through the landmark LEAP study and subsequent meta-analyses comparing functional outcomes between limb salvage and early...

Lower extremity reconstruction is one of the most challenging areas of plastic surgery, where surgeons must decide between limb salvage and primary amputation. This episode breaks down the principles from the PRS CME article by Reddy and Stevenson, giving residents and fellows a clear roadmap for evaluation, decision-making, and flap selection.We start with preoperative assessment: patient...

Major upper extremity amputation is one of the most devastating injuries a patient can face. Unlike lower extremity amputations where prosthetics may restore function, the upper limb remains uniquely challenging. That’s why every effort should be made to replant the amputated extremity. But replantation is only the beginning — secondary reconstructive surgery is often required to optimize...