Tissue Surgery - part 1 potx

ZiX# ^c i]^h ejWa^XVi^dc YdZh cdi ^bean!. lVh cdi b^haZVY^c\# Bn \dVa lVh id ÑcY XgZVi^kZ Xdc" ig^Wjidghl^aa^c\idh]VgZi]Z^gcdkZaiZX]c^fjZh!l]^aZVii]ZhVbZi^bZZchjg^c\i]Vi i]Z iZX]c^fjZh l

CZlIZX]c^fjZh^cI^hhjZHjg\Zgn

BVg^VO#H^Zb^dcdl :Y

Tissue Surgery

L^i]&%%;^\jgZh

9^gZXidgd[EaVhi^XHjg\ZgnGZhZVgX]

=ZVY!B^Xgdhjg\ZgnIgV^c^c\

9ZeVgibZcid[EaVhi^XHjg\Zgn

I]Z8aZkZaVcY8a^c^X;djcYVi^dc

8aZkZaVcYD=

JH6

7g^i^h]A^WgVgn8ViVad\j^c\^cEjWa^XVi^dc9ViV

6XViVad\jZgZXdgY[dgi]^hWdd`^hVkV^aVWaZ[gdbi]Z7g^i^h]A^WgVgn

A^WgVgnd[8dc\gZhh8dcigdaCjbWZg/'%%*.'-&,+

>H7C"&%/&"-*'((".,%"*  

Z">H7C/&"-)+'-"&'-"-

>H7C"&(/.,-"&"-*'((".,%"-Eg^ciZYdcVX^Y"[gZZeVeZg

Heg^c\Zg"KZgaV\AdcYdcA^b^iZY'%%+

6eVgi[gdbVcn[V^gYZVa^c\[dgi]ZejgedhZhd[gZhZVgX]dgeg^kViZhijYn!dgXg^i^X^hbdggZk^Zl!VheZgb^iiZY jcYZgi]Z8deng^\]i!9Zh^\chVcYEViZcih6Xi&. !i]^hejWa^XVi^dcbVndcanWZgZegdYjXZY!hidgZYdgigVch" b^iiZY!^cVcn[dgbdgWnVcnbZVch!l^i]i]Zeg^dgeZgb^hh^dc^clg^i^c\d[i]ZejWa^h]Zgh!dg^ci]ZXVhZd[ gZegd\gVe]^XgZegdYjXi^dc^cVXXdgYVcXZl^i]i]ZiZgbhd[a^XZcXZh^hhjZYWni]Z8deng^\]iA^XZch^c\6\ZcXn# :cfj^g^ZhXdcXZgc^c\gZegdYjXi^dcdjih^YZi]dhZiZgbhh]djaYWZhZciidi]ZejWa^h]Zgh#

I]Z jhZ d[ gZ\^hiZgZY cVbZh! igVYZbVg`h! ZiX# ^c i]^h ejWa^XVi^dc YdZh cdi ^bean! ZkZc ^c i]Z VWhZcXZ d[ V heZX^ÑXhiViZbZci!i]VihjX]cVbZhVgZZmZbei[gdbi]ZgZaZkVciaVlhVcYgZ\jaVi^dchVcYi]ZgZ[dgZ[gZZ[dg

\ZcZgVajhZ#

EgdYjXi a^VW^a^in/ I]Z ejWa^h]Zg XVc \^kZ cd \jVgVciZZ [dg ^c[dgbVi^dc VWdji Ygj\ YdhV\Z VcY Veea^XVi^dc i]ZgZd[XdciV^cZY^ci]^hWdd`#>cZkZgn^cY^k^YjVaXVhZi]ZgZheZXi^kZjhZgbjhiX]ZX`^ihVXXjgVXnWnXdchjai"

^c\di]Zge]VgbVXZji^XVaa^iZgVijgZ#

Eg^ciZY^ci]ZH^c\VedgZ  7H$@ND

. - , + * ) ( ' &

Heg^c\ZgHX^ZcXZ7jh^cZhhBZY^V

heg^c\Zgdca^cZ#Xdb

v

>lVhkZgnZci]jh^Vhi^Xl]Zc>lVhVeegdVX]ZY^cCdkZbWZg'%%)idZY^iVWdd`dci^hhjZ

hjg\Zgn^ci]ZCZlIZX]c^fjZh^cHjg\ZgnhZg^Zh#>lVhXdck^cXZYi]Vi^ildjaYWZ\gZVi

id]VkZVWdd`^cVXdaaZXi^dci]VihdZaZ\Vcianh]dlhi]Zegd\gZhh^cdjgjcYZghiVcY^c\! ]VcYa^c\!VcYVeegdVX]idY^[[ZgZciineZhd[i^hhjZh#I]Z\gZViZhiX]VaaZc\ZlVhidZchjgZ

i]Vi i]Z i^iaZ! CZl IZX]c^fjZh! lVh cdi b^haZVY^c\# Bn \dVa lVh id ÑcY XgZVi^kZ Xdc"

ig^Wjidghl^aa^c\idh]VgZi]Z^gcdkZaiZX]c^fjZh!l]^aZVii]ZhVbZi^bZZchjg^c\i]Vi i]Z iZX]c^fjZh lZgZ je"id"YViZ Vi i]Z i^bZ d[ ejWa^XVi^dc# Id VX]^ZkZ i]^h \dVa! Wdd` egdYjXi^dcXdjaYcdiZmXZZYdcZnZVgVcYi]ZXdcig^Wjidgh]VYidXdbb^iidh]VgZi]Z^g bdhi ^ccdkVi^kZ VeegdVX]Zh id i^hhjZ hjg\Zgn l]^aZ bV^ciV^c^c\ hX]ZYjaZY YZVYa^cZh# I]^h lVh V X]VaaZc\^c\ iVh`! Wji bn XdaaVWdgVi^kZ Z[[dgih ^c i]Z ÑZaY dkZg eVhi YZXVYZ ZcVWaZYbZidÑcYXgZVi^kZVcYhjeedgi^kZhjg\Zdchl]dbZii]dhZgZfj^gZbZcih#;^cVaan! i]Z egZhZciVi^dc d[ cZl iZX]c^fjZh ^c hjg\Zgn ]VY id WZ hjeedgiZY Wn i]Z ZmeZg^ZcXZ VcYgZejiVi^dcd[i]Zhjg\Zdchl]d^cigdYjXZYi]Zb#

I]Zi^iaZd[i]ZWdd`!I^hhjZHjg\Zgn!ZcXdbeVhhZYYZhXg^ei^dchd[Y^[[ZgZcihjg\^XVa

egdXZYjgZh eZg[dgbZY dc V kVg^Zin d[ i^hhjZ ineZh Wn ZmeZgih ^c i]Z ÑZaYh d[ eaVhi^X hjg\Zgn! dgi]deZY^X hjg\Zgn! ]VcY hjg\Zgn! Zhi]Zi^X hjg\Zgn! VcY \ZcZgVa hjg\Zgn# I]Z ilZakZX]VeiZghVgZVggVc\ZYhdi]ViVY^gZXia^c`Zm^hihWZilZZci]ZgZXZcianZhiVWa^h]ZY egdXZYjgZh VcY VaiZgcVi^kZ hjg\^XVa dei^dch# Dei^dch i]Vi VgZ iZX]c^XVaan edhh^WaZ VcY ZmeZg^bZciVaanegdkZc!WjicdiVeea^ZYXa^c^XVaandcVgdji^cZWVh^hdgZkZcÄVh^ci]Z XVhZd[[VXZigVcheaVci"cdieZg[dgbZYVii]^hbdbZci#

I]ZÑghii]gZZX]VeiZghhjbbVg^oZcZliZX]c^XVaX]VaaZc\Zh^cgZeV^gVcYgZhidgVi^dc d[[jcXi^dcl^i]^ckZgnheZX^Va^oZYXdbedh^iZi^hhjZh!hjX]Vhi]Zi]dhZd[i]Z]VcYdg i]ZaZ\#8]VeiZg&hjbbVg^oZhi]ZVji]dgÈhjc^fjZXdcXZeiVcYZmeZg^ZcXZl^i]dgi]d" eaVhi^X hjg\Zgn Vh Veea^ZY id a^bW hVakV\Z egdXZYjgZh# 8]VeiZg ' ^cigdYjXZh Xa^c^XVa Veea^XVi^dcd[Xdbedh^iZi^hhjZVaad\gV[iigVcheaVcih!hjX]Vhi]Z]jbVc]VcY!VWYdb^" cValVaa!`cZZ!aVgncm!igVX]ZV!cZgkZ!iZcYdcbjhXaZ!VcYidc\jZ#BZX]Vc^hbd[VXi^dc d[Y^[[ZgZci^bbjcdhjeegZhh^kZgZ\^bZchVcYi]Z^gh^YZZ[[ZXihVgZY^hXjhhZY#8]VeiZg ( ^cigdYjXZh kZghVi^aZ kVhXjaVg Xdbedh^i^dc d[ hbVaa ^cig^ch^X ÒVeh l^i]^c i]Z ]VcY Veea^ZY[dgdcZ"hiV\ZXdkZgV\Zd[adXVa]VcYYZ[ZXihl^i]i]ZVYkVciV\Zd[ZVganVXi^kZ bdW^a^oVi^dc#

I]Zc! 8]VeiZg ) jc^fjZ YZhXg^WZh i]Z ^ciZ\g^in VcY bdW^a^in d[ i]Z hjWXjiVcZdjh i^hhjZha^Y^c\hnhiZb#>iYZhXg^WZhi]ZVji]dgÈheZghdcVaZmeZg^ZcXZVcYe]^adhde]ndc ]dlY^[[ZgZcii^hhjZineZh^cdjgWdYnVgZ^ciZgXdccZXiZYVcY^ciZgYZeZcYZci^ci]Z^g [jcXi^dc#I]ZVji]dgc^XZanZmZbea^ÑZhi]^hgZaVi^dch]^eWnegZhZci^c\i]Zjc^fjZdg\V" c^oVi^dcd[i]Zbjai^b^XgdkVXjdaVgVWhdgW^c\ha^Y^c\hnhiZb#I]ZgdaZd[i]^hhnhiZb^c IZcYdci^hhjZhjg\Zgn!^cXajY^c\]jbVciZcYdcVaad\gV[iigVcheaVciVi^dc!^hegZhZciZY# 8]VeiZg*^hYZkdiZYidi]ZgZhidgVi^dcd[cZgkZ[jcXi^dcjh^c\cdkZaVeegdVX]ZhVcY

^cY^XVi^dch[dgeVi^Zcihl^i]Y^VWZi^XcZjgdeVi]negdWaZbhVcYeVi^Zcihl^i]Vc`aZVcY h]djaYZgeV^chncYgdbZh#I]ZVji]dgh^cigdYjXZi]Z^gYZcZgkVi^dciZX]c^fjZ[dgeVi^Zci l^i]iZbedgdbVcY^WjaVg_d^ciegdWaZbh#

8]VeiZg+djia^cZhb^c^bVaan^ckVh^kZiZX]c^fjZhVeea^ZY[dgeZg^e]ZgVacZgkZegdW" aZbh^ci]ZjeeZgZmigZb^in#9^[[ZgZcicZgkZXdbegZhh^dchncYgdbZhVgZYZbdchigViZY k^VZcYdhXden!VhVgZi]ZgZhjaihd[ZcYdhXde^XVaanVhh^hiZYYZXdbegZhh^dc#8]VeiZg, egZhZciÈhVhde]^hi^XViZYVeegdVX]ideZg[dgVidgÒVehjg\ZgnVcY^iÈhVeea^XVi^dcidY^[" [ZgZci i^hhjZh ineZh# I]Z Vji]dgÈh \dVa ^h id VX]^ZkZ i]Z WZhi VZhi]Zi^X djiXdbZ l]^aZ b^c^b^o^c\Ydcdgh^iZbdgW^Y^in#8]VeiZg-ZbWVg`hdcVhZVgX]idgZYjXZi]Zg^h`hd[ [gZZÒVe[V^ajgZ#BZi]dYhd[ÒVeXdcY^i^dc^c\VcY]VcYa^c\VgZegZhZciZYWVhZYdci]Z Vji]dghÈWVh^XhX^ZcXZZmeZg^ZcXZ#

8]VeiZgh.VcY&%djia^cZXjggZcihjg\^XVaiZX]c^fjZhVeea^ZYidi]Zbdhi^bedgiVci dg\Vc^cdjgWdYnÄi]Z]jbVc[VXZ#>c8]VeiZg.!iZX]c^fjZhd[[VXZgZ_jkZcVi^dc!l^i] cdkZaVeegdVX]ZhidVkVg^Zind[X]VaaZc\^c\eVi^ZciedejaVi^dch^cXajY^c\edhiWVg^Vig^X hjg\Zgn VcY =>K$6>9H eVi^Zcih! VgZ egZhZciZY# >c XdcigVhi id igVY^i^dcVaan VXXZeiZY VeegdVX]Zh!hjX]VhZhi]Zi^Xhjg\Zgn!8]VeiZg&%egZhZcihdjgegZeVgVi^dc[dgi]Zbdhi X]VaaZc\^c\egdXZYjgZ^ci^hhjZhjg\ZgnÄi]Z]jbVc[VXZigVcheaVciVi^dc#

8]VeiZgh&&VcY&'hjbbVg^oZi]ZbdhiXjggZciVeegdVX]Zhidi^hhjZZc\^cZZg^c\VcY hiZbXZaaWVhZYi]ZgVe^Zh#I]ZegdhVcYXdchd[Xa^c^XVaanVeean^c\Vgi^ÑX^Vai^hhjZXdc" higjXih VgZ egZhZciZY# BZi]dYh d[ hiZb XZaa bVc^ejaVi^dch VcY egdeV\Vi^dc ^cid i]Z Y^[[ZgZcii^hhjZineZh[dg]ZVa^c\VcYgZ\ZcZgVi^dcVgZY^hXjhhZY#

>]deZi]Vii]^hWdd`l^aacdidcan^cigdYjXZcZlbZi]dYhVcYiZX]c^fjZh^ci^hhjZ hjg\Zgn! Wji l^aa Vahd hi^bjaViZ e]^adhde]^XVa VcY Zi]^XVa Y^hXjhh^dch dc djg [jijgZ VeegdVX]Zh VcY a^b^iVi^dch ^c hjg\Zgn# BVnWZ lZ VgZ l^icZhh^c\ V bV_dg X]Vc\Z ^c i]Z ÑZaY d[ i^hhjZ hjg\Zgn VcY lZ l^aa WZ VWaZ! ^c i]Z cZVg [jijgZ! id eVgVe]gVhZ i]Z

:XXaZh^VhiZhVe]dg^hbi]ViÅI]ZgZ^hhdbZi]^c\cZljcYZgi]Zhjc#Æ

vii

 & Dgi]deaVhi^XGZXdchigjXi^dcd[i]Z6gbhVcYAZ\h

 A#HXdiiAZk^c # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # &

 ' 8a^c^XVa6eea^XVi^dcd[8dbedh^iZI^hhjZ6aad\gV[ih

 BVg^VO#H^Zb^dcdl!HV`^gJcVaVcY<Va^e6\Vd\aj # # # # # # # # # # # # # # # # # # # # # # &&

 ( 6YkVcXZY8dcXZeih^cKVhXjaVg^oZYI^hhjZIgVch[Zg^ci]Z=VcY

 =da\Zg:c\ZaVcY<“ciZg<ZgbVcc # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # #  '(

 ) HjWXjiVcZdjhI^hhjZ;jcXi^dc/I]ZBjai^b^XgdkVXjdaVg6WhdgW^c\

 ?ZVc8aVjYZ<j^bWZgiZVjVcY?dhZe]7V`]VX] # # # # # # # # # # # # # # # # # # # # # # # # # # )&

 * >ccdkVi^dch^cEZg^e]ZgVaCZgkZHjg\Zgn

 8]g^hide]ZgI#BVadcZn!?g#VcY6#AZZ9Zaadc# # # # # # # # # # # # # # # # # # # # # # # # # # # # **

 + B^c^bVaan>ckVh^kZVcY:cYdhXde^XIZX]c^fjZh^cEZg^e]ZgVa

 GZ^bZg=d[[bVcc # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # #  ,&

 , Hd[iI^hhjZGZXdchigjXi^dcl^i]EZg[dgVidg;aVeh

 E]^aa^eC#7adcYZZa# # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # -,

 - GZbdiZ>hX]Zb^XEgZXdcY^i^dc^c\d[;aVeh/8jggZci8dcXZeih

 BVg`jhK#@“cihX]Zg!7ZgcY=VgibVccVcY<“ciZg<ZgbVcc # # # # # # # # # # # # #  (

  6YkVcXZh^c;VX^Va6Zhi]Zi^XHjg\Zgn/CZl6eegdVX]Zhid

 ?VbZh:#O^chVcY6cYgZVBdgZ^gV"<dcoVaZo # # # # # # # # # # # # # # # # # # # # # # # # # # # # &%&

&% EZgheZXi^kZh[dg;VX^Va6aad\gV[iIgVcheaVciVi^dc^c=jbVch

 BVg^VO#H^Zb^dcdlVcY<Va^e6\Vd\aj # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # &&

&& I^hhjZ:c\^cZZg^c\/8jggZci6eegdVX]ZhVcY;jijgZ9^gZXi^dch

 6b^g=#6_VgVcY<gZ\dgnG#9#:kVch # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # &(*

&' I]ZGdaZd[HiZb8Zaah^cEaVhi^XHjg\Zgn

 BVg^VO#H^Zb^dcdlVcYHZaV]Vii^cyobZc # # # # # # # # # # # # # # # # # # # # # # # # # #  &)(

>cYZm # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # #  &*

?ZVc8aVjYZ<j^bWZgiZVj!B9

>chi^iji6fj^iV^c8]^gjg\^ZEaVhi^fjZ! EZhhVX!7dgYZVjm!;gVcXZ

7ZgcY=VgibVcc!B9 7jgc8ZciZg$9ZeVgibZci[dgEaVhi^X Hjg\Zgn!Jc[Vaa`gVc`Zc]Vjh7Zga^c! 7Zga^c!<ZgbVcn

GZ^bZg=d[[bVcc!B9

@a^c^`[“gEaVhi^hX]Z8]^gjg\^ZjcY

=VcYX]^gjg\^Z!:kVc\Za^hX]Zh

@gVc`Zc]VjhDaYZcWjg\!DaYZcWjg\!

<ZgbVcn BVg`jhK#@“cihX]Zg!B9!E]9 7jgc8ZciZg$9ZeVgibZci[dgEaVhi^X Hjg\Zgn!Jc[Vaa`gVc`Zc]Vjh7Zga^c!7Zga^c!

<ZgbVcn A#HXdiiAZk^c!B9!;68H 9^k^h^dcd[EaVhi^X!GZXdchigjXi^kZ BVm^aad[VX^VaVcYDgVaHjg\Zgn!9j`Z Jc^kZgh^inBZY^XVa8ZciZg!9jg]Vb!C8! JH6

8]g^hide]ZgI#BVadcZn!?g#!B9 9ZeVgibZcid[EaVhi^XHjg\Zgn!

CZjgdhjg\ZgnVcY6cVidbn!

Jc^kZgh^ind[6g^odcV!IjXhdc!6O! JH6

6cYgZVBdgZ^gV"<dcoVaZo!B9 9ZeVgibZcid[EaVhi^XHjg\Zgn!I]Z 8aZkZaVcY8a^c^X;djcYVi^dc!

8aZkZaVcY!D=!JH6

9ZeVgibZcid[EaVhi^X!

GZXdchigjXi^kZVcY6Zhi]Zi^XHjg\Zgn!

<Vo^Jc^kZgh^in;VXjaind[BZY^X^cZ! 6c`VgV!Ijg`Zn

ix

<Va^e6\Vd\aj!B9

9ZeVgibZcid[EaVhi^XHjg\Zgn!I]Z

8aZkZaVcY8a^c^X;djcYVi^dc!

8aZkZaVcY!D=!JH6

6b^g=#6_Vg!B9

6Zhi]Zi^XVcYEaVhi^XHjg\Zgn>chi^ijiZ!

Jc^kZgh^ind[8Va^[dgc^V!>gk^cZ!DgVc\Z!

86.'-+-!JH6

?dhZe]7V`]VX]!B9

>chi^iji6fj^iV^c8]^gjg\^ZEaVhi^fjZ!

EZhhVX!7dgYZVjm!;gVcXZ

E]^aa^eC#7adcYZZa!B9!E]9

9ZeVgibZcid[EaVhi^XVcYGZXdchigjXi^kZ

Hjg\Zgn!Jc^kZgh^in=dhe^iVa<Zci!

7Za\^jb

6#AZZ9Zaadc!B9

>chi^ijiZ[dgEZg^e]ZgVaCZgkZHjg\Zgn!

>cX#!7Vai^bdgZ!B9!JH6

=da\Zg:c\Za!B9

9ZeVgibZcid[=VcY!EaVhi^XVcY

GZXdchigjXi^kZHjg\Zgn!7jgc8ZciZg!

7<"IgVjbV!8ZciZgAjYl^\h]V[Zc!

Jc^kZgh^ind[=Z^YZaWZg\!

AjYl^\h]V[Zc!<ZgbVcn

<gZ\dgnG#9#:kVch!B9!;68H

I]Z8ZciZg[dg7^dbZY^XVa:c\^cZZg^c\

VcY6Zhi]Zi^XVcYEaVhi^XHjg\Zgn

>chi^ijiZ!Jc^kZgh^ind[8Va^[dgc^V!

>gk^cZ!86!JH6

<“ciZg<ZgbVcc!B9!E]9

9ZeVgibZcid[=VcY!EaVhi^XVcY

GZXdchigjXi^kZHjg\Zgn!7jgc8ZciZg!

7<"IgVjbV!8ZciZgAjYl^\h]V[Zc!

Jc^kZgh^ind[=Z^YZaWZg\!

AjYl^\h]V[Zc!<ZgbVcn

9ZeVgibZcid[EaVhi^XHjg\Zgn!I]Z

8aZkZaVcY8a^c^X;djcYVi^dc!8aZkZaVcY

D=!JH6

HV`^gJcVa!B9

9ZeVgibZcid[EaVhi^XHjg\Zgn!

I]Z8aZkZaVcY8a^c^X

;djcYVi^dc!8aZkZaVcY!D=!

JH6

?VbZh:#O^ch!B9 9ZeVgibZcid[EaVhi^XHjg\Zgn!

I]Z8aZkZaVcY8a^c^X;djcYVi^dc! 8aZkZaVcY!D=!JH6

7nYZÑc^i^dc!VeVi^ZcihjhiV^c^c\VcdeZc[gVX"

ijgZ ^c Vc Vgb dg aZ\ ]Vh V hd[i i^hhjZ ^c_jgn!

VhlZaaVhVWdcn^c_jgn#I]ZhZild^c_jg^ZhVgZ

^cZmig^XVWana^c`ZY#H^cXZi]ZYVnhd[=^eedXgViZh!

[gVXijgZh ]VkZ WZZc hiVW^a^oZY Wn jh^c\ hea^cih

dg ZmiZgcVa ÑmVidgh! VcY hd[i i^hhjZ ^c_jg^Zh

]VkZ WZZc igZViZY l^i] kVg^djh edi^dch VcY

hVakZh# IZX]c^fjZh [dg egdeZg a^bW Va^\cbZci

VcY hd[i i^hhjZ Vh lZaa Vh [gVXijgZ ]ZVa^c\ ]VkZ

WZZc i]Z hjW_ZXi d[ bZY^X^cZ i]gdj\]dji i]Z

bdYZgcZgV#

I]Z]^hidgnd[bZY^X^cZ[gdbi]Z&+i]XZcijgn

id i]Z b^YYaZ d[ i]Z &.i] XZcijgn Vaadlh jh id

^cigdYjXZ i]Z XdcXZeih d[ dgi]deVZY^X! eaVhi^X!

VcY dgi]deaVhi^X hjg\Zgn# >cY^k^YjVah hjX] Vh

6bWgd^hZ EVg‚! <VheVg IV\a^VXdoo^! 7Vgdc

<j^aaVjbZ9jejnigZc!6a[gZYAdj^hKZaeVj!VcY

?ZVc";gVcd^h BVa\V^\cZ lZgZ bVhiZg hjg\Zdch

VcYVgZi]Z[djcY^c\[Vi]Zghd[i]ZhZgZheZXiZY

heZX^Vai^Zh#

Hjg\^XVa heZX^Vai^Zh YZkZadeZY Vi i]Z XdcXaj"

h^dcd[i]Z&.i]XZcijgn#BdYZgceaVhi^Xhjg\Zgn

]Vh^ihgddih^ci]ZigZcX]Zhd[LdgaYLVg>VcY

hd ^h VWdji &%% nZVgh daY# EgdWVWan i]Z Ñghi

bdYZgc dgi]deVZY^X eaVhi^X XdaaVWdgVi^dc

lVh WZilZZc H^g L# 6gWji]cdi AVcZ VcY H^g

=VgdaY <^aaZh# >c &.&.! AVcZ! Vc dgi]deVZY^X

hjg\Zdc!lgdiZi]ZegZ[VXZ[dg<^aaZhÈhiZmiWdd`!

VcY hd WZ\Vc i]Z bdYZgc ZgV d[Ådgi]deaVhi^X

hjg\Zgn#Æ

I]Z YZkZadebZci d[ gZXdchigjXi^kZ b^Xgd"

hjg\ZgnVaadlZYbdYZgcdgi]deaVhi^Xhjg\Zgnid

YZkZade#>c&.+%!?VXdWhZcVcYHjVgZo^cigdYjXZY

i]Z deZgVi^c\ b^XgdhXdeZ id V^Y ^c hjijg^c\

hbVaa kZhhZah# >c &.+-! IVbV^ gZedgiZY i]Z Ñghi

hjXXZhh[ja Y^\^iVa gZeaVciVi^dc# Di]Zg b^Xgdhjg"

\^XVa hjXXZhhZh ZkdakZY ^c i]Z aViZg eVgi d[ i]Z

&.+%h#8dbedh^iZigVch[Zghd[kVhXjaVg^oZYi^hhjZ

1

Orthoplastic Reconstruction of the Arms and Legs

L Scott Levin

WZXVbZ XdbbdceaVXZ ^c i]Z &.-%h! l^i] Vc Zmeadh^dcd[iZX]c^fjZh!ÒVeh!VcYi]ZedejaVg"

^oVi^dc d[ b^XgdkVhXjaVg hjg\Zgn! cdi _jhi id igZVi igVjbVi^X ^c_jg^Zh d[ i]Z ]VcY VcY [dg gZeaVciVi^dc!WjiVahd[dgZaZXi^kZgZXdchigjXi^kZ hjg\Zgn#& GZÑcZbZcih Xdci^cjZY id iV`Z eaVXZ!

^cXajY^c\ÒVeegZZmeVch^dc!egZ[VWg^XVi^dc!VcY bdY^ÑXVi^dc d[ i^hhjZ igVch[Zgh ^c i]Z & %h#'!(

>ci]ZaViZgeVgid[i]Z'%i]XZcijgn!\dkZgcbZci V\ZcX^Zh! hjg\^XVa hdX^Zi^Zh! VcY ^chjgVcXZ XdbeVc^Zh WZ\Vc id Vh` [dg ÅdjiXdbZ YViV!Æ hjX] Vh Xdhi"Z[[ZXi^kZcZhh hijY^Zh VcY eVi^Zci" hVi^h[VXi^dc hijY^Zh id YZiZgb^cZ l]Zi]Zg XdbeaZm b^Xgdhjg\^XVa egdXZYjgZh VXijVaan

^begdkZfjVa^ind[a^[Z#)!*

Orthoplastic Surgery

Dgi]deaVhi^Xhjg\ZgnVhlZYZÑcZ^i^hÅi]Zeg^c" X^eaZhVcYegVXi^XZhd[Wdi]heZX^Vai^Zhdgi]deVZ"

Y^X VcY eaVhi^X hjg\Zgn Veea^ZY id V Xa^c^XVa

egdWaZb!Z^i]ZgWnVh^c\aZegdk^YZg!dgiZVbhd[ egdk^YZgh ldg`^c\ ^c XdcXZgi [dg i]Z WZcZÑi d[i]ZeVi^Zci#Æ*!+!,

BdgZ i]Vc (, nZVgh V[iZg IVbV^Èh gZedgi i]Vi

\ZcZgViZY ^ciZgZhi [gdb hjg\Zdch VgdjcY i]Z ldgaY! XVgZ d[ i]Z bji^aViZY ]VcY l^i] b^Xgd" hjg\^XVaiZX]c^fjZ^hhiVcYVgYegVXi^XZ#

I]Z igV^c^c\ d[ dgi]deVZY^X hjg\Zdch ]Vh h]^[iZY \gVYjVaan idlVgY eZg[dgb^c\ b^Xgd" hjg\Zgn! l]ZgZVh igVY^i^dcVaan! bV^can eaVhi^X hjg\Zdch ]VkZ YdcZ b^Xgdhjg\Zgn! YZeZcY^c\ dc cVi^dcVa^in# =VcY VcY b^XgdkVhXjaVg [Zaadl" h]^ehbVndgbVncdiVYZfjViZanegZeVgZndjc\ hjg\Zdch id eZg[dgb i]Z [jaa heZXigjb d[ gZXdchigjXi^kZ b^Xgdhjg\Zgn! l]^X] ^h k^iVaan

^bedgiVci^cdgi]deaVhi^XgZXdchigjXi^dc# DkZg i]Z eVhi *% nZVgh! Wjgc XVgZ! VZhi]Zi^X hjg\Zgn! XgVc^d[VX^Va hjg\Zgn! VcY ]VcY hjg\Zgn

1

I]Z8aZkZaVcY8a^c^X;djcYVi^dc! 8aZkZaVcY!D=!JH6

7nYZÑc^i^dc!VeVi^ZcihjhiV^c^c\VcdeZc[gVX"

ijgZ...

6Zhi]Zi^XVcYEaVhi^XHjg\Zgn>chi^ijiZ!

Jc^kZgh^ind[8Va^[dgc^V!>gk^cZ!DgVc\Z!

86. ''-+ -! JH6

?dhZe]7V`]VX]!B9

>chi^iji6fj^iV^c8]^gjg\^ZEaVhi^fjZ!

EZhhVX!7dgYZVjm!;gVcXZ... # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # -,

 - GZbdiZ>hX]Zb^XEgZXdcY^i^dc^c\d[;aVeh/8jggZci8dcXZeih

 BVg`jhK#@“cihX]Zg!7ZgcY=VgibVccVcY<“ciZg<ZgbVcc