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LEECH THERAPY The European medicinal leech ( Hirudo medicinalis ) is an inver - tebrate annelid; its saliva contains hirudin (an anticoagulant), hyaluronidase (which facilitates anticoagulant penetration into - the wound) and histamine (to maintain vasodilatat...

Learning objectives To be aware of: A variety of plastic surgical techniques used to restore • bodily form and function To know: The relevant anatomy and physiology of skin • Learning objectives To be aware of: A variety of plastic surgical techniques used to ...

Lipotransfer Lipotransfer, or autologous fat grafting, is a useful reconstruc - tive technique to achieve soft-tissue augmentation, i.e. increase plac - the volume in a specific region, hence it is sometimes referred to ) onlay as ‘lipomodelling’. Common indi...

MICROSURGERY Microsurgery is a surgical subspecialty that makes use of magni fication, precision tools and surgical techniques to enable the anastomosis of small blood vessels and coaptation of nerves. The diameter of a typical suture is between 0.01 and 0.0...

RECONSTRUCTIVE TECHNIQUES These range from the simple, including healing by secondary intention or skin grafting, to the complex, including free tissue - transfer or vascularised composite allotransplantation. They also include the use of autologous tissue, ...

WHAT IS RECONSTRUCTIVE PLASTIC SURGERY? Reconstructive plastic surgery is a surgical specialty that aims to restore form and function. The word plastic derives from the ancient Greek plassein – to mould or shape. Unlike all other specialties, plastic surgery i...

WOUND DRESSINGS These are a vital part of wound care and are used to optimise healing. The most suitable dressing is selected based on the type Jean-Nicolas Marjolin , 1780–1850, Professor of External Pathology , Hôtel-Dieu de Paris, Paris, France. moist env...

WOUND HEALING There are various ways in which a wound can heal (see Chapter 3 ). Plastic surgeons can a ff ect the way in which wounds heal. Primary healing, or ‘healing by primary inten - tion’, occurs when the wound is closed soon after the injury by reapprox...

Aetiology The common primary brain tumours mentioned above mostly occur sporadically . There is no proven risk due to environmen tal factors, except for radiation exposure, but germline genetic syndromes may also predispose ( Table 48.5 ). Theodor Schwann , 18...

BRAIN TUMOURS The term ‘brain tumour’ applies to more than 100 distinct pathologies detailed in the World Health Organization (WHO) classification. Many are malignant, but even histologically benign tumours may carry a grave prognosis when they encroach on key ...

Brain abscess and empyema Abscesses arise when the brain is exposed directly , for example as a result of fracture or infection of an air sinus, or at surgery . They also result from haematogenous spread, typically in asso - ciation with respiratory and dent...

Brain tumours in children Brain tumours are the most common solid tumours in children but are nonetheless seen only infrequently outside specialist units. They typically present with developmental regression and enlarging head circumference in the youngest, wi...

Brainstem death This is defined as the irreversible loss of cerebral and brainstem function. Brainstem death is legally equivalent to death, and is a precondition for the harvesting of organs for transplant from heart-beating donors. /uni25CF identification ...

Classification WHO classifies primary brain tumours on the basis of cell of origin and histological grade ( Figure 48.20 ), with the 2016 edition including a number of additional molecular classifica tions assigned in parallel to constitute an ‘integrated’ diag...

Clinical features of raised intracranial pressure Symptoms of raised ICP include a ‘high-pressure headache’ that is worse on coughing or bending forward. By contrast, low-pressure headaches, typically associated with excessive Henri Parinaud , 1844–1905, Fren...

Common brain tumours Cerebral metastases Cerebral metastases ( Figure 48.21 ) are the most common intracranial tumours and are diagnosed in 25% of patients with cancer, a proportion that is increasing with extended survival associated with more e ff ective tre...

Craniosynostosis Normal fusion of the coronal, lambdoidal, squamosal and sagittal sutures occurs between 6 and 12 months of age; others such as the frontal suture fuse later. Craniosynostosis is the premature fusion of one (simple craniosynostosis) or more ...