May Surgery Spotlight hightlights two surgeries from Dr. William Kuzon

IN THE MAY SURGERY SPOTLIGHT, William Kuzon, MD, demonstrates a genital sex reassignment procedure in a 41-year-old male. Dr. Kuzon discusses the importance of ensuring that patients for this procedure have met the criteria set forth by the World Professional Association for Transgendered Health (WPATH) including adaption to hormonal therapy and living full-time in the female gender for more than one year. Preoperatively, he also discusses the importance of confirming normal male anatomy with no testicular mass or in-groinal hernias, which would complicate the planned procedure.

In collaboration with a urologist, Dr. Kuzon demonstrates the procedure for designing the flap which will become the back wall of the new vagina, prior to dissecting the bulbocavernosus and identifying the juncture of the anal sphincter. He performs an orchiectomy and then the penis is degloved and the penile skin tube separated from the penile corporal bodies. The dorsal neurovascular bundle is isolated and a portion of the glans harvested to form the neo clitoris. The corpus spongiosum is then separated from the corpora cavernosa and a catheter inserted into the urethra. Dr. Kuzon demonstrates the blunt dissection of the new vagina and discusses the risks of rectal tear and rectal vaginal fistula. Finally, he demonstrates the placement of the neo clitoris on the midline, the anchoring of the penile urethra, the inversion of the penile tissue and the trimming and position of the remaining scrotal skin to form the new labia.

Also this launched this month, Dr. Kuzon performs an approach for treating a condition known as “Buried” or “Hidden Penis.” In this instance, a 53-year-old patient had previously had difficulty with phimosis, had undergone a circumcision at a different institution and subsequently developed recurrent cicatrix difficulties with urination, hygiene and sexual function. Dr. Kuzon notes that while each patient’s treatment is personalized depending on the extent of the deformity, his general approach, demonstrated in this video, is to deglove the penile shaft, retrieve the corpora, and in combination with a superpubic lipectomy, anchor the corpora in a projected position with deep dermal sutures to the corpus cavernosum. This often requires skin grafting to the penile shaft. Watch Dr. Kuzon perform this procedure on PSEN.

Dr. Kuzon is the Reed O. Dingman Professor of Surgery in the Section of Plastic Surgery at the University of Michigan. He has performed a large number of gender-related procedures and is the director of surgical services at the University of Michigan Comprehensive Gender Services Program. In addition, Dr. Kuzon performs a wide array of surgical procedures, including the reconstruction of patients with facial paralysis, the management of difficult wounds, the management of patients after weight loss, and the management of defects resulting from the excision of sarcomas and other forms of cancer.

Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD Library. Surgery Spotlight is a video-based product line produced by the Plastic Surgery Education Network (PSEN).

Surgery Spotlight Highlights High Wing Le Fort I with Genioplasty

IN THE LATEST Surgery Spotlight, Steven Buchman MD, demonstrates how to correct the effects of a congenital craniofacial syndrome on a young woman by performing a High Wing Le Fort I Osteotomy and accompanying genioplasty. Dr. Buchman describes the importance of preoperative planning for the procedure and utilization of a surgical model based on impressions of the patient’s teeth. The model is marked and then adjusted to demonstrate the desired operative outcome. Measurements can then be taken to determine the amount of movement that must be achieved on the patient during the actual procedure. Dr. Buchman illustrates on the patient the various key points of anatomy while dissecting the maxilla and its four buttresses before cutting and finally down-fracturing the maxilla so that the upper tooth-bearing segment can be moved freely within the mouth. Utilizing a splint that was designed from the surgical model, Dr. Buchman places the upper to the lower mandible into IMF (Intermaxillary fixation; the proper closed bite position), and then demonstrates how to position the maxilla and the zygoma and remove bony and cartilaginous interferences to allow the osteotomized maxillary segment to be secured to the stable facial bones.

Following the successful plating of the Le Fort, Dr. Buchman demonstrates a genioplasty on the patient who has a very thick, vertically long and retrusive chin and demonstrates how removing an interpositional segment of bone from her chin will improve her resulting profile and bring her facial bones into better position and symmetry following the Greek “Golden Rule” of ideal facial proportion. After marking the midline and then removing an interpositional segment of bone, he demonstrates plating the remaining bones of the chin back together.

In the third and final portion of this patient’s combined procedures, Dr. Buchman then demonstrates how to shape the bone excised from the chin so that it can be grafted to the patient’s mid face in order to improve the projection and symmetry of the malar eminence.

Dr. Buchman is a leader in the field of reconstructive craniofacial surgery. He is a Tenured Professor of Surgery in the Section of Plastic & Reconstructive Surgery and holds a joint appointment as a Professor Neurosurgery at the University of Michigan Medical School. Dr. Buchman has won numerous awards for excellence in teaching, research and clinical care.

Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD Library. Surgery Spotlight is a video-based product line produced by the Plastic Surgery Education Network (PSEN).

Management of Complications Recordings Available

RECORDINGS FROM the Management of Complications in Plastic Surgery symposium on March 28-29, 2014 in Rosemont, IL are now available on PSEN. Recap the meeting with over 12 hours of sessions on the root causes of complications and how to manage them. The sessions can be purchased for $500 member/$600 non-member.

Recorded session topics include:

  • Medico-Legal, Financial and Patient Communication in Handling Complications
  • Using Personality Assessment to Identify, Avoid and Manage Problem Patients
  • Creating and Maintaining a Positive Doctor-Patient Relationship When Managing Complications
  • “I Want My Money Back!” The Art of Managing Financial Issues with the Unhappy Patient
  • ALCL and Infromed Consent: What to Say, How to Say It
  • Managing the Preoperative Consult

Get more information and purchase the recordings here.

New videos from Elsevier’s 6-volume Plastic Surgery reference

WITH PERMISSION FROM ELSEVIER, PSEN has posted seven videos from the award-winning, six-volume Plastic Surgery reference. The videos highlight aesthetic, craniofacial, and hand and upper limb surgical techniques. Watch the videos for free on the Procedural Videos page.

The videos include:

Fully updated to meet the demands of the 21st-century surgeon, Plastic Surgery provides you with all the most current knowledge and techniques across your entire field, allowing you to offer every patient the best possible outcome. Edited by Drs. Mathes and Hentz in its last edition, this six-volume plastic surgery reference now features new expert leadership, a new organization, new online features, and a vast collection of new information – delivering all the state-of-the-art know-how you need to overcome any challenge you may face. Renowned authorities provide evidence-based guidance to help you make the best clinical decisions, get the best results from each procedure, avoid complications, and exceed your patients’ expectations.

New Surgery Spotlight highlights mandible reconstruction

IN THE NEW SURGERY SPOTLIGHT, Henry C. Vasconez MD, plans the harvest of a fibula osteocutaneous free flap to perform mandible reconstruction on a 21-year-old male with severe craniofacial microsomia and other congenital anomalies. In addition, the patient will also undergo a sagittal split mandibular osteotomy on the contralateral side, as well as a rotational LeFort 1 maxillary advancement in order to obtain improved symmetry and occlusion.

Dr. Henry Vasconez is a board-certified plastic surgeon in Lexington, Kentucky. In addition to private practice, he serves as a professor at the University of Kentucky. His interests include craniofacial surgery, pediatric plastic surgery, breast reconstruction and aesthetic surgery.

Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD Library. Surgery Spotlight is a video-based product line produced by the Plastic Surgery Education Network (PSEN).