Performed by urologists and paediatric surgeons, hypospadias procedures go unnoticed in many classical treatises of plastic surgery. Hypospadias is a very common malformation that occurs in nearly 1 in 250 male births. It consists of an abnormal opening of the urethral meatus at some point of its dorsal aspect. It is associated with an incomplete, semi‐circumferential foreskin and in nearly half of the patients it may be accompanied with a curvature of the penile shaft called chordee. Most classifications differentiate between distal, middle and proximal presentations. Different techniques have been proposed for its treatment; some of the most usual ones are briefly revised. Continued improvement in surgical management has made currently practised one‐stage repairs possible. We provide an introduction to the current techniques, as well as operative tips and an overview of the most common pitfalls the surgeon must bear in mind when treating this condition.
Part of the book: Issues in Flap Surgery
Current hair transplantation techniques require a reliable anesthesia for long periods of time (2 h or more). They demand hemostasis of extended surfaces on wide-awake patients. A combination of anesthetic agents and local vasoconstrictors is needed. We present customary technical characteristics of these procedures as local nerve blocks (supratrochlear nerve, supraorbital nerve, zygomaticotemporal nerve, auriculotemporal nerve, retroauricular nerve, lesser occipital nerve, great occipital nerve) and tumescent field anesthesia. The ordinary drug combinations for premedication and procedure are presented. Special emphasis is done to discuss recommendations to cope with undesirable events that may arise during anesthesia (vasovagal syncope, anesthetic toxicity, anaphylactic and allergic reactions).
Part of the book: Alopecia