Dr. Lara's Plastic Surgery Compendium

This episode reviews the core principles of arthritic hand and wrist reconstruction , focusing on the major differences between rheumatoid arthritis, osteoarthritis, inflammatory arthropathies, and surgical salvage strategies . Topics include the biology of rheumatoid arthritis as a systemic inflammatory disease of the synovium and tenosynovium , including pannus formation, ligament attenuation, m...

This episode reviews the core principles of benign and malignant tumors of the hand , focusing on evaluation, imaging, biopsy technique, tumor biology, and reconstructive decision-making . Topics include the initial workup of a hand mass, including key history clues such as cold hypersensitivity in glomus tumors , NSAID-responsive night pain in osteoid osteoma , and systemic clues for gouty tophi....

This episode reviews the core principles of hand infections and clinical mimics , focusing on anatomy, microbiology, diagnosis, and surgical decision-making . Topics include Kanavel’s fascial spaces , bacterial burden, Staphylococcus aureus , MRSA, polymicrobial infection in high-risk patients, foreign bodies, lymphangitis, osteomyelitis imaging pitfalls, and the principle that operative treatment...

This episode reviews the core principles of hand rehabilitation , focusing on postoperative assessment, splinting, tendon protocols, nerve recovery, and return-to-function decision-making . Topics include objective measurement of recovery using volumetric displacement , the McGill Pain Questionnaire , Semmes-Weinstein monofilaments, two-point discrimination, the 10 Test , grip dynamometry, pinch t...

This episode reviews the core principles of upper extremity replantation, revascularization, and vascularized composite allotransplantation , focusing on ischemia, microsurgical decision-making, postoperative monitoring, and functional recovery . Topics include the distinction between replantation and revascularization , warm versus cold ischemia, the major difference between digits and muscle-con...

This episode reviews the core principles of soft tissue reconstruction of the hand and upper extremity , focusing on mangled hand evaluation, debridement, flap selection, and functional salvage . Topics include the definition of a mangled hand , the importance of radical debridement, the four Cs of muscle viability , tourniquet release for perfusion assessment, second-look surgery, and the reconst...

This episode reviews the core principles of thumb reconstruction , focusing on functional priorities, defect location, flap selection, microsurgery, and congenital thumb reconstruction . Topics include the functional importance of the thumb, including opposition, pinch, grasp, sensation, length, stability, mobility, and appearance . Reconstruction is organized using the classic rule of thirds , di...

This episode reviews the core principles of nerve and tendon transfers for upper extremity palsies , focusing on timing, donor selection, biomechanics, and functional restoration . Topics include the decision-making framework for nerve transfers versus tendon transfers , with emphasis on “time is muscle,” Wallerian degeneration, motor end plate survival, nerve regeneration at approximately 1 mm/da...

This episode reviews the core principles of upper extremity compartment syndrome , focusing on anatomy, pathophysiology, diagnosis, and surgical decompression . Topics include the volar, dorsal, and mobile wad compartments of the forearm, the deep volar danger zone containing FDP, FPL, and pronator quadratus , and the 10 compartments of the hand . The episode also explains the pressure-gradient ph...

This episode reviews the core principles of upper extremity compression neuropathies and acute compartment syndrome , focusing on nerve pathophysiology, anatomic compression sites, diagnosis, and surgical treatment . Topics include the progression from venous congestion to intraneural edema, ischemia, demyelination, and axonal loss , with emphasis on physical exam findings such as Tinel sign, Semm...

This episode reviews the core principles of peripheral nerve injuries and brachial plexus pathology , focusing on nerve microanatomy, injury classification, diagnosis, and surgical strategy . Topics include the structure of peripheral nerves, including the axon, endoneurium, perineurium, epineurium, Schwann cells, nodes of Ranvier, and vasa nervorum . The episode also explains Wallerian degenerati...

This episode reviews the core principles of flexor and extensor tendon repair , focusing on anatomy, tendon zones, repair technique, and rehabilitation . Topics include FDS and FDP anatomy , Camper’s chiasm , the Verdan flexor tendon zones , and the pulley system, with emphasis on preserving A2 and A4 to prevent bowstringing. The episode also reviews tendon blood supply through the vincula , intri...

This episode reviews the core principles of nail bed injuries, fingertip trauma, and digital amputations, focusing on anatomy, repair technique, flap selection, and functional reconstruction. Topics include the germinal and sterile matrix, eponychium, hyponychium, nail growth, Beau’s lines, subungual hematoma management, and the modern approach to trephination when the nail plate is intact. The ep...

This episode reviews the core principles of scaphoid fractures and carpal instability , focusing on wrist biomechanics, diagnosis, fixation strategy, and collapse patterns . Topics include the scaphoid as the key link between the proximal and distal carpal rows, its retrograde blood supply , and why waist and proximal pole fractures are at risk for nonunion and avascular necrosis . The episode als...

This episode reviews the core principles of distal radius, carpal, metacarpal, and phalangeal fractures , focusing on biomechanics, radiographic assessment, fixation strategy, and functional recovery . Topics include the three-column theory of the distal radius , classic fracture patterns such as Colles, Smith, Barton, chauffeur, and die-punch fractures , and key radiographic parameters including...

This episode reviews the core principles of congenital hand anomalies , focusing on limb embryology, classification systems, functional diagnosis, and reconstructive strategy . Topics include upper limb development during weeks 4–8 , the major embryologic signaling centers including the AER/FGF , ZPA/Sonic Hedgehog , and Wnt7a pathways, and modern classification using the Oberg-Manske-Tonkin (OMT)...

This episode reviews the core principles of hand anatomy, biomechanics, and clinical examination , focusing on the hand as an integrated system of skin, fascia, bones, tendons, nerves, vessels, and functional diagnosis . Topics include the contrast between loose dorsal skin and fixed palmar skin , dorsal edema from volar pathology, Littler’s diamonds , Kaplan’s cardinal line, the recurrent motor b...

This episode reviews the core principles of breast reduction, mastopexy, augmentation-mastopexy, and breast fat grafting , focusing on anatomy, patient selection, operative planning, and complication prevention . Topics include breast blood supply from the internal mammary perforators , nipple sensation through the lateral cutaneous branch of T4 , smoking cessation, cotinine testing, breastfeeding...

This episode reviews the core principles of breast augmentation, mastopexy, and augmentation-mastopexy , focusing on preoperative planning, implant selection, pocket control, and breast shape optimization . Topics include the Tebbetts High Five system , soft tissue pinch thickness, base width, breast stretch, nipple-to-IMF distance, sternal notch-to-nipple measurements, and the importance of respe...

This episode reviews the core principles of breast cancer and autologous breast reconstruction , focusing on oncologic context, reconstruction timing, radiation strategy, and flap selection . Topics include breast conservation therapy vs mastectomy , tumor biology, TNM staging, receptor status, and how systemic therapies such as tamoxifen affect reconstructive risk. The episode also reviews skin-s...

This episode reviews the core principles of implant-based breast reconstruction , focusing on patient selection, mastectomy flap viability, pocket control, and revision surgery . Topics include direct-to-implant vs two-stage reconstruction , the “ small, healthy, tight ” candidate for DTI, the importance of a well-performed mastectomy, and how to evaluate skin flap perfusion using clinical judgmen...

This episode provides a comprehensive review of radiation injury and its implications for reconstructive surgery , focusing on radiobiology, tissue toxicity, and surgical decision-making. The discussion begins with the fundamentals of ionizing radiation , including free radical formation, DNA damage, and the role of oxygen-dependent injury . Key principles of radiobiology are reviewed, including t...

This episode reviews the core principles of breast cancer management and reconstruction , focusing on diagnosis, mastectomy planning, radiation, and reconstructive decision-making . Topics include high-yield breast anatomy, NAC sensation from the fourth intercostal nerve , Cooper’s ligaments , and key clinical distinctions such as fibroadenoma vs phyllodes tumor , LCIS vs DCIS , Paget disease , Mo...

Episode Description (aligned to your script) This episode provides a comprehensive review of breast cancer biology, risk factors, diagnosis, staging, and surgical decision-making , forming the foundation for modern breast reconstruction. Topics include genetic mutations (BRCA, PALB2, TP53) , hormonal risk factors, and the role of estrogen in tumor development. The episode reviews the triple assess...

This episode reviews the core principles of congenital breast deformities, gynecomastia, and chest wall reconstruction , focusing on embryology, anatomy, diagnosis, and operative strategy . Topics include the mammary ridge , polythelia , polymastia , amastia , amazia , and athelia , with emphasis on recognizing ectopic breast tissue and protecting the developing breast bud in children. The episode...