Foot and ankle reconstruction is a battlefield of function and form. Every subunit has its own demands — the dorsum needs thin, pliable coverage; the heel demands durable, glabrous-like skin. In this landmark PRS 2010 paper, Hollenbeck et al. applied the subunit principle to 165 free flaps, giving surgeons a blueprint for tailored, long-term reconstruction success.

Summary:This episode breaks down the seven distinct subunits of the foot and ankle, each with unique reconstructive goals. We discuss the data behind flap outcomes, limb salvage (89% at 5 years), and complication rates, including the common pitfalls like flap debulking and late ulceration — especially in the heel subunit.
We’ll explore how subunit-based flap planning improves durability, shoe-fit, and overall limb function — plus, how specific flaps like the radial forearm, ALT, and latissimus dorsi perform across zones.

Key Takeaways:

• 7 subunits = 7 reconstructive goals.

• Heel (Subunit 5) = highest instability risk.

• Mean ambulation: 3.1 months.

• Limb salvage: 89% at 5 years.

• Subunit mapping improves both form and function.

  
  

Citation:

Hollenbeck ST, Woo S, Komatsu I, et al. Longitudinal Outcomes and Application of the Subunit Principle to 165 Foot and Ankle Free Tissue Transfers. Plast Reconstr Surg. 2010;125(3):924–934. DOI: 10.1097/PRS.0b013e3181cc9630

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Orbital floor fractures are among the most common midfacial injuries—and understanding when and how to operate is key for every resident. In this episode, we break down the anatomy, evaluation, and evidence-based management of orbital blowout fractures, based on Gart & Gosain’s Plastic and Reconstructive Surgery 2014 review.

We cover:

• Mechanisms — buckling vs. hydraulic theory, and why both matter.

• Clinical findings — diplopia, enophthalmos, oculocardiac reflex.

• Timing of repair — urgent (<48 hrs) indications vs. delayed (within 2 weeks).

• Surgical approaches — transconjunctival vs. subtarsal vs. subciliary.

• Implant materials — bone grafts, porous polyethylene, titanium mesh, and resorbables.

• Pediatric nuances — trapdoor fractures, oculocardiac reflex, and growth considerations.

🔑 Key Takeaways:

1. Early repair (<48 hrs) improves outcomes in entrapment and oculocardiac reflex.

2. Enophthalmos >2 mm or >50% floor involvement = strong indication for repair.

3. Transconjunctival approach offers lowest visible scarring; avoid subciliary ectropion.

4. In children, consider resorbable materials to avoid growth restriction.

📚 Reference:
Gart MS, Gosain AK. Orbital Floor Fractures. Plast Reconstr Surg. 2014;134(6):1345–1355. DOI: 10.1097/PRS.0000000000000719

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Mandible fractures are the most common indication for surgical repair of facial fractures, and their management continues to evolve with modern plating systems and imaging.

In this episode of Plastics in Practice, we break down the key anatomy, causes, diagnostic pearls, and surgical strategies you need to know for the boards and the operating room.

We start with the anatomy of the mandible — from condyle to symphysis — and review the opposing muscle forces that make fracture management so challenging . Then we dive into epidemiology: in the U.S., interpersonal violence dominates, while motor vehicle collisions are more common worldwide .

From there, we walk through preoperative evaluation and imaging, emphasizing the role of CT over panoramic radiographs for detecting posterior fractures. We also cover timing of repair, antibiotic prophylaxis, and surgical principles: restoring occlusion, rigid vs. functional fixation, and key approaches to angle, symphysis, bilateral, condylar, comminuted, and edentulous fractures.

• Mandible fractures occur most often in men 25–34, usually from assaults or MVCs.

• CT is the gold standard for imaging.

• Early repair is ideal, but delays >72h don’t significantly raise infection risk.

• Antibiotics are recommended, but evidence for type/duration remains weak.

• Surgical principle: restore occlusion + stable fixation, tailored to fracture site.

  
  

📚 References:Morrow BT, Samson TD, Schubert W, Mackay DR. Evidence-Based Medicine: Mandible Fractures. Plast Reconstr Surg. 2014;134(6):1381–1390. doi:10.1097/PRS.0000000000000717

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