Flaps and Grafts in Dermatologic Surgery

Description

Authored by experts in the field, this brand-new reference presents a systematic approach to which flap or graft to use in which clinical situation and how to cut and move the skin. More than 350 full-color photographs and line drawings offer you step-by-step guidance. And, a DVD containing high-quality video clips demonstrates reconstructive procedures, including cutting, positioning, and suturing of flaps and grafts. Describes which flap or graft to choose in specific clinical situations, how to execute each repair (with a multitude of images and diagrams), and how to minimize the risks as well as manage potential complications. Provides algorithms to assist with flap and graft choices, as well as hundreds of superb full-color illustrations throughout. Includes an all-new chapter on Surgical Complications and Scar Revisions. Includes access to high-quality videos showing exactly how the flap/graft is incised, moved, and sutured. New videos include the Rhomboid Transposition Flap for Defect on the Lower Lid, the Island Pedicle Flap with Canthal Suspension, and the Primary Lid Repair with Diagonal Tarsal Suture Sine Marginal Sutures. Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices. Front Cover 1 Anatomy Abstract Keywords Introduction Surface Landmarks and Surface Anatomy Masseter Muscle and Midpupillary Line Relaxed Skin Tension Lines Cosmetic Units and Junction Lines Free Margins: Concept of Tension Vector of Closure Concavities and Convexities: Implications for Second Intention Healing The Aging Face The Musculoaponeurotic System Introduction Muscles Acting Around the Eyelids Muscles Acting Around the Nose Muscles Acting Around the Mouth Motor Nerves Introduction Facial Nerve (Cranial Nerve VII) Temporal Nerve Zygomatic and Buccal Nerves Marginal Mandibular and Cervical Nerves Sensory Nerves of the Head and Neck Trigeminal Nerve (Cranial Nerve V) Ophthalmic Nerve (V1) Maxillary Nerve (V2) Mandibular Nerve (V3) Vascular System External Carotid System Internal Carotid System Venous System Lymphatic System Special Structures: Lip, Nose, Eyelids, and Ear Lip Nose Eyelids Ear References 2 Basic Principles in Flap Reconstruction Abstract Keywords Basic Terminology Flaps Defined by Blood Supply Flap Physiology Flap Biomechanics Flaps Defined by Movement Advancement Flap Rotation Flaps Transposition Flaps Interpolation Flaps Practical Points Final Pearls References 3 Second Intention Healing and Primary Closure Abstract Keywords Introduction Second Intention Healing Phases of Wound Healing Appearance of Second Intention Healing Scars Ideal Wounds for Second Intention Healing Suboptimal Wounds for Second Intention Healing Patient Factors Affecting Decisions About Second Intention Healing Second Intention Healing as an Adjunct to Reconstructive Surgery Wound Care During Second Intention Healing Complications Conclusion Primary Closure Phases of Wound Healing Principles of Reconstruction Preserve and Restore the Position of Free Margins Preserve and Restore Normal Contour Orient Scars Along Cosmetic Subunit Junction Lines Orient Scars Along Relaxed Skin Tension Lines Variations of the Fusiform Excision Crescentic Excision S-Plasty M-Plasty Serial Elliptical Excisions Standing Cone Deformities: Causes and Corrections Complications of Primary Closure Conclusion References 4 Advancement Flaps Abstract Keywords Flap Design and Considerations Flap Mobilization and Key Sutures Flap Modifications and Applications H-Plasty or Bilateral Advancement Flap T-Plasty L-Plasty Burow Triangle Flap Cheek Advancement Helical Rim Advancement Flap Crescentic Advancement Flap Webster Perialar Crescentic Flap Modifications of the Crescentic Advancement Flap Peng Flap Disadvantages References 5 Rotation Flaps Abstract Keywords Rotation Flap Design: Basic Principles Flap Length Flap Curvature Bilateral Rotation Flaps O–Z Rotation Flap Selected Rotation Flaps Dorsal Nasal Rotation Flap Variants of the Dorsal Nasal Flap Axial Dorsal Nasal Rotation Flap Heminasal Rotation Flap Other Variants The Spiral Flap Tenzel and Mustarde Rotation Flaps Medial Cheek Rotation Flap Cervicofacial Rotation Flaps Rotation Flaps on the Chin and Lip Plane of Flap Elevation and Surgical Undermining Conclusion References 6 V-Y Flaps and Island Flaps Abstract Keywords Technique Modifications Complications References 7 Transposition Flaps Abstract Keywords Flap Design and Considerations Rhombic and Single-Lobed Transposition Flaps Design Z-Plasty Effect of Transposition Flaps Modified Rhombic Flaps Dufourmentel Flap Webster 30-Degree Angle Flap Double 30-Degree Angle Flap Rhombic Flap Execution: Flap Mobilization and Key Sutures Other Transposition Flaps Banner-Type Flaps Banner Transposition Flap Mobilization and Application Multilobe Transposition Flaps Bilobed Flap Bilobed Flap: Mobilization and Key Sutures Trilobed Flap General Applications of Transposition Flaps Dorsum of the Nose and the Nasal Sidewall (Fig. 7.17) Nasal Tip Medial and Lateral Canthi (Fig. 7.18) Temple Cheeks (Fig. 7.19) Perioral Area (Fig. 7.20) Chin (Fig. 7.21) Complications Conclusion References Further Reading 8 Staged Interpolation Flaps Abstract Keywords Paramedian Forehead Flap, Stage I Indication Anatomy Flap Design Anesthesia Execution Cartilage and Lining Restoration Flap Harvesting and Pedicle Mobilization Defect Preparation Flap Preparation and Inset Donor Site Closure Postoperative Care Paramedian Forehead Flap, Stage II Final Paramedian Forehead Flap Variations The Folded Paramedian Forehead Flap Stage I Stage II Stage III Heminasal Paramedian Forehead Flap Paramedian Forehead Flap With Vascular Delay Cheek-to-Nose Interpolation Flap Indications Anatomy Flap Design Execution Postoperative Care Cheek-to-Nose Interpolation Flap, Stage II Final Abbé (Lip-Switch) Flap Indications Anatomy Flap Design Execution Postoperative Care Abbé Flap, Stage II Final Conclusion Complications With Surgery References 9 Skin Grafts Abstract Keywords Introduction Full-Thickness Skin Graft Skin Graft Physiology Graft Selection Full-Thickness Skin Graft Technique Complications and Management Modifications of the Full-Thickness Skin Graft Simultaneous Free Cartilage and Full-Thickness Skin Grafting Split-Thickness Skin Grafts Graft Selection Split-Thickness Skin Graft Technique Complications and Management Conclusion References 10 Scalp Reconstruction Abstract Keywords Scalp Surgical Anatomy Evaluation of the Scalp Defect Basic Reconstruction Concepts Second Intention Healing Primary Closure Split-Thickness Skin Grafts Skin Substitute Reconstruction Full-Thickness Skin Grafts Random Pattern Cutaneous Flaps Advancement Flaps Rotation Flaps Transposition Flaps Conclusion References 11 Forehead and Temple Repair Abstract Keywords Reconstructive Principles Secondary Intention Primary Linear Closure Advancement, Rotation, and Transposition Flaps Complications Conclusion References 12 Periocular Reconstruction Abstract Keywords Introduction Preoperative Assessment Specialized Instrumentation Anatomy Tension Periocular Repairs Linear Repairs Skin Grafts Flap Repairs Defects Below the Lid Margin Defects on the Upper Lid Medial Canthal Defects Full-Thickness Lid Defects Primary Lid Repair Lateral Canthotomy Tenzel Semicircle Flap Tarsoconjunctival Flap Postoperative Considerations References 13 Cheek Reconstruction Abstract Keywords Regional Reconstruction Principles Relaxed Skin Tension Lines Surface Anatomy Skin Texture Subcutaneous Anatomy Special Anatomic Structures Which Reconstructive Procedure? Reconstruction Philosophy Flaps to Avoid Flaps by Cheek Region Medial Cheek Anterior Cheek Infraorbital Cheek Malar Cheek Buccal Cheek Preauricular Cheek Mandibular Cheek Complications Hematoma Eyelid Swelling Flap Necrosis Ectropion Infection Dehiscence Parotid Fistula Hypertrophic Scarring and Keloid Formation Anesthesia Motor Nerve Deficits Telangiectasia Inner Canthus Tenting Conclusion References 14 Ear Reconstruction Abstract Keywords Introduction Ear Aesthetics Embryology Topography Vasculature Innervation General Principles Reconstructive Options Skin Grafts Adjacent Tissue Transfer Cartilage Regional Reconstruction Upper Auricle Tubed Flap. Composite Chondrocutaneous Flap Temporoparietal Flap. Middle Auricle Lower Auricle Lobule Concha Posterior Auricle Prosthetics and When to Refer References 15 Nasal Reconstruction Abstract Keywords Repair Alternatives Primary Closure Full-Thickness Skin Grafts Flap Reconstruction of the Nose Advancement Flaps Rotation Flaps Transposition Flaps Interpolation Flaps Complications Conclusion References 16 Perioral Reconstruction Abstract Keywords Introduction Perioral Anatomy Surface Anatomy Neuromuscular Anatomy Vascular Anatomy Evaluation of the Patient and Defect General Principles of Perioral Reconstruction (Box 16.1) Methods of Closure Second Intention Healing Mucosal Advancement Flap Linear Closure Wedge Repair Flaps Advancement-Rotation Flaps Burow Wedge Rotation Flap V-Y Advancement Flap Full-Thickness Circumoral Flaps Transposition Flaps Lip Switch Flap Philtral Reconstruction Summary References 17 Neck Reconstruction Abstract Keywords Introduction and Perioperative Consideration Anatomy of the Neck Cutaneous Anatomy Triangles Blood Supply Arteries Veins Nerves Lymphatics Neck Reconstruction Other Surgical Considerations Postoperative Considerations and Complications Summary References 18 Surgical Complications and Revision of Scars Abstract Keywords Hemorrhage Infection Wound Dehiscence Eyelid Swelling/Lymphedema Ectropion Motor Nerve Deficits Scars Scar Revision Intralesional Injections Dermabrasion Microneedling Subcision Soft Tissue/Dermal Fillers Laser Treatment Surgical Options for Scar Revision Timing of Scar Revision Conclusion References