Turnover Flap and Composite Graft

Alar And Prevertebra Facial Layer

Lexer 1931, modified by Kastenbauer 1977 A bipedicled turnover flap is used for intranasal lining Fig. 5.39a, b , similar to the technique just described. Then a two-layer composite graft is used to reconstruct the alar rim. The skin of the composite Fig. 5.36 Modification of the anteriorly based alar rotation. a An incision is made around the ala, and two adjacent flaps are outlined. b The ala is brought down to the desired position, and the flaps are transposed. c Appearance after the...

Wound Management and Scar Revision

Eliptical Excision Suture

It is a general rule in facial plastic surgery to sacrifice as little skin as possible. Small wounds that extend obliquely into the tissue should be straightened whenever the surrounding tissue can be mobilized and the wound edges coapted without tension. A subcutaneous suture with a buried knot should always be placed to allow tension-free approximation of the wound margins (see Fig. 2.1). Because the subcutaneous tissue, epidermis, and dermis take different lengths of time to achieve adequate...

Harvesting a Bone Graft from the Iliac Crest

Tensor Fascia Lata Graft Harvest

Autogenous bone is needed for the reconstruction of defects or to correct cosmetic deformities. Along with the tibia, fibula, scapula, and ribs, the iliac crest is among the most common donor sites for autogenous bone. It can furnish extremely large grafts, which are usually taken in the form of compound or composite flaps that include soft-tissue elements see Fig. 14.2 . Indications Cancellous bone chips are used as filling material for mandibular reconstructions and bone cysts, and composite...

Suture Materials and Techniques

Plastic Surgery Suture Types

We use atraumatic cutting needles for the skin, and we generally use round needles for the mucosa. Our suture material of choice for the face is 6-0 or 7-0 monofilament on a very fine needle. Occasionally we use 5-0 monofilament for areas that are not visible. Prolene , PDS , P1 and P6 5-0 needle with P3 or PS 3 needle. Our subcutaneous sutures are composed of ab-sorbable or fast-dissolving braided or monofilament material. Vicryl or PDS, P1, P3 needle Ethicon, Norderstedt, Germany. A suture or...

Upper Eyelid Reconstruction of Fricke and Kreibig

Forehead Flap Eyelid Reconstruction

Large portions of the upper and lower eyelid can be reconstructed with a narrow transposition flap that is raised above the eyebrow on a lateral pedicle. Thick split retroauricular skin grafts can also be used. Fig. 9.3 Mustarde's technique of upper eyelid reconstruction using a laterally based full-thickness flap from the lower lid after Beyer-Machule and Riedel 1993 . a The full-thickness lower lid flap is outlined with a lateral pedicle. b The flap is swung into the upper lid defect, and the...

Pectoralis Major Island Flap

Images Pectoral Major Flap

Flap type myocutaneous island flap of the axial pattern type see Figs. 1.3 and 1.4 . Flap components skin, subcutaneous fat, fascia, muscle pectoralis major . Use myocutaneous island flap for reconstructing major defects in the neck and face microvascular free transfer is possible . Vascular pedicle The skin and muscle are supplied by the thoracoacromial artery, which is the second branch of the axillary artery past the scalene interval. The flap is supplied by the pectoral branches of the...

Converse Scalping Flap Forehead Scalp Flap

Total Forehead Flap

Use of the converse scalping flap is illustrated for subtotal or total nasal reconstruction with partial reconstruction of the upper lip and cheek Fig. 5.50 . The neighboring esthetic units should be reconstructed prior to the nasal reconstruction Fig. 5.50a, b . Soft-tissue expansion in the forehead see Figs. 4.5 and 5.16 may precede the reconstruction. Fig. 5.51 Reconstruction of the external nose with a Converse scalping flap see Fig. 5.50 . The outline of the laterally based forehead flap...

Total Lower Lid Reconstruction

Cheek Advancement Flap

The entire lower lid can be reconstructed with a transposition flap (Fig. 9.11a, b) or a bipedicle flap (myocutaneous flap, Fig. 9.12a, b) from the upper eyelid (Tripier flap). As in other methods, a chon-dromucosal graft from the nasal septum can be used for lining (see Figs. 9.6 and 9.7). The lateral and medial pedicles are divided and inset in a later sitting. Fig. 9.7 Lower lid reconstruction using the rotation-advancement technique of Mustarde (1980). a The mucosal defect is reconstructed...

Trilobed Flap of Weerda 1979

Bilobed Flap Cheek

Occasionally a bilobed flap is insufficient for repairing a cheek defect, which requires one lobe between the ear and defect Fig. 8.10a , a second lobe behind the ear, and a third lobe in the lateral neck. As in an Esser cheek rotation, the lower limb of the third lobe may be extended below the mandible. Closure of the secondary defects may require the excision of Burow's triangles Fig. 8.10b . Fig. 8.11 a, b Bilobed flap from the side of the neck. Fig. 8.11 a, b Bilobed flap from the side of...

Median Scars and Upper Lip Defects

Plasty For Vermilion Border

In cases where the central portion of the upper lip is retracted upward due to scarring after a cleft repair, burn, or the irradiation of a hemangioma, the lip can be reconstructed using a method first described by Celsus ca. 25 A.D. . A two-layer, crescent-shaped excision is made lateral to the alar groove on each side and extended along the nasal base. A portion of the scar can be excised Fig. 6.8a . Both upper lip stumps are then rotated and carefully sutured together to bring down the...