Coverage of Defects in Specific Facial Regions

For smaller facial defects, an attempt is made to achieve coverage by means of flap advancement or local flaps (Fig. 4.1). Keep in mind that these flaps should be placed in RSTLs whenever possible (see p. 6).

If flaps cannot be obtained from the immediate vicinity of the primary defect, regional flaps are used. These are larger flaps involving the movement of tissue somewhat more distant from the recipient site.

The classic "regional flaps" from the neck and chest are no longer in common use. For the most part they have been replaced by myocutaneous island flaps (see p. 120) and free flaps. Even the classic "distant flaps," transferred as tubed flaps from the chest or abdomen over a period of weeks or months, are very rarely used today and have been replaced by myocu-taneous flaps and free tissue transfers with micro-vascular anastomosis (see p. 125). Small facial defects can be excised and reconstructed with small flaps using a technique that will place the scars as close to the RSTLs as possible (Figs. 2.7a and 4.1).

Fig. 4.1 Various small flaps in the face and forehead (dashed red lines: RSTLs).

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