Esthetic Units

If portions of the face need to be reconstructed, better cosmetic results are achieved by reconstructing areas as complete units. This is not always possible, however, especially in tumor resections.

Nasal Subunits

Fig. 2.20 Esthetic units a In the face, b nasal subunits, anterior view, c nasal subunits, lateral view.

Fig. 2.20 Esthetic units a In the face, b nasal subunits, anterior view, c nasal subunits, lateral view.

Fig. 2.21 Tumor resection with histologic control.

a The skin tumor is removed with a margin of healthy tissue, and the edges of the specimen are marked with threads. b The margins and base of the tumor bed are resected in a clockwise direction and checked histologically to verify complete tumor clearance.

Fig. 2.21 Tumor resection with histologic control.

a The skin tumor is removed with a margin of healthy tissue, and the edges of the specimen are marked with threads. b The margins and base of the tumor bed are resected in a clockwise direction and checked histologically to verify complete tumor clearance.

Fig. 2.22 Free skin grafts.

a Following meticulous hemostasis, the split-thickness or full-thickness skin graft (see Fig. 1.1b) is sutured to the wound margin on one side. A thin film of fibrin glue (Tissucol, Baxter Germany, Heidelberg) is applied to the base of the wound, and the graft is pressed firmly against the wound bed for 30 seconds. b A light pressure dressing is particularly recommended in more mobile facial areas. The graft-fixation sutures are left long, and additional 4-0 sutures may be placed 1 cm from the wound margin. We cover the graft with a 1-2-mm thickness of petrolatum foam, followed by a foam or gauze bolster over which the suture tails are tied, exerting gentle pressure on the grafted site. c The tie-over dressing remains in place for at least 6 days.

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