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.
Author(s): Thomas E. Rohrer, Jonathan L. Cook, Andrew J. Kaufman
Edition: 2
Publisher: Elsevier
Year: 2017
Language: English
Pages: 392
Tags: dermatology ,surgery ,skin
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
