Reconstructive facial plastic surgery : A problem- solving manual.

• Publisher: Thieme
• Year: 2015
• Tongue: English
• Leaves: 276
• Edition: 2
• Category: Library

✦ Table of Contents

Reconstructive Facial Plastic Surgery: A Problem-Solving Manual
Title Page
Copyright
Contents
Foreword to the 2nd Edition
Foreword to the First Edition
Preface to the 2nd Edition
Contributors
I Anatomy, Principles of Facial Surgery, and Coverage of Defects
1 Anatomy of the Skin and Skin Flaps
The Skin (Fig. 1.1)
Types of Skin Flaps
Random Pattern Flaps (Fig. 1.2)
Axial Pattern Flaps (Fig. 1.3)
Island Flaps (Fig. 1.4)
Myocutaneous Island Flaps (Fig. 1.5; see also Fig. 12.1)
Neurovascular Island Flaps
2 Basic Principles of Facial Surgery
Suture Materials and Techniques
Basic Instrument Set for Reconstructive Facial Plastic Surgery (Fig. 2.7)
The Binocular Loupe (Fig. 2.7c)
Additional instruments
Wound Management, Repair of Small Defects, and Scar Revision
Relaxed Skin Tension Lines, Vascular Supply (Fig. 2.8i), and “Esthetic Units” (Fig. 2.20)
Wound Management, Repair of Small Defects, and Scar Revision
Management of Wounds with Traumatic Tattooing
Scar Revision by W-Plasty and the Broken-Line Technique of Webster (1969) (Fig. 2.8a–j)
Small Excisions
Z-Plasty (Figs. 2.15 and 2.16)
Postoperative Treatment of Scars
Esthetic Units of the Face (Fig. 2.20)
Tumor Resection with Histologic Control (Fig. 2.21)
Free Skin Grafts (Fig. 2.22)
Composite Grafts (Fig. 2.23)
Cartilagenous and Composite Grafts for Auricular and Nasal Reconstruction
Graft Nomenclature
3 Coverage of Defects
Local Flaps
Advancement Flaps
Advancement Flap of Burow (1855) (Fig. 3.1)
Burow’s U-Advancement (Figs. 3.2–3.7)
V-Y and V-Y-S Advancement of Argamaso (1974) (Figs. 3.8–3.10)
Flaps without Continous Epithelial Coverage (Rettinger 1996a, b)
Sliding Flap (Figs. 3.11–3.14)
Pedicled Flaps
Transposition Flap (Fig. 3.15)
Rotation Flap (Fig. 3.19)
Bilobed Flap (Fig. 3.22)
Rhomboid Flap (Figs. 3.24–3.27)
Turnover Flap (Fig. 3.28)
Tubed Pedicle Flap (Bipedicle Flap) (Fig. 3.29)
Distant Flaps
Distant Tubed Pedicle Flap
Myocutaneous and Myofascial Flaps (see Figs. 12.1–12.3)
Special Part
II Coverage of Defects in Specific Facial Regions
4 Forehead Region
Median Forehead Region
Wedge-Shaped Defects (Fig. 4.1)
H-Flap (Fig. 4.2)
Double Rotation Flap (Fig. 4.3)
Lateral Forehead Defects (Fig. 4.5)
5 Nasal Region
Glabella and Nasal Root (Figs. 5.1–5.9)
U-Advancement Flap of Burow (Fig. 5.1)
V-Y Advancement (Fig. 5.2; see also Figs. 3.8–3.10)
Sliding Flap (Fig. 5.7)
Nasal Dorsum (Figs. 5.8–5.12)
Bilobed Flap (Fig. 5.8)
Island Flap (Fig. 5.9)
Rieger Flap (Fig. 5.10)
Nasolabial Flap (Fig. 5.11)
Median Forehead Flap (Fig. 5.12)
Nasal Tip (Figs. 5.13–5.17)
Bilobed Flap (Fig. 5.13)
V-Y Advancement Flap of Rieger (1957) (Fig. 5.14)
Median and Paramedian Forehead Flap (Fig. 5.15)
Larger Defects of the Nasal Tip and Ala
Frontotemporal Flap of Schmid and Meyer (Figs. 5.17 and 5.18)
Nasal Flank
Flap Advancement of Burow (1855) (Fig. 5.22)
Median Cheek Rotation of Sercer and Mündich (1962) (Fig. 5.23)
Burow’s Laterally Based Cheek Advancement Flap (Fig. 5.24; see also Fig. 3.1)
Imre’s Cheek Rotation (1928) (Fig. 5.25)
Cheek U-Flap (Fig. 5.26)
Island Flap (Fig. 5.32)
Sliding Flap (Fig. 5.33)
Nasal Ala
Full-Thickness Reconstructions
Z-Plasty of Denonvilliers and Joseph (1931) (Fig. 5.34)
Anteriorly Based Alar Rotation (Weerda 1984) (Fig. 5.35)
Modification of the Anteriorly Based Alar Rotation
Coverage with a Transposition Flap
Lowering the Alar Rim as a Full-Thickness Bipedicle Flap and with a Composite Graft (Fig. 5.38)
Turnover Flap and Composite Graft (Lexer 1931, modified by Kastenbauer 1977)
Converting a Peripheral to a Central Defect (Haas 1991) and Reconstructing the Alar Rim with a Transposition Flap (Fig. 5.40)
Wedge-Shaped Defect in the Alar Rim (Fig. 5.41)
Nelaton Flap (Nasolabial Flap) (Fig. 5.42)
Sliding Flap of Barron and Emmett (1965) and Lejour (1972) from the Nasolabial Fold (Fig. 5.44)
In-and-Out Flap of Peers (1967) (Fig. 5.45)
Median Forehead Flap (see Figs. 5.15 and 5.51)
Bilobed Flap from the Cheek (Weerda 1983c) (Fig. 5.46)
Large Defects of the Lateral Nose (Figs. 5.47 and 5.48)
The Columella
Nelaton Flap (Fig. 5.49)
Frontotemporal Flap of Schmid and Meyer (1964)
Composite Graft (Fig. 5.50)
Partial and Total Nasal Reconstruction
Converse Scalping Flap (Forehead-Scalp Flap) (Fig. 5.52)
Total Nasal Reconstruction with the Sickle Flap (Farrior 1974) (Fig. 5.53)
Three-Stage Reconstruction of Total Nasal Defects (after Burget and Menick 1994
Median Forehead Flap with Soft-Tissue Expansion (Fig. 5.55)
Nasal Reconstruction with Distant Flaps
Perforations of the Septum
Small Perforations
Large Defects
Oral Mucosal Flap of Meyer (1988) (Fig. 5.59b)
Nasolabial Flap of Tipton (1975) (Fig. 5.60)
Bipedicle Flap of Schultz-Coulon (1989) (Fig. 5.61)
6 The Lips
Mucosal Defects
Wedge-Shaped Defects (Fig. 6.1)
Large Superficial Defects (Fig. 6.2)
Upper Lip
Median Deficiency (Fig. 6.3)
Thin Upper Lip (Figs. 6.4–6.6)
Thin Upper Lip and Full Lower Lip (Fig. 6.7)
Median Scars and Upper Lip Defects
Scar Revisions
Small Contractures (Fig. 6.11)
Larger Contractures
Larger Scar Contractures Causing Lip Retraction (Figs. 6.12 and 6.13)
Defects in the Nasal Floor and Upper Lip
Transposition Flap from the Nasolabial Fold (Fig. 6.14)
Bilobed Flap (Fig. 6.15)
Neurovascular Island Flap from the Lower Cheek (after Weerda 1980d Figs. 6.19 and 6.28)
Central Defects of the Upper Lip (Fig. 6.20)
Celsus Method Combined with an Abbé Flap (Fig. 6.21; see also Figs. 6.20 and 6.22)
Classic Reconstructive Techniques in the Upper Lip
Abbé Flap (1898, reprinted 1968) (Fig. 6.22)
Estlander Flap (1872) (Figs. 6.24; 6.40)
Upper Lip Reconstruction with a Rotation Flap (Blasius 1840) (Fig. 6.25)
Gillies Fan Flap (1976) (Fig. 6.27)
Neurovascular Skin–Muscle–Mucosal Flap of Weerda (1980d, 1990) (Figs. 6.19 and 6.28)
Combined Defect Repair of the Ala, Columella, Cheek, and Upper Lip (Fig. 6.29)
Lower Lip
Scar Contractures and Small Defects
Small Contractures (Figs. 6.30 and 6.31)
Larger Contractures
Small Defects
Lip Reduction
Sliding Flaps in the Vermilion
Classic Lower Lip Reconstructions
Wedge Excision
Estlander Flap (1872) (Fig. 6.40)
Bilobed Estlander Flap (Fig. 6.41)
Vermilion Reconstruction by the Method of von Langenbeck (1855) (Fig. 6.42)
Tongue Flap (Fig. 6.43)
Brown Modification of the Estlander Flap (1928) (Fig. 6.44)
Unilateral or Bilateral Gillies Fan Flap (1957) (Fig. 6.45e–j)
Universal Method of Bernard (1852), Grimm (1966), and Fries (1971) (Fig. 6.46; unilateral or bilateral)
Reconstruction of the Lateral Lip and Commissure
Burow’s Method of Reconstructing the Lateral Upper Lip (1855) (Fig. 6.48)
Reconstruction of the Commissure by the Method of Rehn (1933), as Modified by Fries (1971) and Brusati (1979) (Fig. 6.50)
Reconstruction of Large Commissural Defects (Fig. 6.51)
Vermilion Defects
Vermilion Advancement of Goldstein (1990)(Fig. 6.52)
Combined Reconstruction of the Lower Part of the Face (Lower Lip, Cheek, Chin, Middle Part of the Mandible) (Fig. 6.53)
Elongation of the Oral Fissure
Method of Converse (1959) (Weerda 1983) (Fig. 6.54)
Method of Converse (1977) (Fig. 6.55)
Method of Ganzer (1921) (Fig. 6.56)
Method of Gillies and Millard (1957) (Fig. 6.57)
7 The Chin
Coverage of Small Defects in the Chin Area
Advancement Flap (Fig. 7.1)
Bilobed Flap (Fig. 7.2a, b)
8 The Cheek
Medial Cheek Defects
Upper Medial Cheek
Esser Cheek Rotation (1918) (Fig. 8.1)
Cheek Reconstruction Combining the Methods of Esser (1918) and Imre (1928) (Weerda 1980) (Fig. 8.2)
Small Cheek Defects
Imre Cheek Advancement Flap (After Haas and Meyer 1973, modified) (Figs. 8.4 and 8.5)
Defect in the Medial Canthus (Fig. 8.6)
Mid-Anterior Cheek (Fig. 8.7)
Pedicled Bilobed Flaps
Large Inferiorly/Anteriorly Based Bilobed Flap (Fig. 8.8)
V-Y Advancement
Upper and Posterior Cheek
Trilobed Flap of Weerda (1979) (Fig. 8.10)
Bilobed Flap (Fig. 8.11)
Lateral Cheek Defects
Small Lateral Cheek Defects
Small Preauricular Defects
Simple Skin Advancement and Rotation (Burow‘s Method) (Fig. 8.17a–d)
Opposing Transposition Flaps (Fig. 8.18)
Large Defects Involving the Auricle
Lateral Cheek Rotation of Weerda (1980c) (Figs. 8.20 and 8.21)
Pedicled Transposition Flaps (Figs. 8.22 and 8.23)
Preauricular Hair Loss (Fig. 8.24)
Inferiorly Based Retroauricular Transposition flap (Weerda 1978b) (Fig. 8.25)
Large Bilobed Flap from the Neck (Weerda 1980b) (Fig. 8.26)
9 The Eyelids
Upper Eyelid
Direct Closure (Fig. 9.1)
Semicircular Flap Closure of Beyer-Machule and Riedel (1993) (Fig. 9.2)
Switch Flap (Fig. 9.3)
Upper Eyelid Reconstruction of Fricke and Kreibig (Fig. 9.4)
Bilobed Flap (Fig. 9.5)
Total Upper Lid Reconstruction by the Two- Stage Mustardé Technique (Beyer-Machule and Riedel 1993) (Fig. 9.6)
Reconstruction of the Lower Eyelid
Reconstruction of Small Defects in the Lower Eyelid
Large Defects (Figs. 9.6 and 9.7)
Reconstruction of the Lower Lid with Ectropion
Transposition Flap (Figs. 9.8 and 9.9)
Total Lower Lid Reconstruction (Figs. 9.11 and 9.12)
Reconstruction of the Medial Canthus (Figs. 9.13 and 9.14; see also Figs. 5.2–5.7)
10 The Auricular Region
Classification (Table 10.1) and Esthetic Units (Fig. 10.1)
Central Defects: Recommended Defect Coverage (Fig. 10.2)
Conchal Defects
Reconstruction with a Full-thickness Skin Graft (Fig. 10.3)
Transposition Flap and U-shaped Advancement (Fig. 10.4)
Reconstruction with Island Flaps (Figs. 10.5–10.7)
Defects of the Antihelix and Combined Central Defects (Figs. 10.8 and 10.9)
Converse and Brent’s (1977) Three-stage Reconstruction of Full-Thickness Defects of the Antihelix (Fig. 10.10)
Superiorly or Inferiorly Based Transposition Flap (Fig. 10.11)
U-shaped Advancement Flap of Gingrass and Pickrell (1968) (Fig. 10.12)
Weerda’s Reconstruction with a Transposition Flap and Temporary Repositioning of the Helix (Fig. 10.13)
Weerda’s Bilobed Flap as a Transposition– Rotation Flap (Fig. 10.14)
Weerda’s Scaphal Reconstruction with a U-shaped Advancement Flap (Fig. 10.15)
Tebbetts’ (1982) Superiorly Based, Preauricular Flap for the Triangular Fossa (Fig. 10.16)
Mellette’s (1991) Preauricular Flap Based Superiorly on the Helical Crus (Fig. 10.17)
Subcutaneous Pedicle Flap of Barron and Emmett (1965) (Fig. 10.18)
Inferiorly Based Preauricular Flap (Fig. 10.19)
Peripheral Defects (Fig. 10.20)
Helix Reconstruction with Auricular Reduction
Simple Wedge Excisions (Fig. 10.21)
Wedge Excision and Burow’s Triangles (Fig. 10.22a–j)
Gersuny’s (1903) Technique of Defect Closure by Transposition of the Helix (Fig. 10.23)
Modification of the Gersuny Technique by Weerda and Zöllner (1986) (Fig. 10.24)
Antia and Buch’s Modification with Mobilization of the Helical Crus (Fig. 10.25)
Lexer’s (1933) Modification (Fig. 10.26)
Argamaso and Lewin’s (1968) Technique of Ear Reduction and Defect Reconstruction Meyer and Sieber’s (1973) (Fig. 10.27) Modification of the Technique (Fig. 10.28)
Tenta and Keyes’ (1981) Excision of the Triangular Fossa with Reduction of the Auricle (Fig. 10.29)
Weerda and Zöllner’s (1986) Technique for Defects of the Helical Crus and Preauricular Region (Fig. 10.30)
Pegram and Peterson’s (1956) Reconstruction with a Free Full-Thickness Composite Graft from the Contralateral Ear
Helix Reconstruction without Auricular Reduction
Superiorly Based Postauricular Transposition Flap (Fig. 10.33)
Preauricular Transposition Flap (Fig. 10.34a–c)
Retroauricular Flap of Smith (1917) (Figs. 10.35a–h)
Tube-Pedicled Flap
Tube-Pedicled Flap for the Superior Helix (Fig. 10.37)
Tubed Bipedicle Flap for Defects of the Superior and Middle Thirds (Figs. 10.38 and 10.39)
Three-stage Reconstruction of a Defect of the Middle Third with a Tube-Pedicled Flap (Fig. 10.39)
Converse and Brent’s (1977) Reconstruction with a Preauricular Tube-Pedicled Flap (Fig. 10.39)
Reconstruction with a Superiorly Based Posterior Flap
Inferior Helix
Partial Reconstruction of the Auricle
Upper-Third Auricular Defects (Fig. 10.40)
Reconstruction with Auricular Reduction
Wedge Excisions
Helical Sliding Flap of Antia and Buch (1967) (Figs. 10.42 and 10.43)
Full-thickness Composite Grafts of the Contralateral Ear, as Described by Pegram and Peterson (1956)
Reconstruction without Auricular Reduction
Reconstruction with a Costal or Conchal (see Fig. 10.48) Cartilage Framework and Skin Pocket
Reconstruction by Insertion of an Expander
Crikelair’s (1956) Reconstruction using an Anterosuperiorly Based Posterior Flap (Figs. 10.51 and 10.52)
Crikelair’s Flap for Coverage of Large Defect (Fig. 10.52)
Harvesting a Skin Graft from the Thorax (Fig. 10.53)
Secondary Reconstruction Using a Postauricular Flap Pedicled on the Helix (Ombredanne 1931) (Fig. 10.54)
Partial Reconstruction with a Temporoparietal Fascial Flap (Fan Flap)
Middle-Third Auricular Defects (Fig. 10.55)
Reconstruction with Auricular Reduction
Reconstruction of the Middle and Lower Thirds, as Described by Templer et al. (1981) (Fig. 10.56)
Reconstruction without Auricular Reduction:
Recommended Methods of Reconstruction
Retroauricular U-shaped Burow Advancement Flap (Fig. 10.57)
Inferiorly and Superiorly Based Transposition Flap of Scott and Klaassen (1992) (Fig. 10.58)
Reconstruction with a Subcutaneous Pocket or a U-shaped Advancement Plasty (Fig. 10.59)
Reconstruction with a Pocket as a Tunneled Flap (Fig. 10.60a–h)
Reconstruction with a Rotation Flap (Fig. 10.61)
Weerda’s Rotation–Transposition Flap
Posterior Auricular Flap Based on Scar Tissue
Reconstruction with a Fan Flap (Temporoparietal Fascial Flap) (Fig. 10.62)
Reconstruction with Tubed Flaps
Lower-Third Auricular Defects (Fig. 10.63)
Recommended Methods
Superiorly and Inferiorly Based Transposition Flap (Fig. 10.64)
Reconstruction of the Entire Lower Auricle Using a Gavello Flap (Fig. 10.65)
Modified Gavello Flap (Fig. 10.66)
Reconstruction with a Modified Gavello Bipedicled Flap (Fig. 10.67)
Reconstruction of the Earlobe (Fig. 10.68)
Traumatic Earlobe Cleft
Reconstruction without Preservation of the Earring Perforation
Passow’s Procedure (Fig. 10.70)
Reconstruction with Preservation of the Earring Perforation
Pardue’s (1973) Method of Reconstruction (Fig. 10.71)
Defects of the Earlobe
Loss of the Earlobe
Gavello’s Method of Earlobe Reconstruction (1907; Figs. 10.65 and 10.66)
Posterior Defects
Postauricular defects (Fig. 10.75)
Small Flaps (Fig. 10.76 and 10.77)
U-Formed Advancement Flap (Fig. 10.78)
V-Y advancement (Fig. 10.79a, b)
Closure of Defects Caused by Skin Harvesting (Fig. 10.80)
Weerda’s Bilobed Flaps
Weerda’s Rotation–Transposition Flap (Fig. 10.81a–f)
Weerda’s Double Rotation Flap (Fig. 10.81)
Retroauricular Defects (Fig. 10.82)
Elliptical or W-shaped Excisions and Primary Closure (Fig. 10.83)
Preauricular Transposition Flap (Fig. 10.84)
Coverage with Skin of the Postauricular Surface and Rotation of the Cavum
Combined Post- and Retroauricular Defects (Fig. 10.85)
Free Skin Grafts (Fig. 10.86)
Subtotal Defects
Special Reconstructive Techniques
Single-stage Reconstruction with Weerda’s Bilobed Flap as a Transposition– Rotation Flap (Fig. 10.87)
Single-stage Reconstruction of the Anterior Surface with a Bilobed Flap (Fig. 10.88)
Loss of the Auricle
Fresh Avulsion Injuries
Microvascular Replantation
Replantation of the Auricular Cartilage
Replantation by the Technique of Mladick et al. (1971)
Auricular Replantation by the Technique of Baudet (1972) and Arfai (in Spira 1974) (Weerda 1980) (Fig. 10.89)
Auricular Reconstruction Following Total Amputation (Figs. 10.90, 10.91, and 10.92; Weerda 1983c, 1987, 1997; Weerda and Siegert 1998)
Reconstruction of the Ear or Auricular Region in Patients with Skin Loss or Burns (Fig. 10.93)
Fan Flap of Parietotemporal Fascia (Fig. 10.93)
Dressing the Ear (Fig. 10.95)
Removal of Sutures
Fine-Tailoring After Operations
Forming the shape of the Helical Crus, Concha, Antitragus, and Intertragic Notch
Reconstruction of Defects of the Auricular Region after Partial or Total Amputation (Figs. 10.99)
Free Skin Graft (See Fig. 2.22, p. 16)
Rotation Flap of the Neck (Fig. 10.101)
Reconstruction with Rotation Flaps (Fig. 10.101) and Double (Bilobed) Flaps (Figs. 10.102 and 10.103)
Bone-Anchored Defect Protheses
III Rib Cartilage, Myocutaneous and Free Flaps, and Microvascular Surgery
11 Rib Cartilage
Obtaining Rib Cartilage for Ear Reconstruction (Fig. 11.1)
Operative Technique
Preparation of Cartilage Grafts (Fig. 11.2; Nagata 1994)
Carving an Auricular Framework (Fig. 11.3)
Instruments
12 Myocutaneous Island Flaps
Pectoralis Major Island Flap (Fig. 12.1)
Latissimus Dorsi Island Flap (Fig. 12.2)
Neurovascular Infrahyoid Myofascial Flap of Remmert et al. (1994) (Fig. 12.3)
13 Deltopectoral Flap
14 Free Flaps
Radial Forearm Flap (Fig. 14.1)
Allen Test
Groin Flap (Fig. 14.2)
Transplants Anastomosed Using a Microvascular Technique (Fig. 14.3 and 14.4)
Microvascular Surgery
Instrumentation (Fig. 14.5)
Practicing for Microvascular Surgery
Knot-Tying Practice Under a Microscope or Binocular Loupe (Fig. 14.6–14.9)
Microvascular Anastomosis in an Experimental Animal: Vascular Dissection in the Rat (Fig. 14.10)
Problems and Complications (Figs. 14.16–14.20)
Test for Patency (Fig. 14.21)
15 Harvesting Bone Graft from the Iliac Crest (Figs. 15.1–15.5)
16 Harvesting Split Calvarian Bone Graft (Fig. 16.1)
17 Dermabrasion (Figs. 17.1)
References
Further Reading
Index