Cummings Chap 24 Reconstruction of facial defects 10/31/12.
-
Upload
justice-simonson -
Category
Documents
-
view
220 -
download
1
Transcript of Cummings Chap 24 Reconstruction of facial defects 10/31/12.
Local flap classificationLocal flaps- designed immed adjacent to defect, pivotal,
advancement, hinge1. Pivotal- shorter flap length greater degree rotation
a) rotationalb) transpositionc) interpolated flap
2. Advancement flap- stretched in single vector into defect
a) unipedicledb) V-Y advancementc) Y-V advancement
3. Hinge flap
Pivotal flaps
Rotational-• Curvilinear• Flap adjacent to defect• usu random/occ axial
blood supply• best if inferiorly based-
allows lymphatic flow• good for mid face
defects.
Pivotal flapsTransposition• Linear• Can be adjacent or
distant to defect more options for skin donor, better scar/orientation of donor site
• usu random/occ axial blood supply
• small-med defect• L:W <1:3
Pivotal flapsInterpolated• axial blood supply• base distant to
defect• pedicle must pass
over/under normal tissue
• req 2nd stage, or can de-ep and tunnel under tissue
Advancement flapUnipedicled-• Primary movement:
Tissue slides into defect
• Secondary movement: tissue around defect pushed in
• 2 burrows triangles- z plasty, “sewn out”
• Bilateral unipedicles H or T plasty
Advancement flapVY advancement• V shaped flap covers defect results in triangular defect
at donor site closed by advancing 2 edges of the triangle forming stem of the Y
• Good for contracted sites that need lengthening/release eg columella in cleft lip, ectropion of vermillion
YV advancement• Similar to above ex 1st flap is Y shaped• Good for reducing redundant tissue
Hinge flap
• pedicle based on defect border, flipped over like page in book, subcut surface covered w/ 2nd flap
• Good for defects that req ext and int coverage eg full thickness nasal defects
Nasal Defects• Nasal subunits:
• T/F Defects involving several subunits should be repaired with single flap if possible.
• If defect involved > ? of the subunit, replace the entire subunit
Nasal Defects• Nasal subunits:
• ala, • side wall • columella• dorsum• tip• Facets
• Repair defect of each aesthetic subunit separately
• If defect involved >50% of the subunit, replace the entire subunit
Nasal defects- ala
• Ala part of ext nasal valve
• 1.5cm or less- bipedicled mucosa flap for internal lining, septal/conchal cart for alar cartilage, interpolated flap from cheek/forehead for external coverage
• 2.5cm or less- septal hinge mucosal graft
Septal hinge
Nasal defects- tip/columella• Composite pivotal
septal flap• Mucoperichondrial
leaves form internal lining as bilat hinge flaps
• Cartilage graft• Paramedian forehead
flap for external coverage
Lip defects
<1/2 – primary closure, w plasty1/2-2/3- lip switch (abbe if away from commissure, estlander + commissureplasty if
near commissure) flap width ½ defect width, kerapanzic>2/3- bernard webster bipedicled advancement flap, melolabial transposition,
temporal forehead flap, free flap
Cheek defectsKeep tension away from
eye/lipRhomboid- Small-med
defectsBilobed- large defects, 1st
lobe 20% smaller than defect,2nd lobe 20% smaller than 1st, inf based
Advancement flapTransposition flap-
melolabial, best sup based b/c redundant lower cheek skin used for flap
Forehead defectsGoals: preserve frontalis fxn,
presernve sensation, place scars withinhorizontal furrows
Aesthetic goals: Eyebrow symmetry, maintain hairline, hide scars (in brow/hairline, keep scars transverse except in midline)
Subunits: • Median- midline• Paramedian- midline to vertical
axis above pupil• Lateral temple- paramedian
border to temporal hairline