Reconstructive Facial Plastic Surgery: A Problem-Solving Manual

by Weerda, Hilko

• ISBN13: 9781588900760
• ISBN10: 1588900762
• Edition: 1st
• Format: Hardcover
• Copyright: 2001-11-01
• Publisher: Thieme Medical Pub

Summary

A step-by-step guide to facial plastic surgery from an international expert! WINNER OF THE 2001 GEORGE DAVEY HOWELLS MEMORIAL PRIZE FROM THE UNIVERSITY OF LONDON! Drawing on decades of teaching and clinical experience,Dr. Weerdagives you a practical, step-by-step guide to facial and auricular reconstructive surgery. This surgical textbook is a virtual encyclopedia of reconstructive options for a wide range of facial, head, and neck defects. More than 600 illustrations and sequential drawings provide both the experienced surgeon and beginner with effective solutions to the most commonly encountered questions and problems in facial plastic surgery. The book covers every aspect of the field, from basic principles, anatomy, wound healing, and scar revisions, to defect closings in various regions, bone grafts, and aurical reconstruction. You'll get valuable information on established surgical procedures as well proposed technical advances in the field. Here is a wealth of information every specialist needs. Add this outstanding clinical resource to your library!

Author Biography

Hilko Weerda, MD, is Professor and Director of the Otolaryngology Clinic at University of Luebeck, Germany

Table of Contents

Anatomy of the Skin and Skin Flaps	p. 1
The Skin	p. 1
Types of Skin Flaps	p. 1
Random Pattern Flaps	p. 1
Axial Pattern Flaps	p. 2
Island Flaps	p. 2
Myocutaneous Island Flaps	p. 2
Neurovascular Island Flaps	p. 2
Basic Principles of Facial Surgery	p. 3
Suture Materials and Techniques	p. 3
Instruments and Accessories	p. 5
Wound Management, Repair of Small Defects, and Scar Revision	p. 5
Relaxed Skin Tension Lines, Vascular Supply, and "Esthetic Units"	p. 5
Wound Management and Scar Revision	p. 5
Management of Wounds with Traumatic Tattooing	p. 7
Scar Revision by W-Plasty and the Broken-Line Technique of Webster (1969)	p. 7
Small Excisions	p. 7
Z-Plasty	p. 8
Postoperative Treatment of Scars	p. 9
Esthetic Units	p. 9
Tumor Resection with Histologic Control	p. 10
Free Skin Grafts	p. 10
Composite Grafts	p. 11
Graft Nomenclature	p. 11
Coverage of Defects	p. 12
Local Flaps	p. 12
Advancement Flaps	p. 12
Advancement Flap of Burow (1855)	p. 12
Burow's U-Advancement	p. 12
V-Y and V-Y-S Advancement of Argamaso (1974)	p. 13
Flaps without Continuous Epithelial Coverage (Rettinger 1996)	p. 13
Sliding Flap	p. 13
Pedicled Flaps	p. 14
Transposition Flap	p. 14
Rotation Flap	p. 15
Bilobed Flap	p. 16
Rhomboid Flap	p. 17
Turnover Flap	p. 18
Tubed Pedicle Flap (Bipedicle Flap)	p. 18
Distant Flaps	p. 19
Distant Tubed Pedicle Flap	p. 19
Special Part	p. 21
Coverage of Defects in Specific Facial Regions	p. 22
Forehead Region	p. 23
Median Forehead Region	p. 23
Wedge-Shaped Defects	p. 23
H-Flap	p. 24
Double Rotation Flap	p. 24
Lateral Forehead Defects	p. 25
Forehead Rotation	p. 25
Nasal Region	p. 26
Glabella and Nasal Root	p. 26
U-Advancement Flap of Burow	p. 26
V-Y Advancement	p. 26
Sliding Flap	p. 27
Nasal Dorsum	p. 28
Bilobed Flap	p. 28
Island Flap	p. 28
Rieger Flap	p. 29
Nasolabial Flap	p. 29
Cheek Flap	p. 29
Nasal Tip	p. 31
Bilobed Flap	p. 31
V-Y Advancement Flap of Rieger (1957)	p. 32
Median Forehead Flap	p. 33
Larger Defects of the Nasal Tip and Ala	p. 34
Frontotemporal Flap of Schmid and Meyer	p. 34
Nasal Flank	p. 36
Flap Advancement of Burow (1855)	p. 36
Median Cheek Rotation of Sercer (1962)	p. 36
Burow's Laterally Based Cheek Advancement Flap	p. 37
Imre's Cheek Rotation (1928)	p. 37
Cheek U-Flap	p. 38
Island Flap	p. 40
Sliding Flap	p. 41
Nasal Ala	p. 41
Full-Thickness Reconstructions	p. 41
Z-Plasty of Denonvilliers and Joseph (1931)	p. 41
Anteriorly Based Alar Rotation (Weerda 1984)	p. 41
Modification of the Anteriorly Based Alar Rotation	p. 42
Coverage with a Transposition Flap	p. 42
Lowering the Alar Rim as a Full-Thickness Bipedicle Flap and with a Composite Graft	p. 42
Turnover Flap and Composite Graft	p. 42
Converting a peripheral to a Central Defect (Haas 1991) and Reconstructing the Alar Rim with a Transposition Flap	p. 43
Wedge-Shaped Defect in the Alar Rim	p. 43
Nelaton Flap (Nasolabial Flap)	p. 44
Sliding Flap of Barron et al. (1965) and Lejour (1972) from the Nasolabial Fold	p. 45
In-and-Out Flap of Peers (1967)	p. 45
Median Forehead Flap	p. 45
Bilobed Flap from the Cheek (Weerda 1983)	p. 45
The Columella	p. 46
Nelaton Flap	p. 46
Frontotemporal Flap of Schmid and Meyer (1964)	p. 46
Composite Graft	p. 46
Partial and Total Nasal Reconstruction	p. 46
Converse Scalping Flap (Forehead-Scalp Flap)	p. 49
Total Nasal Reconstruction with the Sickle Flap (Farrior 1974)	p. 51
Median Forehead Flap with Soft-Tissue Expansion	p. 51
Nasal Reconstruction with Distant Flaps	p. 52
Perforations of the Septum	p. 52
Small Perforations	p. 52
Large Defects	p. 53
Oral Mucosal Flap of Meyer (1988)	p. 53
Nasolabial Flap of Tipton (1975)	p. 53
Bipedicled Flap of Schultz-Coulon (1989)	p. 53
The Lips	p. 55
Mucosal Defects	p. 55
Wedge-Shaped Defects	p. 55
Large Superficial Defects	p. 55
Upper Lip	p. 56
Median Deficiency	p. 56
Thin Upper Lip	p. 56
Thin Upper Lip and Full Lower Lip	p. 56
Median Scars and Upper Lip Defects	p. 58
Scar Revisions	p. 59
Small Contractures	p. 59
Larger Contractures	p. 60
Larger Scar Contractures Causing Lip Retraction	p. 61
Defects in the Nasal Floor and Upper Lip	p. 61
Transposition Flap from the Nasolabial Fold	p. 61
Bilobed Flap	p. 61
Central Defects of the Upper Lip	p. 63
Celsus Method Combined with an Abbe Flap	p. 63
Classic Reconstructive Techniques in the Upper Lip	p. 63
Abbe Flap (1898)	p. 63
Estlander Flap (1872)	p. 65
Upper Lip Reconstruction with a Rotation Flap (Blasius 1840)	p. 66
Upper Lip Reconstruction by the Method of Dean et al. (1975) as Modified by Weerda (1990)	p. 66
Gillies Fan Flap (1976)	p. 66
Neurovascular Skin-Muscle-Mucosal Flap of Weerda (1980, 1990)	p. 67
Lower Lip	p. 68
Scar Contractures and Small Defects	p. 68
Small Contractures	p. 68
Larger Contractures	p. 68
Small Defects	p. 69
Lip Reduction	p. 69
Sliding Flaps in the Vermilion	p. 70
Classic Lower Lip Reconstructions	p. 70
Wedge Excision	p. 70
Estlander Flap (1872)	p. 72
Vermilion Reconstruction by the Method of von Langenbeck (1855)	p. 72
Tongue Flap	p. 73
Brown Modification of the Estlander Flap (1928)	p. 73
Unilateral or Bilateral Gillies Fan Flap	p. 74
Universal Method of Bernard (1852), Grimm (1966), and Fries (1971)	p. 74
Reconstruction of the Lateral Lip and Commissure	p. 77
Burow's Method of Reconstructing the Lateral Upper Lip (1855)	p. 77
Reconstruction of the Commissure by the Method of Rehn (1933) as Modified by Fries (1971) and Brusati (1979)	p. 78
Reconstruction of Large Commissural Defects	p. 78
Large Full-Thickness Reconstruction of the Cheek and Commissure	p. 79
Asymmetric Defects of the Commissure and Cheek	p. 80
Vermilion Defects	p. 80
Vermilion Advancement of Goldstein (1990)	p. 80
Elongation of the Oral Fissure	p. 81
Method of Converse (1959) (Weerda 1983)	p. 81
Method of Converse (1977)	p. 81
Method of Ganzer (1921)	p. 81
Method of Gillies and Millard (1957)	p. 81
The Chin	p. 83
Coverage of Small Defects in the Chin Area	p. 83
Advancement Flap	p. 83
Bilobed Flap	p. 83
The Cheek	p. 84
Medial Cheek Defects	p. 84
Upper Medial Cheek	p. 84
Esser Cheek Rotation (1918)	p. 84
Cheek Reconstruction Combining the Methods of Esser (1918) and Imre (1928) (Weerda 1980)	p. 84
Small Cheek Defects	p. 84
Imre Cheek Advancement Flap (After Haas 1973, Modified)	p. 85
Modified Esser Cheek Rotation For Nasal Flank Defects	p. 85
Defect in the Medial Canthus	p. 85
Mid-Anterior Cheek	p. 86
Pedicled Bilobed Flaps	p. 86
V-Y Advancement	p. 87
Upper and Posterior Cheek	p. 87
Trilobed Flap of Weerda (1979)	p. 87
Bilobed Flap	p. 88
Lateral Cheek Defects	p. 88
Small Lateral Cheek Defects	p. 88
Small Preauricular Defects	p. 90
Simple Skin Advancement and Rotation (Burow's Method)	p. 90
Opposing Transposition Flaps	p. 90
Large Defects involving the Auricle	p. 91
Lateral Cheek Rotation of Weerda (1980c)	p. 91
Pedicled Transposition Flaps	p. 92
Preauricular Hair Loss	p. 93
Inferiorly Based Retroauricular Transposition Flap (Weerda 1978a)	p. 93
Large Bilobed Flap from the Neck (Weerda 1980b)	p. 93
The Eyelids	p. 95
Upper Eyelid	p. 95
Direct Closure	p. 95
Semicircular Flap Closure of Beyer-Machule et al. (1993)	p. 95
Switch Flap	p. 96
Upper Eyelid Reconstruction of Fricke and Kreibig	p. 96
Bilobed Flap	p. 97
Total Upper Lid Reconstruction by the Two-Stage Mustarde Technique (Beyer-Machule and Riedel 1993)	p. 97
Reconstruction of the Lower Eyelid	p. 98
Reconstruction of Small Defects in the Lower Eyelid	p. 98
Large Defects	p. 98
Reconstruction of the Lower Lid with Ectropion	p. 98
Transposition Flap	p. 98
Total Lower Lid Reconstruction	p. 98
Reconstruction of the Medial Canthus	p. 100
The Auricular Region	p. 101
Central Defects	p. 101
Concha	p. 101
Postauricular Island Flap	p. 101
Superiorly or Inferiorly Based Transposition Flap	p. 101
Temporary Separation of the Helix (Weerda 1984)	p. 101
Peripheral Defects	p. 102
Helix	p. 102
Tumor Resection and Helical Defect Closure with a Decrease in Auricular Size	p. 102
Reconstruction of Helical Defects with Preservation of Auricular Size	p. 103
Partial Auricular Defects	p. 104
Upper Third Defects	p. 104
Middle Third Defects	p. 105
Burow's Retroauricular U-Advancement Flap	p. 105
Transposition-Rotation Flap of Weerda (1980b)	p. 106
Larger Middle Third Defects	p. 106
Lower Third Defects	p. 108
Earlobe Reconstruction by the Gavello Technique	p. 108
Weerda's Modification of the Gavello Flap	p. 108
Earlobe Reconstruction by the Alanis Technique	p. 108
Earlobe Reconstruction in Two Stages	p. 108
Acquired Earlobe Cleft	p. 109
Earlobe Reduction	p. 109
Postauricular Surface	p. 110
Subtotal Defects of the Auricle	p. 110
Loss of the Auricle	p. 110
Fresh Avulsion Injuries	p. 110
Microvascular Replantation	p. 110
Replantation of the Auricular Cartilage	p. 110
Replantation by the Technique of Mladick (1971)	p. 111
Auricular Replantation by the Technique of Baudet (1972) and Arfai (1974) (Weerda 1980)	p. 111
Auricular Reconstruction Following Total Amputation	p. 112
Reconstruction of the Ear or Auricular Region in Patients with Skin Loss or Burns	p. 114
Fan Flap of Parietotemporal Fascia	p. 114
Closure of Defects in the Auricular Region	p. 115
Rib Cartilage	p. 117
Obtaining Rib Cartilage	p. 117
Preparation of Cartilage Grafts	p. 118
Carving an Auricular Framework	p. 118
Myocutaneous Island Flaps	p. 120
Pectoralis Major Island Flap	p. 120
Latissimus Dorsi Island Flap	p. 121
Neurovascular Infrahyoid Myofascial Flap of Remmert (1994)	p. 122
Deltopectoral Flap	p. 124
Free Flaps	p. 125
Radial Forearm Flap	p. 125
Allen Test	p. 126
Groin Flap	p. 126
Microvascular Surgery	p. 128
Instrumentation	p. 128
Practicing for Microvascular Surgery	p. 129
Knot-Tying Practice Under a Microscope or Binocular Loupe	p. 129
Microvascular Anastomosis in an Experimental Animal: Vascular Dissection in the Rat	p. 131
Problems and Complications	p. 134
Test for Patency	p. 136
Harvesting a Bone Graft from the Iliac Crest	p. 137
Dermabrasion	p. 140
References	p. 141
Index	p. 145
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