Facial Reconstruction After Mohs Surgery

225 Pages·2018·32.45 MB·English

by  James F. Thornton

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TPS23x31-2|13.11.17-17:36
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Facial Reconstruction After Mohs Surgery
James F. Thornton, MD
Professor
Department of Plastic and Reconstructive Surgery
University of Texas Southwestern Medical Center
Dallas, Texas, USA
Jourdan A. Carboy, BS
Department of Plastic and Reconstructive Surgery
University of Texas Southwestern Medical Center
Dallas, Texas, USA
364 illustrations
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Contents
VideoContents................................................................................... xi
Preface............................................................................................ xiii
Acknowledgments............................................................................... xiv
Contributors...................................................................................... xv
Part1:Introduction
1 SpecialConsiderationsforMohsPatients ..................................................... 3
JamesF.ThorntonandJourdanA.Carboy
1.1 GeneralPrinciples......................... 3 References............................... 6
1.2 ConductoftheOperation ................. 6
2 AnesthesiaforReconstructionofFacialMohsDefects ....................................... 7
JayneColemanandJavierMarull
2.1 GeneralPrinciples......................... 7 2.3.2 MalignantHyperthermia.................... 11
2.2 TypesofAnesthesia....................... 7 2.4 OperatingRoomFires..................... 12
2.2.1 MonitoredAnesthesiaCare.................. 7 2.5 PostoperativeCognitiveDysfunction....... 12
2.2.2 GeneralAnesthesia......................... 8
2.6 ANoteonOffice-BasedAnesthesia......... 12
2.3 Recovery................................. 10
References............................... 12
2.3.1 ObstructiveSleepApnea .................... 11
3 MohsMicrographicSurgery .................................................................... 14
SeanChen,DivyaSrivastava,andRajivI.Nijhawan
3.1 Introduction.............................. 14 3.6.1 NonmelanomaSkinCancers................. 18
3.6.2 BasalCellCarcinoma ....................... 18
3.2 History................................... 15 3.6.3 SquamousCellCarcinoma................... 18
3.6.4 Melanoma................................ 18
3.3 PreoperativeConsiderations............... 15 3.6.5 OtherTumors ............................. 19
3.4 DescriptionofTechnique.................. 15 3.7 Conclusion............................... 19
3.5 PostoperativeConsiderations.............. 17 References............................... 20
3.6 Complications ............................ 17
4 CellularandTissue-BasedWoundCare ........................................................ 22
JamesF.ThorntonandJourdanA.Carboy
4.1 Algorithm................................ 22 4.3 CellularandTissue-BasedProducts ........ 23
4.1.1 GeneralConsiderations ..................... 22 References............................... 27
4.2 Integra................................... 23
v
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Contents
5 Full-ThicknessSkinGrafts........................................................................ 28
JamesF.ThorntonandJourdanA.Carboy
5.1 Algorithm................................ 28 5.3.1 BolsteringtheGraft......................... 29
5.3.2 PostoperativeCare.......................... 30
5.1.1 GeneralConsiderations..................... 28
References................................ 32
5.2 SelectionofDonorSite.................... 29
5.3 GraftElevationandInset.................. 29
6 Split-ThicknessSkinGrafting .................................................................... 33
JamesF.ThorntonandJourdanA.Carboy
6.1 GeneralConsiderations ................... 33 6.4 GraftInset................................ 34
6.2 Donor-SiteSelection...................... 33 References................................ 39
6.3 HarvestTechnique........................ 33
7 CartilageGrafts ................................................................................... 40
JamesF.ThorntonandJourdanA.Carboy
7.1 GeneralConsiderations ................... 40 7.2.3 SeptalCartilageDonorSite................... 41
7.2.4 BankedFrozenAllograftCartilage............. 43
7.2 Donor-SiteSelection...................... 40
References................................ 44
7.2.1 ConchalBowlDonorSite.................... 40
7.2.2 RibCartilageDonorSite..................... 41
8 PedicledFlaps..................................................................................... 45
JamesF.ThorntonandJourdanA.Carboy
8.1 GeneralConsiderations ................... 45 8.2 PostoperativeCare........................ 62
8.1.1 NasolabialFlap ............................ 45 References................................ 65
8.1.2 ParamidlineForeheadFlap.................. 52
9 LocalFlaps......................................................................................... 66
JamesF.ThorntonandJourdanA.Carboy
9.1 GeneralConsiderations ................... 66 9.6 BilobedFlap............................... 71
9.2 LinearClosure............................ 66 9.7 DorsalNasalFlap.......................... 71
9.3 RotationFlaps............................ 66 9.8 MelolabialFlap............................ 73
9.4 AdvancementFlaps....................... 67 9.9 NoteFlap................................. 76
9.5 TranspositionFlaps ....................... 69 References................................ 80
Part2:TechniquesforSpecificAnatomicLocation
10 ScalpReconstruction............................................................................. 83
JamesF.ThorntonandJourdanA.Carboy
10.1 AlgorithmForClosure .................... 83 10.1.1 GeneralConsiderations...................... 83
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Contents
10.2 CommonlyAppliedMethodsofClosure .... 84 10.3 PostoperativeManagement............... 89
10.2.1 BoneExposureandCalvarialDefects.......... 84 References............................... 89
10.2.2 DirectClosure ............................. 84
11 ForeheadReconstruction........................................................................ 91
JamesF.ThorntonandJourdanA.Carboy
11.1 AlgorithmforClosure..................... 91 11.2.2 DirectClosure............................. 93
11.2.3 DefectsInvolvingtheEyebrow............... 93
11.1.1 GeneralConsiderations ..................... 91
11.3 PostoperativeManagement............... 94
11.2 CommonlyAppliedMethodsofClosure .... 92
References............................... 95
11.2.1 DelayedHealing/AcellularAdjuncts........... 92
12 IntroductiontoNoseandSimpleNasalDefects............................................... 96
JamesF.ThorntonandJourdanA.Carboy
12.1 GeneralPrinciplesofNasalReconstruction.. 96 12.3 SevenLocalFlapOptions.................. 98
12.1.1 RegionalConsiderations:UpperTwo-Thirds 12.3.1 PrimaryClosure ........................... 98
versusLowerOne-ThirdoftheNose .......... 97 12.3.2 NoteFlap................................. 98
12.3.3 BilobedFlap............................... 98
12.2 GeneralTechniquesforClosureofSimple 12.3.4 DorsalNasalFlap .......................... 100
NasalDefects............................. 97 12.3.5 V-YAdvancementFlap...................... 100
12.3.6 MelolabialFlap............................ 100
12.2.1 SecondaryHealing ......................... 97 12.3.7 PostoperativeManagement ................. 101
12.2.2 Full-ThicknessSkinGrafting ................. 97
12.2.3 PrimaryClosureandLocalFlapsforSimple References............................... 104
Defects ................................... 98
13 ComplexNasalDefects .......................................................................... 105
JamesF.Thornton,JourdanA.Carboy,andNicholasT.Haddock
13.1 GeneralPrinciplesinComplexNasalDefects 13.2.2 PostoperativeManagement ................. 111
andReconstruction ....................... 105
13.3 FreeTissueTransfer....................... 113
13.1.1 NasolabialFlaps............................ 105
13.1.2 ForeheadFlaps............................. 106 13.3.1 PotentialApproaches....................... 113
13.3.2 Technique ................................ 113
13.2 SpecialConsiderations:Three-Stage
ForeheadFlap............................. 111 13.4 ProblemsandComplications .............. 114
13.2.1 SpecialConsiderations:LiningandCartilage References............................... 117
Support................................... 111
14 NasalReconstructionBasedonSubunits ...................................................... 118
JamesF.ThorntonandJourdanA.Carboy
14.1 AlgorithmforClosure..................... 118 References............................... 130
14.1.1 Sidewall .................................. 118
15 EyelidReconstruction............................................................................ 131
RonaldMancini
15.1 AnatomicalConsiderations................ 131 15.2 AlgorithmforClosure..................... 131
vii
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Contents
15.3 DefectsInvolvingtheCanthus............. 132 15.4.1 UpperandLowerEyelid:Partial-Thickness
Defects.................................... 135
15.3.1 MedialCanthalDefects ..................... 132 15.4.2 UpperandLowerEyelid:Full-Thickness
15.3.2 LateralCanthalDefects ..................... 135 Defects.................................... 136
15.4 DefectsNotInvolvingtheCanthus......... 135 References................................ 142
16 CheekReconstruction............................................................................ 143
JamesF.ThorntonandJourdanA.Carboy
16.1 AlgorithmforClosure..................... 143 16.5 CervicofacialAdvancementFlaps........... 146
16.1.1 GeneralConsiderations..................... 143 16.6 Full-ThicknessSkinGrafts.................. 148
16.1.2 CommonlyAppliedMethodsofClosure....... 144
16.7 PostoperativeManagement................ 150
16.2 PrimaryClosure .......................... 144
References................................ 150
16.3 V-YAdvancementFlap .................... 145
16.4 PerialarCrescenticAdvancementFlap...... 146
17 ChinReconstruction.............................................................................. 151
JamesF.ThorntonandJourdanA.Carboy
17.1 AlgorithmforClosure..................... 151 17.4 Full-ThicknessSkinGrafts.................. 152
17.2 CommonlyAppliedMethodsofClosure.... 151 17.5 PostoperativeManagement................ 153
17.2.1 PrimaryClosure ........................... 151 References................................ 153
17.2.2 BilobedFlaps.............................. 152
17.3 V-YAdvancementFlap .................... 152
18 LipReconstruction................................................................................ 154
JamesF.ThorntonandJourdanA.Carboy
18.1 AlgorithmforClosure..................... 154 18.4.2 CentralDefectsoftheUpperLip:Abbeand
RotationFlaps.............................. 161
18.1.1 Anatomy.................................. 154 18.4.3 LateralCommissureDefects:Advancement
Closure.................................... 162
18.2 CommonlyAppliedMethodsofClosure.... 154 18.4.4 LargeDefectsoftheUpperorLowerLip:
KarapandzicFlap........................... 162
18.2.1 Mucosal-OnlyDefects ...................... 154 18.4.5 UpperandLowerLipMismatch:AlloDerm
Placement................................. 163
18.3 Skin-OnlyDefects......................... 156
18.5 PostoperativeManagement................ 163
18.3.1 DirectClosure............................. 156
References................................ 165
18.4 CombinedSkinandMucosalDefects....... 160
18.4.1 DirectClosurewithorwithoutWedgeResection 160
19 EarReconstruction................................................................................ 166
JamesF.Thornton,JourdanA.Carboy,andChristopherA.Derderian
19.1 AlgorithmforEarReconstruction.......... 166 19.2 CommonlyAppliedMethodsofClosure..... 167
19.1.1 AnatomicalConsiderations.................. 166 19.2.1 SecondaryClosure.......................... 167
viii
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Contents
19.2.2 Full-ThicknessSkinGrafting ................. 167 19.3.1 MedporTechnique......................... 170
19.2.3 LocalFlapWedgeorLocalFlapClosure........ 167 19.3.2 GeneralOperativeSetup.................... 171
19.2.4 FoldedPostauricularTwo-StageEarFlap 19.3.3 ProcedureDetails.......................... 171
Reconstruction(DieffenbachFlap)............ 168 19.3.4 Dressings................................. 174
19.2.5 PostoperativeCare ......................... 170
References............................... 175
19.3 TotalEarReconstruction................... 170
Part3:ManagementofComplicationsandRevisions
20 IntraoperativeComplicationsandInitialManagement ...................................... 179
JamesF.ThorntonandJourdanA.Carboy
20.1 GeneralPrinciples......................... 179 20.2.2 Bronchospasm............................. 180
20.2.3 PerioperativeAnaphylaxis .................. 180
20.1.1 ANoteonPatientConsent................... 179 20.2.4 CornealInjuries............................ 180
20.2.5 NerveInjury .............................. 181
20.2 IntraoperativeComplications.............. 179
References............................... 181
20.2.1 Fire....................................... 179
21 ManagementofComplicationsintheAcuteHealingStage.................................. 182
JamesF.ThorntonandJourdanA.Carboy
21.1 GeneralPrinciples......................... 182 21.1.4 Chondritis ................................ 183
21.1.5 FlapFailure ............................... 185
21.1.1 Hematoma................................ 182
21.1.2 Infection.................................. 182 References............................... 187
21.1.3 Dermatitis ................................ 182
22 ManagementofComplicationsintheLateHealingStage ................................... 188
JamesF.ThorntonandJourdanA.Carboy
22.1 GeneralConsiderations.................... 188 22.1.3 CancerRecurrence......................... 189
22.1.1 Hypo-andHyperpigmentation............... 188 References............................... 190
22.1.2 ContourAbnormalities...................... 188
23 SkinGraftRevisions.............................................................................. 192
JamesF.ThorntonandJourdanA.Carboy
23.1 GeneralPrinciples......................... 192 23.1.3 Dermabrasion............................. 192
23.1.1 InitialPostoperativeVisit.................... 192 References............................... 194
23.1.2 UnacceptableColorMatchorScarContour..... 192
24 LocalFlapRevisions.............................................................................. 195
JamesF.ThorntonandJourdanA.Carboy
24.1 ComplicationsandTheirManagement ..... 195 24.1.3 Z-Plasty .................................. 196
24.1.1 NoninvasiveManagement................... 195 References............................... 199
24.1.2 RevisionSurgery........................... 195
ix