Facial Reconstruction After Mohs Surgery PDF
Preview Facial Reconstruction After Mohs Surgery
MediaCenter.thieme.com plus e-content online TPS23x31-2|13.11.17-17:36 TPS23x31-2|13.11.17-17:36 TPS23x31-2|13.11.17-17:36 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 Thieme New York (cid:129) Stuttgart (cid:129) Delhi (cid:129) Rio de Janeiro TPS23x31-2|13.11.17-17:36 ExecutiveEditor:SueHodgson Importantnote:Medicineisanever-changingscienceundergoing ManagingEditor:HaleyPaskalides continual development. Research and clinical experience are Director,EditorialServices:MaryJoCasey continuallyexpandingourknowledge,inparticularourknowledge ProductionEditor:TorstenScheihagen ofpropertreatmentanddrugtherapy.Insofarasthisbookmen- InternationalProductionDirector:AndreasSchabert tionsanydosageorapplication,readersmayrestassuredthatthe InternationalMarketingDirector:FionaHenderson authors,editors,andpublishershavemadeeveryefforttoensure InternationalSalesDirector:LouisaTurrell thatsuchreferencesareinaccordancewiththestateofknowledge DirectorofInstitutionalSales:AdamBernacki atthetimeofproductionofthebook. SeniorVicePresidentandChiefOperatingOfficer:SarahVanderbilt Nevertheless, this does not involve, imply, or express any President:BrianD.Scanlan guaranteeorresponsibilityonthepartofthepublishersinrespect toanydosageinstructionsandformsofapplicationsstatedinthe Printer:ReplikaPressPvt.Ltd. book.Everyuserisrequestedtoexaminecarefullythemanufac- turers'leafletsaccompanyingeachdrugandtocheck,ifnecessary inconsultationwithaphysicianorspecialist,whetherthedosage LibraryofCongressCataloging-in-PublicationData schedulesmentionedthereinorthecontraindicationsstatedbythe manufacturers differ from the statements made in the present Names:Thornton,JamesF.,author.|Carboy,JourdanA.,author. book.Suchexaminationisparticularlyimportantwithdrugsthat Title:FacialreconstructionafterMohssurgery/JamesF.Thornton, areeitherrarelyusedorhavebeennewlyreleasedonthemarket. Jourdan A.Carboy. Everydosagescheduleoreveryformofapplicationusedisentirely Description:NewYork:Thieme,[2018]|Includesbibliographical attheuser'sownriskandresponsibility.Theauthorsandpublishers references. requesteveryusertoreporttothepublishersanydiscrepanciesor Identifiers:LCCN2017039193|ISBN9781626237346(print)| inaccuraciesnoticed.Iferrorsinthisworkarefoundafterpubli- ISBN9781626237353(e-book) cation,erratawillbepostedatwww.thieme.comontheproduct descriptionpage. Subjects:|MESH:Face–surgery|ReconstructiveSurgical Someoftheproductnames,patents,andregistereddesigns Procedures|Mohs Surgery referredtointhisbookareinfactregisteredtrademarksorpro- Classification:LCCRD119.5.F33|NLMWE705|DDC617.5/ prietarynameseventhoughspecificreferencetothisfact isnot 20592–dc23 always made in the text. 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RepairofSoftTissueFacialDefects|13.11.17-17:23 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 RepairofSoftTissueFacialDefects|13.11.17-17:23 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 vi RepairofSoftTissueFacialDefects|13.11.17-17:23 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 RepairofSoftTissueFacialDefects|13.11.17-17:23 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 RepairofSoftTissueFacialDefects|13.11.17-17:23 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
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