Local and Regional Flaps in Head & Neck Reconstruction: A Practical Approach

263 Pages·2014·139.43 MB·English

by  Rui Fernandes

Local and Regional
Flaps in Head & Neck
Reconstruction
A Practical Approach
R U I F E R N A N D E S

Local and Regional Flaps in Head
& Neck Reconstruction

Local and Regional Flaps in
Head & Neck Reconstruction
A Practical Approach
Rui Fernandes, MD, DMD, FACS
Associate Professor & Associate Chair Department of Oral and Maxillofacial Surgery
Chief of Head and Neck Service
Director, Microvascular Fellowship
University of Florida College of Medicine – Jacksonville
Jacksonville, Florida, USA
Thiseditionfirstpublished2015
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Fernandes,Rui,author.
Localandregionalflapsinhead&neckreconstruction:apracticalapproach/RuiP.Fernandes.
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Localandregionalflapsinheadandneckreconstruction
Includesbibliographicalreferencesandindex.
ISBN978-1-118-34033-2(cloth)
I.Title. II.Title:Localandregionalflapsinheadandneckreconstruction.
[DNLM: 1. Head–surgery. 2. Neck–surgery. 3. Reconstructive Surgical Procedures. 4. Surgical
Flaps. WE705]
RD521
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2014025853
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1 2015
Contents
Preface vii
Acknowledgments ix
Aboutthecompanionwebsite xi
1 Introduction 1
2 Flapclassification 2
3 Bilobedflap 5
4 Rhomboidflap 12
5 Crescenticflap 20
6 Septalflap 31
7 Nasolabialflap 41
8 VtoYadvancementflap 50
9 Keystoneflap 57
10 Paramedianforeheadflap 62
11 Thetemporoparietalfasciaflap 75
12 Temporalismuscleflap 84
13 Cervicofacialadvancementflap 92
14 Submentalislandflap 103
15 Pectoralismajormyocutaneousflap 114
16 Latissimusdorsimyocutaneousflap 123
17 Sternocleidomastoidflap 133
18 Trapeziusflap 140
19 Thesupraclaviculararteryislandflap 147
v
vi Contents
20 Theinternalmammaryperforatorflap 162
21 Earreconstruction 170
22 Lipreconstruction 186
23 Nasalreconstruction 206
24 Scalpreconstruction 222
Index 243
Preface
As a collector of medical books, I have found that the nessmatchesbyreplacinglikewithliketissue.Localand
currentemphasisofmosttextsonheadandneckrecon- regional flaps have great resource-sparing potential for
structivesurgeryisonmicrovascularsurgery.Theimpact thehealthcaresystemintermsinstrumentationandclin-
of free tissue transfer on the surgeon’s ability to repair ical resources, and offer a lower cost to the patient. Use
difficult defects has been revolutionary, to say the least. oftheseflapsalsoprovidesmoreoptionsforreconstruc-
For this reason, it is certainly tempting to focus our tionforsickerpatientswhomaynotbewellsuitedforthe
thought process chiefly on microsurgery for head and rigorsofmicrosurgery.
neck reconstruction. However, my own practice, trav- In this book, I have sought to provide an “how to”
els, and experience have given me a greater apprecia- approach for surgeons with and without specialized
tion for the relevance of regional pedicle flaps, and I traininginheadandneckreconstruction.Ihaveincluded
believethattheyplayabiggerroleinthepracticeofhead my own clinical photos instead of sketches to demon-
and neck reconstruction than most surgeons give them stratehowusefullocalandregionalflapsareinmyown
creditfor. practice.Wheneverbeneficial,Ihaveincludedvideosto
In planning for this project, I evaluated the merits demonstrate the described techniques. My hope is that
of a textbook devoted entirely to local and regional the reader, especially our younger colleagues who have
flaps. When well planned and executed, these flaps grown up in the era of microsurgery, will realize that
oftenyieldbetterresultsthanthoseattainedwithmicro- thereisadefiniteroleforregionalandlocalflapsinhead
surgery,offeringpatientsbettercolor,texture,andthick- andneckreconstruction.
vii