BOOK
Flaps and Grafts in Dermatologic Surgery E-Book
Thomas E. Rohrer | Jonathan L. Cook | Andrew Kaufman
(2017)
Additional Information
Book Details
Abstract
Achieve optimal results in reconstructive surgery involving flaps and grafts with this up-to-date reference written by leading dermatologic surgeons. Using a systematic approach, Flaps and Grafts in Dermatologic Surgery, Second Edition, by Drs. Thomas E. Rohrer, Jonathan L. Cook, and Andrew J. Kaufman, offers practical, easily accessible guidance in this challenging area, including anatomical considerations, the delicate nature of tissue movement, principles of aesthetic surgical closures, relevant tissue biomechanics, and much more. Covering everything from the basic linear and arciform closures, to the more challenging V-Y advancement flaps, and complex staged interpolation flaps, this text clearly presents not just the "how to do it" but more importantly the thought processes behind the selection and execution of each reconstructive procedure.
- Describes which flap or graft to choose in specific clinical situations, how to execute each repair (with a multitude of images and diagrams), and how to minimize the risks as well as manage potential complications.
- Provides algorithms to assist with flap and graft choices, as well as hundreds of superb full-color illustrations throughout.
- Includes an all-new chapter on Surgical Complications and Scar Revisions.
- Includes access to high-quality videos showing exactly how the flap/graft is incised, moved, and sutured. New videos include the Rhomboid Transposition Flap for Defect on the Lower Lid, the Island Pedicle Flap with Canthal Suspension, and the Primary Lid Repair with Diagonal Tarsal Suture Sine Marginal Sutures.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Flaps and Grafts in Dermatologic Surgery | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Video Contents | vi | ||
| Contributors | viii | ||
| Foreword | x | ||
| Preface | xi | ||
| Dedication | xii | ||
| 1 Anatomy | 1 | ||
| Abstract | 1.e1 | ||
| Keywords | 1.e1 | ||
| Introduction | 1 | ||
| Surface Landmarks and Surface Anatomy | 1 | ||
| Masseter Muscle and Midpupillary Line | 1 | ||
| Relaxed Skin Tension Lines | 1 | ||
| Cosmetic Units and Junction Lines | 1 | ||
| Free Margins: Concept of Tension Vector of Closure | 2 | ||
| Concavities and Convexities: Implications for Second Intention Healing | 3 | ||
| The Aging Face | 3 | ||
| The Musculoaponeurotic System | 4 | ||
| Introduction | 4 | ||
| Muscles Acting Around the Eyelids | 5 | ||
| Muscles Acting Around the Nose | 6 | ||
| Muscles Acting Around the Mouth | 7 | ||
| Motor Nerves | 7 | ||
| Introduction | 7 | ||
| Facial Nerve (Cranial Nerve VII) | 7 | ||
| Temporal Nerve | 8 | ||
| Zygomatic and Buccal Nerves | 8 | ||
| Marginal Mandibular and Cervical Nerves | 8 | ||
| Sensory Nerves of the Head and Neck | 8 | ||
| Trigeminal Nerve (Cranial Nerve V) | 8 | ||
| Ophthalmic Nerve (V1) | 9 | ||
| Maxillary Nerve (V2) | 10 | ||
| Mandibular Nerve (V3) | 10 | ||
| Vascular System | 10 | ||
| External Carotid System | 10 | ||
| Internal Carotid System | 11 | ||
| Venous System | 12 | ||
| Lymphatic System | 12 | ||
| Special Structures: Lip, Nose, Eyelids, and Ear | 12 | ||
| Lip | 12 | ||
| Nose | 13 | ||
| Eyelids | 13 | ||
| Ear | 15 | ||
| References | 15 | ||
| 2 Basic Principles in Flap Reconstruction | 16 | ||
| Abstract | 16.e1 | ||
| Keywords | 16.e1 | ||
| Basic Terminology | 16 | ||
| Flaps Defined by Blood Supply | 16 | ||
| Flap Physiology | 18 | ||
| Flap Biomechanics | 20 | ||
| Flaps Defined by Movement | 21 | ||
| Advancement Flap | 21 | ||
| Rotation Flaps | 23 | ||
| Transposition Flaps | 23 | ||
| Interpolation Flaps | 27 | ||
| Practical Points | 27 | ||
| Final Pearls | 29 | ||
| References | 31 | ||
| 3 Second Intention Healing and Primary Closure | 34 | ||
| Abstract | 34.e1 | ||
| Keywords | 34.e1 | ||
| Introduction | 34 | ||
| Second Intention Healing | 34 | ||
| Phases of Wound Healing | 34 | ||
| Appearance of Second Intention Healing Scars | 34 | ||
| Ideal Wounds for Second Intention Healing | 34 | ||
| Suboptimal Wounds for Second Intention Healing | 36 | ||
| Patient Factors Affecting Decisions About Second Intention Healing | 36 | ||
| Second Intention Healing as an Adjunct to Reconstructive Surgery | 37 | ||
| Wound Care During Second Intention Healing | 38 | ||
| Complications | 38 | ||
| Conclusion | 38 | ||
| Primary Closure | 39 | ||
| Phases of Wound Healing | 39 | ||
| Principles of Reconstruction | 39 | ||
| Preserve and Restore the Position of Free Margins | 39 | ||
| Preserve and Restore Normal Contour | 40 | ||
| Orient Scars Along Cosmetic Subunit Junction Lines | 41 | ||
| Orient Scars Along Relaxed Skin Tension Lines | 42 | ||
| Variations of the Fusiform Excision | 42 | ||
| Crescentic Excision | 43 | ||
| S-Plasty | 43 | ||
| M-Plasty | 44 | ||
| Serial Elliptical Excisions | 45 | ||
| Standing Cone Deformities: Causes and Corrections | 45 | ||
| Complications of Primary Closure | 48 | ||
| Conclusion | 49 | ||
| References | 49 | ||
| 4 Advancement Flaps | 50 | ||
| Abstract | 50.e1 | ||
| Keywords | 50.e1 | ||
| Flap Design and Considerations | 50 | ||
| Flap Mobilization and Key Sutures | 50 | ||
| Flap Modifications and Applications | 53 | ||
| H-Plasty or Bilateral Advancement Flap | 53 | ||
| T-Plasty | 56 | ||
| L-Plasty | 58 | ||
| Burow Triangle Flap | 58 | ||
| Cheek Advancement | 61 | ||
| Helical Rim Advancement Flap | 63 | ||
| Crescentic Advancement Flap | 64 | ||
| Webster Perialar Crescentic Flap | 64 | ||
| Modifications of the Crescentic Advancement Flap | 64 | ||
| Peng Flap | 68 | ||
| Disadvantages | 68 | ||
| References | 70 | ||
| 5 Rotation Flaps | 71 | ||
| Abstract | 71.e1 | ||
| Keywords | 71.e1 | ||
| Rotation Flap Design: Basic Principles | 71 | ||
| Flap Length | 71 | ||
| Flap Curvature | 71 | ||
| Bilateral Rotation Flaps | 73 | ||
| O–Z Rotation Flap | 73 | ||
| Selected Rotation Flaps | 74 | ||
| Dorsal Nasal Rotation Flap | 74 | ||
| Variants of the Dorsal Nasal Flap | 75 | ||
| Axial Dorsal Nasal Rotation Flap | 75 | ||
| Heminasal Rotation Flap | 75 | ||
| Other Variants | 76 | ||
| The Spiral Flap | 76 | ||
| Tenzel and Mustarde Rotation Flaps | 76 | ||
| Medial Cheek Rotation Flap | 79 | ||
| Cervicofacial Rotation Flaps | 80 | ||
| Rotation Flaps on the Chin and Lip | 80 | ||
| Plane of Flap Elevation and Surgical Undermining | 80 | ||
| Conclusion | 81 | ||
| References | 81 | ||
| 6 V-Y Flaps and Island Flaps | 82 | ||
| Abstract | 82.e1 | ||
| Keywords | 82.e1 | ||
| Technique | 84 | ||
| Modifications | 88 | ||
| Complications | 92 | ||
| References | 98 | ||
| 7 Transposition Flaps | 99 | ||
| Abstract | 99.e1 | ||
| Keywords | 99.e1 | ||
| Flap Design and Considerations | 99 | ||
| Rhombic and Single-Lobed Transposition Flaps | 99 | ||
| Design | 99 | ||
| Z-Plasty Effect of Transposition Flaps | 100 | ||
| Modified Rhombic Flaps | 101 | ||
| Dufourmentel Flap | 101 | ||
| Webster 30-Degree Angle Flap | 102 | ||
| Double 30-Degree Angle Flap | 102 | ||
| Rhombic Flap Execution: Flap Mobilization and Key Sutures | 102 | ||
| Other Transposition Flaps | 103 | ||
| Banner-Type Flaps | 103 | ||
| Banner Transposition Flap Mobilization and Application | 103 | ||
| Multilobe Transposition Flaps | 105 | ||
| Bilobed Flap | 105 | ||
| Bilobed Flap: Mobilization and Key Sutures | 108 | ||
| Trilobed Flap | 108 | ||
| General Applications of Transposition Flaps | 109 | ||
| Dorsum of the Nose and the Nasal Sidewall (Fig. 7.17) | 109 | ||
| Nasal Tip | 110 | ||
| Medial and Lateral Canthi (Fig. 7.18) | 110 | ||
| Temple | 110 | ||
| Cheeks (Fig. 7.19) | 111 | ||
| Perioral Area (Fig. 7.20) | 111 | ||
| Chin (Fig. 7.21) | 111 | ||
| Complications | 112 | ||
| Conclusion | 114 | ||
| References | 114 | ||
| Further Reading | 115 | ||
| 8 Staged Interpolation Flaps | 116 | ||
| Abstract | 116.e1 | ||
| Keywords | 116.e1 | ||
| Paramedian Forehead Flap, Stage I | 116 | ||
| Indication | 116 | ||
| Anatomy | 116 | ||
| Flap Design | 116 | ||
| Anesthesia | 118 | ||
| Execution | 119 | ||
| Cartilage and Lining Restoration | 119 | ||
| Flap Harvesting and Pedicle Mobilization | 119 | ||
| Defect Preparation | 120 | ||
| Flap Preparation and Inset | 120 | ||
| Donor Site Closure | 120 | ||
| Postoperative Care | 120 | ||
| Paramedian Forehead Flap, Stage II | 121 | ||
| Final | 121 | ||
| Paramedian Forehead Flap Variations | 121 | ||
| The Folded Paramedian Forehead Flap | 121 | ||
| Stage I | 122 | ||
| Stage II | 123 | ||
| Stage III | 123 | ||
| Heminasal Paramedian Forehead Flap | 123 | ||
| Paramedian Forehead Flap With Vascular Delay | 123 | ||
| Cheek-to-Nose Interpolation Flap | 123 | ||
| Indications | 124 | ||
| Anatomy | 124 | ||
| Flap Design | 124 | ||
| Execution | 125 | ||
| Postoperative Care | 125 | ||
| Cheek-to-Nose Interpolation Flap, Stage II | 126 | ||
| Final | 126 | ||
| Abbé (Lip-Switch) Flap | 127 | ||
| Indications | 127 | ||
| Anatomy | 127 | ||
| Flap Design | 127 | ||
| Execution | 128 | ||
| Postoperative Care | 128 | ||
| Abbé Flap, Stage II | 129 | ||
| Final | 130 | ||
| Conclusion | 130 | ||
| Complications With Surgery | 131 | ||
| References | 131 | ||
| 9 Skin Grafts | 132 | ||
| Abstract | 132.e1 | ||
| Keywords | 132.e1 | ||
| Introduction | 132 | ||
| Full-Thickness Skin Graft | 132 | ||
| Skin Graft Physiology | 132 | ||
| Graft Selection | 132 | ||
| Full-Thickness Skin Graft Technique | 136 | ||
| Complications and Management | 137 | ||
| Modifications of the Full-Thickness Skin Graft | 137 | ||
| Simultaneous Free Cartilage and Full-Thickness Skin Grafting | 140 | ||
| Split-Thickness Skin Grafts | 140 | ||
| Graft Selection | 140 | ||
| Split-Thickness Skin Graft Technique | 141 | ||
| Complications and Management | 142 | ||
| Conclusion | 143 | ||
| References | 143 | ||
| 10 Scalp Reconstruction | 145 | ||
| Abstract | 145.e1 | ||
| Keywords | 145.e1 | ||
| Scalp Surgical Anatomy | 145 | ||
| Evaluation of the Scalp Defect | 145 | ||
| Basic Reconstruction Concepts | 146 | ||
| Second Intention Healing | 147 | ||
| Primary Closure | 147 | ||
| Split-Thickness Skin Grafts | 148 | ||
| Skin Substitute Reconstruction | 149 | ||
| Full-Thickness Skin Grafts | 149 | ||
| Random Pattern Cutaneous Flaps | 150 | ||
| Advancement Flaps | 150 | ||
| Rotation Flaps | 150 | ||
| Transposition Flaps | 153 | ||
| Conclusion | 154 | ||
| References | 154 | ||
| 11 Forehead and Temple Repair | 155 | ||
| Abstract | 155.e1 | ||
| Keywords | 155.e1 | ||
| Reconstructive Principles | 156 | ||
| Secondary Intention | 156 | ||
| Primary Linear Closure | 157 | ||
| Advancement, Rotation, and Transposition Flaps | 158 | ||
| Complications | 162 | ||
| Conclusion | 163 | ||
| References | 163 | ||
| 12 Periocular Reconstruction | 165 | ||
| Abstract | 165.e1 | ||
| Keywords | 165.e1 | ||
| Introduction | 165 | ||
| Preoperative Assessment | 165 | ||
| Specialized Instrumentation | 165 | ||
| Anatomy | 165 | ||
| Tension | 166 | ||
| Periocular Repairs | 166 | ||
| Linear Repairs | 166 | ||
| Skin Grafts | 167 | ||
| Flap Repairs | 167 | ||
| Defects Below the Lid Margin | 167 | ||
| Defects on the Upper Lid | 167 | ||
| Medial Canthal Defects | 175 | ||
| Full-Thickness Lid Defects | 176 | ||
| Primary Lid Repair | 176 | ||
| Lateral Canthotomy | 178 | ||
| Tenzel Semicircle Flap | 178 | ||
| Tarsoconjunctival Flap | 179 | ||
| Postoperative Considerations | 181 | ||
| References | 182 | ||
| 13 Cheek Reconstruction | 183 | ||
| Abstract | 183.e1 | ||
| Keywords | 183.e1 | ||
| Regional Reconstruction Principles | 183 | ||
| Relaxed Skin Tension Lines | 183 | ||
| Surface Anatomy | 183 | ||
| Skin Texture | 183 | ||
| Subcutaneous Anatomy | 184 | ||
| Special Anatomic Structures | 184 | ||
| Which Reconstructive Procedure? | 184 | ||
| Reconstruction Philosophy | 184 | ||
| Flaps to Avoid | 185 | ||
| Flaps by Cheek Region | 185 | ||
| Medial Cheek | 185 | ||
| Anterior Cheek | 192 | ||
| Infraorbital Cheek | 194 | ||
| Malar Cheek | 196 | ||
| Buccal Cheek | 201 | ||
| Preauricular Cheek | 201 | ||
| Mandibular Cheek | 201 | ||
| Complications | 202 | ||
| Hematoma | 202 | ||
| Eyelid Swelling | 202 | ||
| Flap Necrosis | 203 | ||
| Ectropion | 203 | ||
| Infection | 203 | ||
| Dehiscence | 203 | ||
| Parotid Fistula | 206 | ||
| Hypertrophic Scarring and Keloid Formation | 206 | ||
| Anesthesia | 206 | ||
| Motor Nerve Deficits | 206 | ||
| Telangiectasia | 206 | ||
| Inner Canthus Tenting | 206 | ||
| Conclusion | 206 | ||
| References | 208 | ||
| 14 Ear Reconstruction | 210 | ||
| Abstract | 210.e1 | ||
| Keywords | 210.e1 | ||
| Introduction | 210 | ||
| Ear Aesthetics | 210 | ||
| Embryology | 210 | ||
| Topography | 210 | ||
| Vasculature | 211 | ||
| Innervation | 212 | ||
| General Principles | 212 | ||
| Reconstructive Options | 212 | ||
| Skin Grafts | 212 | ||
| Adjacent Tissue Transfer | 212 | ||
| Cartilage | 213 | ||
| Regional Reconstruction | 214 | ||
| Upper Auricle | 215 | ||
| Tubed Flap. | 215 | ||
| Composite Chondrocutaneous Flap | 215 | ||
| Temporoparietal Flap. | 216 | ||
| Middle Auricle | 216 | ||
| Lower Auricle | 220 | ||
| Lobule | 220 | ||
| Concha | 221 | ||
| Posterior Auricle | 221 | ||
| Prosthetics and When to Refer | 222 | ||
| References | 222 | ||
| 15 Nasal Reconstruction | 223 | ||
| Abstract | 223.e1 | ||
| Keywords | 223.e1 | ||
| Repair Alternatives | 229 | ||
| Primary Closure | 229 | ||
| Full-Thickness Skin Grafts | 231 | ||
| Flap Reconstruction of the Nose | 234 | ||
| Advancement Flaps | 235 | ||
| Rotation Flaps | 238 | ||
| Transposition Flaps | 242 | ||
| Interpolation Flaps | 244 | ||
| Complications | 252 | ||
| Conclusion | 257 | ||
| References | 257 | ||
| 16 Perioral Reconstruction | 258 | ||
| Abstract | 258.e1 | ||
| Keywords | 258.e1 | ||
| Introduction | 258 | ||
| Perioral Anatomy | 258 | ||
| Surface Anatomy | 258 | ||
| Neuromuscular Anatomy | 258 | ||
| Vascular Anatomy | 259 | ||
| Evaluation of the Patient and Defect | 259 | ||
| General Principles of Perioral Reconstruction (Box 16.1) | 260 | ||
| Methods of Closure | 260 | ||
| Second Intention Healing | 260 | ||
| Mucosal Advancement Flap | 260 | ||
| Linear Closure | 262 | ||
| Wedge Repair | 263 | ||
| Flaps | 265 | ||
| Advancement-Rotation Flaps | 267 | ||
| Burow Wedge | 267 | ||
| Rotation Flap | 269 | ||
| V-Y Advancement Flap | 270 | ||
| Full-Thickness Circumoral Flaps | 272 | ||
| Transposition Flaps | 275 | ||
| Lip Switch Flap | 283 | ||
| Philtral Reconstruction | 285 | ||
| Summary | 286 | ||
| References | 287 | ||
| 17 Neck Reconstruction | 289 | ||
| Abstract | 289.e1 | ||
| Keywords | 289.e1 | ||
| Introduction and Perioperative Consideration | 289 | ||
| Anatomy of the Neck | 289 | ||
| Cutaneous Anatomy | 289 | ||
| Triangles | 289 | ||
| Blood Supply | 289 | ||
| Arteries | 289 | ||
| Veins | 291 | ||
| Nerves | 291 | ||
| Lymphatics | 291 | ||
| Neck Reconstruction | 292 | ||
| Other Surgical Considerations | 298 | ||
| Postoperative Considerations and Complications | 299 | ||
| Summary | 299 | ||
| References | 299 | ||
| 18 Surgical Complications and Revision of Scars | 300 | ||
| Abstract | 300.e1 | ||
| Keywords | 300.e1 | ||
| Hemorrhage | 300 | ||
| Infection | 301 | ||
| Wound Dehiscence | 301 | ||
| Eyelid Swelling/Lymphedema | 301 | ||
| Ectropion | 301 | ||
| Motor Nerve Deficits | 302 | ||
| Scars | 302 | ||
| Scar Revision | 302 | ||
| Intralesional Injections | 303 | ||
| Dermabrasion | 303 | ||
| Microneedling | 304 | ||
| Subcision | 304 | ||
| Soft Tissue/Dermal Fillers | 304 | ||
| Laser Treatment | 304 | ||
| Surgical Options for Scar Revision | 306 | ||
| Timing of Scar Revision | 307 | ||
| Conclusion | 308 | ||
| References | 309 | ||
| Index | 311 | ||
| A | 311 | ||
| B | 311 | ||
| C | 311 | ||
| D | 312 | ||
| E | 312 | ||
| F | 312 | ||
| G | 313 | ||
| H | 313 | ||
| I | 313 | ||
| J | 313 | ||
| K | 313 | ||
| L | 313 | ||
| M | 313 | ||
| N | 314 | ||
| O | 314 | ||
| P | 314 | ||
| R | 314 | ||
| S | 315 | ||
| T | 315 | ||
| U | 316 | ||
| V | 316 | ||
| W | 316 | ||
| Z | 316 | ||
| Inside Back Cover | ibc1 |