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Facial Soft Tissue
Reconstruction
Thomas Procedures in Facial Plastic Surgery
Gregory H. Branham MD, FACS
Professor and Chief-Facial Plastic and Reconstructive Surgery
Department of Otolaryngology
Washington University School of Medicine
St. Louis, Missouri, USA
2011
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All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of the publisher.
11 12 13 14/PMPH/9 8 7 6 5 4 3 2 1
ISBN-13: 978-1-60795-149-0
ISBN-10: 1-60795-149-5
Printed in China by People’s Medical Publishing House
Copyeditor/Typesetter: Spearhead Global, Inc.
Cover Designer: Mary McKeon
LibraryofCongressCataloging‐in‐PublicationData
Branham, Gregory H.
Facial soft tissue reconstruction : Thomas procedures in facial plastic surgery / Gregory H. Branham.
p. ; cm. — (Thomas procedures in facial plastic surgery)
Includes bibliographical references and index.
ISBN-13: 978-1-60795-149-0
ISBN-10: 1-60795-149-5
1. Face--Surgery. 2. Surgery, Plastic. I. Title. II. Series: Thomas procedures in facial plastic surgery.
[DNLM: 1. Face--surgery. 2. Reconstructive Surgical Procedures--methods. WE 705]
RD523.B63 2011
617.5’2059--dc23 2011013824
Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication.
However, since research and regulation constantly change clinical standards, the reader is urged to check the product
information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particularly important with new or infrequently used drugs. Any treatment regimen, particularly
one involving medication, involves inherent risk that must be weighed on a case-by-case basis against the benefi ts
anticipated. The reader is cautioned that the purpose of this book is to inform and enlighten; the information contained herein is not intended as, and should not be employed as, a substitute for individual diagnosis and treatment.
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https://t.me/medicina_free
To my coauthors whose contributions have enriched this text in immeasurable ways
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To Regan Thomas, my mentor and fellowship director
To my wife, Cindy, and my three wonderful children,
Allison, Matthew and Grace for their love and support
To my mother, Theodocia Hearon Branham, who taught me
the value of hard work, perseverance and a good education.
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Preface
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Facial Soft Tissue Reconstruction is a multi-step
process that begins with a thoughtful and detailed
preoperative plan followed by meticulous execution.
Attentive postoperative care followed by scar enhancement/camoufl age techniques will achieve the
best result. A mindset of critical analysis of results,
acquisition of new knowledge and refi nement of
techniques is imperative to hone the surgeon’s skills
and provide the best possible care to patients.
Facial Soft Tissue Reconstruction is a very rewarding discipline and offers many unique opportunities and challenges. Whether dealing with a Moh’s
surgical defect following skin cancer or repairing a
soft tissue loss from trauma, the ability to “think on
your feet” and problem solve is essential. Being prepared and acquiring experience are essential to success. An understanding of the healing process and
how it impacts soft tissues through such forces as
contracture and scar formation allow us to plan for
these as we reconstruct a defect. By understanding
the vascular anatomy of the skin and the physiology of the fl aps that we raise we are able to avoid
complications that plagued the early reconstructive
surgeons.
While there are many possibilities for the reconstruction of a soft tissue defect, not all are equivalent. Education and experience are the best teachers
with regard to which technique is best for a particular patient’s defect. This text provides a useful
beginning to the educational portion and experience over time will guide you forward. This text is
not an encyclopedic or exhaustive review of every
possible fl ap that has ever been used, nor is it an historical review of the origins of the local fl aps and
soft tissue reconstructive techniques.
Rather, in this text the authors have taken a
pragmatic approach to the reconstruction of these
defects and as such have attempted to outline commonly used techniques that yield consistent and
reproducible results. We have emphasized the techniques and procedural aspects of this discipline providing step by step illustrations of the techniques.
I hope that you will fi nd the text helpful and that
it contributes to your success as a facial soft tissue
reconstructive surgeon whether you are still in residency training, beginning your practice or are a seasoned veteran in the operating room.
Gregory H. Branham, MD, FACS
https://t.me/medicina_free
Contributors
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Gregory H. Branham, MD, FACS
Associate Professor and Chief-Facial Surgery
Department of Otolaryngology
Washington University School of Medicine
St. Louis, MO
Michael J. Brenner, MD, FACS
Facial Plastic & Reconstructive Surgery
Assistant Professor
Southern Illinois University School of Medicine
Springfi eld, IL
Mark A. Checcone, MD
Assistant Professor, Facial Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO
Jill L. Hessler, MD
Adjunct Clinical Assistant Professor Stanford
University
Premier Plastic Surgery
Palo Alto, CA
John B. Holds, MD, FACS
Clinical Professor
Departments of Ophthalmology and
Otolaryngology
Head and Neck Surgery
Saint Louis University School of Medicine
St. Louis, MO
Christina K. Magill, MD
Resident in Otolaryngology
Washington University School of Medicine
St. Louis, MO
Jasmine Mohadjer, MD
Ophthalmic Plastic and Reconstructive Surgery
The Eye Institute of West Florida
Largo, Florida
Arash Moradzadeh, MD
Resident in Otolaryngology
Washington University School of Medicine
St Louis, MO
Chad J. Sukut, MD
Fellow, Mohs Microcraphic Surgery
Division of Dermatology
Southern Illinois University School of Medicine
Springfi eld, IL
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