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Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 334 - файл
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b
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11 Lips/Chin
c
e
d
Fig. 11.35 Nanofat injection. (a) Harvested nanofat, (b) Nanofat injection, (c) Pre injection
appearance, (d & e) Post injection appearance
Suggested Algorithm
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Suggested Algorithm
Lips
Lower Lip
Skin Only
Small
1. Primary closure (along rhytids)
2. M/W closure
Medium
1. A-T, V-T ap
2. Inferiorly based nasolabial ap
3. Superiorly based nasolabial ap
Mucosa Only
Small
1. Primary closure
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Medium/Large
1. Mucosal advancement ap
Full-thickness Defect
Small
1. Primary closure
2. W excision
Medium
1. Bilateral advancement ap
2. Karapandzic ap
3. Abbe ap
4. Abbe–Estlander ap
Large Defects
1. Karapandzic ap
2. Bilateral advancement ap
3. Karapandzic ap+Abbe ap
4. Fan ap
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Upper Lip
Skin Only
Small
1. Primary closure
2. A-T ap
Medium
1. Laterally based rotation/transposition ap
2. Unilateral/bilateral perialar crescentic advancement ap
3. Island advancement ap
4. Inferiorly based nasolabial ap
Full Thickness
Small
1. Primary closure
Medium
1. Perialar crescentic advancement ap
2. Karapandzic ap
3. Abbe ap
4. Abbe–Estlander ap
11 Lips/Chin
Large
1. Bilateral nasolabial ap+Abbe ap
Upper/Lower Lip (Chronic Ulcers/Atrophy)
Nanofat injection
Chin Defects
Small
1. Primary closure
Medium
1. V-T ap
2. Rotation ap
3. Bilobed ap
4. Rhombic ap
Neck Defects
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Subunits andAnatomical Considerations
The circumferential neck unit can be dened superiorly by the lower border of the
mandible anteriorly and the hair line posteriorly. The inferior limits are the clavicle
anteriorly and the upper border of the scapula posteriorly. The neck can be divided
into anterior and posterior subunits, with the anterior subunit, being further divided
into a midline and two lateral units (Fig.12.1).
The thickness and mobility of the neck skin vary with the location and are often
dened by the age of the person and general body habitus. The platysma muscle
overlies the investing layer of the cervical facia and is often dehiscent in the midline. The anterior and external jugular veins lie immediately beneath the muscle.
The nerves of the cervical plexus emerge from the posterior border of the sternomastoid muscle and along with the mandibular and cervical branches of the facial
nerve also lie beneath the platysma. The RSTLs are obliquely and transversely oriented in the neck.
© Springer Nature Switzerland AG 2024
V. Ilankovan et al., Local Flaps in Facial Reconstruction,
https://doi.org/10.1007/978-3-031-49464-2_12
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12 Neck Defects
The skin of the posterior neck is thicker than that in the anterior/lateral neck and
less mobile. The trapezius muscle enclosed by the investing layer lies beneath
the skin.
The skin redundancy and the RSTLs allow aps to be raised in the neck to recon-
struct a variety of neck and adjacent defects, with good aesthetic outcomes. It also
enables relatively large defects to be closed primarily.
Subunits andAnatomical Considerations
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Fig. 12.1 Neck subunits
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12 Neck Defects
Central Neck
Primary Closure
Indications: Small and medium defects.
Technique: The defect is converted into an ellipse, along the RSTLs. The wound
margins can be undermined supercial or deep the platysma and closed in layers
(Fig.12.2a–c).
Tips: Care should be taken to avoid damage to the underlying nerves and vessels
if dissection is undertaken deep to the platysma.
Subunits andAnatomical Considerations
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a
b
c
Fig. 12.2 Excision and primary closure. (a) Markings for excision, (b) Excision defect, (c)
Final closure
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12 Neck Defects
O-Z Flap
Indications: Small- and medium-sized defects, circular defects.
Technique: The defect is modied into a circle. Two curvilinear incisions are
made from the opposite poles of the defect. The aps are elevated supercial or
deep to the platysma and mobilised into the defect. The wounds are closed in layers
(Fig.12.3a–i).
Tips: O-Z aps are rotation transposition aps. The direction of the “Z” can be
adjusted according to the area of maximum skin laxity and RSTLs. Care should be
taken to avoid damage to the underlying nerves and vessels if dissection is undertaken deep to the platysma.
Subunits andAnatomical Considerations
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a
c
b
d
Fig. 12.3 O-Z ap. (a) Markings for excision and ap, (b) Excision defect and aps raised, (c)
Final closure, (d) Markings for excision and ap, (e) Excision defect, (f) Incisions for ap, (g)
Undermining of edges, (h) Trial transposition, (i) Final closure
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