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12 Neck Defects
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Fig. 12.3 (continued)
Subunits andAnatomical Considerations
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Rhombic Flap
Indications: Medium-sized defects.
Technique: The defect is modied into a rhombus with 60° and 120° internal
angles. A rhomboid ap is designed by extending the short diagonal to a distance
equal to one of the sides, and a further line is drawn from its extremity, parallel to
the adjacent side of the defect. The ap is raised supercial or deep to the platysma
and mobilised into the defect. The wound is closed in layers (Fig.12.4a–d).
Tips: Though four aps could be raised for any given defect, inferiorly based
aps are able to best utilise the tissue laxity and avoid damage to the mandibular
branches of the facial nerve in the upper neck.
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Fig. 12.4 Rhombic ap. (a) Markings for excision and ap, (b) Excision defect and ap raised,
(c) Flap transposed into defect, (d) Final closure
12 Neck Defects
Subunits andAnatomical Considerations
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467
Lateral 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.12.5a–e).
Tips: Care should be taken to avoid damage to the underlying nerves and vessels
if dissection is undertaken deep to the platysma.
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a
b
12 Neck Defects
e
c
Fig. 12.5 Excision and primary closure. (a) Excision defect, (b) Final closure, (c) Markings for
excision, (d) Excision defect, (e) Final closure
Subunits andAnatomical Considerations
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O-Z Flaps
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.12.6a–c).
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.
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12 Neck Defects
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b
c
Fig. 12.6 O-Z ap. (a) Markings for excision and aps, (b) Excision dfect and aps raised, (c)
Final closure
Subunits andAnatomical Considerations
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471
Rotation Transposition Flap
Indications: Medium defects.
Technique: The defect is modied into a triangle, and a curvilinear incision is
made from the base of the defect. The ap is raised supercial or deep to the platysma and mobilised into the defect. The wounds are undermined widely and closed
in layers (Fig.12.7a–c, d–h).
Tips: The orientation of the curvilinear incision can be varied according to the
adjacent tissue laxity and RSTLs. The aps can be raised anterior or posterior to the
defect. Care should be taken to avoid damage to the underlying nerves and vessels
if dissection is undertaken deep to the platysma. The difference is length and thickness of the wound margins can be accommodated by differential suturing. Any dog
ears that develop are excised along the RSTLs.
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ad
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12 Neck Defects
c
Fig. 12.7 Rotation/transposition ap. (a) Markings for excision and ap, (b) Excision defect and
ap mobilised, (c) Final closure, (d) Lesion left neck, (e) Markings for excision and ap, (f)
Excision defect, (g) Flap raised, (h) Final closure
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Subunits andAnatomical Considerations
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Fig. 12.7 (continued)
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