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Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 334 - файл
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12 Neck Defects
Posterior Neck
Primary Closure
Indications: Small and medium defects.
Technique: The defect is converted into an ellipse, and the wound margins
undermined in the subcutaneous plane and closed in layers (Fig.12.8a–c, d–g).
Tips: The ellipse can be oriented along a horizontal or vertical axis. A horizontal
ellipse will have to take into account wound tension during neck exion.
Subunits andAnatomical Considerations
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a
d
e
b
f
c
Fig. 12.8 Excision and primary closure. (a) Markings for excision, (b) Excision defect, (c) Final
closure, (d) Lesion posterior neck, (e) Markings for excision, (f) Excision and defect, (g) Final closure
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Fig. 12.8 (continued)
12 Neck Defects
g
Subunits andAnatomical Considerations
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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 in the subcutaneous plane and mobilised into the defect. The wounds are closed in layers
(Fig.12.9a–d).
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 in the case of a horizontal
orientation will have to take into account wound tension during neck exion.
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ab
cd
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12 Neck Defects
Fig. 12.9 O-Z ap. (a) Markings for excision and ap, (b) Excision defect and aps raised, (c)
Flaps mobilsed into defect, (d) Final closure
Subunits andAnatomical Considerations
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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 in the subcutaneous plane and
mobilised into the defect. The wound is closed in layers (Fig.12.10a–c).
Tips: The orientation of the curvilinear incision can be varied according to the
adjacent tissue laxity, but is best placed vertically. A horizontal orientation will have
to take into account wound tension during neck exion. The difference is length and
thickness of the wound margins can be accommodated by differential suturing. Any
dog ears that develop are excised outside the margins of the ap to avoid vascular
compromise.
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12 Neck Defects
a
b
c
Fig. 12.10 Rotation transposition ap. (a) Markings for excision and ap, (b) Excision dfect and
ap raised, (c) Final closure
Suggested Algorithm
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Suggested Algorithm
Central Neck
1. Primary closure
2. O-Z ap
3. Rhombic ap
Lateral Neck
1. Primary closure
2. O-Z ap
3. Rotation/transposition ap
Posterior Neck
1. Primary closure
2. O-Z ap
3. Rotation/transposition ap
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Algorithms forSpecic Sites
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Scalp
Central (Vertex) Defects
Small
1. Primary closure
2. Healing by secondary intention
Medium
1. Rotation/transposition ap
2. O-Z closure
3. Unilateral/bilateral advancement ap
4. Multiple rotation (pin wheel) ap
5. Multiple Limberg ap
6. Skin graft
7. RECELL
®
Large
1. Skin graft
2. Skin graft with Integra
3. Skin graft with pericranial ap
4. Multiple rotation ap
5. Rotation/transposition ap with skin graft to secondary defect
Lateral Defects
Small
1. Primary closure
© Springer Nature Switzerland AG 2024
V. Ilankovan et al., Local Flaps in Facial Reconstruction,
https://doi.org/10.1007/978-3-031-49464-2
®
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Algorithms forSpecic Sites
Medium
1. Unilateral/bilateral advancement ap
2. Rotation/transposition ap
3. O-Z closure
4. Skin graft
Large
1. Rotation/transposition ap with skin graft to secondary defect
2. Skin graft
3. Skin graft with Integra
®
Forehead
Central Defects
Small
1. Primary closure (vertical)
2. “M” excision (superior)
3. “W” excision (Inferior)
Medium
Upper
1. V-T ap
2. Unilateral/bilateral advancement ap
Lower
1. A-T ap
2. Unilateral/bilateral advancement ap
Paramedian
Small
1. Primary closure (vertical/horizontal)
Medium
Upper
1. V-T ap
2. Unilateral/bilateral advancement ap
3. Rotation/transposition ap
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