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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

PEOPLE’S MEDICAL PUBLISHING HOUSE—USA

SHELTON, CONNECTICUT

People’s Medical Publishing House-USA

2 Enterprise Drive, Suite 509 Shelton, CT 06484 Tel: 203-402-0646 Fax: 203-402-0854 E-mail: info@pmph-usa.com

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

LibraryofCongressCataloging‐in‐PublicationData

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

https://t.me/medicina_free

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.

https://t.me/medicina_free

Preface

https://t.me/medicina_free

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

https://t.me/medicina_free

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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