Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
.pdf
4 Rhytidectomy (Cervicobuccal Plasty)
https://t.me/med1917
Dissection of the Lipocutaneous Flap (Fig. 4.19–4.28)
䊏
Subsequently, sharp dissection is continued in the preauricular region.
䊏
The assisting surgeon pulls the cavity of concha dorsally. The surgeon
dissects a 2-cm broad lipocutaneous strip with the number 15 blade
until the superficial temporal artery is reached. This artery and vein are
then exposed together.
(Fig. 4.19)
100
Fig. 4.19
https://t.me/med1917
4 Rhytidectomy (Cervicobuccal Plasty)
101
4 Rhytidectomy (Cervicobuccal Plasty)
https://t.me/med1917
䊏
Above this vascular bundle, the surgeon works between the two fascial
sheets of the temporal muscle in the temporal region, i.e., dissection is
continued one layer deeper here than in the preauricular region in
order to protect the hair roots.
(Fig. 4.20)
䊏
From this access, the entire forehead can be detached blun tly with the
raspatory in an endoscopically controlled procedure. This is accomplished quickly and effortlessly , owing to the prior dissection via
tumescence.
(Fig. 4.21)
102
Fig. 4.20
https://t.me/med1917
4 Rhytidectomy (Cervicobuccal Plasty)
Fig. 4.21
103
4 Rhytidectomy (Cervicobuccal Plasty)
https://t.me/med1917
䊏
The temporal vascular bundle is now exposed by precise blunt and
sharp dissection.
䊏
Blunt dissection is performed with a saline compress placed over the
index finger. The skin is pushed up to the lateral orbital margin in this
manner.
(Fig. 4.22)
䊏
Sharp dissection is carried out cranially with the Wullstein scissors.
The vascular bundle, consisting of the superficial temporal artery and
vein, is explicitly exposed.
䊏
Following precise exposure, the temporal vascular bundle is ligated
with 3/0 Vi cryl suture material.
(Fig. 4.23)
104
Fig. 4.22
https://t.me/med1917
4 Rhytidectomy (Cervicobuccal Plasty)
Fig. 4.23
105
4 Rhytidectomy (Cervicobuccal Plasty)
https://t.me/med1917
This vascular bundle is an important anatomical structure. It represen ts
the cranial dissection boundary which must be respected to avoid
injury to the branch of the facial nerve in the forehead. (Fig. 4.24)
Dissection of the Cheeks and Neck (Fig. 4.25, 4.26)
䊏
Afterwards, further dissection is carried out in the cheek region with
the Mang dissecting scissors.
䊏
For this purpose, the surgeon inserts the roller hook in the lipocutaneous flap and pulls it up vertically with his or her thumb. The surgeon
nowhasagoodviewofthedissectinglayer.Theparotidcapsuleserves
as a guide structure. Following the perforations created by the tumescence dissection, the surgeon detaches the thick lipocutaneous flap.
During the dissection in the direction of the orbit, a hard resilient cord
is encountered. This is the ligament of the orbicularis oculi muscle. It is
exposed and transected.
䊏
Creating constant tension by pulling upwards with his or her left thumb
in the roller hook, the surgeon continues dissection up to the nasolabial
fold. This fold constitutes the medial dissection boundary.
䊏
For the dissection of deeper lying areas, the roller hook is replaced by
Langenbeck forceps. In place of the Mang scissors, a swab or a saline
compr e ss placed over the index finger can be very useful as a blunt dissection instrument.
To ensure optimal lighting conditions, the novice is advised to use a
battery-powered forehead lamp.
106
Fig. 4.24
https://t.me/med1917
4 Rhytidectomy (Cervicobuccal Plasty)
Fig. 4.25
107
4 Rhytidectomy (Cervicobuccal Plasty)
https://t.me/med1917
䊏
This is followed by medium-level and deep-level retroauricular dissection.
䊏
The assisting surgeon places the long two-pronged hook in the retroauricular fold and pulls the auricle towar d the front. The surgeon inserts
the two-pronged roller hook in the lipocutaneous flap that has already
been formed and pulls it tautly toward the dorsal region. The dissection
layer is now in clear view. Further dissection is carried out along the
sternocleidomastoid muscle dorsally and caudally with the Mang dissectionscissors.Careshouldbetakennottodamagethegreatauricular
nerveorthejugularvein.
Dissection is now much easier to accomp li s h in the throat and neck
area as a result of the perforations created by the prior tumescent liposuction procedure.
(Fig. 4.26)
108
Fig. 4.26
https://t.me/med1917
4 Rhytidectomy (Cervicobuccal Plasty)
109
Соседние файлы в папке Библиотека им академика М.И. Перельмана