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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
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4 Rhytidectomy (Cervicobuccal Plasty)
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Temporal Flap Resection and Sutures (Fig. 4.46–4.47)
䊏
This is followed by flap resection in the temporal hair region. Following
release of the Backhaus hook, the excess skin flap is excised without
any tension and attached step by step in the cranial direction with
3/0 Resolon sutures. If there are areas of tension here, subcutaneous
sutures must be made at this location as well.
It is important to distribute this tension mainly among the sutures in
the hair region to prevent scar formation in the visible areas in front of
and behind the auricle.
130
Fig. 4.46
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4 Rhytidectomy (Cervicobuccal Plasty)
Fig. 4.47
131
4 Rhytidectomy (Cervicobuccal Plasty)
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Ifthehairlineistoohighatthecranialauricularpoleorifthepatient’s
hair is too thin, we make a hairline cut.
In this case, the incision does not go through the temporal hair region.
Instead it runs from the upper auricular pole on an almost horizontal
course along the caudal temporal hair boundary in the direction of the
orbitae.
(Fig. 4.48)
132
Fig. 4.48 ······· Tumescence and suction margin
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– –– Preparation margin
–––– Incision line
4 Rhytidectomy (Cervicobuccal Plasty)
133
4 Rhytidectomy (Cervicobuccal Plasty)
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䊏
Cutaneous wound closure is now performed in the retroauricular fold.
This can be accomplished with continuous or interrupted sutures.
We use 5/0 Prolene as suture material.
Caution must be exercised in any case to position the sutures about
2 mm above the fold. This is the only way to achieve perfect aesthetic
results.
(Fig. 4.49)
Periauricular Wound Closure
䊏
Wound closure is now carried out in the visible preauricular region
with continuo us 6/0 Prolene sutures.
This can be accomplished with no tension at all since several sutures
have already been made subcutaneously and have taken all the tension
out of the wound surface.
Intracutaneous sutures are a possibility at this point. However, they do
not offer any aesthetic advantages.
Care should be taken to achieve exact anatomical positioning of the
auricular lobe. The ear lobe should not be sutured to the head.
(Fig. 4.50)
134
Fig. 4.49
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4 Rhytidectomy (Cervicobuccal Plasty)
Fig. 4.50
135
4 Rhytidectomy (Cervicobuccal Plasty)
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Retroauricular Skin Resection, Redon Drain, and Wound Closure
(Fig. 4.51–4.53)
䊏
The excess lipocutaneous flap is now removed in the retroauricular and
mastoid regions.
The assisting surgeon holds the ear toward the front with the long
two-pronged hook.
䊏
The excess lipocutaneous flap is resected with the number 10 blade.
䊏
Afterwards, the Backhaus hook is first removed from the surgical area
together with the skin flap.
䊏
The surgeon shaves the area with a radius of 2 mm around the incision
edges with a number 10 scalpel to ensure that the wound is clean. The
shaved hair grows back quickly and covers the incision line completely
in this case.
If the hairline is too high in the occipital region, the incision lines
described above are precluded. In this case, the hairline cut that runs
alongtheoccipitalhairlinemustbeused(seepictureofthehairlinecut,
p. 133).
136
Fig. 4.51
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4 Rhytidectomy (Cervicobuccal Plasty)
137
4 Rhytidectomy (Cervicobuccal Plasty)
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䊏
Finally, the wound is closed layer by layer with 3/0 Resolon sutures,
starting in the dorsal hair region.
At this location as well, subcutaneous sutures have already been made
with 4/0 PDS or Monocryl.
(Fig. 4.52)
䊏
After about four sutures, a Redon drain is inserted. This drain must be
pushed forward carefully with a long bent hook on both sides in order
to achieve a good suction effect in the entire cervicobuccal area. The
drain is attached behind the auricle and left in place for 24 h. It can be
replaced if necessary .
䊏
Subcutaneous wound closure is now carried out in the visible retroauricular region, i.e., the region without hair .
䊏
This incision, which is about 3 cm long, is closed – like a Z-plasty –
with 5/0 contin uous Prolene sutures without any tension.
䊏
This is followed by connection of the Redon drain and checking of the
suction effect.
(Fig. 4.53)
138
Fig. 4.52
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4 Rhytidectomy (Cervicobuccal Plasty)
Fig. 4.53
139
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