Faculty Bibliography

BACKGROUND: The senior author has previously described a deep-plane cervicofacial hike flap as a workhorse for reconstruction mid-cheek defects. One important modification commonly used involves overcorrection of the defect in order to reduce the incidence of ectropion. This report outlines the senior author's experience in surgical treating complex cheek defects with an overcorrected deep-plane cervicofacial hike flap. METHODS: The authors performed a retrospective review of the senior author's patients with cheek and eyelid reconstruction. The authors initially identified all patients who had undergone a deep-plane cervicofacial hike flap, then filtered those charts for patients who had overcorrection of their deformity in order to prevent ectropion. RESULTS: A total of 3 patients had an overcorrected flap. Overcorrection was accomplished either by cheek advancement with suture fixation to the deep temporal fascia, or by placement of drill holes and bone anchors. Lower eyelid malposition was avoided in all 3 patients. Patient satisfaction at long term follow-up was very high, and no revision surgery was needed. CONCLUSION: If gravitational or cicatricial forces can potentially distort the eyelid in patients with cheek or eyelid reconstruction, it is necessary to overcorrect the cheek flap. This modification of the deep-plane cervicofacial flap is an important tool in reconstructing defects in this area.

ABSTRACT: This manuscript is a compilation of clinical lessons learned from 30 years of treating hemangiomas. We review relevant clinical anatomy, the role of lasers and medications, timing of surgery, and operative judgment, as it pertains to the treatment of hemangiomas.

ABSTRACT: It is well established that raw edges of the skin have a natural tendency to tube on themselves. Although this often presents a challenge for plastic surgeons, the following article demonstrates how the plastic surgeon can capitalize on this phenomenon to successfully recreate the natural appearance of curved anatomic elements. Two areas that are particularly susceptible to appearing "unnatural" after surgery are the earlobe and alar base. Herein, we present the concept of "autotubing" to recreate the natural curvature of these anatomic regions.

INTRODUCTION: : A cervicofacial flap remains the principal method to close defects of the posterior cheek. Schrudde described a variant of this technique, termed the angle-rotation flap, which allowed primary closure of the donor site. This flap has been elevated in the deep plane for the more medial defects. We extend this technique for upper lip reconstruction. METHODS: : Two cases were reviewed that underwent upper lip reconstruction with the deep-plane Schrudde flap. RESULTS: : Two cases are presented to describe the use of the deep-plane angle-rotation flap. The first patient sustained a burn to his upper lip and the second patient had a partially grafted defect following a Mohs excision. DISCUSSION: : In patients with insignificant nasolabial folds, the deep-plane Schrudde flap is a good option to reconstruct perioral defects. The utilization of the deep plane improves the blood supply and allows improved contour for reconstruction of deeper defects

Large temple and suprabrow lesions can pose a reconstructive challenge. When the lesion extends anterior to the hairline, esthetically acceptable local flaps may be difficult to design. We describe a modified scalp flap (ie, part Converse scalping flap and part scalp rotation flap) that can be tailored to reconstruct a variety of difficult temple and suprabrow lesions while simultaneously maintaining eyebrow position.The modified scalp flap is raised in a subgaleal plane until approximately 2.5 cm above the brow. At this level, dissection proceeds in the subcutaneous plane to protect the frontal branch of the facial nerve and to keep the flap thin. (The key to the modified scalp flap is the dissection plane change that protects the frontal branch of the facial nerve.) The extent of posterior subgaleal dissection is dictated by the amount of anterior rotation necessary. A temporal dog-ear is removed subfollicularly to permit modified flap rotation and preserve the superficial temporal artery.The modified scalp flap has been used to reconstruct temple and suprabrow lesions in 10 patients ranging in age from 4 months to 22 years. There were no complications. Four typical cases are presented.Temple and suprabrow lesions can be excised and successfully reconstructed in one stage using a modified scalp flap that is extended from the hair-bearing scalp onto the glabrous skin of the forehead. This novel modified scalp flap prevents eyebrow/hairline distortion and avoids facial nerve injury

Patients who present for alloplastic jaw angle augmentation have 2 potentially troublesome choices. The use of a silicone implant can mean unpredictable motion, and if the lower pterygomasseteric sling is breached during implant placement, the masseter insertion will ride up without anything to which to adhere. When the patient bites down, a bulge will be present.The porous alternative even has a ledge made to go under the gonial angle, which if not removed, guarantees violation of the pterygomasseteric sling and an implant that is longer than the muscle can cover. The inferior muscle insertion is disrupted and is left to ride up serendipitously.This article presents 5 instances of these issues in which one case required a revision via a modified Risdon approach to access the uncovered material which stuck out beyond the high riding masseter.The basic aim of this article is to advocate the need to maintain the pterygomasseteric sling, and describe the consequences of the failure to do so

When the editor asked me to write something related to the chin, I (B.M.Z.) told him I would like to concentrate on the soft tissue of the perioral and chin region, something previously not presented before in this Journal specifically or anywhere. Dr. Flores and I have chosen certain soft tissue cases of the lower face, each of which presents certain dilemmas. The reconstructive methods in each case are unique, previously not shown, and represent salvage from prior failures. Case 1 shows how an interior Abbe flap can be used for ipsilateral lip reconstruction. Case 2 shows how a large upper lateral lip elemental loss can be regained from cheek and not the lower lip. Cases 3 and 4 show how to regain proper white roll bulge and symmetry by overcorrection, then exact adjustment in a second stage. Case 5 shows how a failed chin/lip reconstruction can be salvaged to regain sulcus height and aesthetic unit reconstruction. Each case depicts unique reconstructive designs to produce an aesthetic final result