Principles of Facial Reconstruction After Mohs Surgery
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1 Objectives Principles of Facial Reconstruction After Mohs Surgery Identify important functional anatomy and aesthetic units of the face. Describe techniques used in facial reconstruction. Discuss postoperative care and complications. Participate in an interactive discussion on caring for patients with skin cancer of the face. September 30, 2013 Ken Deem, MD, MPH Otolaryngology Head and Neck Surgery Group Health Cooperative Tacoma, Washington Mohs Micrographic Surgery Resources. New York: Thieme, Objectives Identify important functional anatomy and aesthetic units of the face. Functional Anatomy Anatomical Unit Eyelids Lacrimal System External Nose Lips External Ear Function Corneal Protection Lubrication and Drainage Nasal Airway Speech and Swallowing Sound Conduction 1
2 Functional Anatomy Functional Anatomy Eyelids & Lacrimal System External Nose and Septum medfriendly.com/images/lacrimal.gif Chan & Most. Op Tech OHNS. 2008;19(4):263. Functional Anatomy Functional Anatomy Lips and Facial Musculature External Ear Aesthetic Unit Scalp Forehead Eyes Ears Nose Cheek Lips Chin Border Hairline Preauricular Crease Orbital Rim Nasofacial Groove Melolabial Fold Labiomental Crease Border of Mandible Forehead Subunits Central Forehead Lateral (Temporal) Forehead Eyebrows 2
3 Eye Subunits Upper Eyelid Lower Eyelid Medial Canthus Lateral Canthus Nasal Subunits Dorsum Sidewall Tip Ala Columella Facet/ Soft Triangle Cheek Subunits Medial Zygomatic Buccal Lateral Ear Subunits Helix Antihelix Scapha Triangular Fossa Concha Lobe Lip and Chin Subunits Lateral Upper Lip Philtrum Vermillion Lower Lp Chin 3
4 Objectives Describe techniques used in facial reconstruction. Reconstructive Ladder Free Flaps Regional Tissue Flaps Local Tissue Flaps Tissue Expansion Skin Grafting pathol.med.stu.edu.cn Relaxed Skin Tension Lines Lines of Maximal Extensibility 4
5 Grafting Local Tissue Flap Skin Cartilage Bone 5
6 Local Tissue Flap Local Tissue Flap Local Tissue Flap Local Pedicled Flap Local Pedicled Flap Objectives Discuss postoperative care and complications. 6
7 Reconstructive Ladder Free Flaps Regional Tissue Flaps Local Tissue Flaps Tissue Expansion Skin Grafting Antibiotic Ointment Non-adherent Dressing Peroxide Extended Healing Time Scar Contracture Distortion of Anatomy Excessive Tension Scarring Wound Separation Distortion of Anatomy Skin Graft Split Thickness Scalp Full Thickness Facial Units Revascularization ~ 1 Week Minimize Shearing Forces Bolster Dressing x 1 Week Skin Graft Complications Seroma / Hematoma Graft Failure Contraction Pin-cushioning Poor color match 7
8 Local Tissue Flaps Dermal Blood Supply Incision Care Avoid Tension Local Tissue Flaps Complications Dog-ear Deformity Inadequate Blood Supply Graft Necrosis Healing by Secondary Intention Pedicled Flaps Staged Procedure 1.Flap Raised & Transferred 2.Pedicle Divided & Flap Inset Pedicled Flaps Complications Donor Site Reconstruction Distortion of Anatomy Revascularization ~ 3 Weeks Pedicle Kept Clean Avoid Shearing Forces Avoid Tension Graft Failure Objectives Discussion Participate in an interactive discussion on caring for patients with skin cancer of the face. How can we best care for patients with skin cancer of the face? 8
9 Discussion Multidisciplinary Team: What roles do nurses play in the care of these patients? Thank You How can nurses lead improved care for these patients? September 28, 2013 Ken Deem, MD, MPH Otolaryngology Head and Neck Surgery Group Health Cooperative Tacoma, Washington 9
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