Defects of the nose, lip, and cheek: rebuilding the composite defect. Plastic and reconstructive surgery [Plast Reconstr Surg] Journal article | | Title | Defects of the nose, lip, and cheek: rebuilding the composite defect. | | Author(s) | Menick FJ | | Institution | drmenick@drmenick.com | | Source | Plast Reconstr Surg 2007 Sep 15; 120(4):887-98. | | MeSH | Carcinoma, Basal Cell
Cheek
Facial Neoplasms
Female
Follow-Up Studies
Humans
Lip Neoplasms
Male
Middle Aged
Nose Neoplasms
Reconstructive Surgical Procedures
Surgical Flaps
Suture Techniques
| | Abstract | BACKGROUND: The face can be divided into regions (units) with characteristic skin quality, border outline, and three-dimensional contour. A defect may lie entirely within a single major unit or encompass several adjacent units, creating unique problems for repair. Composite defects overlap two or more facial units. Nasal defects often extend into the adjacent lip and cheek. The simplest solution may appear to be to simply "fill the hole"--just replace the missing bulk. Poor contour, incorrect dimension, malposition, asymmetry, poor blending into adjacent normal tissues, and a patch-like repair often follow.
METHODS: The following principles of regional unit repair were applied to guide these complex reconstructions: (1) reconstruct units, not defects; (2) alter the wound in site, size, shape, and depth; (3) consider using separate grafts and flaps for each unit and subunit, if appropriate; (4) use "like" tissue for "like" tissue; (5) restore a stable platform; (6) build in stages; (7) use distant tissue for "invisible" needs and local skin for resurfacing; and (8) disregard old scars.
RESULTS: Clinical cases of increasing composite complexity were repaired with local, regional, and distant tissues. Excellent aesthetics and function were obtained.
CONCLUSIONS: Careful visual analysis of the normal face and the defect can direct the choice, timing, and technique of facial repair. Regional unit principles provide a coordinated approach to the vision, planning, and fabrication of these difficult wounds. The entire repair should be intellectually planned, designed step by step, and laid out in a series of coordinated steps, with general principles applied to successfully repair composite defects of the nose, lip, and cheek. | | Language | eng | | Pub Type(s) | Case Reports
Journal Article
| | PubMed ID | 17805115 |
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