Facial Mohs Reconstruction
James Thornton2018, Seminars in plastic surgery
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Reconstruction of Mohs Defects Located in the Head and Neck
Journal of Craniofacial Surgery, 2019
Background: Defects following Mohs micrographic surgery (MMS) can range in size from small defects requiring linear closure to large defects needing flap coverage. Reconstruction is dependent on defect size and facial aesthetic unit involvement. The aim of this study was to review the types of facial reconstruction per aesthetic unit involvement and describe their outcomes. Methods: All data were retrieved for patients !18 years who underwent multidisciplinary treatment including dermatological MMS and plastic surgical reconstruction at a single tertiary hospital center (2001-2017). Patient characteristics, tumor pathology, surgical specifics, reconstructive modalities, and surgical outcomes were analyzed. Results: A total of 418 patients were included. Patients were predominantly White, non-Hispanic (97%) and female (58%) with a mean age of 60 AE 13.9 years. Tumor pathology was predominantly basal cell carcinoma in 73% of all cases followed by squamous cell carcinoma in 14%. The nasal aesthetic unit was mostly affected (50%). Local advancement flaps and different types of grafts were used in 51% and 25% of reconstructions, respectively. Complications were observed in 3% and local cancer recurrence in 4% of the patients. Scar revision was needed in 6% of the patients. Conclusion: Reconstruction of facial defects after Mohs micrographic surgery can be challenging due to its technical complexity and aesthetic implications. There were differences in complications in reconstructions performed within the same day versus 1 week, with a majority of complications occurring within same-day Mohs reconstructions. A multidisciplinary structured approach, which incorporates patient-reported outcomes, may be needed to optimize surgical results.
A Survey of North American Burn and Plastic Surgeons on Their Current Attitudes Toward Facial Transplantation
Journal of The American College of Surgeons, 2009
BACKGROUND: Feasibility of composite tissue allotransplantation (CTA) has been substantiated by transplantations of the hand, abdominal wall, and face. CTA has the potential to reconstruct "like with like," but the risk-to-benefit ratio and clinical indications have yet to be determined. We sought to examine the current attitudes about the emerging field of CTA from those who treat complex facial injuries. STUDY DESIGN: In 2007, a Web-based blinded survey was sent to both burn and plastic surgeons involved in facial reconstruction. We examined the practice profile with regard to complex facial injuries and asked respondents to assess the level of risk in CTA and indications for facial transplantation. Surgeons were asked to evaluate three clinical cases (two closely mirroring clinical face transplantations) for suitability for treatment with CTA.
The Cosmetic Considerations in Facial Defect Reconstruction
A Textbook of Advanced Oral and Maxillofacial Surgery, 2013
Facial reconstruction after resection for cutaneous malignancies
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2013
The reconstruction of facial defects after the resection of cutaneous malignant lesions is challenging. Knowledge of several key principles, such as that of facial subunits and of the reconstructive ladder, is paramount to achieving functionally and aesthetically pleasing surgical outcomes. Various reconstructive modalities, from local flap closure to free tissue transfer, are available to the practicing surgeon depending on the defect requiring reconstruction. In this article we describe several of the most commonly used local and regional flaps in facial reconstruction as well as some of the special challenges faced when reconstructing areas such as the eyelid, the lips, the nose, and the ear.
Facial skin cancer reconstructive and cosmetic outcomes: Analysis with algorithm for its management
Background: Management of facial skin cancer and its complications is important research topics needing continuous update to improve the outcome.
Canadian Society of Plastic Surgeons
Plastic and Reconstructive Surgery, 1976
Team communication is essential to patient safety, and research suggests that poor or insufficient communication is a primary cause of medical errors. Strong team communication may be facilitated through the use of communication protocols that are standardized within an organization or team. This presentation will describe a research program-"Team Talk"which has implemented and evaluated preoperative briefings to structure interprofessional discussions among surgeons, anesthesiologists, and nurses prior to surgical procedures. Results will include the team briefing's impact on team communication failure rates and collaborative work processes, followed by a discussion of challenges and lessons learned. LEARNING OBJECTIVES: At the end of this presentation, audience members will be able to: 1. Understand the relationship between team communication and patient safety 2. Explain how preoperative team briefings can impact communication breakdowns and work processes 3. Appreciate the facilitators and barriers to implementing new communication routines in the operating room. EF02 THE BURNED FACE: ACUTE CARE AND RECONSTRUCTION R Spence OBJECTIVES: 1. Understand recent advances in acute care of the burned face. 2. Understand an approach to the analysis and reconstruction of severe facial burn deformities. 3. Understand techniques used personally in the reconstruction of total and subtotal facial reconstruction. OUTLINE: Advances in Treatment of Acute Burns of the Face Determination of depth of burn Usual criteria-make most diagnoses Laser Doppler Imaging Superficial burn-topical treatment Deep burn-excision and grafting Thick split-thickness skin grafts IntegraTM synthetic dermis Burn Reconstruction of the Head and Neck Problems in Facial Burn Reconstruction Scarcity of donor sites, esp. in large burns. Leave deforming donor sites. Require multiple operations. Beyond skill, patience, and/or courage of most reconstructive surgeons. Fundamental Principles Gillies Principles Aesthetic units (Gonzalez-Ulloa) Matching of skin qualities (e.g. color, texture, thickness) (Gonzalez-Ulloa, Edgerton & Hanson) Optimize use of original facial skin. Ideal Facial Reconstruction System: Reliable and reproducible. Provides economy of tissue. Results in adequate well-matched skin. Minimizes donor site deformity. Minimizes hospital stay and operations. Within the skill and patience of most reconstructive surgeons. Use of patient's own tissues-no rejection/immunosuppression. The Story Expanded full-thickness skin grafts Expanded transposition flap The Algorithm Distinct regions of the face Peripheral Resurface large areas with skin with similar qualities to facial skin. Flap better than skin graft. Central Reconstruct fine architectural structures. Resurface with thin skin well-matched in qualities. Flap generally too thick for resurfacing. Combination of Peripheral and Central Shoulder/Chest skin available-expanded transposition flap provides both flap for peripheral and FTSG for central deformities Shoulder/Chest skin not available-expand available normal skin and resurface with expanded FTSG.
Audit of head and neck defect reconstruction
The Professional Medical Journal
Objective: To share our experience with reconstruction of the head and neck defects and to standardize the reconstruction options for such defects. Study Design: Descriptive Cross Sectional study. Setting: Burns and Plastic Surgery Center, Peshawar. Period: November 2018 to December 2022. Material & Methods: Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (< 3 cm), medium (4 cm to 8 cm) and large (> 8 cm). Data was analyzed using SPSS. Results: Over the study period, 112 (70%) male and 48 (30%) female patients, with mean age of 44.36 + 21.35, were operated. The main cause of head and neck defects, were malignant lesions; 60% (n=96) cases. The most common site of was nose, either alone or in combination with surrounding areas. In 54 (33.4%) cases, the reconstructed defects were of medium size, followed by large defects (n=52, 32.5%). In 79 (49.4%) cases, the defects we...
Keep it simple. A ten-year experience in reconstructions after Mohs micrographic surgery
Anais Brasileiros de Dermatologia, 2020
Background: Mohs micrographic surgery is worldwide used for treating skin cancers. After obtaining tumor-free margins, choosing the most appropriate type of closure can be challenging. Objectives: Our aim was to associate type of surgical reconstructions after Mohs micrographic surgery with the characteristics of the tumors as histological subtype, anatomical localization and especially number of surgical stages to achieve complete excision of the tumour. Methods: Transversal, retrospective analyses of medical records. Compilation of data such as gender, age, tumor location, histological subtype, number of stages to achieve clear margins and type of repair used. Results: A total of 975 of facial and extra-facial cases were analyzed. Linear closure was the most common repair by far (39%) and was associated with the smallest number of Mohs micrographic surgery stages. This type of closure was also more common in most histological subtypes and anatomical locations studied. Using Poisson regression model, nose defects presented 39% higher frequency of other closure types than the frequency of primary repairs, when compared to defects in other anatomic sites (p < 0.05). Tumors with two or more stages had a 28.6% higher frequency of other closure types than those operated in a single stage (p < 0.05). Study limitations: Retrospective study with limitations in obtaining information from medical records. The choice of closure type can be a personal choice.
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Canadian Society of Plastic Surgeons Société Canadienne des Chirurgiens Plasticiens: Abstracts presented at the 62nd Annual Meeting / 62e Réunion annuelle June 24 – 28 2008, St John’s, Newfoundland
OUTLINE:Advances in Treatment of Acute Burns of the FaceDetermination of depth of burnUsual criteria – make most diagnosesLaser Doppler ImagingSuperficial burn – topical treatmentDeep burn – excision and graftingThick split-thickness skin graftsIntegraTM synthetic dermisBurn Reconstruction of the Head and NeckProblems in Facial Burn ReconstructionScarcity of donor sites, esp. in large burns.Leave deforming donor sites.Require multiple operations.Beyond skill, patience, and/or courage of most reconstructive surgeons.Fundamental PrinciplesGillies PrinciplesAesthetic units (Gonzalez–Ulloa)Matching of skin qualities (e.g. color, texture, thickness) (Gonzalez–Ulloa, Edgerton & Hanson)Optimize use of original facial skin.Ideal Facial Reconstruction System:Reliable and reproducible.Provides economy of tissue.Results in adequate well-matched skin.Minimizes donor site deformity.Minimizes hospital stay and operations.Within the skill and patience of most reconstructive surgeons.Use of patient...
Facial transplantation: A real option in facial reconstruction?
International Journal of Surgery, 2006
The Ever-Evolving State of the Art: A Look Back at the AONA Facial Reconstruction and Transplantation Meetings
Craniomaxillofacial Trauma and Reconstruction, 2016
Historically, periodic academic meetings held by surgical societies have set the stage for discussion and exchange of ideas, which in turn have led to advancement of clinical practices. Since 2007, the AONA State of the Art: Facial Reconstruction and Transplantation Meeting (FRTM) has been organized to provide a forum for specialists around the world to engage in open conversation about the approaches currently at the forefront of facial reconstruction. Review of registration data of FRTM iterations from 2007 to 2015 was performed. The total number of participants, along with their level of medical training, location of practice, and medical specialty, was recorded. Additionally, academic programs and 2015 participant feedback were evaluated. From 2007 to 2011, there was a decrease in the overall number of participants, with a slight increase in the number of clinical specialties present. In 2013, a sharp increase in total participants, international attendance, and represented clin...
Reconstruction of Complex Facial Defects After Radical Resection of Advanced Skin Cancers
Clinics in Plastic Surgery, 2005
Current Trends in Facial Resurfacing: A Survey of American Academy of Facial Plastic and Reconstructive Surgery Members
Archives of Facial Plastic Surgery, 2010
How to Reconstruct a Complex Multiunit Skin Defect: A Single-case Survey Study
Journal of dermatology and skin science, 2021
Allotransplantation of the Face: How Close Are We?
Clinics in Plastic Surgery, 2005
Immunosuppressive strategies used in clinical composite tissue allograft transplants & Experimental facial allograft transplantations Hemifacial transplant model in dog Composite full facial and scalp transplant model Composite hemifacial transplant model & Psychologic, social, and ethical issues in facial transplantation & The pros and cons of facial allograft transplantation & Media-related issues & Allotransplantation of the face: how close are we? & References For decades, plastic surgeons have been working on the refinement of techniques applicable to facial reconstruction in patients severely disfigured by burns, trauma, cancer, or congenital deformities. Despite these efforts and the development of innovative approaches, outcomes have not changed over the years and are rarely considered satisfactory. The surgical options are well established and include combinations of standard skin grafting, application of local flaps, tissue expansion, prefabrication, and free-tissue transfers [1-7]. However, the long-term outcome of these surgical procedures is far from ideal, because they result in a tight, mask-like face with a lack of facial expression and an unsatisfactory cosmetic appearance. Severely burned patients are often subjected to multiple surgical procedures, sometimes exceeding 30 operations, in search of an improved appearance. These patients no longer even dream of looking like themselves; they simply want to look a little better-a little ''less noticeable,'' as one burned patient commented. Why are we unable to make these patients look better? The rules of aesthetic-unit reconstruction are well known, but they are not applicable to cases where the ''total face'' is damaged. Surprisingly, the results of total face and scalp replantation give patients a more natural look than do attempts at facial skin reconstruction during elective procedures [8,9]. The nature of facial skin provides a clue to this success. In cases of facial replantation, the patient's own facial skin is used to cover the defect. In burned or traumatized patients, the facial skin is damaged, and no perfect replacement tissue is available elsewhere in the body. The only alternative for facial-defect coverage with skin of the same texture, color, and pliability is facial skin from a human donor.
Facial reconstruction: The art of the science
Egyptian Journal of Forensic Sciences, 2012
Achieving Aesthetic Results in Facial Reconstructive Microsurgery
Plastic and Reconstructive Surgery, 2012
Background: Free tissue transfer to improve bulk and contour in facial deformities has been proven useful, yet refinements that turn an acceptable result into an excellent result are essential to reconstruction. The authors reviewed their experience and described these refinements. Methods: The charts of 371 free tissue transfer cases (1989 to 2010) performed by the senior author (J.W.S.) were reviewed. Free tissue transfer of a circumflex scapular variant flap or superficial inferior epigastric was performed to treat deformities arising from hemifacial atrophy (n ϭ 126), hemifacial microsomia (n ϭ 89), radiation therapy (n ϭ 40), bilateral malformations including lupus and polymyositis (n ϭ 50), other congenital anomalies (n ϭ 25), facial palsy (n ϭ 17), and burns and trauma (n ϭ 24). Results: Revision surgery planning began at initial flap operation where the flap was stretched maximally and interdigitated with recipient tissue. More tissue was required in the malar region. Revision refinement was indicated in all cases (after 6 months). Flap revision involved liposuction, debulking, reelevation, and release of tethering, followed by tissue rearrangement by means of advancement, rotation, transposition, and/or turnover flaps of subcutaneous tissues from the previous free flap. The jawline frequently required more debulking. Periorbital reconstruction was combined with lower lid support with or without canthal repositioning. Conventional face-lift techniques with the flap as superficial musculoaponeurotic system augmented the result. Autologous fat injection to the alar rim, medial canthus, upper eyelid, and lip was a useful adjunct. Severe lip deficiencies were addressed with local flaps. Conclusion: The keys to improving results were continual critical reassessment, open-mindedness to new approaches, and maintaining high expectations. (Plast.
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