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Grafts and Flaps in Head and Neck Reconstruction
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
TechniquePlan: Assess height of forehead. Find origin of supratrochlear artery (1 cm medial to supraorbital foramen above midpoint of pupil). Line drawn vertically up is axis of flap. Plan pedicle length in reverse from pivot point and template defect on distal flap. Keep ‘extra’ 15% in pedicle length from pivot.Procedure: Incise around the flap and pedicle, raise flap distal to proximal in plane under frontalis, and 1 cm superior to the supraorbital ridge, go subperiosteal to protect the vessel. Rotate and inset flap into defect. Graft underside of pedicle for haemostasis. If unable to close donor, then dress. Flap is thinned +/− pedicle division at 3 weeks.
The upper third of the face
Published in Jani van Loghem, Calcium Hydroxylapatite Soft Tissue Fillers, 2020
Yates Yen-Yu Chao, Jani van Loghem
Thin to medium thickness soft tissue fillers can be used for dermal treatment of wrinkles, while keeping in mind that the wrinkles here are dynamic and will also benefit from pretreatment with botulinum toxin. Ideally, a hyaluronic acid filler with a low visco-elasticity, but high cohesivity should be used, preferably in an intradermal (blanching) technique, indicating papillary dermis placement, to correct forehead wrinkles. For intradermal injections, a sharp needle should be used, as nontraumatic cannulas do not penetrate the dermis readily. Subsequently, arterial danger zones have to be considered, and care should be taken that the needle tip does not proceed through the dermis, but rather remains intradermal [4]. Subcutaneously, medium-thickness fillers can be used for volumizing the frontal concavity. Caution should be taken as important danger zones are present in this area: the supraorbital artery (medial branch), the supratrochlear artery, the central forehead artery and their branches. Intra-arterial injection into any of these arteries can potentially lead to permanent blindness, so injection with a nontraumatic cannula should be considered, ideally horizontally, perpendicular to the (vertical) direction of the arteries. Superficially placed product can potentially be seen during movement of the brows, as the position of the filler will change relative to the concavity. This will result in a visible convexity just above the concavity when the patient raises the brows, which aesthetically might be a suboptimal result [5].
Grafts and Local Flaps in Head and Neck Cancer
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The forehead flap is a local cutaneous axial flap based on the supratrochlear artery. It is one of the oldest flaps in use and the earliest available description is from 600 BC by Susruta in India.57 A large flap of skin from the forehead can be raised on this vessel which can then be used to cover defects around the orbit and the nose. The donor site can be the vertical height of the forehead or the flap can be planned obliquely to maximize the length and therefore the reach of the flap. An obliquely placed donor site also reduces the arc of rotation. The donor site can be closed directly if the width of the flap is kept small (less than 2.5 cm) and this leaves minimal scarring. If a wider flap is required, the defect needs to be skin-grafted; an alternative to this is to leave the defect to heal by secondary intention, which can give a very acceptable cosmetic outcome.58 The transfer is normally carried out in two stages: the flap is raised and the tip of the flap inset into the primary defect. The remainder of the flap is then tubed to form a pedicle. After 3 weeks, the tip of the flap will have undergone some revascularization from the recipient site and the pedicle is then divided and reinset into the secondary defect (see Figure 91.18d–f). Alternatively, when reconstructing nasal defects, a third stage can be included.59 The flap is raised 2 weeks after it is inset, thinned and then reinset. The pedicle is then divided after a further 2 weeks. This prevents having a bulbous nasal tip, giving an overall better cosmetic result.
Specific complications associated with non-surgical rhinoplasty
Published in Journal of Cosmetic and Laser Therapy, 2020
Tuyet A. Nguyen, Shivani Reddy, Nima Gharavi
The nose is a complex structure with a robust vascular supply (Figure 1). The nose and surrounding structures are uniquely supplied by both the internal and external carotid system through anastomoses between the dorsal nasal artery and the angular artery. The dorsal nasal artery arises from the supratrochlear artery and courses over the nasal root to form anastomoses with the angular artery (4). Because of the anastomoses that occur in this area, there is an increased risk of complications such as the retrograde flow of intravascular filler into vital structures supplied by the internal carotid, including the ophthalmic artery, as well as increased risk of intracranial infection. In addition, the nasal root, a common location for filler placement for non-surgical rhinoplasty, lies just adjacent to the glabella which is well known for complications of vascular occlusion and soft tissue necrosis.
Visual impairment by multiple vascular embolization with hydroxyapatite particles
Published in Orbit, 2018
Yayoi Marumo, Miki Hiraoka, Masato Hashimoto, Hiroshi Ohguro
The result of a literature search of visual disturbances caused by hydroxyapatite filler injections is summarized along with our case (Table 1). In all cases, patients received filler injections in the glabella area mainly for nose augmentation, and complications occurred immediately after the injections. Radiesse® was applied in three cases, and it was not mentioned in other cases. In most of the cases, skin necrosis developed from the glabella to the forehead region. From this, it was speculated that hydroxyapatite particles had migrated into the supratrochlear artery. In four out of six cases, ocular motility disturbance developed. In addition, in all cases dilated pupils were seen.
Oral mucosa grafting in periorbital reconstruction
Published in Orbit, 2018
The use of OMGs in lacrimal outflow surgery is and has remained experimental. Conjunctivodacryocystorhinostomy (CDCR) using a Jones tube is commonly performed in patients with total canalicular block. Closure of the non-epithelialized channel may occur if the tube becomes dislodged or lost. OMGs have been used to line the CDCR tract to obviate closure in the event that the tube migrates out.26–28,63 Successful reconstruction of the medial canthal area and relief of canalicular obstruction secondary to chemical injury was achieved in one stage by Benlier et al.63 using a supratrochlear artery-based island flap combined with a buccal OMG wrapped around a silicone tube.