Facial Reconstruction The Sublime Beauty of Normal P. Daniel - - PDF document

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Facial Reconstruction The Sublime Beauty of Normal P. Daniel - - PDF document

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Facial Reconstruction The Sublime Beauty of Normal P. Daniel Knott, MD FACS Facial Plastic and Reconstructive Surgery Disclosures Genentech Surgical Advisory Board 2 1 Introduction Scale of the problem Mohs Technique and

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Facial Reconstruction

  • P. Daniel Knott, MD FACS

Facial Plastic and Reconstructive Surgery

The Sublime Beauty of Normal

Disclosures

  • Genentech Surgical Advisory Board

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Introduction

  • Scale of the problem
  • Mohs Technique and outcomes
  • Review standard reconstructive

techniques

  • New pearls for reconstruction

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What do you do?

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Mohs Micrographic Surgery

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5 Year Recurrence rates: Primary BCC

1989 meta-analysis of studies performed since 1945

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Treatment Modality 5 Year Recurrence Rate Mohs Micrographic Surgery 1.0% Surgical Excision 10.1% Radiation Therapy 8.7% ED&C 7.7% Cryosurgery 7.5%

J Dermatol Surg Oncol. 1989 Mar;15(3):315-28. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up.Rowe DE, Carroll RJ, Day CL Jr.

5 Year Recurrence rates: Recurrent BCC

1989 meta-analysis since 1945

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Treatment Modality 5 Year Recurrence Rate Mohs Micrographic Surgery 5.6% Surgical Excision 17.4% Radiation Therapy 9.8% ED&C 40.0% Cryotherapy 13.0%

J Dermatol Surg Oncol. 1989 Mar;15(4):424-31. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma.Rowe DE, Carroll RJ, Day CL Jr.

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Vismodegib: Effectiveness

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Vismodegib: Adverse Reactions

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Anatomic distribution

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Feeling The Heat

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Sun Exposure

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Facial Subunits

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Menick, FW; Nasal Reconstruction, PRS 125: 138e, 2010

Paramedian Forehead Flap

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Menick, FW; Nasal Reconstruction, PRS 125: 138e, 2010

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Paramedian Forehead Flap

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Kishi K, et al. Alternative 1-Step Nasal Reconstruction Technique, Arch Facial Plast Surg. 2012;14(2):116-121

Paramedian Forehead Flap

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Kishi K, et al. Alternative 1-Step Nasal Reconstruction Technique, Arch Facial Plast Surg. 2012;14(2):116-121

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Forehead Flaps

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Internal Lining Defects

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Menick, FW; Nasal Reconstruction, PRS 125: 138e, 2010

3 Stage Forehead Flap

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Cervicofacial Flaps

  • Subplatysmal elevation
  • Back-cut made as low as necessary for

adequate rotation

  • Very useful for color-matched skin
  • Careful patient selection for

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Cervicofacial Flaps

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Cervicofacial Advancements

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Cervicofacial Flaps

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Nasolabial Flaps

  • Used primarily when defect is limited to

the ala

  • Scar is well hidden in nasolabial fold
  • Preference for females
  • Preference for inferiorly based
  • Usually performed in 2 stages

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Nasolabial Flaps

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Nasolabial Flaps

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Lip Reconstruction

  • Maintain neural input
  • Maintain red lip, vermillion border, and cutaneous

contour and color match

  • Maintain symmetry of upper and lower lip relative

lengths

  • Subunit principle with reconstructive incision

planning

  • Maintenance or reconstruction of the commissure
  • Absolute preservation of lip material
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Lip R

Choices

Less than 50% without commissure involvement = Abbe Less than 50% with commissure involvement = Estlander More than 50% of lip absent = Karapandzic More than 75% absent = Free tissue

Lip R

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Lip R Lip R

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V-Y Island Flaps

41 Lip R

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Lip R Lip R

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Lip R 46

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Lip R Lip R

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Lip R Lip R

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Lip R Lip R

Commissure reconstruction

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Lip R Lip R

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Lip R Lip R

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Lip R Lip R

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Thank you for your attention