Principles and techniques of eyelid reconstruction springerlink. The mustarde flap is indicated for the reconstruction of large greater than 50 % full thickness lower eyelid defects. Mustarde rap lower lid reconstruction after malignancy o z i o. Like many otoplasty candidates, he felt as if his ears were simply too prominent. Reconstruction of cheek skin defects by the yinyang. The required area of skin and tissue is moved without interrupting the blood supply. The flap provides a vascularized anterior lamellar flap. Surgical treatment with locoregional flaps for the eyelid. This flap may best be reserved for patients who cannot undergo a twostaged operation hughes tarsoconjunctival flap or when an extensive lower lid defect extends over 7 mm below the lid margin. Of the 10 mustarde flaps performed to reconstruct the entire lower lid, 1 flap. Mustarde cheek rotation flap represents the first choice in most of the.
The fricke flap has been modified previously by barbagomez et al with an inferior extension of the flap into the central cheek. Cervicofacial flaps for head and neck reconstruction vula. The main advantage of this procedure is the absence of scar at the donor site. Lower eyelid reconstruction with pericranium graft and. This flap technique has evolved since its introduction, and several. Skin grafts and flaps dr ehsanur reza shovan assistant professor department of surgery. Reconstruction of cheek skin defects by the yinyang rotation of the mustarde flap and the temporoparietal scalp. This is mustarde cheek rotation flap by david haider on vimeo, the home for high quality videos and the people who love them.
At the conclusion of the case the defect is closed with minimal tension with the lid in good positon and the skin types respected. Match tissue characteristics as best as possible for grafts and flaps. One of these layers can be a free graft, but at least one must be in the form of a flap with a continuous. Switch flap for upper eyelid reconstructionhow soon. Otoplasty without cartilage section using the mustarde. Mustarde reconstruction of the full thickness of an eyelid requires two basic layers. Many techniques have been developed for the treatment of protruding ears. Tenzel semicircular advancement flap is a useful technique in eyelid reconstruction both superior and inferior. Comparing rates of distal edge necrosis in deepplane vs. Reconstruction of combined fullthickness defect of the. Mustarde antihelix otoplasty case study san diego ca. A laterally based postauricular dermal flap as an addition to mustarde and furnas to prevent suture extrusion and recurrence.
Reconstruction of large, fullthickness upper eyelid defects is a challenge to the ophthalmic plastic surgeon. Pdf comparison of local flaps and skin grafts to repair. The mustarde cheek rotation flap is indicated in lower eyelid defects involving over 75% of the lid margin. The mustarde rotational cheek flap has been used to reconstruct 1 the lower eyel ids of 55 patients since 1964. Pdf otoplasty using the postauricular skin flap technique. Otoplasty case study 3 this is a somewhat unique case of cosmetic ear reshaping, or otoplasty surgery, that involves primarily use of antihelix sutures to contour the ear. Free implies that the tissue is completely detached from its blood supply at the original location donor site and then transferred to another. In group 1 patients, the mustarde technique was carried out through an incision in the postauricular groove, detachment of the skin flap in the direction of the helix, generation of four to five posterior sutures to shape the new antihelix along the upper twothird of the ear, and resection of the excess skin spindle. Mustarde cheek rotation flap, after almost 40 years, remains the most versatile method since it ensures good coverage and satisfactory functional and aesthetic results in case of large full thickness defects of the lower eyelids. Versatility of mustarde cheek rotation prelaminated flap for. Versatility of mustarde cheek rotation prelaminated flap for reconstruction of the wide full thickness lower lid defects.
The mustarde cheek flap is used to reconstruct defects of the anterior lamella of the inferior eyelid and medial cheek defects. Fricke supraorbital flap for reconstruction of total lower. Final skin closure is via interrupted vertical mattress. The flap described by fricke in 1829 was used for reconstruction of anterior lamella in six lower eyelid defects. One of these layers can be a free graft, but at least one must be in. This flap minimizes the tension of the lower eyelid, recruiting tissue laterally to the defect and not below. In this technique, a fullthickness flap on a pedicle is switched from lower lid to upper lid to reconstruct a large fullthickness eyelid defect there. The flap is rotated medially, and tacking sutures are placed in the same manner as in the sc technique.
A fullthickness skin graft is used to replace the upper eyelid skin. Jul 23, 2017 repair of a medial canthal defect depends on its position and depth. The rotation of the facial flap has allowed the coverage of cheek defects of up to 7 cm in our patients. Mustarde revolutionized his eponymous technique and pioneered in. Cheek rotation skin mustarde flap to the lower eyelid. This procedure is performed on an outpatient basis and is optimal for aged patients who present with skin cancer and who require total lowereyelid reconstruction. Pdf versatility of mustarde cheek rotation prelaminated flap for. Ideally, the defect should be reconstructed with tissues similar or identical to those that have been lost. The yinyang rotation of the mustarde flap and the temporoparietal scalp allows an easy closure of mediumsized cheek skin defects localised at the suborbital area, particularly in cases where there is no skin laxity. Repair of a medial canthal defect depends on its position and depth.
It requires knowledge of various surgical techniques and anatomy to obtain satisfactory functional and aesthetic results eyelid defects can be divided into congenital and acquired and can be due to diverse etiologies, with cutaneous tumors being one of the most prevalent, especially the nonmelanoma. Sep 17, 2004 the fricke flap is a temporally based monopedicle forehead transposition flap, first described by jochim fricke in 1829. Advancement flap performed with a primary defect from excision of 1. The adjacent lower eyelid also requires special attention to avoid or minimize ectropion. Basat so, ceran f, askeroglu u, aksan t, orman c, yazar m, uscetin i, akan m, bozkurt m. Mar 21, 2017 the mustarde cheek flap is used to reconstruct defects of the anterior lamella of the inferior eyelid and medial cheek defects. The patient is status post excision of a basal cell carcinoma which has also resulted in an upper and lower canalicular defect.
Eyelid thin skin, areolar tissue, orbicularis occuli ms. The correction of epicanthus associated with blepharophimosis is a difficult surgical problem. Frickes lower cheek flap is an easytoperform, important and oftennecessary technique that, in some cases, has yielded positive functional and aesthetic results. Comparison of local flaps and skin grafts to repair cheek skin defects. Jun 26, 2016 cheek rotation skin mustarde flap to the lower eyelid j. Full thickness eyelid replacement requires composite grafting of the skin, together with tarsal support of its substitute and mucosa. Rbcp refinement of the mustarde technique for the treatment. Evaluation of a new suture otoplasty technique jpras open. However, the best technique is one that is reproducible, simple, and versatile. Since it involves minor detachment of the tissues, this flap has shown lower risks of seroma, hematoma, and necrosis than the technique of mustarde.
Skin graft a skin graft is a procedure performed where healthy skin is removed from one area of the. Results and complications were welldocumented with preoperative and postoperative photographs, and the patients have been followed from one to 14 years with a. We recently modified this flap design so that it could be used in the treatment of toe syndactyly involving fusion of the areas distal to the proximal interphalangeal joint. Modern otoplasty techniques consist of two main surgical categories, cartilage sparing and cartilage cutting, along with many variations.
It preferred to eyelid sharing techniques for reconstruction of large lower eyelid defects in monocular patients, those with active corneal disease, and in children as. The flap described by fricke in 1829 was used for reconstruction of anterior lamella in six lower eyelid. In the last two decades, fascial flap based techniques, first described by horlock et al, 12 have been used to correct prominent ear deformity otoplasty. The glabellar flap is then sutured to the mustarde flap with interrupted 50 fast absorbing sutures. This skin plasty combines the vyplasty technique with the rotation flaps of the s plasty. In order to achieve satisfactory medicalization of the ear the 2 techniques are often.
Citations may include links to fulltext content from pubmed central and publisher web sites. This is a somewhat unique case of cosmetic ear reshaping, or otoplasty surgery, that involves primarily use of antihelix sutures to contour the ear this male patient from san diego consulted with me for reshaping of his ears. Mustarde flap lower lid reconstruction after malignancy. For all free flaps, the blood supply is reconstituted using microsurgical techniques to reconnect the artery brings blood into the flap and vein allows blood to flow out of the flap. The terms free flap, free autologous tissue transfer and microvascular free tissue transfer are synonymous terms used to describe the transplantation of tissue from one site of the body to another, in order to reconstruct an existing defect. May 28, 2016 the mustarde flap is indicated for the reconstruction of large greater than 50 % full thickness lower eyelid defects. Preventing suture extrusion and recurrence in mustarde and furnas otoplasties by using laterally based postauricular dermal flap, longterm results. Reconstruction of the lower eyelid is a challenge for plastic surgeons. This pennant flap was raised attached to the lower edge of the fricke flap. Orbital exenteration and reconstruction with mustarde flap were performed. The modified 3square flap method for reconstruction of.
The color and texture of the reconstructed skin must reproduce that of the surrounding skin while minimizing the appearance of scars. The mustarde,1 scaphoconchal suture, is a common method by which to accentuate the antihelical fold while the furnas conchomastoid suture2 reduces the depth of the conchal bowl. However, the eye closure was not affected since the upper eyelids were functional and slightly ptotic. The two common anatomical abnormalities seen in prominent ears are. The mustarde rotational cheek flap has been used to reconstruct the lower eyelids of 55 patients since 1964. Results and complications were welldocumented with preoperative and postoperative photographs, and the patients have been followed from one to 14 years with a mean age followup of seven years. A 40 silk suture is placed through the lower lid at the level of the meibomian gland orifices to provide traction during the case. Different techniques have been used to reconstruct major lowereyelid defects, including the mustarde flap, 1 the hughes transposition flap, the tenzel flap, the median forehead flap and the free tarsal flap, which is used for defects greater than 50%.
Split or full thickness eyelid defects resulting from tumor destruction or surgical excision present a dilemma for plastic and reconstructive surgeons. We conducted a case series study of 25 patients who underwent bilateral otoplasty for prominent ears over a 4year. Kami parsa performs a mustarde flap jumping man on a 3 year old with blepharophimosis syndrome in amman, jordan. When dealing with larger defects, strategies can largely vary and the most appropriate reconstruction technique has to be chosen among. A similarly modified mustarde flap can be used for extensive cheek defects. The incision is then continued laterally to the preauricular crease toward the. Results and complications were welldocumented with preoperative and postoperative photographs, and the patients have been followed from one to 14 years. Closure is performed with 40 polyglactin 910 sutures for smasmuscle approximation, as well as sc closure. To evaluate the efficacy of the postauricular skin flap technique in otoplasty. Mustarde cheek rotation flap for lower eyelid repair. In this paper, the author will describe the different fascial flap techniques and discuss the advantages and specific applications of each technique based on a comprehensive literature search. Bandoh reported the 3squareflap method as a procedure for interdigital space reconstruction in patients with minor syndactyly. The vy advancement flap is equivalent to the mustarde flap for ectropion prevention in the. Chondromucosal flap for total and subtotal upper eyelid.
The lower pennant flap was raised to incorporate the orbicularis oculi muscle to preserve blood supply and to add bulk to the flap. Resection was performed under frozen section technique and the defect inner canthus, two thirds of the lower eyelid and 2. Switch flap for upper eyelid reconstructionhow soon should. The patient returns in one week for suture removal. The fricke flap was incised and raised in the subcutaneous plane over the full temporal skin region. Versatility of mustarde cheek rotation prelaminated flap. Modified cervicofacial flap for large cheek defect reconstruction.
The patient is status post mohs excision of a basal cell carcinoma. Mustarde utilized different cervical rotation flaps for the repair of orbital. This video demonstrates repair of a deep medial canthal defect which straddles the medial canthal tendon with a combination mustarde and glabellar flap. Pdf versatility of mustarde cheek rotation prelaminated.
Our preferred approach to the cervicofacial rotation advancement flap is an inferomedially based design similar to that originally described. Otoplasty with mustarde suture, cartilage rasping, and. Using a flap provides a satisfying texture and colour match with adjacent tissues and ensures short. Mustarde cheek rotation flap for lower eyelid repair facial. Mustarde flap for cheek reconstruction wikiplastic. It can be elevated subcutaneously or submuscularly. This video demonstrates the use of a mustarde rotational flap to repair a defect of the lower lid and cheek.
We report the case of a 68yearold man with a left lower eyelid basal cell carcinoma with squamous differentiation. An example of free flap could be a free toe transfer in which the great toe or the second toe is transferred to the hand to reconstruct a thumb. The vy advancement flap is equivalent to the mustarde flap for. Pubmed comprises more than 26 million citations for biomedical literature from medline, life science journals, and online books. The flap was tailored to match the defect without tension and sutured to the wound edges. The cervicofacial advancementrotation flap carf has long been a widely used local flap for the reconstruction such defects.
Tarsoconjunctival flap for upper eyelid reconstruction. The fricke flap is a temporally based monopedicle forehead transposition flap, first described by jochim fricke in 1829. Jflap is software for experimenting with formal languages topics including nondeterministic finite automata, nondeterministic pushdown automata, multitape turing machines, several types of grammars, parsing, and lsystems. For a deeper defect, a flap is preferable over a skin graft in order to prevent a mismatch in thickness.
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