The skin is incised down to the periosteum of the orbital rim. A sterile marker should be used to mark the 4 points through which the suture will pass to create a u suture. Modified cervicofacial flap for large cheek defect reconstruction. Flipbuilder flip book maker for converting pdf to flip book. In our series, we used gore tex thread or nylon suture. Reconstruction of large, fullthickness upper eyelid defects is a challenge to the ophthalmic plastic surgeon. Ideally, the defect should be reconstructed with tissues similar or identical to those that have been lost. It may be possible to directly close the lower lid. Despite this approach, ectropion can still be problematic, and elevation of the cheek poses its own set of potential complications. Reconstruction of the lower eyelid is a challenge for plastic surgeons. A comparison of the mustarde and hortondevine flipflap.
This was done by using the mustarde technique figures 3 and 4. This flap minimizes the tension of the lower eyelid, recruiting tissue laterally to the defect and not below. Mustarde flap for cheek reconstruction wikiplastic. Free implies that the tissue is completely detached from its blood supply at the original location donor site and then transferred to another. The defect was repaired with a rotational advancement flap with total primary and secondary defect area of 4. Pdf on jan 1, 2007, dragos pieptu and others published versatility of mustarde cheek rotation prelaminated flap for reconstruction of the wide full thickness lower lid defects find, read and. Of the 10 mustarde flaps performed to reconstruct the entire lower lid, 1 flap. The flap provides a vascularized anterior lamellar flap.
D hopital saint joseph paris the mustarde cheek flap is used to reconstruct defects of the anterior lamella of. All the patients showed aesthetic eyelid contour, good color, and texture match as well as. Principles and techniques of eyelid reconstruction springerlink. The surgical techniques used included mathieus repair in 216 52%, ducketts in 148 35%, onlay preputial flaps in 42 10% and the mustarde flap procedure in 12 3%. The mustarde rotational cheek flap has been used to reconstruct 1 the lower eyel ids of 55 patients since 1964. Sep 17, 2004 the fricke flap is a temporally based monopedicle forehead transposition flap, first described by jochim fricke in 1829. Match tissue characteristics as best as possible for grafts and flaps. Mustarde flap lower lid reconstruction after malignancy.
Nov 01, 20 basic principles of local flap in plastic surgery 1. Surgical treatment with locoregional flaps for the eyelid. The mustarde flap is indicated for the reconstruction of large greater than 50 % full thickness lower eyelid defects. The musculocutaneous flaps were harvested from both orbicularis and paranasal regions and clinical outcomes were recorded and analyzed. To name just a few, these including transposing part of the lower lid e.
The remainder of the flap is then draped over the defect and trimmed to size. A superiorly pedicled flap, composed of septal cartilage and mucosa of the septum contralateral to the lesion, was rotated and sutured to the orbital rim to support the skin flaps. If the temporal skin can be mobilized, then a semicircular advancement tenzel flap technique can be utilized 12. It can be elevated subcutaneously or submuscularly. The flap israised with blunt dissection toavoid damage to the lacrimal canaliculus fig. The mustarde cheek flap is used to reconstruct defects of the anterior lamella of the inferior eyelid and medial cheek defects. Pdf versatility of mustarde cheek rotation prelaminated. I submitted my claim with cpt 14040 advancement flap, 1205251 repair, and 1164251 malignant lesion excision. Mustarde rap lower lid reconstruction after malignancy o z i o. Since it involves minor detachment of the tissues, this flap has shown lower risks of seroma, hematoma, and necrosis than the technique of mustarde. The lower edge of the fricke flap, which was the pennant flap, was rotated and inset into the lower eyelid defect with interrupted 60 prolene suture figure 3.
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. The flap is suspended from the deep temporal fascia above the level of the lateral canthus to minimize the inferior tension placed on the lid margin. The traditional 60 angle zplasty will give a theoretical lengthening of the central limb of 75%. Since this flap is devoid of the tarsus, autogenous cartilage from the ear can be used. The fricke flap is a temporally based monopedicle forehead transposition flap, first described by jochim fricke in 1829. The defect would be too big for applying this technique. Tarsoconjunctival flap for upper eyelid reconstruction jama. The use of composite flaps in the management of large fullt. His sutures were removed at 7 days and time allowed for routine healing. The correction of epicanthus associated with blepharophimosis is a difficult surgical problem.
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. Request pdf reconstruction of cheek skin defects by the yinyang rotation of the mustarde flap and the temporoparietal scalp when the skins laxity is. An inferiortosuperior vy advancement flap has also been described, but its use is often limited because of the perceived increased risk of ectropion. Modified cervicofacial flap for large cheek defect. 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. From design to delivery we focus on simplicity in use and power in function. Cervicofacial flaps for head and neck reconstruction vula. It is then turned downward to course in front of the ear, approximately 1 to 1 cm.
Mutaf triangular flap technique in the repair of infraorbital skin. Once flap dissected, a lateral canthotomy performed on upper limb of lateral canthal tendon to help rotation. Mustarde flap incision can be o converted into a bilobed flap, swinging a retroauricular flap shaded green into the preauricular defect. A laterally based transverse flap of the lower eyelid is transposed to the upper lid. Eyelid reconstruction 45 superiorlybased muculocutaneous flap starting at lateral canthus and extending in semicircle inferiorly with diameter of at least 3 cm. Reconstruction of cheek skin defects by the yinyang rotation of the. The fricke flap was incised and raised in the subcutaneous plane over the full temporal skin region. Reconstruction of cheek skin defects by the yinyang rotation of the mustarde flap and the temporoparietal scalp. Reconstruction of cheek skin defects by the yinyang. There is a central limb which is either the scar itself.
As a general rule, the larger the defect, the more that undermining, rotation, and advancement are required. Specific modifications include the doubleopposing zplasty sometimes called a jumping man flap which can be useful for release of webbing of the medial canthus or release of 1st web space contractures. 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. 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.
The vy advancement flap is equivalent to the mustarde flap. Not suitable wounds to direct sutures can be restored with skin grafts or local flaps, such as the lindberg flap, mustarde cheek flap, nasolabial flap. Versatility of mustarde cheek rotation prelaminated flap for. This flap technique has evolved since its introduction, and several modifications have been. Most commonly used techniques, such as the mustarde technique, require meticulous measurements, and their theoretical geometric basis and flap designs are often confusing. Management of eyelid lacerations tomy rm kerala j ophthalmol. Surgeons experience with this technique may expand flaps adaptability. We present a procedure similar to the hughes tarsoconjunctival flap technique. Mutaf triangular flap technique in the repair of infraorbital skin losses. Mar 21, 2017 the mustarde cheek flap is used to reconstruct defects of the anterior lamella of the inferior eyelid and medial cheek defects. Mustarde utilized different cervical rotation flaps for the repair of orbital defects 2. No major complications were observed in any of the patients.
The direction of this line can be straight, horizontal, or oblique, thus allowing the surgeon to create a medial canthal area that fits within the ethnic characteristic of each patient. During this time the eyes remained closed since part of this technique results in. The flap is harvested along the lines and is undermined in suborbicularis plane to create a composite flap with conjunctiva and eyelid retractor system and then is advanced under the bridge of lower eyelid margin and stitched, respecting different layers, to upper eyelid defect. The fundamental unit of a zplasty is a triangular double transposition flap. Otoplasty without cartilage section using the mustarde. Versatility of mustarde cheek rotation prelaminated flap. Our range of applications include tools for converting almost any kind of document to elegant flip books. This video demonstrates the use of a mustarde rotational flap to repair a defect of the lower lid and cheek. Microcystic adnexal carcinoma of the centrofacial region. May 28, 2016 the mustarde flap is indicated for the reconstruction of large greater than 50 % full thickness lower eyelid defects.
Otoplasty for the protruded ear pubmed central pmc. In order to achieve satisfactory medicalization of the ear the 2 techniques are often. First described by mustarde in 1971, the advancementrotation temporojugal skin flap has been used largely for the loss of areas of the cheek, the temple, and the inferior eyelid. Reconstruction of combined fullthickness defect of the. Dixon walker from the division of urology, department of surgery, university of florida, gainesville, florida abstract we compared the results and complications of the hortondevine flip flap and mustarda techniques for 1stage repair of distal hypospadias. 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. The transposed section of eyelid was left in place as a transposition flap for two weeks.
This pennant flap was raised attached to the lower edge of the fricke flap. In a classic zplasty three incisions of equal length create two equilateral triangular flaps see figures 1b and 1c. Evaluation of a new suture otoplasty technique jpras open. The lower pennant flap was raised to incorporate the orbicularis oculi muscle to preserve blood supply and to add bulk to the flap. A 40 silk suture is placed through the lower lid at the level of the meibomian gland orifices to provide traction during the case. Orbital exenteration and reconstruction with mustarde flap were performed. We start at the top of the pavilion, then descend and take 2 or 3 stitches as necessary. The patient is status post mohs excision of a basal cell carcinoma. By 1963, the everpopularized mustarde technique was developed to create the antihelical tubing using permanent conchoscaphal mattress sutures without excision of cartilage.