Clinical significance of submental artery island flap. department of oral and maxillofacial surgery. presentation from international science conference 2016-17
This document discusses various techniques for mandibular reconstruction after resection for tumors or injuries. The goals of reconstruction are to restore mandibular continuity, alveolar bone height, facial contours and function. Options include reconstruction plates, non-vascularized bone grafts for smaller defects, and microvascular free flaps for larger defects or those needing implant placement. The fibula and scapula flaps are commonly used, providing adequate bone stock. Proper classification of defect type and immediate versus delayed reconstruction must be considered to achieve optimal aesthetic and functional outcomes.
The radial forearm flap is based on the radial artery and its venae comitantes. It can be harvested as a fasciocutaneous or osteocutaneous flap with a long vascular pedicle. The radial forearm flap is commonly used in reconstructive surgery due to its reliable vascular anatomy, long pedicle length allowing for versatile positioning, and ability to provide a hairless skin match. Potential donor site complications include functional impairment and need for skin grafting or local flaps.
Local flaps in head & neack reconstructionMd Roohia
A flap is a unit of tissue transferred from one site to another while maintaining its own blood supply. Flaps are classified based on their location as local or distant. Local flaps can be random, which rely on subdermal vessels, or axial, relying on named vessels. Flaps are also classified based on their composition, such as skin, muscle, or bone flaps. When planning local flaps, goals include color and thickness match, sensory preservation, and minimal secondary defects. Common local flap techniques include advancement, rotation, and transposition flaps to close facial defects. Complications can be prevented through proper planning to avoid tension and including a flap margin.
Local and regional flaps in head and neck reconstructionSaleh Bakry
Local and regional flaps are used for head and neck reconstruction. There are several types of flaps classified by blood supply, location, configuration, tissue content, and transfer method. Local flaps use adjacent tissue while regional flaps are near but not adjacent. Free flaps completely detach tissue and reconnect blood vessels microsurgically. Examples of local and regional flaps discussed are advancement, rotation, and transposition flaps as well as pedicled and free myocutaneous flaps.
The document describes the pectoralis major island flap technique. It can be used for reconstruction of the pharynx, tongue, face, neck, and skullbase defects. The flap has a large arc of rotation from the clavicle to the xiphoid process. It provides a single stage transfer with a muscle carrier but does not match the color and texture of facial skin. The document outlines the surgical technique including flap design, elevation of the vascular pedicle, and closure of the donor site. Variations including osteomyocutaneous flaps with rib bone and use of the flap as a free tissue transfer are also discussed. Complications, risk factors, and modifications to the technique are summarized.
Here are the key points about lips and their beauty:
- Full, plump lips are generally considered beautiful. The ideal lip shape is described as having well-defined cupid's bow and vermilion border, with upper lip slightly fuller than the lower lip.
- There are three natural lip shapes: thin lips have little definition, full lips are protruding with color, heart-shaped lips are full at the center but taper at the corners.
- Beautiful natural lips have a smooth texture, well-defined shape, and natural color from circulation and pigmentation and are free of scarring or discoloration. Subtle lip liner can enhance natural fullness.
- Procedures like fillers can temporarily
The document discusses different incision techniques for lip splitting surgeries. It describes various incisions used for lower and upper lip splitting, including the Roux-Trotter, McGregor, Robson, Bhatt, Hayter, Rassekh, Weber-Ferguson, and Altemir incisions. It emphasizes that incisions should follow relaxed skin tension lines to minimize scarring, protect important structures like nerves and vessels, and allow for adequate exposure while achieving good functional and cosmetic outcomes. The Hayter incision, which incorporates a chevron shape into the vermilion border, is highlighted as one of the best techniques.
This document discusses various techniques for mandibular reconstruction after resection for tumors or injuries. The goals of reconstruction are to restore mandibular continuity, alveolar bone height, facial contours and function. Options include reconstruction plates, non-vascularized bone grafts for smaller defects, and microvascular free flaps for larger defects or those needing implant placement. The fibula and scapula flaps are commonly used, providing adequate bone stock. Proper classification of defect type and immediate versus delayed reconstruction must be considered to achieve optimal aesthetic and functional outcomes.
The radial forearm flap is based on the radial artery and its venae comitantes. It can be harvested as a fasciocutaneous or osteocutaneous flap with a long vascular pedicle. The radial forearm flap is commonly used in reconstructive surgery due to its reliable vascular anatomy, long pedicle length allowing for versatile positioning, and ability to provide a hairless skin match. Potential donor site complications include functional impairment and need for skin grafting or local flaps.
Local flaps in head & neack reconstructionMd Roohia
A flap is a unit of tissue transferred from one site to another while maintaining its own blood supply. Flaps are classified based on their location as local or distant. Local flaps can be random, which rely on subdermal vessels, or axial, relying on named vessels. Flaps are also classified based on their composition, such as skin, muscle, or bone flaps. When planning local flaps, goals include color and thickness match, sensory preservation, and minimal secondary defects. Common local flap techniques include advancement, rotation, and transposition flaps to close facial defects. Complications can be prevented through proper planning to avoid tension and including a flap margin.
Local and regional flaps in head and neck reconstructionSaleh Bakry
Local and regional flaps are used for head and neck reconstruction. There are several types of flaps classified by blood supply, location, configuration, tissue content, and transfer method. Local flaps use adjacent tissue while regional flaps are near but not adjacent. Free flaps completely detach tissue and reconnect blood vessels microsurgically. Examples of local and regional flaps discussed are advancement, rotation, and transposition flaps as well as pedicled and free myocutaneous flaps.
The document describes the pectoralis major island flap technique. It can be used for reconstruction of the pharynx, tongue, face, neck, and skullbase defects. The flap has a large arc of rotation from the clavicle to the xiphoid process. It provides a single stage transfer with a muscle carrier but does not match the color and texture of facial skin. The document outlines the surgical technique including flap design, elevation of the vascular pedicle, and closure of the donor site. Variations including osteomyocutaneous flaps with rib bone and use of the flap as a free tissue transfer are also discussed. Complications, risk factors, and modifications to the technique are summarized.
Here are the key points about lips and their beauty:
- Full, plump lips are generally considered beautiful. The ideal lip shape is described as having well-defined cupid's bow and vermilion border, with upper lip slightly fuller than the lower lip.
- There are three natural lip shapes: thin lips have little definition, full lips are protruding with color, heart-shaped lips are full at the center but taper at the corners.
- Beautiful natural lips have a smooth texture, well-defined shape, and natural color from circulation and pigmentation and are free of scarring or discoloration. Subtle lip liner can enhance natural fullness.
- Procedures like fillers can temporarily
The document discusses different incision techniques for lip splitting surgeries. It describes various incisions used for lower and upper lip splitting, including the Roux-Trotter, McGregor, Robson, Bhatt, Hayter, Rassekh, Weber-Ferguson, and Altemir incisions. It emphasizes that incisions should follow relaxed skin tension lines to minimize scarring, protect important structures like nerves and vessels, and allow for adequate exposure while achieving good functional and cosmetic outcomes. The Hayter incision, which incorporates a chevron shape into the vermilion border, is highlighted as one of the best techniques.
The buccal fat pad is a mass of fatty tissue located in the cheek. It has an excellent blood supply from the facial, transverse facial, and internal maxillary arteries. The buccal fat pad flap can be used to repair small to medium sized defects in the palate, alveoli, and buccal mucosa. It is a simple and reliable flap that causes minimal donor site morbidity and has an excellent blood supply. The flap is delivered into the oral cavity by incising its capsule and gently retracting it. It is then sutured into the defect site and will epithelialize within a month.
This document discusses the forehead flap procedure. It provides background on the history and anatomy of the forehead flap, which is based on the superficial temporal artery and its branches. The forehead flap can be used to reconstruct large defects in the nose, eyelids, cheeks, mouth, chin, and tongue. The technique involves outlining the flap based on the eyebrows and behind the ear. A tunnel is constructed to pass the flap to the defect site, either directly through the cheek or deep to the zygomatic arch. The donor site is closed primarily while the flap is monitored, with a second surgery needed to divide and close the bridge of the flap. Complications are rare given the rich blood supply but include infection, nerve injury, and
The temporoparietal fascial flap (TPF) uses fascia from the scalp which is supplied by the superficial temporal artery. It can be used as a pedicled or free flap for reconstruction of facial, orbital, and skull defects. The relevant anatomy is described including landmarks for incision and dissection. Indications include reconstruction of oral, orbital, and cranial defects. Advantages are an easy harvest with a reliable vascular pedicle and low donor site morbidity. Disadvantages include a short pedicle length and potential scarring or alopecia at the donor site.
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
The nasolabial flap is used to reconstruct defects of the nose, lower eyelid, cheek, lip, oral commissure and anterior oral cavity. It has a reliable blood supply from the facial and angular arteries. The flap can be raised in a superior or inferior direction and is outlined along the nasolabial fold. The technique involves raising the flap in a supra-muscular plane and transferring it to the defect site through a transoral tunnel. Advantages are a concealed donor site scar and good color and texture match. Complications include infection, necrosis and asymmetry.
Microvascular flaps for reconstruction in head and neck cancermurari washani
(1) The document discusses the history and advances in microvascular surgery, which allows for complex tissue reconstruction through free tissue transfer.
(2) It outlines the key advantages of microvascular free flaps over traditional pedicled flaps, such as the ability to transfer large amounts of composite tissue from a variety of donor sites.
(3) The document provides details on planning microvascular surgery, including patient evaluation, vessel preparation, and anastomosis techniques to successfully reattach blood vessels between the donor tissue and recipient site.
This document discusses the classification and reconstruction of palato-maxillary defects. It classifies defects into 4 classes based on the extent of maxillectomy. Class 1 involves no oroantral fistula, while Class 4 is the most extensive, including orbital exenteration and possible anterior skull base resection. Reconstruction goals are outlined, such as separating oral and nasal cavities and restoring facial contour. Reconstruction methods are suggested depending on the class, including local flaps for small Class 1 defects and bone-containing free flaps for larger defects to provide support for dentition or globe positioning. Complex Class 3 and 4 defects require reconstruction of multiple subunits using composite free flaps.
This powerpoint describes the types of maxillectomy & operative steps for total maxillectomy. It also enumerates various flaps used for reconstruction of maxillectomy defect.
This document provides information on nose anatomy, blood supply, nerve supply, history of nose reconstruction, principles of aesthetic nasal reconstruction, approaches to reconstruction, aesthetic subunits of the nose, analysis of defects, goals of reconstruction, options for surface defect repair including skin grafts and local flaps, intranasal lining reconstruction using mucosal flaps, sources of nasal support grafts including cartilage, and skin grafting techniques for nasal cover reconstruction.
Elevate the skin flaps superiorly to the level of the ramus of mandible. Identify and protect the external jugular vein.
Surgeon: Okay, elevating the skin flaps now. Carefully dissecting in the plane just deep to the platysma muscle. There's the external jugular vein, I'm protecting that as I elevate the flap. Almost to the level of the ramus now.
This document discusses the use of tongue flaps in reconstructive surgery. It provides a brief history of tongue flaps dating back to 1909. Various types of tongue flaps are described, including posterior based dorsal flaps, anterior based dorsal flaps, transverse dorsal tongue flaps, perimeter flaps, and dorsoventral flaps. Indications for tongue flaps include moderate sized oral defects, defects exposing bone, and repairs after cancer resections. Four case studies are presented demonstrating the use of different tongue flap techniques for reconstructing posterior palatal, maxillary, and anterior palatal defects. Tongue flaps are concluded to be a reliable and versatile option for oral reconstruction with over 100 years of successful use and minimal
The document describes the anatomy and surgical technique for harvesting a deep circumflex iliac artery (DCIA) flap. The DCIA flap can include bone from the iliac crest and either the internal oblique muscle or just the overlying muscles. The standard incision is an S-shaped incision over the iliac crest. Dissection proceeds through the muscle layers to identify the DCIA and its branches. The flap is then harvested by ligating the DCIA, performing osteotomies, and transecting the pedicle once the reconstruction site is ready. Closure involves reapproximating the muscles and skin.
Free fibula flap OMFS 2021 journal club presentationRobertMbaluka
The free fibula flap involves harvesting the fibula bone with its vascular pedicle for reconstruction at a recipient site. The fibula is well-suited for this due to its length, cortical thickness, and vascular anatomy. It can reconstruct mandibular and other skeletal defects when paired with skin, muscle, or nerve grafts. Advantages include the ability to harvest a long segment of bone and concurrently operate at donor and recipient sites. Proper knowledge of fibula anatomy is important for designing and performing the flap successfully.
scope of Pedicled flaps in oral and maxillofacial surgeryAnil Narayanam
The document discusses various types of pedicled flaps that can be used to reconstruct orofacial defects. It begins by classifying flaps based on their blood supply and proximity to the defect. It then describes several commonly used pedicled flaps for the orofacial region, including the deltopectoral flap, pectoralis major myocutaneous flap, forehead flap, temporalis muscle flap, and buccal fat pad flap. It discusses the advantages, disadvantages, indications, and surgical techniques for each flap.
This document summarizes reconstruction of the maxilla following maxillectomy. It describes the anatomy and goals of maxillary reconstruction. Maxillectomy defects are classified and reconstruction options are outlined, including prosthetic obturators, local and regional pedicled flaps, microvascular free flaps, bone grafts, and titanium mesh. Defect-specific reconstruction approaches are provided for different types of maxillectomy defects, such as palate defects, inferior maxillectomies, total maxillectomies with and without orbital exenteration, and orbitomaxillectomies.
Access osteotomies in oral & cranio-maxillofacial surgeryDr Rayan Malick
This document discusses various surgical approaches and osteotomies for accessing lesions in the skull base and deep neck spaces. It begins with an introduction and history of access osteotomy. It then discusses the indications, classifications, advantages/disadvantages of different approaches like Lefort I/II osteotomies, zygomatic osteotomies, and transpalatal approaches. Specific approaches like fronto-orbitozygomatic and transnaso-orbitomaxillary are also summarized. The goal of these osteotomies is to provide direct surgical access while minimizing trauma.
Micro vascular free flaps used in head and neck reconstruction /certified fi...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
This document discusses approaches for reconstructing maxillary defects. It begins with an introduction on causes of maxillary defects like tumors and trauma. It then describes Brown's classification system for maxillary defects, which categorizes defects based on their vertical and horizontal extent. The document outlines different treatment approaches based on the class of defect, including local flaps, prosthetics like obturators, grafts, implants, and free vascularized flaps. For more extensive defects, a composite vascularized flap is recommended. The document concludes with brief descriptions of various reconstructive techniques like prosthetics, grafts, flaps, and implants.
This document provides an overview of various osteotomy approaches for accessing lesions in the skull base and neck. It discusses the history, classification, advantages, and disadvantages of different osteotomies. Key approaches mentioned include fronto-nasal-orbital osteotomy, Lefort I osteotomy, zygomatic osteotomy, and mandibulotomy. The document emphasizes that the choice of osteotomy depends on factors like the location and extent of the lesion as well as involvement of surrounding structures. Modifications to standard approaches are also described to optimize exposure and resection of different pathologies.
This document discusses different types of reconstructions in the orofacial region including grafts and flaps. It defines grafts as tissue detached from its blood supply that is placed in a new area, while flaps maintain some or all of their original blood supply. The document classifies grafts as autografts, homografts, xenografts, or isografts. It describes various types of grafts including split thickness and full thickness grafts. It also discusses indications, contraindications, and complications of grafts. Regarding flaps, the document discusses pedicled and free flaps, as well as classifications based on blood supply, component tissues, relation to the defect, and
The buccal fat pad is a mass of fatty tissue located in the cheek. It has an excellent blood supply from the facial, transverse facial, and internal maxillary arteries. The buccal fat pad flap can be used to repair small to medium sized defects in the palate, alveoli, and buccal mucosa. It is a simple and reliable flap that causes minimal donor site morbidity and has an excellent blood supply. The flap is delivered into the oral cavity by incising its capsule and gently retracting it. It is then sutured into the defect site and will epithelialize within a month.
This document discusses the forehead flap procedure. It provides background on the history and anatomy of the forehead flap, which is based on the superficial temporal artery and its branches. The forehead flap can be used to reconstruct large defects in the nose, eyelids, cheeks, mouth, chin, and tongue. The technique involves outlining the flap based on the eyebrows and behind the ear. A tunnel is constructed to pass the flap to the defect site, either directly through the cheek or deep to the zygomatic arch. The donor site is closed primarily while the flap is monitored, with a second surgery needed to divide and close the bridge of the flap. Complications are rare given the rich blood supply but include infection, nerve injury, and
The temporoparietal fascial flap (TPF) uses fascia from the scalp which is supplied by the superficial temporal artery. It can be used as a pedicled or free flap for reconstruction of facial, orbital, and skull defects. The relevant anatomy is described including landmarks for incision and dissection. Indications include reconstruction of oral, orbital, and cranial defects. Advantages are an easy harvest with a reliable vascular pedicle and low donor site morbidity. Disadvantages include a short pedicle length and potential scarring or alopecia at the donor site.
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
The nasolabial flap is used to reconstruct defects of the nose, lower eyelid, cheek, lip, oral commissure and anterior oral cavity. It has a reliable blood supply from the facial and angular arteries. The flap can be raised in a superior or inferior direction and is outlined along the nasolabial fold. The technique involves raising the flap in a supra-muscular plane and transferring it to the defect site through a transoral tunnel. Advantages are a concealed donor site scar and good color and texture match. Complications include infection, necrosis and asymmetry.
Microvascular flaps for reconstruction in head and neck cancermurari washani
(1) The document discusses the history and advances in microvascular surgery, which allows for complex tissue reconstruction through free tissue transfer.
(2) It outlines the key advantages of microvascular free flaps over traditional pedicled flaps, such as the ability to transfer large amounts of composite tissue from a variety of donor sites.
(3) The document provides details on planning microvascular surgery, including patient evaluation, vessel preparation, and anastomosis techniques to successfully reattach blood vessels between the donor tissue and recipient site.
This document discusses the classification and reconstruction of palato-maxillary defects. It classifies defects into 4 classes based on the extent of maxillectomy. Class 1 involves no oroantral fistula, while Class 4 is the most extensive, including orbital exenteration and possible anterior skull base resection. Reconstruction goals are outlined, such as separating oral and nasal cavities and restoring facial contour. Reconstruction methods are suggested depending on the class, including local flaps for small Class 1 defects and bone-containing free flaps for larger defects to provide support for dentition or globe positioning. Complex Class 3 and 4 defects require reconstruction of multiple subunits using composite free flaps.
This powerpoint describes the types of maxillectomy & operative steps for total maxillectomy. It also enumerates various flaps used for reconstruction of maxillectomy defect.
This document provides information on nose anatomy, blood supply, nerve supply, history of nose reconstruction, principles of aesthetic nasal reconstruction, approaches to reconstruction, aesthetic subunits of the nose, analysis of defects, goals of reconstruction, options for surface defect repair including skin grafts and local flaps, intranasal lining reconstruction using mucosal flaps, sources of nasal support grafts including cartilage, and skin grafting techniques for nasal cover reconstruction.
Elevate the skin flaps superiorly to the level of the ramus of mandible. Identify and protect the external jugular vein.
Surgeon: Okay, elevating the skin flaps now. Carefully dissecting in the plane just deep to the platysma muscle. There's the external jugular vein, I'm protecting that as I elevate the flap. Almost to the level of the ramus now.
This document discusses the use of tongue flaps in reconstructive surgery. It provides a brief history of tongue flaps dating back to 1909. Various types of tongue flaps are described, including posterior based dorsal flaps, anterior based dorsal flaps, transverse dorsal tongue flaps, perimeter flaps, and dorsoventral flaps. Indications for tongue flaps include moderate sized oral defects, defects exposing bone, and repairs after cancer resections. Four case studies are presented demonstrating the use of different tongue flap techniques for reconstructing posterior palatal, maxillary, and anterior palatal defects. Tongue flaps are concluded to be a reliable and versatile option for oral reconstruction with over 100 years of successful use and minimal
The document describes the anatomy and surgical technique for harvesting a deep circumflex iliac artery (DCIA) flap. The DCIA flap can include bone from the iliac crest and either the internal oblique muscle or just the overlying muscles. The standard incision is an S-shaped incision over the iliac crest. Dissection proceeds through the muscle layers to identify the DCIA and its branches. The flap is then harvested by ligating the DCIA, performing osteotomies, and transecting the pedicle once the reconstruction site is ready. Closure involves reapproximating the muscles and skin.
Free fibula flap OMFS 2021 journal club presentationRobertMbaluka
The free fibula flap involves harvesting the fibula bone with its vascular pedicle for reconstruction at a recipient site. The fibula is well-suited for this due to its length, cortical thickness, and vascular anatomy. It can reconstruct mandibular and other skeletal defects when paired with skin, muscle, or nerve grafts. Advantages include the ability to harvest a long segment of bone and concurrently operate at donor and recipient sites. Proper knowledge of fibula anatomy is important for designing and performing the flap successfully.
scope of Pedicled flaps in oral and maxillofacial surgeryAnil Narayanam
The document discusses various types of pedicled flaps that can be used to reconstruct orofacial defects. It begins by classifying flaps based on their blood supply and proximity to the defect. It then describes several commonly used pedicled flaps for the orofacial region, including the deltopectoral flap, pectoralis major myocutaneous flap, forehead flap, temporalis muscle flap, and buccal fat pad flap. It discusses the advantages, disadvantages, indications, and surgical techniques for each flap.
This document summarizes reconstruction of the maxilla following maxillectomy. It describes the anatomy and goals of maxillary reconstruction. Maxillectomy defects are classified and reconstruction options are outlined, including prosthetic obturators, local and regional pedicled flaps, microvascular free flaps, bone grafts, and titanium mesh. Defect-specific reconstruction approaches are provided for different types of maxillectomy defects, such as palate defects, inferior maxillectomies, total maxillectomies with and without orbital exenteration, and orbitomaxillectomies.
Access osteotomies in oral & cranio-maxillofacial surgeryDr Rayan Malick
This document discusses various surgical approaches and osteotomies for accessing lesions in the skull base and deep neck spaces. It begins with an introduction and history of access osteotomy. It then discusses the indications, classifications, advantages/disadvantages of different approaches like Lefort I/II osteotomies, zygomatic osteotomies, and transpalatal approaches. Specific approaches like fronto-orbitozygomatic and transnaso-orbitomaxillary are also summarized. The goal of these osteotomies is to provide direct surgical access while minimizing trauma.
Micro vascular free flaps used in head and neck reconstruction /certified fi...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
This document discusses approaches for reconstructing maxillary defects. It begins with an introduction on causes of maxillary defects like tumors and trauma. It then describes Brown's classification system for maxillary defects, which categorizes defects based on their vertical and horizontal extent. The document outlines different treatment approaches based on the class of defect, including local flaps, prosthetics like obturators, grafts, implants, and free vascularized flaps. For more extensive defects, a composite vascularized flap is recommended. The document concludes with brief descriptions of various reconstructive techniques like prosthetics, grafts, flaps, and implants.
This document provides an overview of various osteotomy approaches for accessing lesions in the skull base and neck. It discusses the history, classification, advantages, and disadvantages of different osteotomies. Key approaches mentioned include fronto-nasal-orbital osteotomy, Lefort I osteotomy, zygomatic osteotomy, and mandibulotomy. The document emphasizes that the choice of osteotomy depends on factors like the location and extent of the lesion as well as involvement of surrounding structures. Modifications to standard approaches are also described to optimize exposure and resection of different pathologies.
This document discusses different types of reconstructions in the orofacial region including grafts and flaps. It defines grafts as tissue detached from its blood supply that is placed in a new area, while flaps maintain some or all of their original blood supply. The document classifies grafts as autografts, homografts, xenografts, or isografts. It describes various types of grafts including split thickness and full thickness grafts. It also discusses indications, contraindications, and complications of grafts. Regarding flaps, the document discusses pedicled and free flaps, as well as classifications based on blood supply, component tissues, relation to the defect, and
The document discusses ankyloglossia (tongue-tie), including its incidence, potential complications, clinical assessment, and treatment options. Ankyloglossia is a congenital condition where the lingual frenulum limits tongue mobility and can impair functions like speech, swallowing, and breastfeeding. Surgical techniques like frenotomy and frenectomy aim to release the frenulum and improve tongue function. Assessment considers factors like a patient's ability to protrude and elevate their tongue tip.
This document summarizes a journal meeting discussing perforator flaps. It covers:
1) The evolution of flap reconstruction and goal of optimal tissue replacement with minimal donor site impact leading to perforator flaps.
2) Research on 217 flaps from 40 cadavers identifying over 350 perforators, each with its own vascular territory called a perforasome.
3) Dynamic 4D-CT imaging showing direct linking vessels between perforasomes and directional flow within perforasomes.
This document discusses Gorlin Goltz Syndrome, a rare genetic condition caused by mutations in the PTCH1 gene. It presents three key points:
1. Gorlin Goltz Syndrome is characterized by multiple basal cell carcinomas, odontogenic keratocysts of the jaws, and other abnormalities like skeletal anomalies and ovarian fibromas. It has an autosomal dominant inheritance pattern.
2. The case presentation describes a 32-year-old female patient found to have multiple recurrent odontogenic keratocysts in the mandible and maxilla, leading to a diagnosis of Gorlin Goltz Syndrome based on major and minor diagnostic criteria.
3. Management of odontogenic kerat
This document discusses hand reconstruction techniques following injuries. It introduces relevant hand anatomy and the goals of reconstruction, which are to restore functional, sensate hands that are aesthetically acceptable. Various local and regional flap options for covering dorsal and palmar hand defects ranging from fingertips to multiple fingers are described, including considerations for selecting the appropriate flap based on defect size and location. Post-operative care and potential complications are also mentioned.
1. The document discusses various types of flaps used in reconstructive surgery including local flaps, regional flaps, and free flaps.
2. Different types of local flaps are described such as rotation flaps, transposition flaps, and advancement flaps which allow redistribution of tissue near a defect.
3. Regional flaps like the pectoralis major flap provide tissue from a distance away but within the same anatomical region and rely on named vessels within a vascular pedicle.
Reconstruction in head and neck surgeriesDavid Edison
This document discusses various reconstructive surgery options for restoring form and function after defects in the head and neck region. It outlines a reconstructive ladder ranging from primary closure and skin grafts for small defects, to local and regional flaps, myocutaneous flaps, and free flaps for more complex reconstructions. Key flaps discussed include the pectoralis major flap, fibula flap, radial forearm flap, and anterolateral thigh flap. Patient factors, defect characteristics, and the goal of restoring oral competence, speech, and swallowing are considered in surgical planning. The conclusion emphasizes that reconstructive surgery is essential for improving head and neck cancer survivors' quality of life.
The document discusses various types of skin grafts and flaps used in head and neck reconstruction. It describes skin grafts such as split-thickness skin grafts (STSG) and full-thickness skin grafts (FTSG), and how they are harvested. It also discusses different types of flaps based on their blood supply patterns (random or axial), methods of transfer (advancement, transposition, rotation), configurations (rhomboid, bilobed), and locations (local, regional, distant). Common regional flaps used in head and neck reconstruction like pectoralis major, deltopectoral, and latissimus dorsi flaps are also described.
This document discusses the anatomy and examination of the upper eyelid, as well as the diagnosis and treatment of ptosis (drooping of the upper eyelid). It describes the levator aponeurosis and Muller's muscle that retract the upper eyelid. True ptosis results from dysfunction of these structures, while pseudoptosis is unrelated. Examination involves measuring eyelid position, levator function, and classifying ptosis severity. Surgical treatments include mullerectomy, levator resection/plication, and frontalis sling depending on ptosis severity and levator function. Complications include asymmetry, corneal issues, lid malpositions, and wound issues.
POST ONCOSURGICAL HEAD NECK RECONSTRUCTION - harsh aminHarsh Amin
This document discusses head and neck cancer reconstruction using free flaps. It begins by outlining the anatomy of the head and neck region and factors to consider for reconstruction such as integrity, function and form. Common free flap options are described including the anterolateral thigh flap, radial forearm flap, rectus abdominis flap, fibula flap and jejunum flap. Key steps in planning a reconstruction including evaluating the defect, donor site, patient factors and surgical experience are highlighted. The importance of microvascular expertise and equipment for free flap reconstruction is emphasized.
This document provides an overview of ptosis, or drooping of the upper eyelid. It defines ptosis and classifies it as either congenital or acquired, with mechanisms including neurogenic, myogenic, aponeurotic, or mechanical causes. It describes measurements used in diagnosis such as margin-reflex distance, palpebral fissure height, levator function, upper eyelid crease, and lagophthalmos. Common types of ptosis like congenital, Marcus Gunn jaw-winking syndrome, and involutional are explained. Differential diagnosis and management options including non-surgical and surgical treatments like eyelid crutches, levator advancement, resection, and frontalis suspension are summarized
Dr. Harsh Bharat Amin is the director of ADORN cosmetic clinic. He specializes in hair loss conditions like alopecia, which can negatively impact appearance, social life, self-esteem, and mental health. Hair grows in follicles located in the dermis and goes through different growth phases. Common causes of hair loss include hormones, nutrition, infections, drugs, trauma, pregnancy, and genetics. Options for treating baldness include lifestyle changes, medications, procedures like mesotherapy and PRP, wearing wigs, scalp surgery, and hair transplants using the FUT or FUE methods.
Follicular Unit Extraction or FUE that has become a common trend nowadays indeed is a very effective procedure. A highly effectual hair transplant procedure, FUE is a very powerful technique in which hair follicles are extracted separately from the individual’s donor part and then transplanted into the balding region. Check this beautiful slideshare presentation and have your valuable feedback.
Prem Laser & Cosmetic Surgery is one of the most renowned and highly recommended hair transplant clinic in Kolkata. Get back to us to diagnose and share your hair problems and enjoy a happy life.
1. Submental artery islandSubmental artery island
flapflap
Department of oral and maxillofacial surgery
Vinnitsa National medical University
Presentation by,
Patrick Royson
Albertina Sheehama
Supervised by: Kulytska O.V.
2. contentscontents
• Definition and introduction
• Indications
• Anatomy and contents of the flap
• Classification of flaps
• Types for pedicle elongation
• Clinical cases
• Advantages
• Disadvantages
• Conclusion
3. Definition and introductionDefinition and introduction / Визначення/ Визначення
The submental artery island flap(SAIF) is an
axial pattern flap introduced by Martin et.al
in 1993 and has become popular over the
years in reconstruction of oral and
maxillofacial area defects.
Aim : Restoration of form and function
Form:
Cosmetic
Restoration of contour
Expression of face
Oral competence
Functions:
Speech
Mastication
Deglutition
Pic. 01. Schematic picture of submental artery flap
Shahram Nazerani , A Textbook of Advanced Oral and Maxillofacial
Surgery Volume 2,Chapter 26 :Reconstruction of Facial Hair Bearing
Areas in the Male Patient /page no.597/fig.no.18
4. IndicationsIndications / Покази/ Покази
SAIF can be used for reconstruction
of the following defects
• Facial gun shot defect
• Oral cavity tumors
- floor of the mouth
- tongue
- mucosa of the cheeks
- soft palate
- hard palate
• Skin tumors (lower 2/3 of the
face)
• Noma defects
Підпідборідні клапті
використовуються для відновлення
таких дефектів:
• Вогнепальні дефекти
• Пухлини ротової порожнини
- дно порожнини рота
- язик
- слизова щік
- м'яке піднебіння
- тверде піднебіння
• Пухлини шкіри (нижні 2/3 обличчя)
• Дефекти після номи
5. Anatomy and contents of the flapAnatomy and contents of the flap / Анатомія/ Анатомія
• Submental artery
• Branches of submental artery
- superficial and deep branch
• Anastomoses
- superficial branch with inferior labial
artery
- deep branch with inferior labial artery
and mental branch of inferior alveolar
artery
- submental artery also anastomoses
with sublingual artery and mylohyoid
branch of inferior alveolar artery
• Підпідборідна артерія
• Гілки:
- поверхнева і глибока
• Анастомози:
- з нижньої губною артерією
- з підборідною гілочкою
нижньоальвеолярної артерії
-з під'язиковою артерією та
щелепно-язиковою гілочкою
нижньоальвеолярної артерії
6. Anatomy and contents of the flapAnatomy and contents of the flap
Pic. 02. Diagram showing submental artery Pic. 03. Anatomical specimen showing submental artery
7. Classification / Класифікація
Based on the flap composition and blood supply
Based on flap composition / По складу
1.Myocutaneous flaps (м'язово-шкірний)
2.Osteomuscular flap (кістково-
м'язовий)
Based on blood supply / По
кровопостачанню
1.Pedicled flap (на ніжці)
2.Free flap (вільний)
3.Perforator flap (із використанням
перфоруючих судин)
Rahpeyma A. Submental artery island flap in intraoral
reconstruction: A review. / A. Rahpeyma, S. Khajehahmadi. // J
Craniomaxillofac Surg. - 2014. - № 42. - P. 983-989
Pic.04. Submental artery pedicled flap
8. Types for pedicle elongationTypes for pedicle elongation // Види подовженняВиди подовження
Pic. 05. Types for pedicle elongation
a. Additional dissection of the pedicle
b. Y-V procedure
Pic. 06. Types for pedicle elongation
a. Reverse flow
b. Section of facial vein and microvascular
anastomosis
Ferrari S. The submental island flap: Pedicle elongation and indications in head and neck reconstruction. / S. Ferrari, C.
Copelli, B. Bianchi, A.S. Magri, A. Ferri, A. Varazzani, T. Poli, T. Ferri., E. Sesenna. // J Craniomaxillofac Surg. - 2014. - № 42. -
P. 1005-1009
9. Clinical casesClinical cases / Клінічні випадки/ Клінічні випадки
Treatment of eccrine
Carcinoma of the Chin
via Submental Island
Flap
(Лікування раку шкіри
підборіддя з
використанням
підпідборідного
острівцевого клаптя)
Pic. 07. Preoperative view of eccrine carcinoma lesion of the chin.
PAPPAS-POLITIS ET AL ,Treatment of Eccrine Carcinoma of the Chin via Submental Island Flap,Effie
Pappas-Politis, MD,aDavid C. Driscoll,b Yvonne N. Pierpont, MD,a,bPaul R. Albear, MD,a,cWilliam L.
Carter, MD,a,cLisa J. Gould, MD, PhDa,c/ Published April 8, 2010/page 223-230
10. Clinical casesClinical cases / Клінічні випадки/ Клінічні випадки
Pic. 08. Intraoperative view of chin defect and
submental artery island flap design
Pic. 09 Intraoperative view of extended chin
reconstruction with submental artery island flap inset.
11. Clinical casesClinical cases / Клінічні випадки/ Клінічні випадки
Pic. 10 One-year postoperative result of extended chin
reconstruction with submental artery island flap
Pic.11 One-year postoperative result of extended chin
reconstruction with submental artery island flap
12. Clinical casesClinical cases / Клінічні випадки/ Клінічні випадки
Pic. 12. A woman, 62 y.o. with cancer of cheeck (Жінка 62 р. з плоскоклітинним раком слизової щоки):
b. Intraoral picture e. Closure of the defect d. Appearance after the treatment
Ferrari S. The submental island flap: Pedicle elongation and indications in head and neck reconstruction. / S.
Ferrari, C. Copelli, B. Bianchi, A.S. Magri, A. Ferri, A. Varazzani, T. Poli, T. Ferri., E. Sesenna. // J
Craniomaxillofac Surg. - 2014. - № 42. - P. 1005-1009
13. Clinical cases / Клінічні випадки
Pic. 13. a. A man, 57 y.o. with cancer of skin in temporal region (Мужчина 57 лет с
базальноклеточным раком кожи височной области)
b. Appearance of the defect c. Appearance of the patient after the treatment
Ferrari S. The submental island flap: Pedicle elongation and indications in head and neck reconstruction. / S. Ferrari, C. Copelli,
B. Bianchi, A.S. Magri, A. Ferri, A. Varazzani, T. Poli, T. Ferri., E. Sesenna. // J Craniomaxillofac Surg. - 2014. - № 42. - P. 1005-
1009
14. Advantages / Переваги
The donor site scar is hidden
under the mandible.
Less donor morbidity
Flap has a large and reliable
vascular pedicle with excellent
reach to most of the oral cavity.
Ideal thickness for
reconstructing buccal mucosa and
tongue defects.
Less bulk and less time
consuming when compared with
free flaps
• Рубець схований під краєм
н/щелепи
• Менша кількість ускладнень із
донорської сторони
• Клапоть має велику і надійну
ніжку
• Ідеальна товщина для
реконструкції слизової щоки і
язика
• Менший об'єм і менша
тривалість операції порівняно з
вільними клаптями
15. DisadvantagesDisadvantages / Недоліки/ Недоліки
• Submental flap harvested with
a thick surrounding fibro fatty
tissue and tissues around the
facial vessels can compromise
the lymphatic clearance. So it
is better to avoid this flap in
patients with clinically
significant node in level IA
and IB.
• If the flap is taken from facial hair
bearing area of male patient then
there is a chance of growth of hair
after reconstruction. In this case
we have to wait until the wound
heals then only we can do laser
treatment and remove the hair
from mouth. So until this time patient
will have discomfort and bad oral hygiene
from this hair.
Pic. 14. SAIF reconstruction of tongue in a male with
hairy skin
Основним недоліком слід вважати наявність
волосся на клапті. В такому випадку після загоєння
рани виконується лазерне видалення волосся.
16. ССonclusiononclusion / Висновки/ Висновки
• Submental artery island flap is a suitable choice for oral and face
reconstruction due to its advantages over other types of flaps.
• It can be used for reconstruction of the defects of lower 2/3 of the face and
with different methods of elongation – even for superior 1/3.
• Presence of hair on the flap is both a disadvantage and an advantage
• Підпідборідний острівцевий клапоть має багато переваг для реконструкції
дефектів обличчя і ротової порожнини порівняно з іншими видами клаптів
• Може бути використаний для заміщення дефектів нижніх 2/3 обличчя, а з
використанням різних методів подовження – і для верхньої 1/3 обличчя
• Наявність волосся на клапті є і недоліком і перевагою одночасно