xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Larrabee & Moyer

432

Fig. 8. Lip H-plasty flap. ( A ) Patient with a 2 cm (in diameter) right upper lip Mohs defect. ( B ) Planned incision lines marked along the vermilion-cutaneous border and immediately below the nasal sill and on the right extend ing into the alar facial sulcus. The arrows depict the vectors of advancement. ( C ) Vertical mattress sutures using 5-0 Prolene were placed to close the vertical limb of the H-plasty.

a triangle of tissue, which represents the standing cutaneous deformity that will form from advance ment of the two flaps. 6 This excision converts the round defect into a triangular one. Wide undermin ing in the subcutaneous plane of adjacent skin lessens wound closure tension and minimizes the risk of philtrum distortion. 6 After the flaps have been advanced and secured, the Burrow tri angles are excised, if required, at the most medial and lateral aspects of the horizontal flap limbs. 6

Rotation flap Cutaneous lip rotation flaps are most frequently used to reconstruct lateral lip defects. 3 Skin is moved medially from the area immediately lateral to the defect. The rotation advancement flap is designed so the lateral border of the flap is in or parallel to the melolabial crease. The inferior aspect of the flap can extend below the level of the oral commissure. The width of the flap should provide sufficient tissue to reconstruct

Fig. 9. V-Y advancement flap design. ( A, B ) The V-Y advancement flap achieves advancement by recoil or by being pushed forward. It is not stretched or pulled toward the defect. The wound closure forms a Y-shaped configuration. ( C ) The arrows indicate the direction of maximum tension. ( From Baker SR. Flap classification and design. In: Baker SR, editor. Local flaps in facial reconstruction. 2nd edition. St Louis: Mosby; 2007. p. 92; with permission.)