xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Larrabee & Moyer

434

Fig. 11. O-T flap (or T-plasty) design. O-T flaps require 2 flaps advanced toward each other. Standing cutaneous deformity excised at the vertical limb of the T. Arrows represent the point of greatest wound tension. ( From Baker SR. Advancement flaps. In: Baker SR, editor. Local flaps in facial reconstruction. 2nd edition. St Louis (MO): Mosby; 2007. p. 161; with permission.)

the vertical height of the lip. 3 Adequate flap width is obtained by extending the lateral border of the flap laterally into the cheek. Dissection is in the subcutaneous tissue plane superficial to

the orbicularis oris and facial muscles. 3 The lateral wound border is longer than the medial wound border, which can be remedied by equally dividing the skin redundancy during closure. 3 If

Fig. 12. O-Tflap. ( A ) Patient with a 1.3 cm 0.9 cm defect of the upper cutaneous and dry vermilion. ( B,C )AnOtoT advancement flap was created to close the cutaneous portion of the defect. The arrows depict the vectors of advance ment. The standing cutaneous deformity was removed superiorly up to the nasal sill. A mucosal advancement was elevated over the orbicularis oris muscle to repair the vermilion defect. ( D, E ) Postoperative appearance showing a slightly depressed scar and malalignment of the vermilion cutaneous junction. ( F ) Two Z-plasties designed for scar revi sion. Direct excision of scar at the vermilion-cutaneous junction. ( G ) Postoperative appearance 2 years after the scar revision and 3.5 years after the O-T plasty.