By Gerald J. Harris MD FACS
This full-color atlas is a pragmatic, step by step advisor to the reconstruction of periocular defects following tumor excision or tissue-loss trauma. The ebook addresses the explicit anatomic matters in each one oculofacial zone with adapted surgical rules and strategies designed to enhance aesthetic outcomes.
Full-color illustrations with particular explanatory legends depict every one step of every surgical procedure. Flap layout and mobilization are proven at once on surgical images, instead of in idealized drawings. The transparent, available writing kind will entice ophthalmic and plastic surgeons, non-ophthalmic surgeons, and non-surgical ophthalmic specialists.
A significant other web site will contain an internet photo bank.
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Extra resources for Atlas of Oculofacial Reconstruction: Principles and Techniques for the Repair of Periocular Defects
Continuous contact and friction between the upper eyelid and cornea require that absorbable tarsal sutures either be nonbraided or do not extend through full-thickness tarsoconjunctiva. Posterior lamella replacement with palatal or nasal mucosa is generally avoided in all cases; use of these tissues in the upper eyelid is particularly likely to compromise the cornea. 69. 50 A, B. Upper eyelid defect involving a 10-mm marginal segment of tarsus. In elderly patients, the risk of postoperative ptosis with even mild horizontal tension requires generous relaxation of canthal attachments.
33 If defect width does not allow edge approximation using the aforementioned techniques, an eyelid-sharing procedure is necessary. Options include a tarsoconjunctival flap resurfaced with a skin graft or flap, and a tarsal free graft resurfaced with a flap. 34 The classic Wendell Hughes3 procedure combines a tarsoconjunctival transposition flap from the upper eyelid with a full-thickness skin graft. The upper eyelid is everted, and the height of the required tarsus is measured downward from the upper tarsal border (white solid line), maintaining at least 4 mm of marginal 33 34 tarsus.
8-cm (one-half to two-thirds) defect of the left lower eyelid. Patient 1 year after surgery. 32 A 59-year-old man with a broad defect relative to eyelid tension, precluding repair with a semicircular flap. To narrow the lashless zone and avoid eyelid sharing, reconstruction included pentagonal resection/repair of the deeper medial half and an advancement skin flap anchored at the lateral orbital rim (asterisk) and raised to the margin (see Chapter 3 for a discussion of anchored advancement flaps).