For proper seating of a flap gate, doublehinge action is necessary. Our glabellar flap in flap technique for the reconstruction of medial canthal defects has several advantages such as maintaining concavity of the canthus without distortion of the surrounding. Discussion the skin of the nose is a frequent site of malignancy, most of which are basal cell carcinomas 2,4,911. Its blood supply can be based on muscular perforators so that the skin base can be narrowed or the flap converted to an island. Pdf a new glabellar flap modification for the reconstruction of. Dec 04, 2016 glabellar rectangular flap for medial canthus scc duration. However, flexibility is required at the bottom pivot points to allow seating of the flap against the seat. This video illustrates how to perform a glabellar flap authors. The glabellar rhytid has not only dynamic but also static cause, which is usually achieved by injection of filler. Pdf use of retroauricular temporal flap forlarge post. Correction of deep static glabellar lines with acellular. The patient returns in one week for suture removal. In the glabellar flap operation, an inverted v is created in the glabellar region and the glabellar tissue is rotated into the medial canthal region colour atlas of ophthalmic plastic surgery.
The nasal glabellar rotation flap, initially described by gillies and later modified by reiger, has evolved into a choice flap for nasal defects of cover since it provides local skin with an exact. Feb 08, 2017 the disadvantages of the glabellar flap and its modifications include the thick skin of the glabella, which is frequently discrepant with the thickness of the skin of the defect. At the conclusion of the case the defect is closed with minimal tension with the lid in good positon and the skin types respected. Superiorly based bilobed flap for inferior medial canthal and. In general, it is wise to direct these incisions away from the base of the flap so that the flap is not compromised. Reconstruction of the medial canthal area presents many challenges for surgeons.
Methods a glabellar flap that can be divided into two parts was designed and elevated according to the defect in the medial canthal. Glabellar flaps in nasal reconstruction facial plastic surgery. A new glabellar flap modification for the reconstruction of medial. The challenge is to maintain the medial edge eyebrow border and the glabellar area integrity. Aesthetic considerations in forehead reconstruction in skin. A useful flap combination in wide and complex defect. The narrowing of its vascular pedicle to the cutaneous arterial branch of the angular artery categorizing it as an axial flap pattern. Unlisted or miscellaneous cpthcpcs codes should only be used if a more specific code. This video demonstrates the use of a glabellar flap to close a medial canthal defect. Although coverage of small defect can be straight forward, few options are available for the coverage of large area. Objective independent assessment of the outcomes revealed overall excellent results, with no flap loss, hematoma, or dehiscence. Reconstruction of nasal defects presents a particularly unique challenge for the surgeon. Ijhns original article use of retroauricular temporal. The glabellar flap was raised and transposed to cover the superior portion of the defect.
Lid reconstruction after tumour excision in a patient with. Use of skin flaps for nasal reconstruction after neoplastic. The glabellar transposition banner flap is relatively simple and efficient. It is a rotationadvancement sickleshaped flap, based on branches of. Repair of a glabellar and inferior forehead defect repair of a glabellar and inferior forehead defect desai, ruchik s donnelly, heidi b. The contralateral paramedian forehead flap is usually used for large defects. For example, field described a modification of the vy advancement, which he called the glabellar transposition banner flap, in which the pedicle of the flap. Two cases of contour deformity were noted in male patients with preexisting rhinophyma in the area of. Combination of glabellar and vy cheek advancement flaps for. Glabellar flaps in nasal reconstruction request pdf. By uploading your videos here you can share your knowledge with a worldwide community of surgeons. Defect is shown as well as adjacent areas of prior resection, reconstruction.
Vy cheek advancement flaps take advantage of laxity in the cheek, and are best for more inferior nasal sidewall defects. To describe and illustrate a technique to repair medial canthal defects. Nasal reconstruction 17391 int j clin exp med 2016. Flap design in facial reconstruction is particularly delicate given the face is the most visible structure of the body and has some of the most complex threedimensional topography. Again the pedicle can be extended to 5 mm below the brow line. Two versatile local flaps for nasal reconstruction are the glabellar flap and an extension of the glabellar flap, the dorsal nasal flap. Jan 03, 2018 this video illustrates how to perform a glabellar flap. Apr 25, 2017 the glabellar flap can be used by itself or in combination with other procedures to reconstruct the medial canthus. Two patients were operated for recurrent basal cell carcinoma and dermatofibrosarcoma respectively. Available in a variety of sizes, pockets, closures, materials, expansions, and with preprinted and customizable tabs. A new modification of conventional glabellar flap which was named flap in flap technique was raised to cover medial canthal defect. The same group demonstrated in 2010 that botulinum toxin type a injection to the glabella has been shown to improve both dynamic glabellar rhytides and those in repose.
This is performed with buried interrupted 50 vicryl sutures. The patient developed contralateral cicatricial ectropion after cutaneous malignancy excision and repair at an outside. Postoperative result with closed eye case 2 figs 8 to a 37yearold woman presented with dermatofibrosarcoma protuberance of glabellar area. The glabellar flap, based on the contralateral angular artery, takes advantage of laxity in the nasion and provides reliable coverage for superior nasal sidewall and medial canthal skin defects 4. Top, lateral nasal defect repaired with glabellar bilobed flap. This is glabellar rhomboid flap by ric caesar on vimeo, the home for high quality videos and the people who love them. The authors have performed reconstruction with combined glabellar and orbicularis oculi myocutaneous advancement flaps in 12 patients. A wide variety of file folder with flap options are available to you, such as folder, wallet, and bag. Keep your desk, work surface or countertop organized with a smead expanding file.
The dorsal nasal flap, a rotation flap first described by rieger in 1967, has undergone numerous modifications since its original description. A 15 blade is used to make an incision through the skin and subcutaneous. Medial canthal reconstruction with combined glabellar and. Botox to stop the cause muscle movement and injectable fillers to fill the defects. In addition, donor area morbidity is minimal and surgical technique is simple. Allen, md, phd, section of ophthalmology, department of head and neck surgery, md anderson cancer center, 1400 pressler st, unit 1445, houston, tx 77030. This zone iii is the glabellar area, which is very complex due to the anatomical area between the eyebrows. Surgical technique the glabellar flap is designed in a triangular shape over the area of maximal skin laxity the in the glabellar region.
Original article the management of nasal defects after non. We used a myocutaneous nasal root island flap based on the periocular muscles for the reconstruction of these defects with primary closure of the donor site. The glabellar flap can be used by itself or in combination with other procedures to reconstruct the medial canthus. The disadvantages of large glabellar flaps are dogear deformity and shortening of the distance between the eyebrows after closure of the donor area. To present a modified technique for the preparation of. Nasal reconstruction following soft tissue resection. Glabellar flaps in nasal reconstruction plastic surgery key. Medial canthal reconstruction by a modified glabellar flap. It can be designed either on a curved glabellar line or as a vertical midline closure, depending upon requirements and aesthetic variables. What you actually have are three distinct vertical glabellar lines, the central one is just the most deep. A flap that is released in a linear fashion at the gingival margin but has no vertical releasing incisions. A subciliary incision was extended from the medial border of the defect to beyond the lateral canthus depending on the size of the defect. Transformation of the glabellar flap into an island flap springerlink. Transformation of the glabellar flap into an island flap.
To reduce venous congestion, park8 resected the procerus muscle and undermined in the glabellar region. If two vertical releasing incisions are included in the flap design. Repair of a glabellar and inferior forehead defect deepdyve. Glabellar rotation advancement flap for medial canthal and dorsal nasal reconstruction. A case report mustapha j, nyenze e department of ophthalmology, college of health sciences, university of nairobi, p. A bilobed flap was used for the reconstruction of the nasal tip in 6 46. The incision can be well hidden in glabellar furrows figure 7 figure 8 dorsal nasal flap rieger flap. Combination of glabellar and vy cheek advancement flaps. Glabellar flaps for reconstruction of skin defects pocket dentistry. A periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. The primary lobe of the flap is of ideal thickness and color match for dorsal nasal repair.
The required area of skin and tissue is moved without interrupting the blood supply. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or h flap for the forehead, the rotary door flap for the auricle of the ear, the mustarde flap for the infraorbital cheek, the oz. Reconstruction techniques of choice for the facial. We reconstructed medial canthal defects using ipsilateral paramedian forehead flaps, minimizing glabellar bulkiness. Nov 01, 20 basic principles of local flap in plastic surgery 1. Lid reconstruction after tumour excision in a patient with seborrhoiec keratosis.
A ftsg from the preauricular area used to repair the ensuing anterior lamella defect figure 4. Therefore, the authors introduce a novel method of inserting a small strip of acellular dermal matrix adm underneath the wrinkle line. It is a rotationadvancement sickleshaped flap, based on branches of the angular artery as it descends along the. The midpoint of the triangle is midline, extending a few centimeters above the superior border of the eyebrow. Ninety patients of malignant nasal skin tumours were included in this. Jan 01, 2006 repair of a glabellar and inferior forehead defect repair of a glabellar and inferior forehead defect desai, ruchik s donnelly, heidi b. Ii, a double sliding door flap should be advanced figure 5.
Glabellar flaps have traditionally been used to cover nasal skin and soft tissue defects. Use of retroauricular temporal flap for large post oncosurgical glabellar and forehead defects international journal of head and neck surgery, mayaugust 2011. The flap is then thinned in the area where the thicker glabellar skin will be adjacent to the thinner eyelid skin. Other options for medial canthal reconstruction include a bilobed flap, rhomboid flap, and fullthickness skin graft eye 86. In general, these flaps are most useful for medial canthal defects that are superior to the medial canthal tendon. The flap has been designed and a 15 blade is used to make an incision along the markings. A 15 blade is used to make an incision through the skin and subcutaneous fat.
A combination of glabellar rotation and nasolabial vy advancement flaps is a. Aesthetic considerations in forehead reconstruction in. Y advancement flaps is an effective method for repairing large medial canthal defects. It is a cephalometric landmark that is just superior to the nasion. After the elevation of glabellar and nasolabial flaps in a random and suprafascial fashion with a lengthtowidth ratio of 3. Request pdf glabellar flap defects of the medial canthus and nose can occur due to trauma, congenital anomalies, or as a result of tumor resection. The glabellar flap is designed in a triangular shape over the area. The term is derived from the latin glabellus, meaning smooth. Deep glabellar rhytides, however, are difficult to correct with filler. A useful flap combination in wide and complex defect reconstruction.
The glabellar flap is then sutured to the mustarde flap with interrupted 50 fast absorbing sutures. Combination lateral rotational and glabellar flaps for. Island inner canthal and glabellar flaps for nasal tip reconstruction. The investigators reported excellent cosmetic results without any cases of partial or complete flap loss. The main hinge action on any flap gate is about its upper pivot points. Superiorly based bilobed flap for inferior medial canthal. Eyelid reconstruction riva lee asbell philadelphia, pa. The oncologic resection resulted in moderate sized glabellar defects. This flap utilized the loose glabellar skin to the nasal radix to repair defects in this area. Colour atlas of ophthalmic plastic surgery, boston, 2008. Nasolabial flap definition of nasolabial flap by medical. Indeed, if the artery cannot be palpated preoperatively, then an alternative reconstructive technique should be planned. Adigun et al10 published a case report of a singlestage forehead. Obtaining tumorfree borders and satisfying aesthetic results are foremost aim in nasal reconstruction.
A new glabellar flap modification for the reconstruction of medial canthal and nasal dorsal defects. The pedicle lies over and includes the glabellar frown line usually located approximately 9 mm from the midline and should be wide enough to cover a minimum distance of 6 mm lateral to this line. To prevent the latter, some modifications are suggested in the literature. Department of ophthalmology, cole eye institute, cleveland clinic foundation, cleveland, ohio, u. From may 2009 to march 2012, 30 patients were treated for deep glabellar. In general i think medial canthal defects which are superior to the medial canthal tendon are best repaired with this procedure. In zone iii a double sliding curtain flap was design, as. The possible need for subsequent surgical debulking and a shortening of the distance between the brows are known consequences of large glabellar flaps. Mar 12, 2016 it is the first quick, less invasive and effective, nonsurgical technique for both brow lift and rhytid treatment. Nasal root island flap for reconstruction of glabellar defec.
For example, field described a modification of the vy advancement, which he called the glabellar transposition banner flap, in which the pedicle of the flap arises from the lateral nasal side wall on the side opposite the defect. The donor site is then closed with interrupted 40 vicryl sutures placed in a buried interrupted fashion. Three cases are presented, the first of which typifies the standard glabellar flap with an intact skin and subcutaneous pedicle. It is important to know that the standard treatment would be a combination of botox and injectable fillers. The glabella, in humans, is the skin between the eyebrows and above the nose. Additional sutures are then used to place the flap into position. It also refers to the underlying bone which is slightly depressed, and joins the two brow ridges. Lateral rotationalglabellar flaps for medial canthal defects. The glabellar flap can easily be performed, using local skin that is of similar structure, texture, consistency, and color to that of the defect.
Extension of the thicker glabellar flap skin into the region of the thinner eyelid skin may necessitate thinning of the flap postoperatively, as noted in the 2 largest defects of our series. Reconstruction of large defect in glabellar and forehead areas poses a perplexing problem for a reconstructive surgeon. The 3 most popular methods of transferring skin from the glabellar region include the median glabellar flap, the vtoy rotation glabellar flap, and the transposition glabellar flap. The goals of facial reconstruction center on closing defects in an inconspicuous manner.
Reconstruction techniques of choice for the facial cosmetic. If one vertical releasing incision is included in the flap design. The flap is also thinned at the area where it will be sutured to the thin eyelid skin. Complex aesthetic subunits and limited available adjacent mobile skin with varying color, texture, and thickness all contribute to this task. The glabellar region is an area from which a number of local flaps have been designed to reconstruct wounds of the superior and lateral nose.
The aim of this work is the evaluation of the feasibility and outcome of levator anguli oris muscle based flaps. A a 74yearold female with a medial canthal and dorsal nasal defect secondary to multiply recurrent squamous cell carcinoma. Fortunately, the robust vascular supply of the face allows. This video demonstrates a glabellar flap for repair of a medial canthal defect. The authors describe the use of these two local flaps for reconstruction of nasal defects and modifications of these procedures for certain indications, as well as their use in medial canthal reconstruction. The rintala flap, bilobed glabellar flap and flap in flap technique are some of the described methods 2,46. The donor sites were closed primarily in all of the patients. Inferiorly, there appears to be some redundancy to the area.
Oct 29, 2018 the glabellar region is an area from which a number of local flaps have been designed to reconstruct wounds of the superior and lateral nose. The flap adds protection and security and allows you to take your files wherever you go. Code all procedures performed by the oculoplastic surgeon. There was considerable variability in the choice of flap for the repair of defects on the tip of the nose, but the bilobar flap fig. Superiorly based bilobed flap for inferior medial canthal and nasojugal fold defect reconstruction julian d. A glabellar flap was fashioned to cover the medial. C step 5 ftsg used for upper lid temporal defect the right upper eyelid lesions were excised 3 weeks later also leaving an anterior lamellar defect. Glabellar flap for medial canthal defect university of iowa. The frontoglabellar skin has long served in reconstruction of certain nasal and canthal defects. The other two cases utilize a glabellar island flap based on a subcutaneous pedicle containing cutaneous arterial branch of the angular artery. The glabellar flap has traditionally been described as a vy advancement flap based on a random blood supply for the reconstruction of defects of the upper third of the nose.
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