Plastic and Reconstructive Treatment of Facial Skin Lesions

Abstract

There are two reasons why I chose skin defects for my lecture today: on the one hand, we are very often confronted with malignant skin diseases in the head-neck region, especially in the older patient. On the other hand, we are convinced that the head and neck surgeon is especially qualified to treat this kind of disease as he considers not only the surface of the disease but also underlying structures and tissues like salivary glands, nerves, bone, and the pneumatic system of the sinuses. I shall try now to deal with the distinct regions of the face separately wherever possible. Extensive soft tissue defects of the frontal region may be reconstructed using a bridge flap from the scalp or with full-thickness skin grafts taken from the supraclavicular fossa or from the groin. The advantage of constructing a bridge flap is that it has the same thickness as the original tissue. However, this flap is usually used only as provisional cover, since hair growth is undesirable in the forehead area. The free skin graft is in many cases more advantageous, as large areas of it can be provided without causing large-scale defects in the donor region. In the frontal region, however, free skin grafts should be used only after an interval of several weeks, when the level of the defect has been elevated by granulation tissue. This superficial layer of granulation tissue must be removed immediately prior to skin graft transplantation. The second granulation tissue layer has a more substantial structure and provides excellent nourishment for free skin grafts. Frontal skin defects originating from frontal skin flap excision are frequently closed by a procedure known as the H-shape plastic. This plastic is capable of closing defects up to a maximum width of 3 cm. An incision close to the eyebrows is frequently not required. In such cases, the plastic resembles a T-shape instead of an H-shape. As the scars in the donor region are usually dissolved by the Z-plasty technique, they are almost invisible in many cases, for example after raising a frontal skin flap for reconstructing defects in the nasal region.