Schnittführungen und Nahttechniken im Gesichtsbereich
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Incision- and suture-techniques in plastic surgery of the face
In plastic and reconstructive surgery of the face it is very important to consider the RSTL (Borges 1962; Denecke 1968) for getting satisfactory scar postoperatively. Sometimes it is necessary to regard the so called esthetic units of the face (Converse) especially in free grafting. Unsatisfactory scars will be improved by using the Z- und W-plasty techniques.
The incision should always be perpendicular to the surface of the skin, assuming that the skin has been made tense by the left hand of the surgeon or by the hand of the assistant. The subcutaneous dissection and mobilization is performed with a scalpel with the blade held flat, parallel to the surface of the skin using a hook rather than a tissue forceps. The haemostasis should be as perfect as possible. The infiltration of a local analgesic solution with epinephrin greatly facilitates the haemostasis, careful coagulation by fine bipolar tissue forceps is possible.
The principal types of transcutaneous, subcutaneous and intradermal interrupted and continuous sutures are described.