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Basic Wound Repair: Surgical Techniques, Flaps, and Grafts

  • Jackson Lever
  • Frank A. Nesi
  • Mark R. Levine
Chapter

Abstract

Understanding basic wound healing and basic surgical techniques is critical to optimizing surgical outcomes. Basic surgical technique includes having an understanding of facial anatomy, relaxed skin tension lines, wound construction, and wound healing. Choosing the proper suture technique and material is dependent on the location, size, tension, and suture handling characteristics. Reconstruction of defects can be aided greatly by the use of flaps and grafts. Flaps offer the advantage of being vascularized. Variation of flaps includes sliding, advancement, rotation, rhomboid, bilobed, transposition, Z-plasty, and V-Y-plasty. Split-thickness and full-thickness grafts may be used when adjacent tissue is insufficient and when an underlying blood supply is available.

Keywords

Wound repair Suture Flap Graft Single interrupted Horizontal mattress Vertical mattress Sliding flap Advancement flap Transposition flap Rotational flap Rhomboid flap Bilobed flap Z-plasty V-Y-plasty Partial-thickness skin graft Full-thickness skin graft 

Supplementary material

419986_5_En_3_MOESM1_ESM.mp4 (87.1 mb)
Video 3.1 Upper eyelid advancement flap 1. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Upper-lid-Advancement-Flap-1.htm (MP4 89198 kb)
419986_5_En_3_MOESM2_ESM.mp4 (75.1 mb)
Video 3.2 Upper eyelid advancement flap 2. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Upper-lid-Advancement-flap-2.htm (MP4 76937 kb)
419986_5_En_3_MOESM3_ESM.mp4 (101.5 mb)
Video 3.3 Lateral rotation flap. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Lateral-Rotational-flap.htm (MP4 103968 kb)
419986_5_En_3_MOESM4_ESM.mp4 (54.9 mb)
Video 3.4 Rhomboid flap. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Rhomboid-Flap.htm (MP4 56169 kb)
419986_5_En_3_MOESM5_ESM.mp4 (72.7 mb)
Video 3.5 Glabellar transposition flap. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Glabellar-Flap.htm (MP4 74415 kb)
419986_5_En_3_MOESM6_ESM.mp4 (58.6 mb)
Video 3.6 O- to Z-plasty. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/O-Z-Flap.htm (MP4 60030 kb)
419986_5_En_3_MOESM7_ESM.mp4 (90.5 mb)
Video 3.7 Bilobed flap. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Bilobe-Flap.htm (MP4 92641 kb)
419986_5_En_3_MOESM8_ESM.mp4 (103.2 mb)
Video 3.8 Split-thickness skin graft. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Split-thickness-skin-graft.htm (MP4 105692 kb)
419986_5_En_3_MOESM9_ESM.mp4 (169 mb)
Video 3.9 Full-thickness skin graft. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Full-Thickness-skin-graft.htm (MP4 173061 kb)

References

  1. 1.
    Patrinely JR, Marines HM, Anderson RL. Skin flaps in periorbital reconstruction. Surv Ophthalmol. 1987;31(4):249–61.CrossRefPubMedGoogle Scholar
  2. 2.
    Baker SR. Local flaps in facial reconstruction. 2nd ed. St. Louis: Mosby; 2007.Google Scholar
  3. 3.
    Levine M, editor. Manual of oculoplastic surgery. 4th ed. Thorofare: SLACK Incorporated; 2010.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jackson Lever
    • 1
  • Frank A. Nesi
    • 2
  • Mark R. Levine
    • 3
    • 4
    • 5
  1. 1.Intermountain Healthcare, Country Hills Eye CenterOgdenUSA
  2. 2.Department of Ophthalmology, Oculoplastic SurgeryWm. Beaumont HospitalRoyal OakUSA
  3. 3.Case Western Reserve University School of MedicineClevelandUSA
  4. 4.Department of OphthalmologyUniversity Hospitals of ClevelandClevelandUSA
  5. 5.Cleveland Clinic FoundationClevelandUSA

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