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 publication addresses the categorical anatomic matters in every one oculofacial area with adapted surgical ideas and methods designed to enhance aesthetic outcomes.
Full-color illustrations with special explanatory legends depict every one step of every surgical approach. Flap layout and mobilization are proven at once on surgical photos, instead of in idealized drawings. The transparent, available writing type will attract ophthalmic and plastic surgeons, non-ophthalmic surgeons, and non-surgical ophthalmic specialists.
A spouse web site will contain a web photo bank.
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Additional resources for Atlas of Oculofacial Reconstruction: Principles and Techniques for the Repair of Periocular Defects
44 Combined Hughes and anchored temple/cheek flaps. A, B. Advanced basal cell carcinoma and post-Mohs defect involving the entire lower tarsus, part of the lower retractor complex, the lower limb of the lateral canthal tendon, and the skin of the lower eyelid, lateral canthus, and outer upper eyelid. A relaxing incision began at the superior pole of the defect within the upper eyelid and continued laterally to the hairline. After advancement and anchoring of the temple/cheek flap, a residual superomedial skin defect was resurfaced with a graft from the left upper eyelid (see Chapters 3 and 5 for a discussion of anchored cheek and temple flaps).
However, structural and functional differences between the upper and lower eyelids do have reconstructive implications. That the eyelids and variably curved globe surface can move widely in relation to each other without losing apposition is permitted by compliance or elasticity of the eyelid tissues and their canthal attachments. As shown earlier, this â slackâ is freely exploited in the reapproximation of lower eyelid defect edges. However, the considerably greater excursion of the upper eyelid over the corneal convexity can permit overexploitation in this regard.
Patient 10 months after surgery. 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.
Atlas of Oculofacial Reconstruction: Principles and Techniques for the Repair of Periocular Defects by Gerald J. Harris MD FACS