Complex layered facial closures Flashcards
The superficial musculoaponeurotic system (SMAS) begins in the forehead as a continuation of the galea aponeurotica
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The skin is both viscoelastic and anisotropic
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This means its stretchability is non-linear
‘Creep’ refers to the skin’s ability to stretch over time
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Suspension sutures should be placed between the deep fascia or periosteum and the overlying superficial dermis
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Overlying reticular dermis
get dimpling if too superficial
The supraorbital transposition flap for closure of complex upper eyelid defects allows the wound to be closed without tension on the eyelid
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Lateral canthopexy involves attaching single or multiple suspension sutures from the conjoined tendon of the lower lid travelling superiorly and laterally to anchor in to the periosteum of the inner aspect of the lateral orbital rim
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Suspension of the lower eyelid to counteract downward forces and prevent or correct ectropion can be accomplished by placement of a suspension suture at the medial canthus
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Lateral canthus
this is a Lateral canthopexy
The face lift or rhytidectomy is the hallmark procedure for repositioning the mid-face
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Facial rhytidectomy involves developing a skin flap that has the SMAS as its floor and the subcutaneous fat and skin as the roof
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the tissue is undermined lifitng the fat off the SMAS
called a ‘SMAS flap’ although this is misleading
For facial rhytidectomy, plication of the SMAS is accomplished by placing interrupted suspension sutures from the SMAS overlying the cheek to the superficial temporal muscle
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To the deep temporal or preauricular fascia
Mid-face suspension lifting sutures can be used to elevate the malar fat pad
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Suspension sutures cannot be used to minimise tenting of flaps across natural concavities
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good for this - needed in cheek advancement flaps to recreate the NLF by tacking the flap to the periosteum of the maxilla
Incisions crossing lines of demarcation between geometric units disrupt the natural contour and facial symmetry
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A suspension suture that is placed under too much tension can lead to dimpling of the skin flap, focal tissue necrosis and poor cosmetic outcome
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The second pass of a suspension stitch proceeds blindly through deeper tissue structures
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Must have good knowledge of anatomy
takes a bite of underlting deep fascia, tendon, muscle and periostium depending on site
(first pass is through the reticular dermis of the flap)
