The particular anatomy of the scalp largely dictates utilization of its parts and adjacent attached integument for reconstructive purposes. Unusually large movements of scalp skin are generally required with a variety of basic techniques and ancillary procedures. Rotation flaps are considered the prime "work-horses" for scalp flap reconstructions. Anatomic factors will be interspersed with clinical applications, and a series of photographs and commentary will highlight these considerations.
The author presents the results of a study of 200 patients with surgical defects of the nose following excision of skin malignancies. The location, size, depth, and quality of the adjacent skin, the reconstruction choice, and the cosmetic result were recorded. Healing by second intention was most useful for wounds in concave areas. Full-thickness skin grafts were used for defects too large for local flaps, or for defects on the nasal tip or alar surface. Local flaps were the most useful choice for nasal reconstruction. Transposition flaps, in particular, were most useful for each cosmetic sub unit of the nose.
Reconstructions of the lower lid, the upper lid, the medial canthus, the infraorbital area, and the eyebrow area are reviewed. Various flap procedures are described.
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