Facial Reconstruction

Local & Regional Flaps

Flap surgery refers to reconstruction that is achieved by harvesting tissue from a healthy part of the body and transfering it to the site, while leaving the donor tissue attached to the body by a major artery and vein (or at its base) so as to maintain blood flow. This piece of tissue – known as the flap, or skin graft – is then surgically placed onto the injured area, The flap is sometimes comprised of skin and fatty tissue only, but in other cases it may also involve muscle from the donor site.

If you’ve suffered tissue loss in any region of your body via mastectomy, skin cancer excision or traumatic injury, you’re a candidate for reconstructive flap surgery. More specifically, flaps used in reconstructive plastic surgery tend to fall into two main categories.

Local Flap

When healthy tissue near the surgery site is available, a local flap is freed and moved from the adjacent area to the recipient site, all while remaining attached to the body at its base, with blood vessels that feed the flap from the donor site.

There are four major types of local flaps, differentiated by the type and extent of movement that’s required:

The advancement flap. This moves directly forward to the recipient area with no lateral movement.
The rotation flap. This rotates around an attached pivot point and is placed into the adjacent recipient area.
The transposition flap. This moves laterally in relation across a pivot point and is placed into the adjacent recipient area.

The interpolation flap. You may have noticed that the first three flap types all involve taking healthy tissue from a place on the body that’s adjacent to the recipient site. The interpolation flap is what’s used to take healthy tissue from a site close (but not adjacent) to the defect site. In this scenario, a portion of the flap ends up forming what’s called a “skin bridge”, wherein it passes above or below an area of intact tissue. After being placed in the recipient site, the interpolation flap is then separated from the donor site.

Regional Flap

When healthy tissue is not available near the surgery site, tissue from other areas of the body may be transplanted to the recipient site, at which point the tissue is surgically reconnected to arteries and veins near the wound, reestablishing healthy blood supply.

Dermal Skin Grafts

s the largest and most important organ in our bodies, our skin serves multiple purposes that are essential functions to our survival: protection, temperature regulation, and hydration. Our skin has a natural repair mechanism and response to wound to healing. But what happens when the wound is too signification for our skin’s regenerative power?

Painfully severe wounds are nearly unimaginable, and the destruction it may leave could be too much for your skin’s natural repair system to handle. This means you become more at risk for bacterial infections causing certain reactions and if your body cannot regulate back to normalcy, you will go into shock. The best and most effective solution is skin grafting.

Skin grafting is often used to treat:

• Extensive trauma
• Wound healing
• Burns
• Skin loss due to infection
• Skin cancer removal
• Millions of Americans require some form of dermal grafting each year because of the outstanding long-term results and minimal risk factors.

Skin Grafting Procedure

At the Center for Plastic Surgery at Castle Rock our surgeons offer two types of skin grafts:

Full-thickness dermal grafting requires a piece of your skin to be cut into the exact size and shape to fit your wound which reaches deep into body. It requires that all three skin layers – epidermis, dermis, and hypodermis – be removed from a donor site which includes a number of areas in the body that have skin redundancy, such as the ear, upper eyelid, the groin, thigh or abdominal areas. This type of grafting includes the removal and transplant of hair follicles, sweat glands and blood vessels.

Split-thickness dermal grafting requires the shaving of skin in areas the reach the epidermis and only part of the dermis. This technique is used to treat the shallowest of wounds.

During surgery, the donor skin is removed and sutured onto the wound. The donor site will also need to be stitched back together. Grafting requires a lot of antibiotic ointments and continuous redressing to help the new skin layers regenerate and heal. Healing takes time, and scarring is usual inevitable. It is extremely important that you follow the aftercare instructions given to you by our team of surgeons very closely as to prevent any infections and reduce any possibility of future surgeries.

Scarring may be reduced – only after a full recovery from your skin grafting – through some of our non-surgical methods of skin care.

Restoring Functionality

Facial reanimation helps to restore facial function for patients with longstanding facial paralysis or a sudden loss of facial function without likelihood of recovery.

There are many determining factors that allow our plastic surgeons to decide if you are a candidate for facial reanimation surgery, such as:

• Cause of paralysis
• Length of your condition
• Prior surgical history
• Prior non-surgical therapies
• Past testing result (such as an EMG)

Each of these factors plays a role in how our surgeons decide how best to diagnose your paralysis. In addition to such factors, the area in which you are experiencing non-functional muscle movement also determines the length, depth, and number of procedures you will need.

The Facial Reanimation Reconstructive Procedure

Typically, a facial reanimation procedure lasts around four to five hours with a secondary surgery lasting five to seven hours. The first surgery will require an overnight stay in the hospital, and the second surgery will require a little more observation – generally a three- to four night stay. On average, you should be able to see movement and functionality return anywhere from five to six months after completion of the second surgery.

As with any surgery, most patients want to know what they can do to help speed up recovery once home and resting. Our plastic surgeons will usually suggest facial rehabilitation, therapy, and/or exercise – but only after you begin to see the first initial functionalities return.

Begin with a Consultation for Facial Reanimation

Our plastic surgeons have extraordinary artistic talents when it comes to facial reconstruction procedures like reanimation. Their involvement in all stages of your procedure – from planning to performing to follow-up – will provide the comfort and care you need. Give us a call to schedule your facial reanimation surgery at the Center for Plastic Surgery at Castle Rock.

Ectropian and Entropian Repair

Eyelid defects come about due to a number of things, including genetics, but the two most common causes of eyelid defects are severe trauma and tumor excision – essentially, in the wake of a patient suffering trauma or having a large growth or skin cancer removed, a defect in the eyelid sometimes happens as a subsequent side effect. At the Center for Plastic Surgery at Castle Rock, our surgeons focus on two areas of eyelid reconstruction:

• Ectropion repair
• Entropion repair

Entropionis a medical term describing the condition where the eyelid (most often the lower lid) folds inward and stays that way. Entropion is not only incredibly uncomfortable – folded inward as they are, the eyelashes are flush up against the cornea, rubbing and irritating it – but can lead to eyelid scarring and nerve damage.

Ectropionis is something of the opposite: it’s the condition in which the lower eyelid folds outwards. In addition to being caused by a weakening of the tissue in the lower lid, ectropionis sometimes appears in newborns who have Harlequin-type ichthyosis (a severe congenital skin disease).

Suffering From Eye Irritations?

Fortunately, entropion and ectropion conditions can be repaired surgically, and our plastic surgeons have a high level of experience and expertise in doing exactly that. If you or one of your loved ones is in need of eyelid reconstruction, please get in touch with us, and our caring team of professionals will arrange for a consultation at the Center for Plastic Surgery at Castle Rock.