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The Ear The Face The Neck Cleft Lip The Nose The Scalp Scalp and Skull

The Ear

The ear may require partial reconstruction because of tissue absence after trauma or cancer surgery. However, the greatest challenge for the reconstructive surgeon is total ear reconstruction in cases of congenital absence of the external structures ("microtia"). Restoration in these cases will usually require staged surgery (beginning around the age of 7 years) employing grafts of cartilage and skin. If the patient is not a heavy scar former, reasonable results can be obtained by the creation of a framework from rib cartilage and its investment with skin.

Microtia Repair

The Neck

The neck may need to be resurfaced after devastating burn injury or following surgery which removes cancerous tissues. The contour of the neck and its mobility may both be severely compromised by either of these two. If the defect involves a small area, simple surgery such as grafting may suffice. For those circumstances when a large area is involved, resurfacing of the neck as a unit is often best from both the functional and cosmetic standpoint.

Neck Resurfacing

Cleft Lip

Abnormal embryonic development of lower facial structures may lead to a condition often referred to as "harelip", (more proper;y, "cleft lip"). The most common form of this deformity involves incomplete upper lip development and associated abnormality of the portion of the underlying jaw which will hold the teeth. Surgical repair of the cleft may be done shortly after birth, or may be delayed until the child is a few months old. Although there are several different methods of repair, all seek to reestablish normal lip anatomy and bring anterior jaw growth under the influence of intact soft tissues.

Cleft Lip Repair

The Nose

Nasal defects are repaired in a host of different ways. As early as 600 B.C., Indian artisans used tissue transferred from the forehead to recreate the nose for those who had suffered the punishment of nasal amputation. This "Indian flap" was "rediscovered" in the 19th century and today can still provide the best solution for subtotal or total nasal loss. For some, however, forehead tissues are insufficient, and other solutions must be sought. Transfers of flesh over a distance were once performed in stages, but today, can be accomplished in one step using microvascular surgery. An example shown here involves use of thin tissues from the arm for nasal restoration.

Total Nasal Reconstruction

The Scalp and Skull

When parts of the scalp are lost or removed, skin grafts or rearrangement of the remaining scalp will often produce acceptable results. If the scalp and skull are both breached, however, more complex tissues need to be used for reconstruction. Since the advent of reliable microsurgical tissue transfer, large blocks of thick tissue have become available for the reconstruction of complex defects of the scalp and skull.

Scalp and Skull Reconstruction

The Face

Many defects of the facial skin may call upon the ingenuity of the plastic surgeon for solution. Commonest among the problems leading to facial skin deficiency are the skin cancers. Simple excisions of cancer may often be remedied by careful undermining of adjacent skin and suturing. However, when this proves impossible, transfers of tissue from elsewhere may be needed. For limited defects full thickness skin grafts can provide and acceptable solution. This is especially true when the patient is elderly and has modest cosmetic goals. If the defect is larger and located in a place difficult to hide with hair or shadows, flap transfers of the full thickness of skin with fat may be preferred.

A Skin Graft Reconstruction

A Skin Flap Reconstruction

The Scalp

When hair is lost because of genetic baldness, hair replacement with mini-grafts may allow for gratifying results. If large areas of hair and scalp are lost from cancer surgery, burns, or other trauma, flaps of nearby scalp may be moved in to fill the gap. This process is often much facilitated by the use of "tissue expanders." These are devices which are placed beneath hair-bearing scalp and used to expand the scalp through the serial injection of salt water over a period of many weeks. When the expansion is complete, the device may be removed, and the newly gained scalp transferred to replace the hairless scalp which is excised.

Expander Scalp Flap Reconstruction