DOCSLIB.ORG

University of Southern Denmark the Versatile Modiolus Perforator Flap

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
University of Southern Denmark the Versatile Modiolus Perforator Flap University of Southern Denmark The Versatile Modiolus Perforator Flap Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo Published in: Plastic and Reconstructive Surgery, Global Open DOI: 10.1097/GOX.0000000000000611 Publication date: 2016 Document version: Final published version Document license: CC BY-NC-ND Citation for pulished version (APA): Gunnarsson, G. L., & Thomsen, J. B. (2016). The Versatile Modiolus Perforator Flap. Plastic and Reconstructive Surgery, Global Open, 4(3), [e661]. https://doi.org/10.1097/GOX.0000000000000611 Go to publication entry in University of Southern Denmark's Research Portal Terms of use This work is brought to you by the University of Southern Denmark. Unless otherwise specified it has been shared according to the terms for self-archiving. If no other license is stated, these terms apply: • You may download this work for personal use only. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying this open access version If you believe that this document breaches copyright please contact us providing details and we will investigate your claim. Please direct all enquiries to [email protected] Download date: 30. Sep. 2021 Divya ORIGINAL ARTICLE Original Article Reconstructive xxx The Versatile Modiolus Perforator Flap XXX Gudjon Leifur Gunnarsson, MD* Background: Perforator flaps are well established, and their usefulness as 2016 Jorn Bo Thomsen, MD, PhD† freestyle island flaps is recognized. The whereabouts of vascular perfora- tors and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our ex- Plastic & Reconstructive Surgery-Global Open perience using freestyle facial perforator flaps, we have located areas where perforators are consistently found. This study is focused on a particular 4 perforator lateral to the angle of the mouth; the modiolus and the versatile modiolus perforator flap. Methods: A cohort case series of 14 modiolus perforator flap reconstruc- 3 tions in 14 patients and a color Doppler ultrasonography localization of the modiolus perforator in 10 volunteers. Results: All 14 flaps were successfully used to reconstruct the defects in- Versatile Modiolus Perforator Flap volved, and the location of the perforator was at the level of the modiolus as predicted. The color Doppler ultrasonography study detected a sizeable per- Gunnarsson and Thomsen forator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical find- ing, and flaps based on it can be recommended for several indications from the reconstruction of defects in the perioral area, cheek and nose. Conclusions: The modiolus is a well-described anatomical area containing a sizeable perforator that is consistently present and readily visualized using color Doppler ultrasonography. We have used the modiolus perforator flap success- fully for several indications, and it is our first choice for perioral reconstruction. (Plast Reconstr Surg Glob Open 2016;4:e661; doi: 10.1097/GOX.0000000000000611; Published online 22 March 2016.) erforator pedicle flaps are largely replacing the some large perforators appears to be consistent and concept of random flaps in our practice, and for predictable.1,2 Lateral to the angle of the mouth, cor- the past 8 years, freestyle perforator flaps have responding to the modiolus area, is a reliable perfora- P 1 been our first choice local flap for facial reconstruction. tor that we have previously referred to as “the modiolus During this time, we have noticed that the location of perforator.”1 The modiolus is a landmark representing a dermal insertion and decussation of muscles derived From the *Department of Plastic Surgery, Telemark Hospital, from the second branchial arch.3 Studies have shown Skien, Norway; and †Department of Plastic Surgery, that the facial artery is located lateral to the modiolus em- Lillebaelt Hospital and Odense University Hospital, bedded in a fibrofatty tissue that allows for its mobility.4,5 Denmark. The aim of this article was to evaluate the consistency Received for publication August 13, 2015; accepted December of the modiolus perforator, based on our clinical ex- 31, 2015. perience and random sample evaluation using color Drs. Gunnarsson and Thomsen contributed equally to the preparation of this article. Copyright © 2016 The Authors. Published by Wolters Disclosure: The authors have no financial interest Kluwer Health, Inc. on behalf of The American Society of to declare in relation to the content of this article. The 13August2015 Plastic Surgeons. All rights reserved. This is an open-access Article Processing Charge was paid for by The Plastic article distributed under the terms of the Creative Commons Surgery Department, Telemark Hospital. Attribution-Non Commercial-No Derivatives License 4.0 31December2015 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Supplemental digital content is available for this be changed in any way or used commercially. article. Clickable URL citations appear in the text. Society of Plastic Surgeons. All rights reserved. DOI: 10.1097/GOX.0000000000000611 10.1097/GOX.0000000000000611 www.PRSGlobalOpen.com 1 PRS Global Open • 2016 Doppler ultrasonography (CDU), and review of our Digital Content 1, which displays the versatility of the findings in the context of the current literature. modiolus perforator flap and range of motion. This video is available in the “Related Videos” section of MATERIALS AND METHODS the Full-Text article on PRSGlobalOpen.com or avail- We performed a volunteer study to confirm the able at http://links.lww.com/PRSGO/A178.) The perfo- location of the modiolus perforator using a CDU on rator was not skeletalized in any of the cases. A simple 20 hemifaces and a prospective clinical series using detachment of the surrounding adhesions to the zy- the modiolus perforator as a pedicle for a freestyle gomaticus major, risorius, and depressor anguli oris perforator flap design. muscles was done to enable flap rotation (Fig. 3). CDU Volunteer Study CDU-guided Technique We examined 10 volunteers bilaterally by CDU, The facial artery was identified below the angle 3 men and 7 women aged 26 to 57 (43), using a of the mouth. The artery was then followed by a very BK Medical color Doppler ultrasonographer with slow movement upward until the modiolus perfora- a 10- to 12-mHz linear transducer. The technique tor was identified. The location was then marked by was performed as described above, and the loca- a permanent marker. The flap was designed based tion of the perforator was marked with a perma- on the CDU findings and the size of the defect and nent marker (red dot). The corresponding CDU surgery commenced as described above (Fig. 4). screen images are shown next to the clinical image (Fig. 1). RESULTS Clinical Study CDU Volunteer Study We reviewed 14 cases, 3 male and 11 female pa- We identified a usable perforator close to the tients aged 6 to 85, reconstructed by an island flap modiolus by CDU bilaterally in 10 subjects, 3 males based only on the modiolus perforator lateral to the and 7 females, median age 42 (26–57) years. In angle of the mouth. Four patients were smokers. The the majority of cases, we found that the perfora- surgical indications were defects following removal tor branched off from the main artery as a single of basal cell carcinoma in 6 cases, malignant mela- branch; however, in a few cases, it divided into 2 or noma in 4 cases, 2 squamous cell carcinoma, 1 atypi- 3 branches. In most cases, the perforator was curved cal fibroxanthoma, and 1 trichoid epithelioma. The or even S-shaped as it passed between the muscles. reconstructions were performed on the cheek in 6 The perforator branching point from the facial cases, upper lip in 5, nose in 2 and lower lip in 1. The artery was marked with a red dot in the figures. operative technique was either freestyle exploration Despite the observed perforator branching point or guided by preoperative CDU localization. variations, it appeared to pass through to the sub- cutis lateral to the angle of the mouth at the level of Freestyle Technique the modiolus in all cases. The perforator location was explored through a nasolabial incision in a caudal direction until the Clinical Study perforator was localized. The flap was dissected cir- We performed 14 perforator flaps based on the cumferentially around the perforator enabling a free modiolus perforator in 14 patients (Table 1). The rotation (Fig. 2 and Video 1) (See Supplemental location of the perforator was at the level of the Fig. 1. CDU findings appeared consistent as shown in all 10 volunteers (20 hemifaces). Modiolus location indicated by red dot. CDU picture on each side. 2 Gunnarsson and Thomsen • Versatile Modiolus Perforator Flap Fig. 2. Intraoperative exploration and reconstruction of nasal dorsum using a cervical ex- tension of the modiolus flap in a patient with previous nasolabial flap reconstruction and a recurrence (operative and 1-year postoperative image). surgical exploration in 6 cases and guided by CDU in the latter 8 cases. DISCUSSION The modiolus has been described to be a fibrous chiasma, a condensation of the deep and superficial facial fascia, where the facial muscles join to form in- sertion at the angle of the mouth.3,4 The facial artery runs lateral to it, superficial to the buccal fat pad, in a window marked by the zygomaticus major muscle su- periorly and risorius muscle inferiorly.4–6 The results of this article show that this window contains a sizeable Video 1.
Load more

Recommended publications
  • Atlas of the Facial Nerve and Related Structures
    Rhoton Yoshioka Atlas of the Facial Nerve Unique Atlas Opens Window and Related Structures Into Facial Nerve Anatomy… Atlas of the Facial Nerve and Related Structures and Related Nerve Facial of the Atlas “His meticulous methods of anatomical dissection and microsurgical techniques helped transform the primitive specialty of neurosurgery into the magnificent surgical discipline that it is today.”— Nobutaka Yoshioka American Association of Neurological Surgeons. Albert L. Rhoton, Jr. Nobutaka Yoshioka, MD, PhD and Albert L. Rhoton, Jr., MD have created an anatomical atlas of astounding precision. An unparalleled teaching tool, this atlas opens a unique window into the anatomical intricacies of complex facial nerves and related structures. An internationally renowned author, educator, brain anatomist, and neurosurgeon, Dr. Rhoton is regarded by colleagues as one of the fathers of modern microscopic neurosurgery. Dr. Yoshioka, an esteemed craniofacial reconstructive surgeon in Japan, mastered this precise dissection technique while undertaking a fellowship at Dr. Rhoton’s microanatomy lab, writing in the preface that within such precision images lies potential for surgical innovation. Special Features • Exquisite color photographs, prepared from carefully dissected latex injected cadavers, reveal anatomy layer by layer with remarkable detail and clarity • An added highlight, 3-D versions of these extraordinary images, are available online in the Thieme MediaCenter • Major sections include intracranial region and skull, upper facial and midfacial region, and lower facial and posterolateral neck region Organized by region, each layered dissection elucidates specific nerves and structures with pinpoint accuracy, providing the clinician with in-depth anatomical insights. Precise clinical explanations accompany each photograph. In tandem, the images and text provide an excellent foundation for understanding the nerves and structures impacted by neurosurgical-related pathologies as well as other conditions and injuries.
    [Show full text]
  • Upper Lip Anatomy, Mechanics of Local Flaps, and Considerations for Reconstruction
    CLINICAL REVIEW Upper Lip Anatomy, Mechanics of Local Flaps, and Considerations for Reconstruction Alexis L. Boson, MD; Stefanos Boukovalas, MD; Joshua P. Hays, MD; Josh A. Hammel, MD; Eric L. Cole, MD; Richard F. Wagner Jr, MD Cupid’s bow, and philtrum, leads to noticeable deformi- PRACTICE POINTS ties. Furthermore, maintenance of upper and lower lip • Comprehensive knowledge of static and dynamic function is essential for verbal communication, facial structural support is imperative in reconstruction of expression, and controlled opening of the oral cavity. upper lip wounds. Similar to a prior review focused on the lower lip,1 we • The surgeon should evaluate deficient structures as conducted a review copyof the literature using the PubMed well as characteristics of the defect to select the most database (1976-2017) and the following search terms: appropriate reconstruction method for optimal func- upper lip, lower lip, anatomy, comparison, cadaver, histol- tional and aesthetic outcomes. ogy, local flap, and reconstruction. We reviewed studies that assessed anatomic and histologic characteristics of thenot upper and the lower lips, function of the upper Reconstruction of defects involving the upper lip can be challenging. lip, mechanics of local flaps, and upper lip reconstruc- The purpose of this review was to analyze the anatomy and function tion techniques including local flaps and regional flaps. of the upper lip and provide an approach for reconstruction of upper Articles with an emphasis on free flaps were excluded. lip defects. The primary role of the upper lip is coverage of dentition The initial search resulted in 1326 articles. Of these, and animation, whereas the lower lip is critical for oral competence,Do 1201 were excluded after abstracts were screened.
    [Show full text]
  • Understanding the Perioral Anatomy
    2.0 ANCC CE Contact Hours Understanding the Perioral Anatomy Tracey A. Hotta , RN, BScN, CPSN, CANS gently infl ate and cause lip eversion. Injection into Rejuvenation of the perioral region can be very challenging the lateral upper lip border should be done to avoid because of the many factors that affect the appearance the fade-away lip. The client may also require injec- of this area, such as repeated muscle movement caus- tions into the vermillion border to further highlight ing radial lip lines, loss of the maxillary and mandibular or defi ne the lip. The injections may be performed bony support, and decrease and descent of the adipose by linear threading (needle or cannula) or serial tissue causing the formation of “jowls.” Environmental puncture, depending on the preferred technique of issues must also be addressed, such as smoking, sun the provider. damage, and poor dental health. When assessing a client Group 2—Atrophic lips ( Figure 2 ): These clients have for perioral rejuvenation, it is critical that the provider un- atrophic lips, which may be due to aging or genetics, derstands the perioral anatomy so that high-risk areas may and are seeking augmentation to make them look be identifi ed and precautions are taken to prevent serious more youthful. After an assessment and counseling adverse events from occurring. as to the limitations that may be achieved, a treat- ment plan is established. The treatment would begin he lips function to provide the ability to eat, speak, with injection into the wet–dry junction to achieve and express emotion and, as a sensory organ, to desired volume; additional injections may be per- T symbolize sensuality and sexuality.
    [Show full text]
  • Anatomy of the Ageing Lip
    AESTHETIC FOCUS Anatomy of the ageing lip With lip augmentation an ever popular option for those seeking more youthful looks it is vital that practitioners have a proper understanding of anatomy. In the first of our two-part special focus on lipsDr Foutsizoglou provides a comprehensive guide to function and anatomy. BY SOTIRIOS FOUTSIZOGLOU he lips are pliable, mobile, muscular folds that encircle the opening of the oral cavity. They contain the orbicularis oris and superior and inferior labial vessels and nerves. The lips are covered externally by skin and internally by mucous membrane. A sagittal cut through the lip can reveal the layers of soft tissue that form this relatively simple anatomical structure. That is, from Tsuperficial to deep: skin, superficial fat compartment, orbicularis oris muscle, deep fat compartment and mucosa. The lips are used for grasping food, sucking liquids, clearing food from the oral vestibule, forming speech, osculation, and controlling the size of the oral aperture. Functions of the lips as part of the tactile senses. Lips are very sensitive to touch, warmth and cold. Food intake Lips serve to close the mouth airtight shut, Erogenous zone to hold food and drink inside. Because of their high number of nerve endings, the lips are an erogenous zone. Mastication The lips therefore play a crucial role in Lips help to hold food between upper and osculation and other acts of intimacy. lower teeth during chewing. Facial expressions Figure 1: Anatomical landmarks of the lip. Deglutition The lips form an integral part of facial Lips push food into the oral cavity proper expression e.g.
    [Show full text]
  • Anatomical and Radiological Evaluation of Modiolus Anguli Oris in Facial Anatomy
    J Surg Med. 2019;3(9):694-697. Research article DOI: 10.28982/josam.621848 Araştırma makalesi Anatomical and radiological evaluation of modiolus anguli oris in facial anatomy Yüzde modiolus anguli oris'in anatomik ve radyolojik değerlendirilmesi Selma Çalışkan 1, Emre Can Çelebioglu 2, Sinem Akkaşoğlu 1, Ceren Günenç Beşer 3, Mustafa Fevzi Sargon 4 1 Department of Anatomy, Faculty of Medicine, Abstract Ankara Yıldırım Beyazıt University, Ankara, Aim: Modiolus is a dense, mobile fibromuscular structure lateral to the mouth corner. It is of great importance in aesthetic and Turkey 2 reconstructive surgery. The aim of this study was to enlighten the structural changes in modiolus with demographic variables such as Department of Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey age and gender in living individuals. 3 Department of Anatomy, Faculty of Medicine, Methods: This retrospective cohort study was conducted on MR images of healthy individuals. Age and sex-related changes in modiolus Hacettepe University, Ankara, Turkey level and volume were retrospectively analyzed in 64 patients [37M; 27F; mean age 48.2(16.3)] who underwent head and neck magnetic 4 Department of Anatomy, Faculty of Medicine, resonance imaging. ROC analysis was performed to determine the cut off values for age of modiolus. Correlation analysis (Pearson and Atılım University, Ankara, Turkey point biserial correlation) was used to determine whether there was a significant correlation between age and volume. Significance of the ORCID ID of the author(s) differences between the volumes of right and left modiolus of the same individual were evaluated by dependent t tests. 3 SC: 0000-0002-5839-3172 Results: The mean volume of the modiolus was calculated as 0.51(0.26) mm .
    [Show full text]
  • Role of Facial Muscles in Complete Denture Prosthesis: a Review
    e-ISSN: 2581-4443 MAVEN | www.idahowrah.org REVIEW ARTICLE Role of Facial Muscles in Complete Denture Prosthesis: A Review Dr. Anindita Majumder 1, Prof. (Dr.) Sugata Mukherjee 2, Prof. (Dr.) Tapan Kumar Giri 3, Dr Ashish Barui 1, Dr Dibyatanu Majumder 1 1Post graduate student, 2Professor and Head of department, 3Professor and Principal, De- partment of Prosthodontics Crown and Bridge, Dr R Ahmed Dental College and Hospital. Kolkata. Corresponding author: Dr. Anindita Majumder, Post graduate student, Department of Prosthodontics Crown and Bridge, Dr R Ahmed Dental College and Hospital. Kolkata. Phone no- 8697687883, Email - [email protected]. Abstract We prosthodontist treat patients with complete denture prosthesis, that replaces missing teeth and maxillofacial tissues. A successful prosthesis requires balance between difeerent related factors and must fullfill the following criteria- of being in harmony with surrounding oral environment and orofacial musculature and preservation of remaining structures, re- stores masticatory efficiency; ability to perform during functions like deglutition, speech, respiration; and be aesthetically pleasing. Among these criteria maintaining harmony be- tween prosthesis and muscles and preservation of the same is of utmost importance and a challange to the dentist. Muscle action influences the fabrication of denture at every step beginning from impression making to jaw relations to teeth setting and finally successful retention, stability and comfortable wearing of denture. Similarly a properly constructed denture helps to restore the health of stomatognathic system of which muscle are a part. It helps muscle to function in its physiological limit and maintain tonicity. So in this review the role of facial muscles in complete denture prosthesis is presented here.
    [Show full text]
  • FIPAT-TA2-Part-2.Pdf
    TERMINOLOGIA ANATOMICA Second Edition (2.06) International Anatomical Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TA2, PART II Contents: Systemata musculoskeletalia Musculoskeletal systems Caput II: Ossa Chapter 2: Bones Caput III: Juncturae Chapter 3: Joints Caput IV: Systema musculare Chapter 4: Muscular system Bibliographic Reference Citation: FIPAT. Terminologia Anatomica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, 2019 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Anatomica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput II: OSSA Chapter 2: BONES Latin term Latin synonym UK English US English English synonym Other 351 Systemata Musculoskeletal Musculoskeletal musculoskeletalia systems systems
    [Show full text]
  • Is It Possible to Define the Ideal Lips? È Possibile Definire Le Labbra Ideali? M
    ACTA OTORHINOLARYNGOLOGICA ITALICA 2018;38:67-72; doi: 10.14639/0392-100X-1511 Maxillo facial and plastic surgery Is it possible to define the ideal lips? È possibile definire le labbra ideali? M. KAR1, N.B. MULUK2, S.A. BAFAQEEH3, C. CINGI4 1 Kumluca State Hospital, ENT Clinics, Antalya, Turkey; 2 Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey; 3 King Saud University, Faculty of Medicine, ENT Department, Riyad-Saudi Arabia; 4 Eskisehir Osmangazi University, Faculty of Medicine, ENT Department, Eskisehir, Turkey SUMMARY The lips are an essential component of the symmetry and aesthetics of the face. Cosmetic surgery to modify the lips has recently gained in popularity, but the results are in some cases disasterous. In this review, we describe the features of the ideal lips for an individual’s face. The features of the ideal lips with respect to facial anatomy, important anatomical landmarks of the face, the facial proportions of the lips and ethnic and sexual differences are described. The projection and relative sizes of the upper and lower lips are as significant to lip aesthet- ics as the proportion of the lips to the rest of the facial structure. Robust, pouty lips are considered to be sexually attractive by both males and females. Horizontal thirds and the golden ratio describe the proportions that contribute to the beauty and attractiveness of the lips. In young Caucasians, the ideal ratio of the vertical height of the upper lip to that of the lower lip is 1:1.6. Blacks, genetically, have a greater lip volume. The shape and volume of a person’s lips are of great importance in the perception of beauty by humans.
    [Show full text]
  • Surgical Anatomy of the Face Implications for Modern Face-Lift Techniques
    ORIGINAL ARTICLE Surgical Anatomy of the Face Implications for Modern Face-lift Techniques Holger G. Gassner, MD; Amir Rafii, MD; Alison Young, MD, PhD; Craig Murakami, MD; Kris S. Moe, MD; Wayne F. Larrabee Jr, MD Objective: To delineate the anatomic architecture of the were found to be located in corresponding anatomic lay- melolabial fold with surrounding structures and to elu- ers and to form a functional unit. Additional findings of cidate potential implications for face-lift techniques. the present study include the description of 3 structur- ally different portions of the melolabial fold, of an ana- Methods: A total of 100 facial halves (from 50 cadav- tomic space below the levator labii superioris alaeque nasi eric heads) were studied, including gross and micro- (sublevator space), and of extensions of the buccal fat scopic dissection and histologic findings. Laboratory find- pad into the sublevator space and the middle third of the ings were correlated with intraoperative findings in more melolabial fold. than 150 deep-plane face-lift dissections (300 facial halves) performed during the study period. Conclusions: The findings of the present study may con- tribute to augment our understanding of the complex Results: In contrast to previous reports, the superficial anatomy of the midface and melolabial fold. Potential im- musculoaponeurotic system (SMAS) was not found to plications for modern face-lift techniques are discussed. form an investing layer in the midface. The SMAS, zy- gomatici muscles, and levator labii superioris
    [Show full text]
  • The Extended SMAS Facelift Identifying the Lateral Zygomaticus Major Muscle Border Using Bony Anatomic Landmarks
    ORIGINAL ARTICLE The Extended SMAS Facelift Identifying the Lateral Zygomaticus Major Muscle Border Using Bony Anatomic Landmarks Arian Mowlavi, MD, and Bradon J. Wilhelmi, MD n the early 1980s, improving the nasolabial fold promi- Abstract: Extended superficial musculoaponeurotic system (SMAS) rhytidectomy has been advocated for improving nasolabial Inence by elevation of the malar soft tissue ptosis was 1 fold prominence. Extended subSMAS dissection requires release of introduced. Skoog had advocated a superficial musculoapo- the SMAS typically from the upper lateral border of the zygomaticus neurotic system (SMAS) component to the facial skin flap, major muscle and continued dissection medial to this muscle. This thus introducing composite tissue flap elevation to rhytidec- maneuver releases the zygomatic retaining ligaments and achieves tomy. Additionally, a biplanar face lift technique had been more effective mobilization and elevation of the ptotic malar soft developed, utilizing independent SMAS and cutaneous flaps.2 tissues, resulting in more dramatic effacement of the nasolabial This technique intended to allow more aggressive traction of crease. Despite its presumed advantages, few reports have suggested central facial tissue by the SMAS but without the resulting greater risk of nerve injury with this technique compared with other “pulled” effect typically observed on the overlying skin. limited sub-SMAS dissection techniques. Although the caudal ex- tent of the zygomaticus muscle insertion to the modiolus of the Next, skin flaps were extended medially across to the naso- mouth has been well delineated, the more cephalad origin has been labial fold in an attempt to increase effacement of the naso- 3 vaguely defined. We attempted to define anatomic landmarks which labial crease.
    [Show full text]
  • Anatomy of the Face and Neck 2 Peter M
    Anatomy of the Face and Neck 2 Peter M. Prendergast 2.1 Introduction Following a description of the hard tissue foundation, the soft tissues of the face will be described, from Safe and effective cosmetic surgical practice relies on a superfi cial to deep, in the following order: clear knowledge and understanding of facial anatomy. 1. Superfi cial fat compartments Techniques evolve and improve as the complex, lay- 2. Superfi cial musculoaponeurotic system (SMAS) ered architecture and soft tissue compartments of the 3. Retaining ligaments face are discovered and delineated through imaging, 4. Mimetic muscles staining techniques, and dissections both intraopera- 5. Deep plane, including the deep fat compartments tively and in the research laboratory on cadavers [ 1 ] . To create a more youthful, natural-looking form, the sur- geon endeavors to reverse some of the changes that 2.2 Facial Skeleton occur due to aging. These include volumetric changes in soft tissue compartments, gravitational changes, and Facial appearance is to a large extent determined by the attenuation of ligaments. Whether the plan of reju- the convexities and concavities of the underlying facial venation includes rhytidectomy, platysmaplasty, autol- bones (Fig. 2.1 ). The “high” cheekbones and strong ogous fat transfer, implants, or endoscopic techniques, chin associated with attractiveness are attributable to a sound knowledge of facial and neck anatomy will the convexities and projection provided by the zygo- increase the likelihood of success and reduce the inci- matic bone and mental protuberance of the mandible, dence of undesirable results or complications. respectively (Fig. 2.2 ). The facial skeleton consists of This chapter describes the anatomy of the face in the frontal bone superiorly, the bones of the midface, layers or planes, with some important structures or and the mandible inferiorly.
    [Show full text]
  • Syddansk Universitet the Versatile Modiolus Perforator Flap
    CORE Metadata, citation and similar papers at core.ac.uk Provided by University of Southern Denmark Research Output Syddansk Universitet The Versatile Modiolus Perforator Flap Gunnarsson, Gudjon L.; Thomsen, Jørn Bo Published in: Plastic and Reconstructive Surgery, Global Open DOI: 10.1097/GOX.0000000000000611 Publication date: 2016 Document version Final published version Document license CC BY-NC-ND Citation for pulished version (APA): Gunnarsson, G. L., & Thomsen, J. B. (2016). The Versatile Modiolus Perforator Flap. Plastic and Reconstructive Surgery, Global Open, 4(3), [e661]. DOI: 10.1097/GOX.0000000000000611 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 19. Apr. 2017 Divya ORIGINAL ARTICLE Original Article Reconstructive xxx The Versatile Modiolus Perforator Flap XXX Gudjon Leifur Gunnarsson, MD* Background: Perforator flaps are well established, and their usefulness as 2016 Jorn Bo Thomsen, MD, PhD† freestyle island flaps is recognized.
    [Show full text]