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Semin Plast Surg
DOI: 10.1055/s-0044-1791829
Review Article

Facial Reconstruction: The Nuances of Managing Undesirable Results

Lauren McAllister
1   Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
James F. Thornton
1   Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations Funding None.
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Abstract

Given the visibility of the face and the importance of its cosmesis, undesirable results following facial reconstruction present significant challenges for both the patient and the surgeon. Intraoperative measures and postoperative management can ameliorate some unfavorable outcomes, but others may require more extensive intervention. Approaching undesirable results with a frank assessment followed by shared decision-making not only improves outcomes but is also essential for patient satisfaction.

Keywords

undesirable results - postoperative scar management - revisions


Publication History

Article published online:
04 November 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Menick FJ. Revising or redoing an imperfect or failed nasal reconstruction. Facial Plast Surg 2014; 30 (03) 342-356
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Schnabl SM, Breuninger H, Iordanou E. et al. Patient satisfaction in 1,827 patients following various methods of facial reconstruction based on age, defect size and site. J Dtsch Dermatol Ges 2018; 16 (04) 426-433
    CrossrefPubMedGoogle Scholar
  • 3 Cheng H, Clymer JW, Po-Han Chen B. et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 2018; 229: 134-144
    CrossrefPubMedGoogle Scholar
  • 4 Taghizadeh F, Troob SH, Wax MK. The role of fluorescent angiography in free flap reconstruction of the head and neck. Laryngoscope 2023; 133 (06) 1388-1393
    CrossrefPubMedGoogle Scholar
  • 5 Surowitz JB, Most SP. Use of laser-assisted indocyanine green angiography for early division of the forehead flap pedicle. JAMA Facial Plast Surg 2015; 17 (03) 209-214
    CrossrefPubMedGoogle Scholar
  • 6 Abdelwahab M, Kandathil CK, Most SP, Spataro EA. Utility of indocyanine green angiography to identify clinical factors associated with perfusion of paramedian forehead flaps during nasal reconstruction surgery. JAMA Facial Plast Surg 2019; 21 (03) 206-212
    CrossrefPubMedGoogle Scholar
  • 7 Schultz TA, Cunningham K, Bailey JS. Basic flap design. Oral Maxillofac Surg Clin North Am 2014; 26 (03) 277-303
    CrossrefPubMedGoogle Scholar
  • 8 Konofaos P, Alvarez S, McKinnie JE, Wallace RD. Nasal reconstruction: a simplified approach based on 419 operated cases. Aesthetic Plast Surg 2015; 39 (01) 91-99
    CrossrefPubMedGoogle Scholar
  • 9 Correa BJ, Weathers WM, Wolfswinkel EM, Thornton JF. The forehead flap: the gold standard of nasal soft tissue reconstruction. Semin Plast Surg 2013; 27 (02) 96-103
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Francis A, Baynosa RC. Hyperbaric oxygen therapy for the compromised graft or flap. Adv Wound Care (New Rochelle) 2017; 6 (01) 23-32
    CrossrefPubMedGoogle Scholar
  • 11 Fife CE, Eckert KA, Carter MJ. An update on the appropriate role for hyperbaric oxygen: indications and evidence. Plast Reconstr Surg 2016; 138 (03) 107S-116S
    CrossrefPubMedGoogle Scholar
  • 12 Elmer NA, Baltodano PA, Webster T. et al. Critical importance of the first postoperative days after head and neck free flap reconstruction: an analysis of timing of reoperation using the National Surgical Quality Improvement Program database. Ann Plast Surg 2022; 89 (03) 295-300
    CrossrefPubMedGoogle Scholar
  • 13 Liebau J, Schulz A, Arens A, Tilkorn H, Schwipper V. Management of lower lid ectropion. Dermatol Surg 2006; 32 (08) 1050-1056 , discussion 1056–1057
    PubMedGoogle Scholar
  • 14 McAllister L, Thornton JF. Approaches to Cheek Reconstruction following Mohs Surgery. . Semin Plast Surg 2024;38(04):
    PubMedGoogle Scholar
  • 15 Sakellariou A, Salama A. The use of cervicofacial flap in maxillofacial reconstruction. Oral Maxillofac Surg Clin North Am 2014; 26 (03) 389-400
    CrossrefPubMedGoogle Scholar
  • 16 Matin MB, Dillon J. Lip reconstruction. Oral Maxillofac Surg Clin North Am 2014; 26 (03) 335-357
    CrossrefPubMedGoogle Scholar
  • 17 Sanniec K, Harirah M, Thornton JF. Lip reconstruction after Mohs cancer excision: lessons learned from 615 consecutive cases. Plast Reconstr Surg 2020; 145 (02) 533-542
    CrossrefPubMedGoogle Scholar
  • 18 Ki SH, Jo GY, Yoon J, Choi MSS. Reconstruction of microstomia considering their functional status. Arch Craniofac Surg 2020; 21 (03) 161-165
    CrossrefPubMedGoogle Scholar
  • 19 Arguello LA, Kerr KM. Managing long-term orofacial contractures and microstomia through intraoral stretching. J Burn Care Res 2024; irae123
    CrossrefPubMedGoogle Scholar
  • 20 Forssman T. Reflections on a journey through the southern Omo Valley, Ethiopia. Digging Stick 2015; 32 (01) 17-21
    PubMedGoogle Scholar
  • 21 Prakash V, Tandon R, Chauhan N. Defect transport for management of lower lip ectropion. Eur J Plast Surg 2014; 37: 43-44
    CrossrefPubMedGoogle Scholar
  • 22 Turissini JD, Elmarsafi T, Evans KK, Kim PJ. Major risk factors contributing to split thickness skin graft failure. Georgetown Med Rev 2019; 3 (01) 1-11
    CrossrefPubMedGoogle Scholar
  • 23 Teh BT. Why do skin grafts fail?. Plast Reconstr Surg 1979; 63 (03) 323-332
    CrossrefPubMedGoogle Scholar
  • 24 Andreassi A, Bilenchi R, Biagioli M, D'Aniello C. Classification and pathophysiology of skin grafts. Clin Dermatol 2005; 23 (04) 332-337
    CrossrefPubMedGoogle Scholar
  • 25 Kanzler MH, Gorsulowsky DC, Swanson NA. Basic mechanisms in the healing cutaneous wound. J Dermatol Surg Oncol 1986; 12 (11) 1156-1164
    CrossrefPubMedGoogle Scholar
  • 26 Sclafani AP, Sclafani JA, Sclafani AM. Successes, revisions, and postoperative complications in 446 Mohs defect repairs. Facial Plast Surg 2012; 28 (03) 358-366
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Surowitz JB, Shockley WW. Enhancement of facial scars with dermabrasion. Facial Plast Surg Clin North Am 2011; 19 (03) 517-525
    CrossrefPubMedGoogle Scholar
  • 28 Juhasz MLW, Cohen JL. Microneedling for the treatment of scars: an update for clinicians. Clin Cosmet Investig Dermatol 2020; 13: 997-1003
    CrossrefPubMedGoogle Scholar
  • 29 Jin R, Huang X, Li H. et al. Laser therapy for prevention and treatment of pathologic excessive scars. Plast Reconstr Surg 2013; 132 (06) 1747-1758
    CrossrefPubMedGoogle Scholar
  • 30 Connell PG, Harland CC. Treatment of keloid scars with pulsed dye laser and intralesional steroid. J Cutan Laser Ther 2000; 2 (03) 147-150
    CrossrefPubMedGoogle Scholar
  • 31 Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am Fam Physician 2009; 80 (03) 253-260
    PubMedGoogle Scholar
  • 32 Meaume S, Le Pillouer-Prost A, Richert B, Roseeuw D, Vadoud J. Management of scars: updated practical guidelines and use of silicones. Eur J Dermatol 2014; 24 (04) 435-443
    CrossrefPubMedGoogle Scholar
  • 33 Menick FJ. Principles and planning in nasal and facial reconstruction: making a normal face. Plast Reconstr Surg 2016; 137 (06) 1033e-1047e
    CrossrefPubMedGoogle Scholar
  • 34 Haddock NT, Saadeh PB, Siebert JW. Achieving aesthetic results in facial reconstructive microsurgery: planning and executing secondary refinements. Plast Reconstr Surg 2012; 130 (06) 1236-1245
    CrossrefPubMedGoogle Scholar
  • 35 Kirsner RS, Eaglstein WH. The wound healing process. Dermatol Clin 1993; 11 (04) 629-640
    CrossrefPubMedGoogle Scholar