ABSTRACT
TIP: Zones 1 and 2 can be reconstructed with cervicofacial flaps, whereas zone 3 typically cannot.
DEFECT ANALYSIS n Analysis of the defect or anticipated defect
• Simple: Skin and subcutaneous tissues • Complex: Muscle, facial nerve, parotid gland and duct, mucosa, bone
n Anatomic reconstruction of all layers when possible • Facial nerve reconstruction (see Chapter 42) • Contour revisions may be necessary for complex reconstructions (see below)
ZONE 1: SUBORBITAL n Primary closure
• Smaller lesions can be closed with an elliptical excision typically oriented in the direction of natural relaxed skin tension lines (RSTLs)
• Care must be taken not to distort structures, such as the lower lid n Skin grafts
• Split-thickness grafts can be used for temporary closure, but they often result in significant distortion, contracture, and/or scarring if used for definitive coverage
• Full-thickness skin grafts provide better long-term results Best donor sites are preauricular, postauricular, supraclavicular
Fig. 37-1 Three overlapping zones of the cheek aesthetic unit.
