Periosteum is left exposed in the area between the initial horizontal incision and the coronal margin of the flap. The small flap size produced little traction at the donor sites. The glabellar flap is then sutured to the mustarde flap with interrupted 50 fast absorbing sutures. A rectangular glabellar flap was designed in accordance with the. Methods a new modification of conventional glabellar flap which was named flap in flap technique was raised to cover medial canthal defect. The glabellar region is an area from which a number of local flaps have been designed to reconstruct wounds of the superior and lateral nose. The glabellar flap was transferred to the medial canthal defect after thinning. A periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. Three cases are presented, the first of which typifies the standard glabellar flap with an intact skin and subcutaneous pedicle. Refinements in the axial frontonasal flap journal of plastic. Department of ophthalmology, cole eye institute, cleveland clinic foundation, cleveland, ohio, u.
The patient returns in one week for suture removal. This video illustrates how to perform a glabellar flap authors. A glabellar transpositional flap is a standard technique for medial canthal reconstruction. The oncologic resection resulted in moderate sized glabellar defects. Nasal reconstruction is always a challenge for the plastic surgeon. Medial canthal reconstruction with combined glabellar and. Pdf glabellar flaps in nasal reconstruction oren friedman. Reconstruction of nasal defects presents a particularly unique challenge for the surgeon. In our experience nasolabial flap is a very reliable flap for the alar defects after tumor resection. A glabellar flap that can be divided into two parts was designed and elevated according to the defect in the medial canthal. This video illustrates how to perform a glabellar flap. The place of nasolabial flap in orofacial reconstruction. The advancement flap allows the physician to cover the other area by stretching the flap longitudinally until the end comes over it.
Besides providing a good colour match, the flap is easy to dissect and inset. Therefore, the authors introduce a novel method of inserting a small strip of acellular dermal matrix adm underneath the wrinkle line. By uploading your videos here you can share your knowledge with a worldwide community of surgeons. The random rotation flap described by rieger3 uses a wide skin. In between the two lies the placement of a dermal fat graft or allogeneic dermis graft threaded into each one of the glabellar grooves. Sometimes bad eyesight or insufficient corrective lenses can contribute to the muscle contractions that deepen the glabellar lines. Forehead subunits atot flap i nte tion in glabellar concavity fig. Its blood supply can be based on muscular perforators so that the skin base can be narrowed or the flap converted to an island. The authors represent their flap in flap technique that provides normal concavity of the canthus and does not cause any complex and undesirable scars. Eyelid reconstruction riva lee asbell philadelphia, pa.
They are caused by small muscles between your eyebrows and in your forehead, an area called the glabella. Yildirim s, akoz t, akan m, cakir b 2001 the use of combined. Kup pdf manager merge, split, trim sklep microsoft store plpl. Code all procedures performed by the oculoplastic surgeon. A useful flap combination in wide and complex defect reconstruction. Along with the procerus and obicularis oculi muscles, the corrugator is responsible for the inferomedial pull of the eyebrows, giving rise to the expression of negative emotions such as anger and anxiety figure 1. Nasal root island flap for reconstruction of glabellar.
Superiorly based bilobed flap for inferior medial canthal. We used a myocutaneous nasal root island flap based on the periocular muscles for the reconstruction of these defects with primary closure of the donor site. Dysport in the treatment of glabellar lines in chinese. Glabellar lines, face wrinkles new york dermatology. Archibald, md, oren friedman, md keywords glabellar flap dorsal. It is the first quick, less invasive and effective, nonsurgical technique for both brow lift and rhytid treatment. Glabellar rotation and nasolabial vy advancement flaps. Glabella lines are usually the first wrinkles on our forehead that we start to notice. An essential app as selected by the microsoft store. Nasal reconstruction following soft tissue resection. Malata, bschb, mbchb, lrcp mrcs, frcsglasg, frcsplasta adepartment of plastic and reconstructive surgery, addenbrookes hospital, cambridge. The glabellar rhytid has not only dynamic but also static cause, which is usually achieved by injection of filler.
Glabellar flaps in nasal reconstruction request pdf. The glabellar transposition banner flap is relatively simple and efficient. In general, these flaps are most useful for medial canthal defects that are superior to the medial canthal tendon. In order to avoid unnecessary facial distortion a vy cheek advancement flap measuring 3. Deep glabellar rhytides, however, are difficult to correct with filler. As you can see the treatment of your glabellar lines is not an easy problem to solve. Loss of nasal mass is mainly caused by resection of skin cancers. A retrospective study by knackstedt et al on cutaneous nasal reconstructive surgery indicated that, while bilobed flaps are employed more frequently than trilobed flaps in repairing the inferior nasal dorsum and sidewall. Like other creases, wrinkles and lines on the face, they are now easily treated with botox.
In general i think medial canthal defects which are superior to the medial canthal tendon are best repaired with this procedure. The same group demonstrated in 2010 that botulinum toxin type a injection to the glabella has been shown to improve both dynamic glabellar rhytides and those in repose. At the conclusion of the case the defect is closed with minimal tension with the lid in good positon and the skin types respected. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The frontoglabellar skin has long served in reconstruction of certain nasal and canthal defects.
The glabellar flap is effective in the reconstruction of defects within the medial canthal region. Nasolabial flap definition of nasolabial flap by medical. This is glabellar flap for medial canthal defect by university of iowa ophthalmology on vimeo, the home for high quality videos and the people who love. In addition, donor area morbidity is minimal and surgical technique is simple.
Listing a study does not mean it has been evaluated by the u. A study of botox for the treatment of glabellar lines. Combine pdf pdfcool allows the user to combine a variety of individual pdf documents into a new pdf document. The major axis of the glabellar flap and a part of the vy flap corresponded to the relaxed skin tension line and the nasolabial fold, respectively, resulting in inconspicuous scars. A 15 blade is used to make an incision through the skin and subcutaneous fat. The authors present their experience with 48 patients who had an aesthetic unit dorsal nasal flap and their technique of incisional interface resurfacing, which. Between 2001 and 2006, combined glabellar and orbicularis oculi myocutaneous advancement flaps were used for the reconstruction of 12 cutaneous defects resulting from the resection of basal cell carcinoma bcc of the medial canthal area. G l a b e l l a r fl a p s i n n a s a l re c o n s t r u c t i o n cody a. This video demonstrates the use of a glabellar flap to close a medial canthal defect.
Glabellar flaps in nasal reconstruction plastic surgery key. Superiorly based bilobed flap for inferior medial canthal and nasojugal fold defect reconstruction julian d. Nasolabial flap, ala reconstruction, skin tumors structive surgeon 4,5,6. Surgical technique the glabellar flap is designed in a triangular shape over the area of maximal skin laxity the in the glabellar region. Combination of glabellar and vy cheek advancement flaps for. Frontglabellar flap, bilobed flap, and sliding flap lateral region tip.
Complex aesthetic subunits and limited available adjacent mobile skin with varying color, texture, and thickness all contribute to this task. Both of these techniques qualify as adjacent tissue transfers or rearrangements, which you should report with the appropriate 14000 series code adjacent tissue transfer or rearrangement. A new glabellar flap modification for the reconstruction of medial canthal and nasal dorsal defects. A new glabellar flap modification for the reconstruction of medial. Combination of glabellar and vy cheek advancement flaps. Vy plasty training myocutaneous simulator for teaching suture and reconstructive surgery duration. Other options for medial canthal reconstruction include a bilobed flap, rhomboid flap, and fullthickness skin graft eye 86. When strategically placed, it can impact the glabellar muscles and minimize vertical glabellar frown lines. The modified apically repositioned flap marf technique uses a single horizontal incision within the keratinized tissue kt, elevating a splitthickness flap, and suturing of the flap to the periosteum in an apical position. The four seasons flap michele di candia, md,a kwok lie,b devor kumiponjera, mrcs, mbchb,a jeremy simcock, mbchb, fracs plast, md,a george c.
This video demonstrates a glabellar flap for repair of a medial canthal defect. Colour atlas of ophthalmic plastic surgery, boston, 2008. Botox can smooth out these two lines and ease and dewrinkle the brow in general. Glabellar flaps have traditionally been used to cover nasal skin and soft tissue defects. How to get rid of frown, glabella or furrow lines on. Glabellar flap, medial canthal recontruction, nasolabial flap.
Merge, split, extract, and combine pdfs with pdf manager. The authors have performed reconstruction with combined glabellar and orbicularis oculi myocutaneous advancement flaps in 12 patients. Botox is a great alternative to help prevent future linewrinkles and can help soften lines on the forehead if theyre not to deep to start, its best you seek a reputable board certified physician for an inperson evaluation to see what may be best for your aesthetic desires. Among the several available alternatives for covering the skin, skin flaps are the first cosmetic and functional choice. Glabella definition of glabella by medical dictionary.
Kakizakicombination of nasolabial vy advancement flap and glabellar subcutaneous pedicled flap for reconstruction of medial canthal. This product works by decreasing the ability of the forehead muscles to contract. Glabellar flap for medial canthal defect ophthalmology. How to avoid contracted glabellar muscles by ramona french frown lines can make you look older and stern.
But at least there are a variety of different options. Dysport in the treatment of glabellar lines in chinese subjects the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Transformation of the glabellar flap into an island flap. The midpoint of the triangle is midline, extending a few centimeters above the superior border of the eyebrow.
Correction of deep static glabellar lines with acellular. In the vast majority of patients with glabellar frown lines, the treatment of choice is botox. It can be designed either on a curved glabellar line or as a vertical midline closure, depending. The flap has been designed and a 15 blade is used to make an incision along the markings. The 3 most popular methods of transferring skin from the glabellar region include the median glabellar flap, the vtoy rotation glabellar flap, and the transposition glabellar flap.