Biomedical subjects
Publications and source records attributed to A F Borges.
Keeping in mind the direction of the relaxed skin tension lines (RSTL), we used a local W-plastic rotation skin flap from the cheek to cover a large nasal defect resulting from the excision of a benign skin lesion. This technique, first described by Imre [7], is superior to the direct single-pedicle advancement flap from the cheek, or to any nasolabial flap, for repair of such nasal defects.
In attempting to prevent or to treat unsatisfactory linear scars by the utilization of one of three scar revision techniques, it is important that the surgeon realizes that there are factors beyond his control and factors under his control. This article reviews the current procedures available for scar revision.
A surgical technique is presented for the correction or improvement of the unaesthetic pleat that arises from the commissures of the mouth and gives the patient a sad look.
In order to obtain the least scarring following a surgical procedure, it is crucial that the surgeon always consider the direction of the relaxed skin tension lines involved in the procedure and attempt to obtain a scar that follows that direction as much as possible. No other factor (except the region where the surgery is to be performed) is as important in obtaining an acceptable scar, including the too frequently heralded factor, surgical technique. This article deals with the determination and surgical application of the relaxed skin tension lines.
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Explore the source record for details and available documents.
The W-plasty scar revision technique has been found to be effective in the repair of the difficult and cosmetically unsatisfactory hairline scar following the ill-advised face lift technique that excises forehead skin.
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In 1835, Serre performed an operation to correct a cicatricial displacement of the right mouth commissure, which he described in his 1842 book. The drawings shown in a plate in the book (Fig. 2) and the description of the technique in the legend depicted the technique he had planned to perform (excision of tissue within lines ABCDE) but was not the technique he actually did. The description of the technique in the text of the book (Fig. 4) is very poor and incomplete. Apparently, he raised a triangular flap, which contained the right commissure, and sutured it into the skin defect on the check that he had created. The Z-plasty technique attributed to him (Fig. 1) in many textbooks is not the technique he had planned nor the technique he performed. He did not describe a Z-plasty but only the transposition of a single flap.
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Facial defects too large for primary closure can sometimes be repaired with the addition of a unilateral or bilateral adjunctive Z-plasty. In this study, the mechanics of the adjunctive Z-plasty are examined experimentally. In vivo experiments using piglets show that closure tension is decreased 30% by each Z-plasty. The true lengthening of the Z when transposed is 80% of that theoretically predicted. The deformation caused by fusiform excision and closure with and without undermining and with one or two Z-plasties is evaluated. In general, the Z-plasty exchanges deformation perpendicular to the long axis of excision for deformation parallel to that axis. A clinical case using the adjunctive Z-plasty for the repair of a large chin defect is reported.
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A case of giant hairy nevus is presented in which prominent experts on diagnosis of this type of lesion were consulted. About half were of the opinion that it had degenerated into a malignant melanoma, but nevertheless the patient is alive and relatively well sixteen years after this diagnosis. This is one more case that attests to the fact that a tumor can appear very malignant histologically but, for reasons still unclear, neither metastasize nor lead to the rapid demise of the patient.
The seven best known skin tension lines are presented. The directions they convey are schematically compared with those of the relaxed skin tension lines. Commentaries and discussion by the author are given in order to help the reader arrive at his or her own conclusions on which directions his or her incisions should take so as to obtain the best scarring.
An interesting case is presented of a young man who underwent reconstruction of the entire right hard palate in a single-stage procedure, using a hinged nasal septum flap. Closure of the large facial defect was accomplished using an abdominal cylindrical flap brought to the face by way of the wrist.