Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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244 Surgery and Healing in the Developing World
Figure 1. 1) Use skin hooks after the skin incision is made. 2) Left the skin and subcutaneous
tissue. 3) Roll elevated flaps toward nostrils and suture.
to 1. With the removal of 1000 cc of blood 3000 cc of normal saline would be given
quickly.
A surgical technique that diminishes the loss of blood is used. This would include
the use of electrocautery or prompt clamping and ligation of bleeders.
The suctioning of blood lost during the procedure is combined with an anticoagulant
for prompt reinfusion to the patient after this phase of surgery is completed.
The restoration of function and overall appearance will be stressed. Exacting
cosmesis achieved only by the use of more time-consuming free flaps are not discussed.
They are difficult to perform and require frequent postoperative Doppler
evaluations.
Reconstruction with a Total Forehead Flap (Fig. 1, 4-9, 11,
13-17)
The forehead flap is an axial pattern flap because its blood supply comes from a
major blood vessel, the temporalis artery. This artery passes near and anterior to the
tragus of the ear and then across the forehead as shown in the line drawing.
The flap is very dependable because the circulation through this single artery
and vein allows the surgeon to elevate the entire forehead skin and subcutaneous
tissue at one time without fear of flap loss.
It can be used for the reconstruction of the
1. The entire nose
2. The central face
3. The upper lip
4. A single side of the face
5. The lower face