Fasiyal Estetik Yüz Cerrahisinde Greft ve Lokal Fleplerin Uygulaması
Özet
Fasiyal estetik yüz cerrahisinde, yüzdeki lezyonların eksizyonu sonrası oluşan defektlerin rekonstrüksiyonunda primer onarım, greft ve lokal flep uygulamaları kritik bir öneme sahiptir. Rekonstrüksiyon yönteminin belirlenmesinde lezyonun boyutu, derinliği, lokalizasyonu ile hastanın yaşı ve beklentileri gibi faktörlerin analizi gerekir. Cilt greftleri; kısmi kalınlıkta, tam kat ve kompozit olmak üzere üçe ayrılır. Tam kat cilt greftleri epidermis ve dermisin tüm katlarını içererek iyi bir doku uyumu sağlarken, kısmi kalınlıkta greftler revaskülarizasyon sorunu olan daha geniş defektlerin kapatılmasında ya da tümör eksizyonları sonrası geçici kapama amacıyla tercih edilir. Kompozit greftler ise iki veya daha fazla farklı dokuyu barındırıp genellikle küçük tam kat nazal defektlerde kullanılır. Dolaşımı korunarak dokuların aktarılması işlemi olan flepler ise vasküler yapılarına göre random paternli ve aksiyel; hazırlanışlarına göre ise rotasyon, transpozisyon, interpolasyon, ilerletme, ada ve Limberg flebi olarak sınıflandırılır. Baş-boyun rekonstrüksiyonunda temel amaç yüzün estetik yapısını ve fonksiyonunu korumaktır; lokal greft ile fleplerin donör sahasının yakınlığı, renk uyumu ve düşük maliyet gibi avantajları bulunsa da büyük defektlerde serbest flepler tercih edilmelidir.
In facial aesthetic surgery, primary repair, graft, and local flap applications hold a critical importance in the reconstruction of defects occurring after the excision of facial lesions. Determining the reconstruction method requires analyzing factors such as the size, depth, and localization of the lesion, as well as the patient's age and expectations. Skin grafts are divided into three types: split-thickness, full-thickness, and composite grafts. While full-thickness skin grafts include all layers of the epidermis and dermis to provide good tissue harmony, split-thickness grafts are preferred for closing wider defects with revascularization problems or for temporary closure after tumor excisions. Composite grafts contain two or more different tissues and are generally utilized in small full-thickness nasal defects. Flaps, which involve transferring tissues while preserving their blood circulation, are classified as random pattern and axial according to their vascular structure, and as rotation, transposition, interpolation, advancement, island, and Limberg flaps according to their preparation. The primary goal in head and neck reconstruction is to preserve the aesthetic structure and function of the face; although local grafts and flaps offer advantages such as donor site proximity, color match, and low cost, free flaps should be preferred for large defects.
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