Skin Incision and Dissection in Primary Cases

The preauricular portion of the U incision is marked from the edge of the tragus upward along the root of the helix and then vertically into the hair-bearing area for approximately 5 cm along the axis of the tragus. The incision is designed with a gentle curve to become horizontal, stopping at 1 cm from the frontal hairline (Fig. 47.1).

Retroauricular Sulcus Define
  1. 47.1. The vertical U incision. Vertical in the temporal area above the ear, and vertical as well in the retroauricular sulcus, continuing in the scalp, parallel to the temporal incision, 2 cm further back. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)
  2. 47.1. The vertical U incision. Vertical in the temporal area above the ear, and vertical as well in the retroauricular sulcus, continuing in the scalp, parallel to the temporal incision, 2 cm further back. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)

From the tragus, the incision descends with a step in front of the lobule. The preauricular incision is continued around the lobule and into the retroauric-ular sulcus, with the pinna retracted anteriorly. The incision is made at the level of the sulcus without climbing the posterior conchal wall. When the sulcus turns anteriorly, the incision is continued in a strictly vertical dissection across the superior aspect of the hairless zone into the hairline. The length of the incision within the hairline is about 3 cm vertically and 2 cm behind and parallel to the vertical branch of the temporal incision (Fig. 47.2).

Retroauric

Fig. 47.2. The retroauricular incision starts in the sulcus, and from there continues vertically at D, where the sulcus turns anteriorly. The scalp is entered at B and is incised vertically for 3 cm. An extensive superficial subcutaneous dissection is made behind the ear, connecting anteriorly with the usual superficial neck dissection. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)

Fig. 47.2. The retroauricular incision starts in the sulcus, and from there continues vertically at D, where the sulcus turns anteriorly. The scalp is entered at B and is incised vertically for 3 cm. An extensive superficial subcutaneous dissection is made behind the ear, connecting anteriorly with the usual superficial neck dissection. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)

The subcutaneous dissection is then performed at the temporal level above the fascia in the hair-bearing area and anteriorly toward the lateral canthus, exposing the orbicularis oculi. After a limited preauricular subcutaneous undermining, the retroauricular skin and scalp elevation is performed. The dissection is started along the incision with a scalpel for about 1 cm and is continued with scissors. One should find the right plane of dissection, which is above the apo-neurosis of the muscle. Adhesions are often tight at the scalp, and one should avoid cutting into the muscle, remaining at the subcutaneous level. A generous preoperative infiltration with a mixture of lidocaine and epinephrine (0.5% lidocaine) helps for this dissection.

This subcutaneous undermining is extended to 6 cm from the retroauricular sulcus (Fig. 47.2) and connected anteriorly with the mastoidal and neck dissection. On the face, our superficial dissection varies in its extent, but at the neck level, we do extensive undermining, getting close to the midline. When there is an excess of fat, we start with a medial liposuction. It is preformed though a 1 cm incision done in the submental fold, and after undermining of the medial submental area with scissors, always preserving a thin layer of fat under the skin, the liposuction is performed with a no. 8 transparent gynecological cannula. The lateral dissection is then connected widely with the medial one. We think that when a midline liposuction has been done, a wide neck undermining should be performed to flatten the neck.

The extent of the lower dissection goes to about the level of the cricoid cartilage. It is especially important to dissect low enough at the level of the sternocleido-mastoidal muscle to allow the redraping of the neck skin. We usually stop our skin dissection 5-6 cm from the retroauricular sulcus.

Was this article helpful?

0 0
How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

Get My Free Ebook


Post a comment