**3. Case presentations**

1.Resurfacing with tissue expansion

The patient sustained avulsion injury of right side forehead, resulting in a palm sized uneven unsightly scar. The right side temple and mid-forehead skin was then expanded by using 2 tissue expanders. Thereafter, the grafted area was removed with sufficient expansion of the forehead skin, which brought about much improved esthetic result (**Figure 1**).

2.Tissue expansion at grafted skin for auricular reconstruction.

This 18 y/o boy had a big AVM at left ear and temple, which was excised and the ear was 3/5 amputated and then skin grafted during his childhood.

To reconstruct his left ear, a 70 ml tissue expander was placed underneath the grafted skin. With gradual expansion at grafted skin, implantation of a carved rib cartilage graft for recontouring of his left ear was accomplished (**Figure 2**).

3.Facial resurfacing with resection of underlying AVM (arteriovenous malformation) at parotid gland, where skin had been expanded with the growth of the AVM.

**Figure 1.**

*Right forehead scar, treated with tissue expansion of neighboring flaps, excision of scar with primary closure. The remaining scar can be inconspicuous.*

#### **Figure 2.**

*Tissue expansion at grafted skin to accommodate a three dimensional carved auricular framework taken from costal cartilage block.*

#### **Figure 3.**

*With complete resection of the underlying AVM, the wound can be closed with pre-expanded skin flaps. The sunken right parotid area was filled with fat graft injection after 2 years. The patient regain satisfactory facial contour without facial asymmetry.*

**121**

**Figure 5.**

**Figure 4.**

*symmetricity was obtained.*

*Finesse in Damage Control Reconstruction for Trauma in Plastic Surgery*

*Chemical burn facial contracture treated with: (1) resurfacing of nose with thick STSG; (2) releasing upper and lower eyelid scar contracture with FTSG; (3) resurfacing upper lip scar with FTSG; and (4) releasing forehead scar contracture to lower down the eyebrow and reconstruct left side forehead hairline with axial pattern scalp flap; followed by Kenacort A injection at remaining scars. Restoration of facial contour and* 

*This girl got assaulted with H2SO4, resulting in facial skin necrosis. Early tangential excision with early grafting* 

*following functional esthetic unit principle gave the girl a smooth, symmetric face.*

*DOI: http://dx.doi.org/10.5772/intechopen.92975*

*Finesse in Damage Control Reconstruction for Trauma in Plastic Surgery DOI: http://dx.doi.org/10.5772/intechopen.92975*

#### **Figure 4.**

*Chemical burn facial contracture treated with: (1) resurfacing of nose with thick STSG; (2) releasing upper and lower eyelid scar contracture with FTSG; (3) resurfacing upper lip scar with FTSG; and (4) releasing forehead scar contracture to lower down the eyebrow and reconstruct left side forehead hairline with axial pattern scalp flap; followed by Kenacort A injection at remaining scars. Restoration of facial contour and symmetricity was obtained.*

#### **Figure 5.**

*This girl got assaulted with H2SO4, resulting in facial skin necrosis. Early tangential excision with early grafting following functional esthetic unit principle gave the girl a smooth, symmetric face.*


Expansion of orbital socket dimension with chondrocutaneous composite graft. Correction of enophthalmos with fat grafting and accommodation of an appropriate size of eye prosthesis, lateral canthopexy, creation of supratarsal fold, strip hair composite graft for eyelash followed.

8.The patient suffers from radiation necrosis of palate, resulting in a sizable palatal defect and scar contracture of soft palate and uvula.

**123**

**Figure 8.**

*Significant deformity after right maxillectomy for cancer.*

**Figure 7.**

*nasopharyngeal insufficiency.*

*Finesse in Damage Control Reconstruction for Trauma in Plastic Surgery*

*(a) Radiation necrosis of hard palate and soft palate. (b) Right palatal flap was employed to repair the big oronasal fistula. (c) Pharyngeal flap was employed to hold the shortened uvula in order to ameliorate* 

*DOI: http://dx.doi.org/10.5772/intechopen.92975*

**Figure 6.** *Reconstruction of left orbital socket lining with dorsalis pedis free flap.*

*Finesse in Damage Control Reconstruction for Trauma in Plastic Surgery DOI: http://dx.doi.org/10.5772/intechopen.92975*

#### **Figure 7.**

*(a) Radiation necrosis of hard palate and soft palate. (b) Right palatal flap was employed to repair the big oronasal fistula. (c) Pharyngeal flap was employed to hold the shortened uvula in order to ameliorate nasopharyngeal insufficiency.*

**Figure 8.** *Significant deformity after right maxillectomy for cancer.*

#### **Figure 9.**

*This 57 y/o patient lost his upper lip, nasal base, and columella due to necrotizing gingivostomatitis. He had ever received upper lip reconstruction with forehead flap; however, the result was disappointing.*

#### **Figure 10.**

*Upper row: This patient got a panfacial fracture after a bad trauma. Diplopia owing to right orbital floor blow out fracture with enophthalmos and ptosis, flattening of nose due to untreated LeFort I, II, III maxillary fracture and displacement bothered him. Right middle: Calvarial bone grafting taken from the outer table of parietal bone was used to correct flat nose and right orbital floor bone defect, diplopia and enophthalmos (lower row). The patient was happy with the result.*

**125**

**Figure 11.**

*position. Upper row: pre-op; lower row: post-op.*

*Finesse in Damage Control Reconstruction for Trauma in Plastic Surgery*

able to regain an intelligible speech (**Figure 7a–c**).

9.Significant deformity after right maxillectomy for cancer.

proper right maxillary obturator and upper denture (**Figure 8**).

10.Reconstruction of complex upper lip, nasal floor and columella

Palatal arterial island flap of the right side was employed to cover the big palatal defect, and nasopharyngeal insufficiency was corrected with the use of pharyngeal flap to hold the uvula [2]. After the reconstruction, the patient was

Full thickness skin graft for maxillary contracture after complete release of the intraoral contracture was employed for reconstruction, followed by fitting a

Full thickness skin graft for maxillary contracture after complete release of the intraoral contracture was employed for reconstruction, botox injection to lessen the activity of levator labii superioris, add volume to right side upper lip with hyaluronic acid, followed by fitting a proper right maxillary obturator and upper denture. The patient was happy to resume to a near normal

The upper lip (**Figure 9**) flap was turned up to reconstruct the columella and nasal base, then Abbe flap from mid-lower lip was employed to reconstruct the

*This girl was a victim of train crash, resulting in avulsion laceration of right frontal area with frontal branch of facial nerve avulsion as well as zygomatic-orbital fracture displacement. She sustained palsy of right frontal branch facial nerve 8 months after operation, with asymmetry of right upper eyelid and eyebrow. Sling operation was employed with medial strip of frontal myoperiosteal flap to bring right eyebrow up to the right* 

*DOI: http://dx.doi.org/10.5772/intechopen.92975*

appearance.

defect.

Palatal arterial island flap of the right side was employed to cover the big palatal defect, and nasopharyngeal insufficiency was corrected with the use of pharyngeal flap to hold the uvula [2]. After the reconstruction, the patient was able to regain an intelligible speech (**Figure 7a–c**).

9.Significant deformity after right maxillectomy for cancer.

Full thickness skin graft for maxillary contracture after complete release of the intraoral contracture was employed for reconstruction, followed by fitting a proper right maxillary obturator and upper denture (**Figure 8**).

Full thickness skin graft for maxillary contracture after complete release of the intraoral contracture was employed for reconstruction, botox injection to lessen the activity of levator labii superioris, add volume to right side upper lip with hyaluronic acid, followed by fitting a proper right maxillary obturator and upper denture. The patient was happy to resume to a near normal appearance.

10.Reconstruction of complex upper lip, nasal floor and columella defect.

The upper lip (**Figure 9**) flap was turned up to reconstruct the columella and nasal base, then Abbe flap from mid-lower lip was employed to reconstruct the

#### **Figure 11.**

*This girl was a victim of train crash, resulting in avulsion laceration of right frontal area with frontal branch of facial nerve avulsion as well as zygomatic-orbital fracture displacement. She sustained palsy of right frontal branch facial nerve 8 months after operation, with asymmetry of right upper eyelid and eyebrow. Sling operation was employed with medial strip of frontal myoperiosteal flap to bring right eyebrow up to the right position. Upper row: pre-op; lower row: post-op.*
