9 Special Considerations for Reconstructive Surgery
Summary
This chapter discusses additional photographic concerns for reconstructive surgical procedures, including timing of photography, assessment of the premorbid state of the patient, and accurate photographic documentation of structure and function throughout the reconstructive process. Suggested imaging series for several more commonly encountered reconstructive situations are described.
Keywords
defect, free anterolateral thigh flap, free fibula flap, free radial forearm flap, function, locoregional flap, pectoralis flap, reconstruction, rib graft, skin graft
9.1
Special Considerations for Reconstructive Surgery
The basic principles of photography for reconstructive surgery are the same as for any other medical photography. However, there are some specific concerns at each phase of the reconstructive process that must be addressed to achieve optimum results.
For planned reconstructive cases, attempt to obtain photos not only prior to surgery, but also prior to the creation of the defect, and at the true premorbid state. This will often mean obtaining old photographs, such as from a yearbook or family photo album (Fig. 9.1). Caution is needed in interpreting these pictures, as an artistic portrait from the teenage years is probably not representative of the state of the patient later in life, but it can still offer usable information.
Photographs of the defect should be obtained according to the methods presented elsewhere in this book, with attention to accurately depicting not just the cosmetic nature of the defect, but also any functional consequences arising from it. The donor site(s) should also be photographed, with similar attention to form and function. This is especially important with complex reconstructive cases in which donor site morbidity is a larger concern.
For multistage procedures, each stage of the repair should be photographed. These photographs can also be used (with appropriate permission) to help communicate with other patients undergoing similar reconstructions, and are especially useful for procedures such as the paramedian forehead flap.
9.2
Photo Series
The photo series that follow represent the most commonly encountered reconstructive problems in the head and neck but are far from exhaustive. The principles enumerated can be readily extrapolated to other reconstructive situations as they arise.
9.2.1 Skin Grafting
For small grafts such as full-thickness postauricular grafts, macrophotographs of the donor and recipient sites are sufficient. For larger grafts, also include the entire structure from several angles, such as the entire thigh, and consider views with the joints above and below flexed and extended.
9.2.2 Local Flaps of Head and Neck
Pertinent images from the series in Chapter 8 are sufficient to depict these flaps. For smaller flaps, it is helpful to also take macrophotographs using the techniques from Chapter 12.
