Lesson 1Grafts: full-thickness versus split-thickness skin grafts—indications, donor sites, take factorsThis section compares full-thickness and split-thickness skin grafts, detailing indications, donor site selection, harvesting technique, graft bed preparation, fixation, and factors influencing graft take and long-term colour and texture match.
Indications for full-thickness skin graftsIndications for split-thickness skin graftsChoosing facial and extrafacial donor sitesGraft bed preparation and hemostasisGraft fixation, bolsters, and dressingsFactors affecting graft take and contractionLesson 2Anatomy of facial soft tissues: skin, subcutaneous fat, SMAS, facial muscles, and sensory/motor nervesThis section reviews layered facial soft tissue anatomy, emphasising skin, subcutaneous fat, SMAS, mimetic muscles, and sensory and motor nerves, to guide safe dissection planes, flap elevation, and preservation of expression and sensation.
Skin thickness, elasticity, and adnexal structuresSubcutaneous fat compartments and retaining ligamentsSMAS anatomy, continuity, and surgical planesMimetic muscle orientation and functional unitsSensory nerve branches and danger zonesMotor nerve branches and safe dissection corridorsLesson 3Wound assessment and timing: contamination, devitalized tissue, and infection riskThis section covers systematic wound assessment, including mechanism, contamination, tissue viability, and infection risk, and explains timing of closure, need for staged procedures, and adjuncts such as irrigation, antibiotics, and negative pressure therapy.
History, mechanism, and energy of facial injuryEvaluating contamination and foreign materialAssessing tissue viability and perfusionClassifying wounds and infection risk levelsPrimary, delayed primary, and secondary closureRole of irrigation, debridement, and antibioticsLesson 4Vascular supply and angiosomes of the face relevant to flap design and graft survivalThis section reviews facial arterial anatomy, angiosomes, and choke vessels relevant to flap design, flap delay, and graft survival, emphasising safe pedicle selection, flap length-to-width ratios, and strategies to optimise perfusion and reduce necrosis.
Facial artery course and key branchesAngular, infraorbital, and transverse facial arteriesAngiosomes, perforasomes, and choke vesselsDesigning flaps along dominant vascular territoriesFlap delay and strategies to improve perfusionOptimizing graft beds and monitoring viabilityLesson 5Local flap types and indications: advancement, rotation, transposition, bilobed, island flapsThis section analyses major local flap types used in facial reconstruction, including advancement, rotation, transposition, bilobed, and island flaps, focusing on indications, design principles, movement vectors, and complication avoidance.
Principles of random pattern local flapsAdvancement flap design and applicationsRotation flaps and arc of rotation limitsTransposition flaps and pivotal point planningBilobed flaps for nasal and small defectsIsland and V-Y flaps for limited laxity areasLesson 6Principles of debridement and preservation of facial landmarks for aesthetic reconstructionThis section outlines principles of meticulous debridement while preserving key facial landmarks, emphasising conservative tissue handling, staged excision, and planning incisions to maintain symmetry, contour, and natural aesthetic boundaries.
Assessing devitalized versus salvageable tissueSharp debridement techniques on the faceProtecting eyelid, lip, and alar landmarksManaging avulsed tissue and composite graftsPlanning incisions along aesthetic bordersStaged revision and scar refinement strategiesLesson 7Scar placement and minimising aesthetic units: relaxed skin tension lines, aesthetic subunit reconstructionThis section explains aesthetic units and relaxed skin tension lines, guiding incision placement, scar camouflage, and subunit-based reconstruction to minimise contour deformities and optimise long-term scar quality in facial soft tissue repair.
Facial aesthetic units and subunits mappingRelaxed skin tension lines and incision planningNatural creases and border camouflage strategiesSubunit excision and replacement principlesManaging scars across junctions and transitionsSuture selection and closure tension controlLesson 8Management of periocular soft tissue injuries: lower eyelid anatomy, canthal support, risk of ectropionThis section details periocular soft tissue anatomy, lower eyelid lamellae, canthal tendon support, and factors predisposing to ectropion, guiding flap design, tension vectors, and canthal fixation to preserve eyelid position and ocular protection.
Lower eyelid anterior and posterior lamellaeMedial and lateral canthal tendon anatomyEctropion risk factors and preventionFlap design and tension vectors in eyelidsCanthopexy and canthoplasty techniquesPostoperative ocular protection and careLesson 9Tissue loss classification and decision framework: primary closure, delayed closure, graft, local flap, regional flapThis section presents classification of facial tissue loss by depth, size, and structures involved, and outlines a stepwise decision framework for choosing primary closure, delayed closure, grafts, or local and regional flaps based on defect and patient factors.
Defect size, depth, and structure involvementAssessing skin laxity and tissue availabilityIndications for primary versus delayed closureWhen to choose grafts over local flapsLocal versus regional flap selection criteriaPatient comorbidities and aesthetic prioritiesLesson 10Cartilage and structural support in periorbital and nasal reconstruction: graft choices and fixation principlesThis section addresses cartilage and structural support in periorbital and nasal reconstruction, reviewing graft materials, shaping and fixation techniques, and strategies to restore contour, airway patency, and eyelid stability while minimising visibility.
Sources of septal, auricular, and costal cartilageCartilage graft shapes for nasal frameworkLower eyelid spacer graft indicationsFixation methods: sutures, pockets, and tunnelsMaintaining airway and valve functionCamouflaging graft edges and contour refinements
