Head and Neck Anatomy and Wound Healing
Core concepts
A candidate must know the layered anatomy of the face (skin, subcutaneous fat, superficial musculoaponeurotic system, deep fascia, muscle, periosteum), the named vascular pedicles used in local flaps (supratrochlear, supraorbital, superficial temporal, facial, submental), and the danger zones where dissection threatens named nerves. Wound healing in the head and neck is privileged by rich vascularity yet complicated by tension, sebaceous skin, and hair-bearing areas.
Traps in questions
- Confusing the facial artery's course relative to the mandible and buccinator; questions often test which pedicle supplies a nasolabial flap.
- Assuming all facial skin heals with fine scars; thick sebaceous nasal and chin skin behaves differently from thin periorbital skin.
- Mismatching suture removal timing to region (face earlier than scalp or trunk).
- Forgetting that the superficial temporal and posterior auricular arteries both contribute to scalp flap viability.
Rule of thumb
Match closure to relaxed skin tension lines (RSTLs), which run perpendicular to the underlying mimetic muscle. Incisions parallel to RSTLs heal with less spreading.
Worked example
A question describes a defect on the nasal dorsum after Mohs surgery and asks the best local option. The rule: small defects (<1.5 cm) on the dorsum often close primarily or with a bilobed flap based on a laterally based pedicle; larger or tip defects favor nasolabial or paramedian forehead flaps with axial supply. Identifying the vascular territory and skin laxity drives the answer.