Layered Closure and Skin Suture Technique

Today, we welcome back Dr. Andrew Jenzer, a renowned expert in oral and maxillofacial surgery and a Clinical Associate in the Department of Surgery at Duke University, where he specializes in craniomaxillofacial trauma and reconstructive surgery. Dr. Jenzer is known for his expertise in the "coronal approach," a technique vital to his field, and in this conversation, he shares his wealth of knowledge and practical tips for mastering it. He outlines the overall approach before detailing the nuances of implementing it. You’ll discover how to conceptualize the layers of the skull, transition to exposing the zygomatic arch, and how to best approach the upper facial skeleton. We discuss the best resources for learning about the method, details on how to make the initial incision, and common misconceptions about the approach. You’ll also learn how to prepare effectively for the procedure, reduce the probability of bacterial infection and other complications, navigate various tissues, leverage Pitanguy’s Line, and much more. Join us as we unpack the coronal approach and learn how to master it with Dr. Andrew Jenzer!

Key Points From This Episode:

• Updates on the Oral & Maxillofacial Surgery Review resources.
• An outline of the topic and overview of the coronal approach.
• Additional resources to help you learn about the coronal approach
• The various fractures and problems this method can treat.
• Different styles and variations of implementing the approach. 
• Tips and recommendations to maintain blood supply during the procedure. 
• Best positions for the patient and how to deal with a patient’s hair before cutting. 
• Steps for prepping the incision area and anesthesia recommendations. 
• RANEY Clips and what type of situations to use them in. 
• Making the initial incision and pragmatic ways to reduce bleeding.
• Transitioning through the different layers and exposing the orbit. 
• The anatomy associated with the process of releasing incisions. 
• How to close an incision effectively and why a drain is important. 

Links Mentioned in Today’s Episode:

Dr. Andrew Jenzer — https://surgery.duke.edu/profile/andrew-clark-jenzer

Dr. Andrew Jenzer Email — andrew.jenzer@duke.edu

Dr. Andrew Jenzer on ORCID — https://orcid.org/0000-0001-9457-7334

The Department of Surgery at Duke University — https://surgery.duke.edu/

Introduction to Contemporary Orthognathic Surgery — https://www.quintessence-publishing.com/usa/en/product/introduction-to-contemporary-orthognathic-surgery

Atlas of Oral and Extraoral Bone Harvesting — https://www.quintessence-publishing.com/usa/en/product/atlas-of-oral-and-extraoral-bone-harvesting

Surgical Approaches to the Facial Skeleton — https://www.amazon.com/dp/149638041X

AO Surgery Reference — https://surgeryreference.aofoundation.org/

'Coronal approach’ — https://surgeryreference.aofoundation.org/cmf/trauma/midface/approach/coronal-approach#harvesting-cranial-bone-grafts

B. Braun Group | RANEY Clips —