Mohs Micrographic Surgery: From Layers to Reconstruction / by: Harmon, Christopher B., Tolkachjov, Stanislav N..

Format:

Book

Author/Creator:

Agarwal, Ashwin., Author.

Brodland, David G., Author.

Cappel, Jonathan., Author.

Castillo, Jason R., Author.

Espinoza, Gabriela M., Author.

Etzkorn, Jeremy R., Author.

Godinez-Puig, Victoria., Author.

Golda, Nicholas., Author.

Hanson, Jennifer L., Author.

Higgins II, H. William., Author.

Hocker, Thomas., Author.

Cawley, Derek T., Author.

Hruza, George J., Author.

Kossintseva, Irèn., Author.

Krunic, Aleksandar L., Author.

Miller, C. J. (Christopher J.), Author.

Powers, Molly., Author.

Proctor Jr, Randall., Author.

Quatrano, Nicola A., Author.

Roenigk, Randall K., Author.

Rohrer, Thomas E., Author.

Shin, Thuzar., Author.

Sobanko, Joseph F., Author.

Stiegel, Evan., Author.

Zitelli, John., Author.

Zloty, David., Author.

Contributor:

Harmon, Christopher B., Editor.

Tolkachjov, Stanislav N., Editor.

Language:

English

Subjects (All):

Surgery.

Dermatology.

Local Subjects:

Surgery.

Dermatology.

Physical Description:

1 online resource (272 pages)

Edition:

1st ed.

Place of Publication:

NEW YORK : Thieme Medical Publishers, Incorporated, 2022.

Summary:

A systematic approach to Mohs surgery and reconstruction from renowned skin cancer surgeons More than 5.4 million cases of nonmelanoma skin cancer, most notably basal cell, squamous cell carcinoma, and melanoma, occur annually in the United States alone. The Mohs technique, developed in the 1950s and refined over the years, has the highest cure rate of any treatment for nonmelanoma skin cancer, is used increasingly for melanoma, and the lowest recurrence rate. Mohs Micrographic Surgery: From Layers to Reconstruction by renowned dermatologic and Mohs surgeons Christopher Harmon and Stanislav Tolkachjov provides a detailed yet succinct road map to learning and mastering Mohs and reconstruction. The algorithmic organization coupled with instructive photographs and illustrations provide a reader-friendly format conducive to learning. The two opening chapters describe the principles of Mohs surgery including: progressive layer excision to determine if wound margins are cancer free, associated pitfalls, recurrences, special sites, reconstructive principles, and general considerations. The subsequent eight chapters are organized by facial site, from the nose to the eyelid/eyebrow. The final two chapters discuss combination reconstructions stretching over multiple subunits and perioperative management and wound care. Key Highlights An impressive group of global Mohs and reconstruction experts provide firsthand pearls that guide optimal treatment Relevant anatomical aspects that impact excision and reconstruction are detailed, including structures, skin tension lines, tissue planes, and dangers zones More than 20 procedural videos provide hands-on guidance on how to perform specific steps in Mohs and reconstruction This unique resource will help residents, fellows, and surgeons in dermatology, plastic surgery, and facial plastic surgery master

nuances of Mohs reconstructive techniques to achieve the most functional and aesthetically pleasing outcomes for patients.

Contents:

Mohs Micrographic Surgery: From Layers to Reconstruction

MedOne Access Information

Title Page

Copyright

Dedication

Contents

Videos

Foreword

Preface

Acknowledgments

Contributors

1 Mohs Micrographic Surgery

1.1 Before the First Stage

1.1.1 Tumor Selection

1.1.2 Documentation of Site

1.1.3 Time-Out

1.2 Procedures before the First Stage

1.2.1 Curettage

1.2.2 Sharp Debulking

1.3 The First Stage

1.3.1 Essentials of the First Stage

1.3.2 Incomplete Excision and Recurrence

1.4 Tissue Processing

1.4.1 Tissue Transfer

1.4.2 Relaxing Incisions and Dividing

1.4.3 Tissue Inking

1.5 Histologic Interpretation/Mapping

1.5.1 Initial Slide Quality Review

1.5.2 Histologic Interpretation

1.5.3 Tissue Mapping

1.6 Subsequent Layers

1.6.1 Subsequent Layers When Malignancy is Present Only in the Deep Tissue

1.7 Nonstandard Situations

1.8 Mohs Layers in Special Sites

1.8.1 Eyelid

1.8.2 Lip

1.8.3 Ear

1.8.4 Nose

1.8.5 Periosteum/Bone

1.8.6 Nail

1.8.7 Anogenital Region

2 Facial Subunit Reconstructive Principles and General Considerations

2.1 Design Principles of Facial Reconstruction

2.1.1 Overview

2.1.2 Free Margins

2.1.3 Contour

2.1.4 Cosmetic Subunit Junction Lines

2.1.5 Relaxed Skin Tension Lines

2.1.6 Color and Texture

2.2 Principles of Tissue Biomechanics

2.2.1 Overview

2.2.2 Preferred Vectors to Move Facial Tissue

2.2.3 How Different Reconstructions Affect Location of Tension Relative to the Primary Defect

2.2.4 Tissue Planes for Undermining and Elevating Flaps

2.3 Key Principles of Anatomy

2.3.1 Overview

2.3.2 Blood Supply to the Face

2.3.3 Superficial Musculoaponeurotic System

2.4 Systematic Approach to Assessing Facial Wounds and Choosing Reconstruction

2.4.1 Overview.

2.4.2 Define What Is Missing

2.4.3 Prioritize Principles for Reconstruction Design

2.4.4 Choose among Reconstruction Options

2.5 Reconstruction Options for Facial Reconstruction

2.5.1 Overview

2.5.2 Second Intention Healing

2.5.3 Linear Closure

2.5.4 Skin Grafts

2.5.5 Sliding Flaps

2.6 Conclusion

3 Nose

3.1 Introduction

3.2 Anatomy

3.3 Nasal Tip

3.3.1 Second Intention Healing

3.3.2 Primary Closure

3.3.3 Bilobed Flap

3.3.4 Dorsal Nasal (Rieger's) Flap

3.3.5 Forehead Flap

3.3.6 Prelaminated and Prefolded Forehead Flap

3.3.7 Conchal Bowl Full-Thickness Skin Graft

3.4 Nasal Ala

3.4.1 Second Intention

3.4.2 Grafts

3.4.3 Medial-Based Bilobed Flap

3.4.4 Spiral Flap

3.4.5 Cheek-to-Nose Interpolation Flap

3.4.6 Spear Flap

3.4.7 Technique

3.5 Soft Triangle/Columella

3.5.1 Turnover Flap

3.5.2 Nasal Tip Rotation Flap

3.6 Nasal Dorsum

3.7 Nasal Root/Lower Glabella

3.8 Nasal Sidewall

3.8.1 Rhombic Transposition Flap

3.8.2 Superior-Based Bilobed Flap

3.8.3 Lateral-Based Rotation Flap/Crescentic Advancement Flap/Cheek-Based Burow's Advancement Flap

3.8.4 V-Y Flap

3.8.5 Single-Stage Nasolabial Flap

3.9 Complications and Revisions

4 Forehead and Temple Reconstruction

4.1 Forehead and Temple Anatomy

4.1.1 Boundaries of the Forehead and Temple Subunits

4.1.2 Muscles of the Forehead and Temple

4.1.3 Blood Supply to the Forehead and Temple

4.2 Preservation of Sensory and Motor Function

4.2.1 Sensory Function

4.2.2 Motor Function

4.3 Achieving Reproducibly Excellent Cosmetic Results

4.4 Evaluating Wounds on the Forehead and Temple

4.5 Reconstruction Options for the Forehead and Temple

4.5.1 Second Intention

4.5.2 Linear Closure

4.5.3 Local Flaps

4.5.4 Sliding Flaps

4.5.5 Transposition Flaps.

4.5.6 Skin Grafts

4.6 Complications

4.7 Conclusion

5 Scalp

5.1 Relevant Anatomy

5.1.1 Skin

5.1.2 Subcutis

5.1.3 Galea Aponeurotica

5.1.4 Subgaleal Loose Connective Tissue

5.1.5 Periosteum

5.2 Reconstructive Options

5.2.1 Algorithm for Scalp Reconstruction

5.2.2 Second Intention Healing

5.2.3 Skin Grafts

5.2.4 Local Flaps

5.3 Complications

6 Cheek

6.1 Introduction

6.2 Relevant Anatomy

6.3 Aesthetic Subunits and Defects

6.4 Reconstructive Options

6.4.1 Primary Closures

6.4.2 Flaps

6.4.3 Second Intention Healing

6.4.4 Full-Thickness Skin Graft

6.5 Complications and Revisions

7 Auricular Reconstruction

7.1 Introduction

7.2 Relevant Anatomy

7.3 Reconstructive Options

7.3.1 Superior Helix

7.3.2 Mid Helix

7.3.3 Lobule

7.3.4 Antihelix

7.3.5 Concha

7.3.6 Tragus

7.3.7 Remainder of the Posterior Ear

7.4 Complications and Revisions

8 Lip (Perioral) Reconstruction

8.1 Introduction

8.2 Cosmetic Subunits and Relevant Anatomy

8.3 Reconstructive Algorithm

8.3.1 Vermilion

8.3.2 Cutaneous Lateral Upper Lip

8.3.3 Philtrum

8.3.4 Cutaneous Lower Lip

8.4 Complications and Revisions

9 Chin Reconstruction

9.1 Relevant Anatomy

9.2 Aesthetic Subunits and Defects

9.3 Reconstructive Options

9.3.1 Algorithm

9.3.2 Healing by secondary intention

9.3.3 Primary closure

9.3.4 Bilateral Advancement (O-T flap)

9.3.5 V-Y Advancement Flap

9.3.6 Rotation flaps

9.3.7 Transposition flaps

9.3.8 Full-Thickness Skin Grafts

9.4 Complications and Revisions

10 Reconstruction of the Eyelids and Eyebrows

10.1 Introduction

10.2 Surgical Anatomy of the Eyelids and Eyebrows

10.2.1 Superficial Topography of the Lids and Eyebrows

10.2.2 Orbicularis Oculi Muscle (OOM).

10.2.3 Orbital Septum (OS) and Postseptal Fat Compartments

10.2.4 Tarsoligamentous Sling

10.2.5 Eyelid Retractors

10.2.6 Conjunctiva

10.2.7 Lacrimal System

10.2.8 Neurovascular and Lymphatic System of the Lids

10.2.9 Orbit

10.2.10 Eyebrow Anatomy

10.3 Principles and Aims of Periocular Reconstruction

10.4 Perioperative Surgical Tips, Instrumentations, and Sutures in Periocular Reconstruction

10.5 Surgical Assessment of the Periocular Defect and Reconstruction Guidelines

10.6 Secondary Intention Healing

10.7 Grafts in Periocular Reconstruction

10.8 Repair of Superficial Nonmarginal Eyelid Defects

10.9 Reconstruction of the Full-Thickness Eyelid Defects

10.9.1 Primary Closure of the Full-Thickness Defects of the Eyelids

10.9.2 Semicircular Flap (Tenzel)

10.9.3 Tarsoconjunctival Flap for Lower Eyelid Reconstruction (Hughes Flap)

10.9.4 Tarsal Transposition Flap for Lateral Upper Eyelid Reconstruction

10.9.5 Cutler-Beard Flap for Complete Upper Eyelid Reconstruction

10.10 Lower Lid Tightening Procedures

10.11 Wound Dressing and Postoperative Care in Periocular Surgery Patients

10.12 Lacrimal Canalicular System Assessment and Reconstruction

10.13 Complications of Eyelid Reconstructions

10.14 Aims and Principles of Eyebrow Reconstruction

10.14.1 Primary Closure of Brow Defects

10.14.2 Advancement Flaps

10.14.3 Island-Pedicle Flaps

10.14.4 Transposition Flaps

10.14.5 Pedicle Flaps

10.14.6 Free Hair-Bearing Grafts (Composite Grafts-Skin and Hair)

10.15 Conclusion

11 Combination Reconstruction

11.1 Introduction

11.2 Combination of Primary and Graft Reconstruction

11.2.1 Arm/Hand

11.2.2 Temple

11.2.3 Cheek

11.3 Combination of Flap and Graft Reconstruction

11.3.1 Lateral Infraocular Cheek

11.3.2 Periauricular Cheek/Ear.

11.3.3 Upper Cutaneous Lip/Philtrum/Alar Sill

11.3.4 Medial Cheek/Nasal Sidewall

11.3.5 Forehead/Temple

11.3.6 Large Nasal Defects

11.4 Combination of Flaps for Reconstruction of Single and Multiple Defects

11.4.1 Large Nasal Defects

11.4.2 Lip

11.5 Reconstruction of Multiple Defects

11.5.1 Multiple Defects Repaired as One

11.5.2 "West by East-West"

11.5.3 O-T Advancement Flap, Scalp/Forehead Rotation Flap, and Paramedian Forehead Flap

11.5.4 "Combo-Z" Flap

11.5.5 Multiple Defects Repaired with Burow's Grafts

11.5.6 The "Kitchen Sink": When Combination Reconstruction and Granulation Gets Us Out of a Jam

11.6 Summary

12 Perioperative Management and Wound Care

12.1 Preoperative Considerations

12.1.1 Antibiotic Prophylaxis

12.1.2 Anticoagulants

12.1.3 Conscious Sedation/Analgesia

12.1.4 Implantable Devices

12.2 Postoperative Care

12.2.1 Granulation/Second-Intention Healing

12.2.2 Porcine Xenografts and Biologic Dressings

12.2.3 Bolster Sutures

12.2.4 Postdermabrasion Care

12.2.5 Postprimary Closure on the Lower Extremity

12.2.6 Postflap Care

12.3 Hematoma Management

12.4 Infection Management

12.4.1 Infection

12.4.2 Antimicrobial Selection

12.5 Pain Management

Index

Additional MedOne Access Information.

Notes:

Print version record.

Description based on publisher supplied metadata and other sources.

ISBN:

3-13-243702-6

3-13-242018-2

OCLC:

1371753012