Mohs Micrographic Surgery: From Layers to Reconstruction [Team-IRA]

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
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