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Figure c20/f001
Figure 20.1
Cosmetic unit bridging. A poorly designed and executed transposition flap has effaced the aesthetically important alar–cheek sulcus and also blunted t...
Figure c20/f005
Figure 20.5
Motor branches of the facial nerve vulnerable in skin surgery. (—) Nerves rarely encountered; (—) nerves at risk during superficial skin surgery on th...
Figure c20/f009
Figure 20.9
(a) Postoperative infection characterized by erythema, crusting and wound swelling and tenderness. (b) Areas of wound dehiscence following a flap repa...
Figure c20/f013
Figure 20.13
Reverse cutting needle.
Figure c20/f017
Figure 20.17
(a,b) Simple interrupted suture.
Figure c20/f021
Figure 20.21
(a,b) Vertical mattress suture.
Figure c20/f025
Figure 20.25
(a) This man had a basal cell carcinoma on the side of the nose; (b) this was excised and the wound was allowed to heal by second intention. (c) The c...
Figure c20/f029
Figure 20.29
Bilobed flap repair on the nose. (a) A Mohs surgical defect of the right lower nasal sidewall and alar. To prevent effacement of the aesthetically cri...
Figure c20/f033
Figure 20.33
Meshed split‐skin graft. (a) A split‐skin graft was harvested from the thigh skin using a power dermatome. (b) The skin was meshed on a mesher, and th...
Figure c20/f037
Figure 20.37
Defects following Mohs micrographic surgery (MMS) for ‘high risk’ facial basal cell carcinoma (BCC) illustrating significant tumour extension beyond t...
Figure c20/f041
Figure 20.41
Shave excision and electrosurgery of a rhinophyma. (a) This disfiguring rhinophyma was reduced in size, and (b) the nose shape recreated by shave exci...
Figure c20/f045
Figure 20.45
Subfrontalis lipoma. This lipoma lies beneath the frontalis muscle. The muscle has been split vertically and is held back with forceps to reveal the l...
Figure c20/f002
Figure 20.2
Arteries of the head and neck encountered in skin surgery. The labial artery lies on the inside (mucosal) surface of the lip approximately 5 mm from t...
Figure c20/f006
Figure 20.6
Potential surgical hazard sites during skin surgery on the head. Nerve. (From Lawrence [ ].)
Figure c20/f010
Figure 20.10
Principles of elliptical excision. The ellipse is designed to follow skin‐crease lines (a), and should be approximately three times as long as it is w...
Figure c20/f014
Figure 20.14
(a–c) Tying knots with the needle‐holder.
Figure c20/f018
Figure 20.18
(a,b) Buried dermal suture.
Figure c20/f022
Figure 20.22
(a,b) Horizontal mattress suture.
Figure c20/f026
Figure 20.26
(a) This man had a basal cell carcinoma on the temple (b) excised. (c) Three months later, the wound had healed but the scar was thick and red; (d) 15...
Figure c20/f030
Figure 20.30
An interpolated paramedian forehead flap. An ill‐defined morphoeic basal cell carcinoma (BCC) of the nose. (a) Following Mohs surgical removal, an ext...
Figure c20/f034
Figure 20.34
(a,b) M‐plasty design in this case prevents the scar extending onto the eyelid skin.
Figure c20/f038
Figure 20.38
The stages of Mohs micrographic surgery.
Figure c20/f042
Figure 20.42
Electrofulguration. Diffuse superficial coagulation can be achieved by passing the electrode of a monopolar electrosurgical unit over the skin without...
Figure c20/f003
Figure 20.3
Potential surgical hazard sites during skin surgery on the head. Potential blood vessel and duct. (From Lawrence [ ].)
Figure c20/f007
Figure 20.7
Nerve damage: transection of the temporal branch of the facial nerve resulting in ipsilateral paralysis of the frontalis muscle.
Figure c20/f011
Figure 20.11
Scar orientation: (a) a surgical defect on the central forehead. (b) Having marked out the forehead skin rhytids, the defect is closed primarily ensur...
Figure c20/f015
Figure 20.15
Surgeon's friction knot.
Figure c20/f019
Figure 20.19
(a,b) Simple running sutures.
Figure c20/f023
Figure 20.23
(a,b) Pulley suture.
Figure c20/f027
Figure 20.27
Rotation flap for the repair of a Mohs surgical defect of the left zygomatic cheek. (a) Note the design of the flap is such that the arc of rotation p...
Figure c20/f031
Figure 20.31
Complications. Flap necrosis. A large modified rhombic transposition flap on the left anterior thigh of a heavy smoker has undergone a degree of tip n...
Figure c20/f035
Figure 20.35
Technique of Z‐plasty. (From Eedy et al. [ ].)
Figure c20/f039
Figure 20.39
Intraoperative picture during Mohs micrographic surgery illustrating the role of the Mohs map in identifying the location of residual tumour. (a) Poor...
Figure c20/f043
Figure 20.43
Electrodesiccation. Focused coagulation, e.g. of bleeding points, can be achieved with a monopolar unit using a fine‐tipped needle to deliver more con...
Figure c20/f004
Figure 20.4
Sensory nerves on the face used in nerve block anaesthesia. Sensation on the face is served by the three main divisions of the trigeminal nerve: the o...
Figure c20/f008
Figure 20.8
Vermilion approximation. (a) The vermilion border and melolabial crease have been marked prior to closure of the Mohs surgical defect. (b) Closure of ...
Figure c20/f012
Figure 20.12
Shave biopsy of benign papular naevi. (a) This patient had a benign tan‐coloured naevus on the face (b) removed by shave excision followed by cautery,...
Figure c20/f016
Figure 20.16
Final throw.
Figure c20/f020
Figure 20.20
(a,b) Running locked sutures.
Figure c20/f024
Figure 20.24
(a,b) Purse string suture.
Figure c20/f028
Figure 20.28
Transposition flap. (a) A large Mohs surgical defect on the right cheek/jawline. (b) The main skin reservoir is located within the ipsilateral neck. A...
Figure c20/f032
Figure 20.32
(a) Surgical defect following excision of a basal cell carcinoma. (b) A template of the defect is created on a non‐adherent dressing. (c) Template in ...
Figure c20/f036
Figure 20.36
Single and multiple Z‐plasty. (a,b) Single Z‐plasty. (c,d) Multiple Z‐plasty. Note breaking up of zone of lateral tension (shaded areas) with multiple...
Figure c20/f040
Figure 20.40
‘High‐risk’ facial basal cell carcinoma (BCC) suitable for Mohs micrographic surgery (MMS). (a) Extensive nasal BCC. (b) Extensive lower eyelid BCC, r...
Figure c20/f044
Figure 20.44
Ring curette. (a) Curettage of a small nodular basal cell carcinoma (BCC) on the forehead using a ring curette. (b) Haemostasis with bipolar diathermy...