Cosmetic unit bridging. A poorly designed and executed transposition flap has effaced the aesthetically important alar–cheek sulcus and also blunted t...
Motor branches of the facial nerve vulnerable in skin surgery. (—) Nerves rarely encountered; (—) nerves at risk during superficial skin surgery on th...
(a) Postoperative infection characterized by erythema, crusting and wound swelling and tenderness. (b) Areas of wound dehiscence following a flap repa...
Reverse cutting needle.
(a,b) Simple interrupted suture.
(a,b) Vertical mattress suture.
(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...
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...
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...
Defects following Mohs micrographic surgery (MMS) for ‘high risk’ facial basal cell carcinoma (BCC) illustrating significant tumour extension beyond t...
Shave excision and electrosurgery of a rhinophyma. (a) This disfiguring rhinophyma was reduced in size, and (b) the nose shape recreated by shave exci...
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...
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...
Potential surgical hazard sites during skin surgery on the head. Nerve. (From Lawrence [ ].)
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...
(a–c) Tying knots with the needle‐holder.
(a,b) Buried dermal suture.
(a,b) Horizontal mattress suture.
(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...
An interpolated paramedian forehead flap. An ill‐defined morphoeic basal cell carcinoma (BCC) of the nose. (a) Following Mohs surgical removal, an ext...
(a,b) M‐plasty design in this case prevents the scar extending onto the eyelid skin.
The stages of Mohs micrographic surgery.
Electrofulguration. Diffuse superficial coagulation can be achieved by passing the electrode of a monopolar electrosurgical unit over the skin without...
Potential surgical hazard sites during skin surgery on the head. Potential blood vessel and duct. (From Lawrence [ ].)
Nerve damage: transection of the temporal branch of the facial nerve resulting in ipsilateral paralysis of the frontalis muscle.
Scar orientation: (a) a surgical defect on the central forehead. (b) Having marked out the forehead skin rhytids, the defect is closed primarily ensur...
Surgeon's friction knot.
(a,b) Simple running sutures.
(a,b) Pulley suture.
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...
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...
Technique of Z‐plasty. (From Eedy et al. [ ].)
Intraoperative picture during Mohs micrographic surgery illustrating the role of the Mohs map in identifying the location of residual tumour. (a) Poor...
Electrodesiccation. Focused coagulation, e.g. of bleeding points, can be achieved with a monopolar unit using a fine‐tipped needle to deliver more con...
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...
Vermilion approximation. (a) The vermilion border and melolabial crease have been marked prior to closure of the Mohs surgical defect. (b) Closure of ...
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,...
(a,b) Running locked sutures.
(a,b) Purse string suture.
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...
(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 ...
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...
‘High‐risk’ facial basal cell carcinoma (BCC) suitable for Mohs micrographic surgery (MMS). (a) Extensive nasal BCC. (b) Extensive lower eyelid BCC, r...
Ring curette. (a) Curettage of a small nodular basal cell carcinoma (BCC) on the forehead using a ring curette. (b) Haemostasis with bipolar diathermy...