Facial Reconstruction After Mohs Surgery-1판

The growing worldwide incidence of melanoma and nonmelanoma skin cancers has driven the development of
effective treatment methodologies. Mohs is the gold standard surgical treatment for excision of skin cancers on the
head and neck. While Mohs surgery has a 99% effectiveness rate for new cancers and 95% for recurrences, more
than 90% of reconstructed patients desire some improvement in their operative scars.

Facial Reconstruction after Mohs Surgery by James Thornton and Jourdan Carboy summarizes 15 years and 12,000
cases in a surgical practice devoted to post-Mohs facial reconstruction. Step-by-step guidance is provided on
efficacious, aesthetically pleasing, and functionally complete repairs, respective of a patient's age, anesthesia
considerations, and available resources. In addition to succinct chapters on lip, ear, cheek, scalp, and nasal
reconstruction, subspecialty chapters cover anesthesia, Mohs surgery, oculoplastic surgery, and microvascular
reconstruction. Throughout the text, complete and concise clinical algorithms serve as a framework to help simplify
difficult clinical concepts.

Key Highlights
　· General techniques including wound care, skin and cartilage grafts; and local and pedicled flaps

　· The management of intraoperative, acute, and late healing stage complications; scar optimization and revision
　　surgeries

　· Additional procedural guidance provided in 20 high quality video clips posted in the Thieme MediaCenter

　· Nearly 500 full-color photos and precise drawings add a rich visual dimension and show stepwise operative
　　sequences

This book is a comprehensive resource on tried and true techniques for soft tissue reconstruction after Mohs cancer
resection. It is essential reading for plastic surgery, facial plastic surgery and dermatology residents and clinicians
with practices devoted to facial plastic surgery.




Part 1 : Introduction

1. Special Considerations for Mohs Patients
　1.1 General Principles
　1.2 Conduct of the Operation

2. Anesthesia for Reconstruction of Facial Mohs Defects
　2.1 Gneral Principles
　2.2 Types of Anesthesia
　　2.2.1 Monitored Anesthesia Care
　　2.2.2 General Anesthesia
　2.3 Recovery
　　2.3.1 Obstructive Sleep Apnea
　　2.3.2 Malignant Hyperthermia
　2.4 Operating Room Fires
　2.5 Postoperative Cognitive Dysfunction
　2.6 A Note on Office-Based Anesthesia

3. Mohs Micrographic Surgery
　3.1 Introduction
　3.2 History
　3.3 Preperative Considerations
　3.4 Description of Technique
　3.5 Postoperative Considerations
　3.6 Complications
　　3.6.1 Nonmelanoma Skin Cancers
　　3.6.2 Basal Cell Carcinoma
　　3.6.3 Squamous Cell Carcinoma
　　3.6.4 Melanoma
　　3.6.5 Other Tumors
　3.7 Conclusion

4. Cellular and Tissue-Based Wound Care
　4.1 Algorithm
　　4.1.1 General Considerations
　4.2 Integra
　4.3 Cellular and Tissue-Based Products

5. Full-Thickness Skin Grafts
　5.1 Algorithm
　　5.1.1 Gneral Considerations
　5.2 Selection of Donor Site
　5.3 Graft Elevation and Inset
　　5.3.1 Bolstering the Graft
　　5.3.2 Postoperative Care

6. Split-Thickness Skin Grafting
　6.1 General Considerations
　6.2 Donor-Site Selection
　6.3 Harvest Technique
　6.4 Graft Inset

7. Cartilage Grafts
　7.1 General Considerations
　7.2 Donor-Site Selection
　　7.2.1 Conchal Bowl Donor Site
　　7.2.2 Rib Cartilage Donor Site
　　7.2.3 Septal Cartilage Donor Site
　　7.2.4 Banked Frozen Allograft Cartilage

8. Pedicled Flaps
　8.1 General Considerations
　　8.1.1 Nasolabial Flap
　　8.1.2 Paramidline Forehead Flap
　8.2 Postoperative Care

9. Local Flaps
　9.1 General Considerations
　9.2 Linear Closure
　9.3 Rotation Flaps
　9.4 Advancement Flaps
　9.5 Transposition Flaps
　9.6 Bilobed Flap
　9.7 Dorsal Nasal Flap
　9.8 Melolabial Flap
　9.9 Note Flap


Part 2 : Techniques for Specific Anatomic Location

10. Scalp Reconstruction
　10.1 Algorithm For Closure
　　10.1.1 General Considerations
　10.2 Commonly Applied Methods of Closure
　　10.2.1 Bone Exposure and Calvarial Defects
　　10.2.2 Direct Closure
　10.3 Postoperative Management

11. Forehead Reconstruction
　11.1 Algorithm for Closure
　　11.1.1 General Considerations
　11.2 Commonly Applied Methods of Closure
　　11.2.1 Delayed Healing/Acellular Adjuncts
　　11.2.2 Direct Closure
　　11.2.3 Defects Involving the Eyebrow
　11.3 Postoperative Management

12. Introduction to Nose and Simple Nasal Defects
　12.1 General Principles of Nasal Reconstruction
　　12.1.1 Regional Considerations: Upper Two-Thirds versus Lower One-Third of the Nose
　12.2 General Techniques for Closure of Simple Nasal Defects
　　12.2.1 Secondary Healing
　　12.2.2 Full-Thickness Skin Grafting
　　12.2.3 Primary Closure and Local Flaps for Simple Defects
　12.3 Seven Local Flap Options
　　12.3.1 Primary Closure
　　12.3.2 Note Flap
　　12.3.3 Bilobed Flap
　　12.3.4 Dorsal Nasal Flap
　　12.3.5 V-Y Advancement Flap
　　12.3.6 Melolabial Flap
　　12.3.7 Postoperative Management

13. Complex Nasal Defects
　13.1 General Principles in Complex Nasal Defects and Reconstruction
　　13.1.1 Nasolabial Flaps
　　13.1.2 Forehead Flaps
　13.2 Special Considerations: Three-Stage Forehead Flap
　　13.2.1 Special Considerations: Lining and Cartilage Support
　　13.2.2 Postoperative Management
　13.3 Free Tissue Transfer
　　13.3.1 Potential Approaches
　　13.3.2 Technique
　13.4 Problems and Complications

14. Nasal Reconstruction Based on Subunits
　14.1 Algorithm for Closure
　　14.1.1 Sidewall

15. Eyelid Reconstruction
　15.1 Anatomical Considerations
　15.2 Algorithm for Closure
　15.3 Defects Involving the Canthus
　　15.3.1 Medical Canthal Defects
　　15.3.2 Lateral Canthal Defects
　15.4 Defects Not Involving the Canthus
　　15.4.1 Upper and Lower Eyelid: Partial-Thickness Defects
　　15.4.2 Upper and Lower Eyelid: Full-Thickness Defects

16. Cheek Reconstruction
　16.1 Algorithm for Closure
　　16.1.1 General Considerations
　　16.1.2 Commonly Applied Methods of Closure
　16.2 Primary Closure
　16.3 V-Y Advancement Flap
　16.4 Perialar Crescentic Advancement Flap
　16.5 Cervicofacial Advancement Flap
　16.6 Full-Thickness Skin Grafts
　16.7 Postoperative Management

17. Chin Reconstruction
　17.1 Algorithm for Closure
　17.2 Commonly Applied Methods of Closure
　　17.2.1 Primary Closure
　　17.2.2 Bilobed Flaps
　17.3 V-Y Advancemnet Flap
　17.4 Full-Thickness Skin Grafts
　17.5 Postoperative Managemnet

18. Lip Reconstruction
　18.1 Algorithm for Closure
　　18.1.1 Anatomy
　18.2 Commonly Applied Methods of Closure
　　18.2.1 Mucosal-Only Defects
　18.3 Skin-Only Defects
　　18.3.1 Direct Closure
　18.4 Combined Skin and Mucosal Defects
　　18.4.1 Direct Closure with or without Wedge Resection
　　18.4.2 Central Defects of the Upper Lip: Abbe and Rotation Flaps
　　18.4.3 Lateral Commissure Defects: Advancement Closure
　　18.4.4 Large Defects of the Upper or Lower Lip: Karapandzic Flap
　　18.4.5 Upper and Lower Lip Mismatch: AlloDerm Placement
　18.5 Postoperative Management

19. Ear Reconstruction
　19.1 Algorithm for Ear Reconstruction
　　19.1.1 Anatomical Considerations
　19.2 Commonly Applied Methods of Closure
　　19.2.1 Secondary Closure
　　19.2.2 Full-Thickness Skin Grafting
　　19.2.3 Local Flap Wedge or Local Flap Closure
　　19.2.4 Folded Postauricular Two-Stage Ear Flap Reconstruction (Dieffenbach Flap)
　　19.2.5 Postoperative Care
　19.3 Total Ear Reconstruction
　　19.3.1 Medpor Technique
　　19.3.2 General Operative Setup
　　19.3.3 Procedure Details
　　19.3.4 Dressings


Part 3 : Managemnet of Complications and Revisions

20. Intraoperative Complications and Initial Management
　20.1 General Principles
　　20.1.1 A Note on Patient Consent
　20.2 Intraoperative Complications
　　20.2.1 Fire
　　20.2.2 Bronchospasm
　　20.2.3 Perioperative Anaphylaxis
　　20.2.4 Corneal Injuries
　　20.2.5 Nerve Injury

21. Management of Complications in the Acute Healing Stage
　21.1 General Principles
　　21.1.1 Hematoma
　　21.1.2 Infection
　　21.1.3 Dermatitis
　　21.1.4 Chondritis
　　21.1.5 Flap Failure

22. Management of Complications in the Late Healing Stage
　22.1 General Cosiderations
　　22.1.1 Hypo-and Hyperpigmentation
　　22.1.2 Contour Abnormalities
　　22.1.3 Cancer Recurrence

23. Skin Graft Revisions
　23.1. General Principles
　　23.1.1 Initial Postoperative Visit
　　23.1.2 Unacceptable Color Match or Scar Contour
　　23.1.3 Dermabrasion

24. Local Flap Revisions
　24.1 Complications and Their Management
　　24.1.1 Noninvasive Management
　　24.1.2 Revision Surgery
　　24.1.3 Z-Plasty

25. Pedicled Flap Revisions
　25.1 Introduction
　25.2 General Principles
　　25.2.1 Early Healing Stage
　　25.2.2 Contour Abnormalities and Late Healing Stage Revisions
　　25.2.3 Autologous Fat Grafting