Flaps and Grafts in Dermatologic Surgery: Text with DVD

257 Pages·2008·30.343 MB·English

by  Thomas E. Rohrer MD, Jonathan L. Cook MD, Tri H. Nguyen MD

FFllaps andd GGraffts iin
Dermatologic Surgery
PLEASE READ THE FOLLOWING AGREEMENT CAREFULLY BEFORE USING THIS DVD-ROM PRODUCT. THIS DVD-ROM PRODUCT IS
LICENSED UNDER THE TERMS CONTAINED IN THIS DVD-ROM LICENSE AGREEMENT (“Agreement”). BY USING THIS DVD-ROM PRODUCT,
YYOU, AN INDIVIDUAL OR ENTITY INCLUDING EMPLOYEES, AGENTS AND REPRESENTATIVES (“You” or “Your”), ACKNOWLEDGE THAT YOU
HAVE READ THIS AGREEMENT, THAT YOU UNDERSTAND IT, AND THAT YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS OF
THIS AGREEMENT. ELSEVIER INC. (“Elsevier”) EXPRESSLY DOES NOT AGREE TO LICENSE THIS DVD-ROM PRODUCT TO YOU UNLESS YOU
AASSENT TO THIS AGREEMENT. IF YOU DO NOT AGREE WITH ANY OF THE FOLLOWING TERMS, YOU MAY, WITHIN THIRTY (30) DAYS
AAFTER YOUR RECEIPT OF THIS DVD-ROM PRODUCT RETURN THE UNUSED, PIN NUMBER PROTECTED, DVD-ROM PRODUCT, ALL
AACCOMPANYING DOCUMENTATION TO ELSEVIER FOR A FULL REFUND.
DEFINITIONSAs used in this Agreement, these terms shall have the following meanings:
“Proprietary Material” means the valuable and proprietary information content of this DVD-ROM Product including all indexes and graphic materials and
software used to access, index, search and retrieve the information content from this DVD-ROM Product developed or licensed by Elsevier and/or its
affiliates, suppliers and licensors.
“DVD-ROM Product” means the copy of the Proprietary Material and any other material delivered on DVD-ROM and any other human-readable or
machine-readable materials enclosed with this Agreement, including without limitation documentation relating to the same.
OWNERSHIPThis DVD-ROM Product has been supplied by and is proprietary to Elsevier and/or its affiliates, suppliers and licensors. The copyright in the
DVD-ROM Product belongs to Elsevier and/or its affiliates, suppliers and licensors and is protected by the national and state copyright, trademark, trade
secret and other intellectual property laws of the United States and international treaty provisions, including without limitation the Universal Copyright
Convention and the Berne Copyright Convention. You have no ownership rights in this DVD-ROM Product. Except as expressly set forth herein, no part of
this DVD-ROM Product, including without limitation the Proprietary Material, may be modified, copied or distributed in hardcopyyor machine-readable
form without prior written consent from Elsevier. All rights not expressly granted to You herein are expressly reserved. Any other use of this DVD-ROM
Product by any person or entity is strictly prohibited and a violation of this Agreement.
SCOPE OF RIGHTS LICENSED (PERMITTED USES)Elsevier is granting to You a limited, non-exclusive, non-transferable license to use this DVD-ROM
Product in accordance with the terms of this Agreement. You may use or provide access to this DVD-ROM Product on a single computer or terminal
physically located at Your premises and in a secure network or move this DVD-ROM Product to and use it on another single computer or terminal at the
same location for personal use only, but under no circumstances may You use or provide access to any part or parts of this DVD-ROM Product on more
than one computer or terminal simultaneously.
YYou shall not (a) copy, download, or otherwise reproduce the DVD-ROM Product in any medium, including, without limitation, online transmissions, local
area networks, wide area networks, intranets, extranets and the Internet, or in any way, in whole or in part, except for printing out or downloading
nonsubstantial portions of the text and images in the DVD-ROM Product for Your own personal use; (b) alter, modify, or adapt the DVD-ROM Product,
including but not limited to decompiling, disassembling, reverse engineering, or creating derivative works, without the prior written approval of Elsevier;
(c) sell, license or otherwise distribute to third parties the DVD-ROM Product or any part or parts thereof; or (d) alter, remove, obscure or obstruct the
display of any copyright, trademark or other proprietary notice on or in the DVD-ROM Product or on any printout or download of portions of the
Proprietary Materials.
RESTRICTIONS ON TRANSFERThis License is personal to You, and neither Your rights hereunder nor the tangible embodiments of this DVD-ROM
Product, including without limitation the Proprietary Material, may be sold, assigned, transferred or sublicensed to any other person, including without
limitation by operation of law, without the prior written consent of Elsevier. Any purported sale, assignment, transfer or sublicense without the prior written
consent of Elsevier will be void and will automatically terminate the License granted hereunder.
TERMThis Agreement will remain in effect until terminated pursuant to the terms of this Agreement. You may terminate this Agreementtat any time by
removing from Your system and destroying the DVD-ROM Product. Unauthorized copying of the DVD-ROM Product, including without limitation, the
Proprietary Material and documentation, or otherwise failing to comply with the terms and conditions of this Agreement shall result in automatic
termination of this license and will make available to Elsevier legal remedies. Upon termination of this Agreement, the license granted herein will terminate
and You must immediately destroy the DVD-ROM Product and accompanying documentation. All provisions relating to proprietary rights shall survive
termination of this Agreement.
LIMITED WARRANTY AND LIMITATION OF LIABILITYNEITHER ELSEVIER NOR ITS LICENSORS REPRESENT OR WARRANT THAT THE
DVD-ROM PRODUCT WILL MEET YOUR REQUIREMENTS OR THAT ITS OPERATION WILL BE UNINTERRUPTED OR ERROR-FREE. WE
EXCLUDE AND EXPRESSLY DISCLAIM ALL EXPRESS AND IMPLIED WARRANTIES NOT STATED HEREIN, INCLUDING THE IMPLIED
WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. IN ADDITION, NEITHER ELSEVIER NOR ITS LICENSORS
MAKE ANY REPRESENTATIONS OR WARRANTIES, EITHER EXPRESS OR IMPLIED, REGARDING THE PERFORMANCE OF YOUR NETWORK OR
COMPUTER SYSTEM WHEN USED IN CONJUNCTION WITH THE DVD-ROM PRODUCT. WE SHALL NOT BE LIABLE FOR ANY DAMAGE OR
LOSS OF ANY KIND ARISING OUT OF OR RESULTING FROM YOUR POSSESSION OR USE OF THE SOFTWARE PRODUCT CAUSED BY ERRORS
OR OMISSIONS, DATA LOSS OR CORRUPTION, ERRORS OR OMISSIONS IN THE PROPRIETARY MATERIAL, REGARDLESS OF WHETHER SUCH
LIABILITY IS BASED IN TORT, CONTRACT OR OTHERWISE AND INCLUDING, BUT NOT LIMITED TO, ACTUAL, SPECIAL, INDIRECT,
INCIDENTAL OR CONSEQUENTIAL DAMAGES. IF THE FOREGOING LIMITATION IS HELD TO BE UNENFORCEABLE, OUR MAXIMUM
LIABILITY TO YOU SHALL NOT EXCEED THE AMOUNT OF THE LICENSE FEE PAID BY YOU FOR THE SOFTWARE PRODUCT. THE REMEDIES
AAVAILABLE TO YOU AGAINST US AND THE LICENSORS OF MATERIALS INCLUDED IN THE SOFTWARE PRODUCT ARE EXCLUSIVE.
If this DVD-ROM Product is defective, Elsevier will replace it at no charge if the defective DVD-ROM Product is returned to Elsevier within sixty (60) days
(or the greatest period allowable by applicable law) from the date of shipment.
Elsevier warrants that the software embodied in this DVD-ROM Product will perform in substantial compliance with the documentation supplied in this
DVD-ROM Product. If You report a significant defect in performance in writing to Elsevier, and Elsevier is not able to correct same within sixty (60) days
after its receipt of Your notification, You may return this DVD-ROM Product, including all copies and documentation, to Elsevier and Elsevier will refund
YYour money.
YYOU UNDERSTAND THAT, EXCEPT FOR THE 60-DAY LIMITED WARRANTY RECITED ABOVE, ELSEVIER, ITS AFFILIATES, LICENSORS,
SUPPLIERS AND AGENTS, MAKE NO WARRANTIES, EXPRESSED OR IMPLIED, WITH RESPECT TO THE DVD-ROM PRODUCT, INCLUDING,
WITHOUT LIMITATION THE PROPRIETARY MATERIAL, AND SPECIFICALLY DISCLAIM ANY WARRANTY OF MERCHANTABILITY OR FITNESS
FOR A PARTICULAR PURPOSE.
If the information provided on this DVD-ROM Product contains medical or health sciences information, it is intended for professional use within the
medical field. Information about medical treatment or drug dosages is intended strictly for professional use, and because of rapid advances in the medical
sciences, independent verification of diagnosis and drug dosages should be made.
IN NO EVENT WILL ELSEVIER, ITS AFFILIATES, LICENSORS, SUPPLIERS OR AGENTS, BE LIABLE TO YOU FOR ANY DAMAGES, INCLUDING,
WITHOUT LIMITATION, ANY LOST PROFITS, LOST SAVINGS OR OTHER INCIDENTAL OR CONSEQUENTIAL DAMAGES, ARISING OUT OF
YYOUR USE OR INABILITY TO USE THE DVD-ROM PRODUCT REGARDLESS OF WHETHER SUCH DAMAGES ARE FORESEEABLE OR WHETHER
SUCH DAMAGES ARE DEEMED TO RESULT FROM THE FAILURE OR INADEQUACY OF ANY EXCLUSIVE OR OTHER REMEDY.
U.S. GOVERNMENT RESTRICTED RIGHTSThe DVD-ROM Product and documentation are provided with restricted rights. Use, duplication or
disclosure by the U.S. Government is subject to restrictions as set forth in subparagraphs (a) through (d) of the Commercial Computer Restricted Rights
clause at FAR 52.22719 or in subparagraph (c)(1)(ii) of the Rights in Technical Data and Computer Software clause at DFARS 252.2277013, or at
252.2117015, as applicable. Contractor/Manufacturer is Elsevier Inc., 360 Park Avenue South, New York, NY 10010 USA.
GOVERNING LAWThis Agreement shall be governed by the laws of the State of New York, USA. In any dispute arising out of this Agreement, You and
Elsevier each consent to the exclusive personal jurisdiction and venue in the state and federal courts within New York County,New York, USA.
FFllaps andd GGraffts iin
Dermatologic Surgery
TThhomas EE RRohhrer TTrii HH NNguyen
MD MD
Skin Care Physicians Director of Mohs/Dermatologic Surgery;
Chestnut Hill, MA, USA AAssociate Professor, Dermatology & Otolaryngology
Clinical Associate Professor, Dermatology Department of Dermatology
Boston University School of Medicine MD Anderson Cancer Center
Boston, MA, USA The University of Texas
Houston, TX, USA
Jonathan L Cook J Ramsey Mellette Jr
MD MD
AAssociate Professor of Medicine (Dermatology) Director of Mohs Surgery
AAssistant Professor of Surgery Department of Dermatology
Director of Mohs and Dermatologic Surgery University of Colorado Health Center
Duke University Medical Center AAurora, CO, USA
Durham, NC, USA
DVD Editor
Michael R Migden
MD
AAssistant Professor, Department of Dermatology
AAssistant Professor, Department of Plastic Surgery
MD Anderson Cancer Center
The University of Texas
Houston, TX, USA
SAUNDERS An imprint off Ellsevier Inc.
© 2007, Elsevier Inc. All rights reserved.
First published 2007
No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise, without the prior permission of the Publishers. Permissions may
be sought directly from Elsevier’s Health Sciences Rights Department, 1600 John F.
Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA: phone: (+1) 215
239 3804; fax: [phone]; or, e-mail:[email protected]. You may
also complete your request on-line via the Elsevier homepage (http://www.elsevier.com),
by selecting ‘Support and contact’ and then ‘Copyright and Permission’.
ISBN-10: 1-4160-0316-9
ISBN-13: 978-1-14160-0316-8
British Library Cataloguing in Publication Data
AA catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
AA catalog record for this book is available from the Library of Congress
Notice
Medical knowledge is constantly changing. Standard safety precautions must be
followed, but as new research and clinical experience broaden our knowledge, changes in
treatment and drug therapy may become necessary or appropriate. Readers are advised to
check the most current product information provided by the manufacturer of each drug
to be administered to verify the recommended dose, the method and duration of
administration, and contraindications. It is the responsibility of the practitioner, relying
on experience and knowledge of the patient, to determine dosages and the best treatment
for each individual patient. Neither the Publisher nor the authorassume any liability for
any injury and/or damage to persons or property arising from this publication.
The Publisher
Commissioning Editor:Karen Bowler
Project Development Manager:Helen Sofio
Project Manager:Rory MacDonald
Design Manager:Jayne Jones
Illustration Manager:Bruce Hogarth
Illustrator:Richard Prime
Marketing Manager(s) (UK/USA):Clara Toombs/Lisa Damico
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contents
CContriibbutors viiii CChhapter 5 RRotatiion FFllaps 59
Foreword ix
Glenn Goldman
Preface xi
Rotation Flap Design: Basic Principles 59
Bilateral Rotation Flaps 61
Special Rotation Flaps 61
Chapter 1 Anatomy 1 Plane of Flap Elevation and Surgical Undermining 67
Conclusion 67
Stuart J Salasche
Introduction 1 Chapter 6 Island Pedicle Flaps 69
Surface Landmarks and Surface Anatomy 1 JJoel Cook
The Aging Face 3
Flap Design and Considerations 69
The Musculoaponeurotic System 4
Technique 70
Motor Nerves 6
Modifications 74
Sensory Nerves of the Head and Neck 8
Complications 76
Vascular System 9
Special Structures: Lip, Nose, Eyelids, Ear 11
Chapter 7 Transposition Flaps 79
Chapter 2 Basic Principles in Flap AAshish Bhatia and Thomas E Rohrer
Reconstruction 15
Flap Design and Considerations 79
Suneel Chilukuri and David J Leffell Rhombic Flaps 79
Other Transposition Flaps 84
Basic Terminology 15
Complications 89
Flaps Defined by Blood Supply 15
Conclusion 89
Flap Physiology 17
Flap Biomechanics 18
Chapter 8 Staged Interpolation Flaps 91
Flaps Defined by Movement 19
Tri H Nguyen
Practical Points 26
Final Thoughts 27 Paramedian Forehead Flap (PFF), Stage I 91
Paramedian Forehead Flap, Stage II 96
Chapter 3 Primary Closure 31
Cheek-to-Nose Interpolation Flap (CNIF) 96
Daniel Berg Cheek-to-Nose Interpolation Flap, Stage II 99
AAbbé (Lip-Switch) Flap 100
Primary Closure Design and Considerations 31
AAbbé Flap, Stage II 103
Modifications or Variations 34
Conclusion 104
AApplications and Disadvantages 37
Chapter 4 Advancement Flaps 41 Chapter 9 Skin Grafts 107
Molly Wanner, Christopher Adams and Désirée Ratner
Christie Travelute Ammirati and Roberta D Sengelmann
Full-Thickness Skin Grafts 107
Flap Design and Considerations 41
Split-Thickness Skin Grafts 112
Flap Mobilization and Key Sutures 42
Conclusion 113
Flap Modifications and Applications 44
Graft Complication 114
Disadvantages 56
vi Contents
CChhapter 100 SScallp RReconstructiion 117 CChhapter 14 EEar RReconstructiion 179
Ken K Lee, Khosrow Mehrany and Neil A Swanson Hayes B Gladstone and Greg S Morganroth
Scalp Surgical Anatomy 117 Introduction 179
Evaluation of the Scalp Defect 118 Ear Aesthetics 179
Basic Reconstruction Concepts 118 Embryology 179
Second Intention Healing 119 Topography 179
Primary Closure 119 General Principles 181
Split-Thickness Skin Grafts 120 Reconstructive Options 181
Full-Thickness Skin Grafts 121 Prosthetics and When to Refer 189
Random Pattern Cutaneous Flaps 121
Conclusion 123 Chapter 15 Nasal Reconstruction 191
JJonathan L Cook
Chapter 11 Forehead and Temple 125
Introduction 191
Christopher B Harmon and Betty Davis
Reconstructive Options 196
Reconstructive Principles 125 Complications 212
Complications 133 Conclusion 214
Conclusion 134
Chapter 16 Perioral Reconstruction 217
Chapter 12 Periocular Reconstruction 137 JJames T Chapman and J Ramsey Mellette Jr
Paul Bowman, Scott W Fosko and Morris E Hartstein
Introduction 217
Introduction 137 General Principals of Lip Reconstruction 218
Periocular Anatomy 137 Reconstruction 219
Preparation 139
General Principles of Periocular Reconstruction 139 Chapter 17 The Neck 235
Methods of Closure 141 Michael M Todd and Victor J Marks
AApproach to Reconstruction by Periocular Subunits 143
Preoperative Considerations 235
Chapter 13 Cheek Reconstruction 159 Relevant Anatomy 235
Reconstructive Options 235
Richard G Bennett
Regional Pearls/Complications 239
Regional Reconstruction Principles 159 Summary 239
Flaps by Cheek Region 160
Complications 173
Index 241
Conclusion 176
Contributors
CChristopher Adams MD JJoell CCookk MMDD KKen KK LLee MMDD
Resident Associate Professor of Dermatology Assistant Professor
College of Physicians and Surgeons of Medical University of South Carolina Department of Dermatology
Columbia University Charleston, SC, USA Oregon Health & Science University
Columbia University Medical Center Portland, OR, USA
New York, NY, USA Jonathan L Cook MD
Associate Professor of Medicine (Dermatology) David J Leffell MD
Christie Travelute Ammirati MD Assistant Professor of Surgery Professor of Dermatology and Surgery
AAssistant Professor of Dermatology Director of Mohs and Dermatologic Surgery Department of Dermatology and Surgery
PennState Milton Hershey Medical Center Duke University Medical Center Yale University School of Medicine
Hershey, PA, USA Durham, NC, USA New Haven, CT, USA
Richard G Bennett MD Betty Davis MD Victor J Marks MD
Clinical Professor of Dermatology Fellow, Mohs Micrographic Surgery Chief of Dermatologic Surgery
University of Southern California and Clinical Department of Dermatology Associate Professor
Professor of Medicine (Dermatology) University of Alabama at Birmingham Department of Internal Medicine
University of California at Los Angeles Birmingham, AL, USA Geisinger Medical Center
Los Angeles, CA Penn State University Geisinger Medical Center
Scott W Fosko MD Danville, PA, USA
Daniel Berg MD FRCPC Director, Mohs Micrographic Surgery Unit
AAssociate Professor, Medicine Associate Professor and Chairman Khosrow Mehrany MD
Dermatology Director Department of Dermatology Instructor, Dermatology
Department of Dermatologic Surgery St Louis University Oregon Health & Science University
University of Washington Medical Center St Louis, MO, USA Portland, OR, USA
Roosevelt Dermatology Clinic
Seattle, WA, USA Hayes B Gladstone MD J Ramsey Mellette Jr MD
Director, Division of Dermatologic Surgery Director of Mohs Surgery
AAshish C Bhatia MD Department of Dermatology Department of Dermatology
Fellow in Mohs Micrographic Surgery, Cosmetic Stanford University School of Medicine University of Colorado Health Center
Surgery and Laser Surgery Stanford, CA, USA Aurora, CO, USA
SkinCare Physicians of Chestnut Hill
Chestnut Hill, MA, USA Glenn D Goldman MD Greg S Morganroth MD
Associate Professor of Medicine, Dermatology Assistant Clinical Professor of Dermatology
Paul Bowman MD Director of Dermatologic Surgery The University of California, San Francisco
Fellow, Mohs Micrographic Surgery Unit Division of Dermatology Adjunct Clinical Assistant Professor of
Instructor The University of Vermont Otolaryngology
Department of Dermatology Fletcher Allen Health Care Department of Head and Neck Surgery
St Louis University Burlington, VT, USA Stanford University
St Louis, MO, USA Stanford, CA, USA
Christopher B Harmon MD
James T Chapman MD Clinical Professor Tri H Nguyen MD
Mohs Micrographic Surgeon Department of Dermatology Director of Mohs/Dermatologic Surgery;
AAdvanced Dermatology University of Alabama at Birmingham Associate Professor, Dermatology &
Skin Cancer and Laser Surgery Center Birmingham, AL, USA Otolaryngology
AAurora, CO, USA MD Anderson Cancer Center
Morris E Hartstein MD The University of Texas
Suneel Chilukuri MD Assistant Professor Department of Dermatology
Instructor in Dermatology Departments of Ophthalmology & Surgery Houston, TX, USA
Department of Dermatologic Surgery St Louis University
YYale University School of Medicine St. Louis, MO, USA
Newhaven, CT, USA
viii Contributors
DDéésiiréée RRatner MMDD SStuart JJ SSallaschhe MMDD MMiichhaell MM TTodddd MMDD
Director of Dermatologic Surgery Clinical Professor Fellow
Columbia University Medical Center University of Arizona Health Sciences Center Department of Dermatology
and George Henry Fox Associate Clinical Tucson, AZ, USA Geisinger Medical Center
Professor of Dermatology Penn State University Geisinger Medical Center
College of Physicians and Surgeons of Roberta D Sengelmann MD Danville, PA, USA
Columbia University Assistant Professor of Dermatology and
New York, NY, USA Otolaryngology Molly Wanner MD
Director, Center for Dermatologic and Cosmetic Resident
TThomas E Rohrer MD Surgery Herbert Irving Center for Dermatology and Skin
Skin Care Physicians Washington University School of Medicine Cancer
Chestnut Hill, MA, USA St. Louis, MO, USA Columbia University Medical Center
Clinical Associate Professor, Dermatology New York, NY, USA
Boston University School of Medicine Neil A Swanson MD
Boston, MA, USA Assistant Professor
Department of Dermatology
Oregon Health & Science University
Portland OR, USA
Foreword
Progress is impossible without change, and those who cannot They are the best and the brightest off what I might immo-
change their minds cannot change anything. destly label a very talented specialty. The organization of the
book allows the reader to build from a clinical discussion off
George Bernard Shaw anatomy, to a conceptual analysis of flap and graft types and
movement, and finally to the application of reconstructive
techniques to relevant anatomic sites. While each chapterr
Progress always involves risk; you can’t steal second base and functions well independently, it is most enjoyable to progress
keep your foot on first. through the book from beginning to end.
Just as each chapter is only a part of a greater whole, so
Frederick Wilcox the book itself is only one dimension of the educational
experience. Progress does indeed involve change. What makes
I am honored and delighted to have been asked to write a the editors approach so very unique is the inclusion off
foreword to this magnificent book. While somewhat sobered extensive high resolution narrated video to illustrate in detail
that individuals recruited to this task are usually viewed as the techniques described in the body of the text. This is a
elder statesmen reflecting on the historical place of a neww three-dimensional process, nearly duplicating the experience
contribution, I am none the less terribly excited to be witness of standing shoulder to shoulder with a personal masterr
to the growth, evolution and maturation of our specialty. instructor. The student is able to read the principles and
Dermatologic reconstructive surgery has indeed come a longg applications and then see in real time the execution of the
wway. The journey has involved risk, criticism, and willingness techniques. There is no better way to learn.
to accept change. It was not too long ago that the use off Finally, I must interject my pride and gratitude in the
the terms ‘dermatologic’ and ‘surgery’ in the same phrase was creation of this book. All of the contributors are personal
vviewed as an oxymoron. Historically, the first volume to define friends and have taught me so much in both conversations
the contributions of dermatology to reconstructive surgery was and formal presentations. They are the leaders of both todayy
published in 1989 by Drs Tromovitch, Stegman and Glogau. and tomorrow. Several of the contributors had been my fellows
It was titled ‘Flaps and Grafts in Dermatologic Surgery’. The at the University of Pennsylvania. I am delighted that theyy
foreword was written by a unique plastic surgeon, Dr Richard have well surpassed their ‘old’ teacher in pushing the field
Webster. He advanced the little accepted concept that the of cutaneous reconstruction well into the future. We, the
cooperative interaction of multiple specialties allows a students of the field, will benefit greatly. However, it is ourr
discipline to advance to a much greater degree than confiningg patients who most importantly will be the most significantt
it to the province of one group. He noted, ‘At the time off beneficiaries of the techniques presented in this book. There
this writing, most physicians and dentists do not realize thatt is an anonymous saying; ‘Some students drink at the fountain
dermatology is both a medical and a surgical specialty orr of knowledge. Others just gargle.’ The contributors of this
discipline. However, traditional dermatology has been changingg book must have indeed been very thirsty!
in the last 50 years…’ I am pleased to report that change is
once again in the air. Leonard M Dzubow MD
This volume presents the most comprehensive synthesis Clinical Professor of Dermatologyy
of cutaneous reconstructive surgery currently available. The Department of Dermatologyy
editors and contributors are recognized for their logical University of Pennsylvania
presentations, clinical honesty and artful surgical technique. Philadelphia, PA, USAA