Delayed Skin Grafting in Facial Reconstruction: When to Use and How to Do

Intraoperative Immunohistochemistry During Mohs Micrographic Surgery and Staged Excision Decreases Local Recurrence Rates for Invasive Cutaneous Melanoma: A Systematic Review and Meta-Analysis

“…Table 1 summarizes the data for the 57 included studies; 6,9,10,27–81 all were retrospective or prospective cohort studies. The studies included a total of 12,043 patients, including 12,590 cases of melanoma encompassing 67.7% melanoma in situ (MIS), 31.6% invasive melanoma, and 0.7% tumors of unreported invasion status; 6,796 (54.0%) of tumors were located on the head and neck, whereas 2,460 (19.5%) did not have the anatomic location reported.…”

“…In all, 23 studies 28,29,32,33,35–38,44,52–55,63,64,68,69,71,72,76–79 used H&E staining alone encompassing 2,851 patients with 2,894 tumors with an average reported Breslow depth of 0.58 mm for invasive tumors; 17 studies 31,34,39–43,46,48–50,52,54,57,60,74,75 used IHC staining for all cases encompassing 3,835 patients with 3,907 tumors with an average reported Breslow depth of 0.84 mm for invasive tumors; 19 studies 6,9,27,30,45,47,51,56,58,59,61,62,65–67,70,73,80,81 included a mix of patients treated with either H&E alone or with IHC encompassing 5,357 patients with 5,789 tumors with an average reported Breslow depth of 1.0 mm for invasive tumors. Two studies included patient subsets treated with H&E alone and IHC alone, so the total sum of articles included in this meta analysis is 57.…”

Errors in Surgical Site Identification during Cutaneous Surgery for Skin Cancer: Review and Recommendations

“…The recommended gross surgical margins are 1 cm for T1 tumors (≤1 mm in thickness) [19] and 2 cm for T2 (1.01 -2 mm), T3 (2 -4 mm), and T4 (>4 mm) tumors [20]. Some surgeons have advocated delaying wider excision, especially when skin grafts are used due to concern for surveillance of subsequent local recurrence [21]. While margins for wide excision have been standardised, several prospective, randomised controlled trials have compared narrow margins with wide margins in patients with melanomas of more than 1 mm Breslow thickness.…”

The "Drumhead" Graft Repair of Deep Nasal Alar Defects

“…Some surgeons advocate delaying grafting for 7 to 14 days to allow a deeper defect to fill with granulation tissue so that better contour may ultimately be realized. [12][13][14][15] Menaker and coworkers 16 describe the use of bilateral dermal advancement flaps to fill deep dorsal nasal defects under grafts. This method was effective in reconstituting a vascularized dermal base for a FTSG on the dorsum of the nose.…”

“…FTSGs are effective in the repair of nonperforating nasal defects 1 but are often inadequate for deep postsurgical defects. Some surgeons advocate delaying grafting for 7 to 14 days to allow a deeper defect to fill with granulation tissue so that better contour may ultimately be realized 12–15 . Menaker and coworkers 16 describe the use of bilateral dermal advancement flaps to fill deep dorsal nasal defects under grafts.…”