Preface

It has now been over a decade since the publication of the first edition of Dermatologic Surgery: A Manual of Defect Repair Options. There remains a need for this style of ‘how-to-do-it’ manual for the busy clinician. The second edition is available in both print and ebook format. We continue the extensive use of diagrams and clinical images to supplement the many video demonstrations, to best illustrate the repair techniques described in the text.

It is clear from the sales of the first edition, and the feedback received, that our target audience is broader and more international than we had anticipated. To reflect this wider interest, new contributors from around the globe have taken on the role of reviewers, updating and improving the original chapters and bringing their collective wisdom and experience to this publication. Doctors Stanford and Storey have taken on an editorial role, while Associate Professor Paver has left us with his invaluable legacy from his involvement in the first edition (in particular, the video archive). We have sought to replace suboptimal images where possible and to add new clinical photos, diagrams and videos. More images have been included that demonstrate typical early results (e.g. at 6 to 8 weeks), and in some cases later outcomes (e.g. 3 months to a number of years). ‘Follow-up’ is a powerful tool for learning and improvement, in particular to understand how well the patient’s expectations have been met as well as to deal with complications proactively.

The manual still assumes the reader has basic skills in cutaneous surgery. It remains focused on repairs that can be done under local anaesthesia. However, new repair options have been added to include those appearing in more recent journal publications, as well as those deemed useful and reliable by our now-larger group of contributors. Mohs defects remain an ideal teaching tool as they represent the closest approximation to the true size, shape and depth of the skin cancers we excise. In the end, the repair options apply to the defect that remains after the lesion, whether benign or malignant, is removed (hopefully completely and definitively). Mohs defects are often smaller than those resulting from complete excision using standard margins and this may allow for a simpler repair. Of course, they are at times considerably larger than anticipated and a great challenge for the reconstructive surgeon. This manual covers repair options for this broad range of defects we see in the Mohs unit and thereby, we hope, will help both the trainee getting started as well as the more experienced practitioner trying to expand their repertoire.

While the first edition was aimed primarily at surgical dermatologists, a new chapter discussing the multidisciplinary approach to management of skin lesions highlights the overlapping and specialised skills of other disciplines involved. This team effort, particularly in dealing with complex or advanced skin cancers, best ensures quality care that is individualised, timely and cost-effective. We hope there is something in this new edition that will help trainees and practitioners from all the disciplines performing dermatologic surgery. As in the first edition, key surgical risks and complications, where relevant to the various body regions, are highlighted at the start of each section or chapter. In this second edition, a standalone chapter, authored by Clinical Professor Shyamala Huilgol, is dedicated to this essential subject and covers, additionally, prevention and management aspects.

The manual is now divided into 10 sections. The new chapters are incorporated into Section 10 with the remaining 9 sections representing the various body regions. The nose, forehead and temple, perioral, cheek, ears and periocular sections are each further subdivided into chapters representing the cosmetic subunits of each region. The final sections cover the scalp, neck and mastoid, and trunk and limbs regions.

Each chapter starts with an overview and a list of the common repair options for that region or subunit. Preferred options are still indicated in that list to highlight repairs that are common and especially useful in that body region. Next, each repair option is discussed by listing advantages and disadvantages, followed by a stepwise description of the technique for each procedure. Practical tips are highlighted, and risks and complications are mentioned where relevant. The book is extensively illustrated with photos and diagrams. This is supplemented by over 100 concise video demonstrations with commentary in order to provide a ‘bird’s-eye view’ of the key points of the procedure. It is intended to simulate looking over the shoulder of an experienced mentor. Although observing a procedure, then performing it with a mentor offering advice along the way, is certainly the best way to learn dermatologic surgery and a key part of specialist training programs, it is simply not possible for all the repair options covered in this book.

For this second edition, we have standardised the order of repairs across the book to maintain a more consistent systematic approach. Trainees may find it helpful to have this ‘checklist’ to structure their deliberations when determining the best repair for a defect to be managed. The following schema has been used: primary closure, second intention, flaps (advancement, rotation, transposition, island pedicle and interpolation), grafts (including full-thickness and split-thickness skin, cartilage and chondrocutaneous, and mucosa) and combined (unless covered as a subsection of a preceding repair). In addition, we have opted to avoid space-consuming repetition by cross-referencing to other sections where the repair has already been covered. Although this is unlikely to concern users of the ebook who can use a hyperlink to the cross-referenced page, print edition readers may need some page turning to find the relevant page.

We hope you find the additions and improvements in this second edition helpful and the new format user-friendly.