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see also: Case Example Lip Reconstruction Peri-alar Crescentic Advancement Flap; Skin Graft Donor Site Care; Zimmer Air Dermatome Instrument Tray
return to: Split Thickness Skin Graft or Full thickness skin graft
S/P "Moat" Procedure for lentigo maligna surrounding invasive melanoma
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Moat Procedure: refers to circumferential clearance of margins by Mohs procedure to ensure adequate peripheral margins - like a "moat around castle" (see references below re: margins for melanoma in situ and 'square' procedure).
see videos below:
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POD #1 after Mohs circumferentially around lentigo maligna. The defect created by removing the margin was sutured closed for comfort and to decrease bleeding prior to definitive resection. |
Definitive resection done of melanoma arising in a field of lentigo maligna. |
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Adjustable setting on Zimmer Dermatome with usual split thickness skin graft between 0.015 and 0.018 inches thick |
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Post-op Day 34 |
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Post-op Day 34 |
Post-op 6 months |
Post-op 6 months |
Post-op 6 months |
References
Demirci H, Johnson TM, Frueh BR, Musch DC, Fullen DR, and Nelson CC: Management of periocular cutaneous melanoma with a staged excision technqiue and permanent sections - the square procedure. Opthalmology 2008 Dec;115(12):2295-2300
Jejurikar SS, Borschel GH, Johnson TM, Lowe L and Brown DL: Immediate, optimal reconstruction of facial lentigo maligna and melanoma following total peripheral margin control. Plast Reconstr Surg. 2007 Oct;120(5):1249-55
Kunishige JH, Brodland DG, and Zitelli JA: Surgical margins for melanoma in situ. J Am Acad Dermatol 2012 Mar;66(3):438-44
Blum A:The moat technique. A two-step surgical technique for extensive basal cell carcinomas of the lip Der Hautarzt 2004 vol:55 iss:9 pg:869-873
Hoffman HT and La Rouere M: A Simple bolster technique for skin grafting. Laryngoscope 1989 May;99(5):558-9