Special Techniques for Different Regions of the Body

Abstract

A good cosmetic result is frequently achieved by an advancement or rotation flap when primary wound suturing is impossible on the scalp. A free transplant must be considered only when the excisions are large in area and the general condition of the patient is poor. As a rule, the excision of malignant and semimalignant neoplasms extends to the periosteum, but if proven necessary (in dermatofibrosarcoma protuberans, for instance,) it too can be removed without risk [56]. To assure optimal vascular supply, the skin areas to be transplanted are cut together with the galea down to the periosteum and transposed. Interrupted sutures (suture material of the strength 0–0 to 1–0) are used for wound closure; atraumatic suture material is not required. Because of the danger of profuse bleeding during extensive operations in the scalp area, prior determination of blood type and a preoperative physical examination are indispensable (coagulation disorder due to loss of blood).