Mohs Surgery and Facial Flaps

  • Dan Robinson
  • Jason Roth
Part of the Head and Neck Cancer Clinics book series (HNCC)


From the early 1930s, Frederic E. Mohs developed the idea of cancer excision with microscopic assistance, a concept which has become known as Mohs micrographic surgery [1]. Initially, a fixed tissue technique was employed using zinc chloride solution; however, today most practitioners employ a fresh-tissue approach [2]. Mohs surgery is a microscopically controlled procedure that allows maximal excision of involved tumour in cutaneous neoplasms while minimizing the excision of uninvolved tissue. It achieves this through mapping the surgical site and successive resection of tumour and subsequent histological analysis of resected borders until clear margins are achieved [3]. Mohs surgery is suited to cutaneous neoplasms in areas with high risk of local recurrence or where for functional or cosmetic reasons tissue is required to be preserved, or in recurrent neoplasms, in particular, large and aggressive tumours with irregular or incomplete resection borders [1].


Advancement Flap Rotation Flap Mohs Micrographic Surgery Forehead Flap Mohs Surgery 
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  1. 1.
    Shriner DL, McCoy DK, Goldberg DJ, et al. Mohs micrographic surgery. J Am Acad Dermatol. 1998;39:79–97.CrossRefPubMedGoogle Scholar
  2. 2.
    Brodland DG, Amonette R, Hanke CW, et al. The history and evolution of Mohs micrographic surgery. Dermatol Surg. 2000;26:303–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Rosai J. Mohs micrographic surgery: a pathologist’s view. Arch Dermatol. 1999;135:1171–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Burget GC, Menick FJ. Nasal support and lining: the marriage of beauty and blood supply. Plast Reconstr Surg. 1989;84:189–202.CrossRefPubMedGoogle Scholar
  5. 5.
    Burget GC, Menick FJ. Aesthetic reconstruction of the nose. St. Louis: Mosby; 1993.Google Scholar
  6. 6.
    Baker SR. Major nasal reconstruction. In: Facial plastic and reconstructive surgery. New York: Thieme Medical; 2008. p. 807–20.Google Scholar
  7. 7.
    Baker SR, Johnson TM, Nelson BR, et al. The importance of maintaining the alar-facial sulcus in nasal reconstruction. Arch Otolaryngol Head Neck Surg. 1995;121:617–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Baker SR. Contemporary aspects of nasal reconstruction. In: Myers EN, Bluestone CD, Brackmann DE, Kranse CJ, editors. Advances in otolaryngology: head and neck surgery. St. Louis: Mosby; 1998. p. 235–61.Google Scholar
  9. 9.
    Zitelli JA. Secondary intention healing: an alternative to surgical repair. Clin Dermatol. 1984;2:92–106.CrossRefPubMedGoogle Scholar
  10. 10.
    Baker SR. Principles of nasal reconstruction. St. Louis: Mosby; 2002.Google Scholar
  11. 11.
    Park SS. Reconstruction of nasal defects larger than 1.5 centimeters in diameter. Laryngoscope. 2000;110:1241–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Vuyk HD. Facial plastic and reconstructive surgery. Boca Raton, Florida: CRC Press; 2006.Google Scholar
  13. 13.
    Webster RC, Davidson TM, Smith RC. The thirty degree transposition flap. Laryngoscope. 1978;88:85–94.CrossRefPubMedGoogle Scholar
  14. 14.
    Walike JW, Larrabee Jr WF. The ‘note flap’. Arch Otolaryngol. 1985;111:430–3.CrossRefPubMedGoogle Scholar
  15. 15.
    Larrabee Jr WF, Trachy R, Sutton D, et al. Rhomboid flap dynamics. Arch Otolaryngol. 1981;107:755–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Tardy Jr ME, Tenta LT, Azem K. The bilobed flap in nasal repair. Arch Otolaryngol. 1972;95:1–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. 1989;125:957–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Flint ID, Siegle RJ. The bipedicle flap revisited. J Dermatol Surg Oncol. 1994;20:394–400.CrossRefPubMedGoogle Scholar
  19. 19.
    McGregor JC, Soutar DS. A critical assessment of the bilobed flap. Br J Plast Surg. 1981;34:197–205.CrossRefPubMedGoogle Scholar
  20. 20.
    Menick FJ. Facial reconstruction with local and distant tissue: the interface of aesthetic and reconstructive surgery. Plast Reconstr Surg. 1998;102:1424–33.CrossRefPubMedGoogle Scholar
  21. 21.
    Becker F. Facial reconstruction with local and regional flaps. New York: Thieme Medical; 1985.Google Scholar
  22. 22.
    Zitelli JA. The nasolabial flap as a single-stage procedure. Arch Dermatol. 1990;126:1445–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Shumrick KA, Smith TL. The anatomic basis for the design of forehead flaps in nasal reconstruction. Arch Otolaryngol Head Neck Surg. 1992;118:373–9.CrossRefPubMedGoogle Scholar
  24. 24.
    El A. Midforehead flaps. In: Baker S, editor. Local flaps in facial reconstruction. Philadelphia: Mosby; 1995. p. 197–223.Google Scholar
  25. 25.
    Menick FJ. Aesthetic refinements in use of forehead for nasal reconstruction: the paramedian forehead flap. Clin Plast Surg. 1990;17:607–22.PubMedGoogle Scholar
  26. 26.
    Renner G. Reconstruction of the lip. In: Baker SR, Swanson NA, editors. Local flaps in facial reconstruction. St. Louis: Mosby; 1995. p. 345–89.Google Scholar
  27. 27.
    Abbe R. A new plastic operation for the relief of deformity due to double harelip. Plast Reconstr Surg. 1968;42:481–3.PubMedGoogle Scholar
  28. 28.
    Estlander JA. A method of reconstructing loss of substance in one lip from the other lip. Plast Reconstr Surg. 1968;42:360–4.CrossRefGoogle Scholar
  29. 29.
    Webster JP. Crescentic peri-alar cheek excision for upper lip flap advancement with a short history of upper lip repair. Plast Reconstr Surg. 1955;16:434–64.CrossRefGoogle Scholar
  30. 30.
    Karapandzic M. Reconstruction of lip defects by local arterial flaps. Br J Plast Surg. 1974;27:93–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Gillies H, Millard Jr DR. The principles and art of plastic surgery. London: Butterworth; 1957.Google Scholar
  32. 32.
    Freeman BS. Myoplastic modification of the Bernard cheiloplasty. Plast Reconstr Surg Transplant Bull. 1958;21:453–60.CrossRefPubMedGoogle Scholar
  33. 33.
    Webster RC, Coffey RJ, Kelleher RE, et al. Total and partial reconstruction of the lower lip with innervated musclebearing flaps. Plast Reconstr Surg Transplant Bull. 1960;25:360–71.CrossRefPubMedGoogle Scholar
  34. 34.
    Siegle RJ. Reconstruction of the forehead. In: Baker SR, editor. Local flaps in facial reconstruction. 2nd ed. Philadelphia: Mosby; 2007. p. 557–79.Google Scholar
  35. 35.
    Bradley DT. Reconstruction of the cheek. In: Baker SR, editor. Local flaps in facial reconstruction. 2nd ed. Philadelphia: Mosby; 2007. p. 525–56.Google Scholar
  36. 36.
    Baker SR. Advancement flaps. In: Baker SR, editor. Local flaps in facial reconstruction. 2nd ed. Philadelphia: Mosby; 2007. p. 157–87.Google Scholar
  37. 37.
    Park SS, Little S. Rhombic flaps. In: Baker SR, editor. Local flaps in facial reconstruction. 2nd ed. Philadelphia: Mosby; 2007. p. 213–30.Google Scholar

Copyright information

© Faruque Riffat, Carsten E. Palme, Michael Veness, Rehan Kazi, Raghav C. Dwivedi 2015

Authors and Affiliations

  1. 1.Otolaryngology-Head and Neck SurgeryGold Coast University HospitalSouth PortAustralia
  2. 2.Otolaryngology-Head and Neck SurgeryPrivate PracticeSydneyAustralia

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