Facial reconstruction after Mohs surgery

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Review by L Flood
Middlesborough, UK

This book summarises 15 years of practice and 12 000 procedures, in what the preface describes as ‘the gold standard’ for what is increasingly prevalent, facial skin malignancy. As the cover tells us, it is also accompanied by 21 online videos to illustrate the surgical techniques involved in Mohs surgery, but, even more, in subsequent reconstruction. The authors have called in experts on anaesthesia, oculoplastic surgery and pinna reconstruction to create something that is of far greater general interest than the title might suggest. The emphasis is, indeed, far more on reconstruction of facial surgical defects, whatever the method of resection, and that might not be obvious to the browser in the bookshop.

Mohs micrographic surgery monitors histological margins of resection and, whilst far from universally adopted, is thought particularly of value in sites prone to high rates of recurrence and in aggressive tumour subtypes. First described in the 1940s, the surgery itself is simply described in a single short chapter. What follows is a superbly illustrated description of every conceivable type of graft, whether free, local, pedicled, compound, etc. The second third of the book then discusses graft selection and strategies for specific sites in the face, including the nose, eyelids, cheeks and ear. The final third looks at complications and flap revision surgery, but assures us that cancer recurrence is ‘gratifyingly rare’. It merits only a single paragraph, a much shorter coverage than is applied to the risk of setting fire to the patient!

I was expecting a highly specialised book, of little relevance to all but the most dedicated facioplastic surgeon (who of course also chooses to practice Mohs surgery). Instead, this is an authoritative review of facial reconstruction, a hot topic in most end-of-training examinations, and of value to plastic surgery, ENT and oral maxillofacial surgery trainees and even their seniors. I do wonder if the title might have been shortened by three words, to increase the general appeal of what is a very impressive publication.

Amazon Link: Facial reconstruction after Mohs surgery
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