SKIN BIOPSY
o b v i o u s ,
b u t
s o m e t i m e s
s k in te sts
a r e
n e e d e d
t o
i d e n t i f y
t h e
a l l e r g e n .
( S e e
a l s o a t o p i c
e c z e m a .)
s k in b io p s y
R e m o v a l o f a p o r t i o n o f s k i n f o r l a b o r a -
t o r y a n a l y s i s t o d i a g n o s e a s k i n d i s o r d e r .
s k in c a n c e r
A m a l i g n a n t s k i n t u m o u r .
B a s a l c e ll c a rc i-
n o m a , s q u a m o u s c e ll c a rc in o m a ,
a n d m a l -
i g n a n t m e l a n o m a
( s e e
m e la n o m a , m a lig -
n a n t
) a r e f o r m s a s s o c i a t e d w i t h e x p o s u r e
t o s u n .
B o w e n ’s d is e a s e ,
a r a r e d i s o r d e r
t h a t c a n b e c o m e c a n c e r o u s , m a y a l s o b e
r e l a t e d
t o s u n e x p o s u r e .
L e s s c o m m o n
t y p e s i n c l u d e
P a g e t’s d is e a s e o f th e n ip p le
a n d
m y c o s is fu n g o id e s . K a p o s i’s s a rc o m a
i s
a t y p e u s u a l l y f o u n d i n
A ID S
p a t i e n t s . M o s t
s k i n c a n c e r s a r e c u r a b l e i f t r e a t e d e a r l y
s k in fla p
A s u r g i c a l t e c h n i q u e i n w h i c h a s e c t i o n
o f
s k in
a n d
u n d e r l y i n g
t i s s u e ,
s o m
e -
t i m e s
i n c l u d i n g
m u s c l e ,
i s
m o v e d
t o
Basal cell carcinoma
This is the most common form of skin cancer. Also
called a rodent ulcer, a basal cell carcinoma
develops most commonly on the face.
c o v e r a n a r e a f r o m w h i c h s k i n a n d t i s -
s u e
h a v e
b e e n
l o s t
o r
d a m a g e d
b y
i n j u r y , d i s e a s e , o r s u r g e r y . U n l i k e a
s k in
g ra ft,
a s k i n f l a p r e t a i n s i t s b l o o d s u p p l y
T h e r e f o r e ,
s k i n
f l a p s
c a n
b e
e i t h e r
a t t a c h e d ( i n w h i c h t h e y r e m a i n a t t a c h e d
t o t h e i r d o n o r s i t e )
o r f r e e
( i n w h i c h
t h e y a r e r e a t t a c h e d t o b l o o d v e s s e l s a t t h e
r e c i p i e n t s i t e b y
m ic ro s u rg e ry ).
S k i n f l a p s
a d h e r e w e l l , e v e n w h e r e t h e r e i s e x t e n -
s i v e l o s s o f d e e p t i s s u e . F o r t h i s r e a s o n ,
t h e y m a y b e u s e d
t o
c o v e r
a r e a s t h a t
h a v e l o s t t h e i r b l o o d s u p p l y .
s k in g ra ft
A t e c h n i q u e t h a t i s c a r r i e d o u t i n o r d e r
t o r e p a i r a r e a s o f l o s t o r d a m a g e d
s k in
t h a t a r e t o o l a r g e t o h e a l n a t u r a l l y , t h a t
a r e s l o w t o h e a l , o r t h a t w o u l d o t h e r -
w i s e l e a v e t i g h t e n i n g o r u n s i g h t l y s c a r s .
A s k i n g r a f t i s o f t e n u s e d i n t h e t r e a t -
m e n t o f b u r n s o r s o m e t i m e s f o r u l c e r s
t h a t a r e n o t h e a l i n g .
A p i e c e o f h e a l t h y s k i n i s d e t a c h e d
f r o m
o n e p a r t o f t h e b o d y a n d t r a n s -
f e r r e d
t o
t h e
a f f e c t e d
a r e a .
N e w s k i n
c e l l s
g r o w
f r o m
t h e
g r a f t
a n d
c o v e r
t h e
d a m a g e d
a r e a . I n a m e s h e d
g r a f t ,
d o n o r s k i n i s r e m o v e d a n d m a d e i n t o a
m e s h b y c u t t i n g . T h e m e s h i s s t r e t c h e d
t o f i t t h e r e c i p i e n t s i t e ; n e w s k i n c e l l s
g r o w
t o
f i l l
t h e
s p a c e s
i n
t h e
m e s h .
I n a
p i n c h g r a f t ,
m u l t i p l e s m a l l a r e a s
o f s k i n
a r e
p i n c h e d
u p
a n d
r e m o v e d
f r o m
t h e
d o n o r
s i t e .
P l a c e d
o n
t h e
r e c i p i e n t s i t e , t h e n e w s k i n c e l l s g r a d u -
a l l y
e x p a n d
t o
f o r m
a
n e w
s h e e t
o f
h e a l t h y s k i n . ( S e e a l s o
s k in f la p .)
s k in p a tch
S e e
tra n s d e rm a l p a tc h .
s k in p e e lin g , c h e m ic a l
A c o s m e t i c p r o c e d u r e t o r e m o v e a c n e
s c a r s ,
f r e c k l e s ,
d e l i c a t e
w r i n k l e s ,
o r
o t h e r
s k i n
b l e m i s h e s .
T h e
p r o c e d u r e
i n v o l v e s a p p l i c a t i o n o f a c a u s t i c p a s t e t o
p e e l a w a y t h e o u t e r l a y e r s o f s k i n .
s k in ta g
A
h a r m l e s s ,
s m a l l ,
b r o w n
o r
f l e s h -
c o l o u r e d f l a p o f s k i n t h a t i s o f t e n f o u n d
o n t h e n e c k ,
u n d e r
t h e b r e a s t s ,
o r
i n
s k i n f o l d s . A s k i n t a g m a y a p p e a r s p o n -
t a n e o u s l y ,
o r
i t m a y r e s u l t f r o m
p o o r
h e a l i n g o f a w o u n d .
s k in te s ts
P r o c e d u r e s t o d e t e r m i n e h o w t h e b o d y
r e a c t s t o v a r i o u s s u b s t a n c e s b y a p p l y i n g
t h e m t o t h e s k i n
( u s u a l l y o n p a t c h e s )
o r
b y
i n j e c t i n g
a
s m a l l
q u a n t i t y
o f a
s u b s t a n c e u n d e r t h e s k i n .
P a tch te sts
a r e u s e d i n t h e d i a g n o s i s
o f c o n t a c t a l l e r g i c
d e rm a t it is ;
a l l e r g e n s
w i l l c a u s e p a t c h e s o f r e d d e n e d o r b l i s -
t e r e d
s k i n . I n j e c t i o n s a r e u s e d t o h e l p
i d e n t i f y s u b s t a n c e s c a u s i n g a l l e r g i c i l l -
n e s s e s s u c h a s
a s t h m a .T h e y
m a y a l s o b e
u s e d t o t e s t i m
m
u n i t y t o c e r t a i n i n f e c -
t i o u s
d i s e a s e s
( a s i n t h e
t u b e rc u lin test
f o r t u b e r c u l o s i s ) .
S
TECHNIQUE FOR A FREE SKIN AND MUSCLE FLAP
A flap of skin and underlying tissue can be moved to a new site to replace lost
tissue; if its blood supply is reconnected, the flap will heal in place. Microsurgery
to rejoin blood vessels facilitates the technique.
I
The donor area needs
a good blood supply if
muscle is also to be taken.
2
The ends ofthe donor area
need to be tapered to
allow satisfactory closure.
3
The skin may have to be
undercut and freed before
the wound is closed.
4
At the recipient site, an artery and a vein
of suitable size must be available to be
joined to blood vessels in the flap.
Skin flaps are particularly useful where there
has been an extensive loss of deep tissue. The
results are usually excellent.
694
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