Peripheral in-continuity tissue examination: a modification of Mohs' micrographic surgery.

The use of peripheral in-continuity tissue examination, in which the surgeon or dermatologist and pathologist combine their talents to remove cutaneous tumors with rapid evaluation of all margins, is useful and practical for excision of basal cell and squamous cell carcinomas that are recurrent, large, or occur in historically difficult areas to treat. This procedure, like Mohs' micrographic surgery, can be used as a tissue-sparing measure while still providing the physician and patient with confidence of complete tumor removal. Because the technique allows for primary closure and immediate reconstruction of larger and more complex tumors, patients can be spared the added inconvenience, pain, and expense of multiple separate procedures that may be necessary with Mohs' micrographic surgery or traditional tumor excision with permanent section margin evaluation.

Countercurve placement of conchal cartilage grafts used for correction of nasal tip deformities.

A novel, straightforward technique which we have used in 7 patients and developed over the past 2 years is presented for help with the correction of nasal tip deformities, lack of nasal tip projection, and dome symmetry using conchal cartilage. Procedures to correct these problems include, but are not limited to, early open rhinoplasties with direct suturing techniques, grafting with cartilage, mobilization of the nasal cartilage, and nasoalveolar molding. We present a simple technique utilizing mature conchal cartilage as a columella strut with a lateral extension that curves over the misshapen side. Using the graft in a unique countercurve placement takes advantage of the structural memory intrinsic to mature cartilage and uses this springlike property to enhance tip projection and support lower lateral cartilage. The keys are (1) adequate mobilization of the nasal cartilage, (2) careful dissection of the pocket, (3) countercurve placement of the conchal cartilage.