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Dr. Joe McGowan FAAD, FACMS

β€’Board-certified dermatologist @germaindermatology β€’Specializing in Mohs micrographic & dermatologic surgery β€’For music tunes go to @joemcgowanmusic

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@drjoemcgowan photos and videos

Working hard to prevent the spread of a poorly differentiated, perineural, recurrent Squamous Cell Carcinoma in this patient by using periosteal elevators to peel away the scalp from the skull. This tumor is tracking the supraorbital nerve, and we are trying our best to prevent spread into the central nervous system through the supraorbital foramen. @paulgrubermd #mohs #skin #skincancer #drjoe #doctor #surgeon

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Working hard to prevent the spread of a poorly differentiated, perineural, recurrent Squamous Cell Carcinoma in this patient by using periosteal elevators to peel away the scalp from the skull. This tumor is tracking the supraorbital nerve, and we are trying our best to prevent spread into the central nervous system through the supraorbital foramen. @paulgrubermd #mohs #skin #skincancer #drjoe #doctor #surgeon

A little older, a little grayer, a little wiser....same scrubs but maybe a little less hair.... 😜 #10yearchallenge #dermatology #surgeon #doctor #drjoe #skincare #skin #healthy #health #grateful #instagood

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A little older, a little grayer, a little wiser....same scrubs but maybe a little less hair.... 😜 #10yearchallenge #dermatology #surgeon #doctor #drjoe #skincare #skin #healthy #health #grateful #instagood

Happy Valentine’s Day y’all! This photo was taken on our first romantic trip to Hudson, NY 6 years ago just hours before we almost burned the house down and hours after we almost drove off a mountain in the midst of an unexpected blizzard!! 😜 through thick and thin, this man is always there for me and I am so grateful to share my life with him! Love you forever @bigbensedona — ❀️❀️😍πŸ₯° #loveislove #instagay #love #grateful #happyvalentinesday #drjoe #doctor #surgeon #surgery #skincare #skin #roadtrip

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Happy Valentine’s Day y’all! This photo was taken on our first romantic trip to Hudson, NY 6 years ago just hours before we almost burned the house down and hours after we almost drove off a mountain in the midst of an unexpected blizzard!! 😜 through thick and thin, this man is always there for me and I am so grateful to share my life with him! Love you forever @bigbensedona — ❀️❀️😍πŸ₯° #loveislove #instagay #love #grateful #happyvalentinesday #drjoe #doctor #surgeon #surgery #skincare #skin #roadtrip

Vote for us πŸ™πŸ™πŸ™ — official #BOC19 kickoff πŸ₯‡ #vote for #germaindermatology as best Dermatology PracticeπŸ‘¨‍βš•οΈπŸ‘¨‍βš•οΈ #mountpleasant #charleston #charlestonsc #bestofcharleston2019 #best #dreamteam #doctor #dermatology #outstanding #drjoe #dermatologist #skin #skincare #healthy #health #cosmetic #teamwork #work #werk #instagood #instafamily #workfamily

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Vote for us πŸ™πŸ™πŸ™ — official #BOC19 kickoff πŸ₯‡ #vote for #germaindermatology as best Dermatology PracticeπŸ‘¨‍βš•οΈπŸ‘¨‍βš•οΈ #mountpleasant #charleston #charlestonsc #bestofcharleston2019 #best #dreamteam #doctor #dermatology #outstanding #drjoe #dermatologist #skin #skincare #healthy #health #cosmetic #teamwork #work #werk #instagood #instafamily #workfamily

Even the smallest lip repairs are never really that easy. 🧐 Especially when a Mohs defect is oriented very close to the vermillion border, I try my best never to cross the junction, unless absolutely necessary. This is because a small step-off can occur unless aligned perfectly. πŸ‘¨‍βš•οΈ Look at the expert job demonstrated here by our incredible Mohs Fellow at DSSC @paulgrubermd — After only a week, we are almost at a near-perfect result. Way to go!! πŸ‘ Here are our suggestions for an excellent outcome after lip reconstruction: 1️⃣ Make sure to dot out the Vermilliocutaneous junction along the entire lip BEFORE administering anesthesia — Lidocaine can quickly obscure important anatomy πŸ’‰ 2️⃣ Avoid crossing the Vermilion border when designing your repair. πŸ‘ 3️⃣ Commit to your expertly-designed repair and do not be deceived intraoperatively — lidocaine infiltration and procedural swelling can distort markings considerably. Don’t second-guess yourself πŸ™ 4️⃣ Counsel your patients: post surgical swelling can last for up to 2 weeks, and a perfect result will need 2 months of healing. βŒ›οΈ 5️⃣ Icing in 20 minute cycles (protecting the skin from direct contact with a cloth) can greatly aid in minimizing swelling and pain. πŸ™ 6️⃣ Valtrex for ALL patients with even a remote history of cold sores or fever blisters πŸ’ŠπŸ’Š 7️⃣ antibiotic prophylaxis πŸ’ŠπŸ’Š 8️⃣ Aquaphor is my HERO for postoperative wound care πŸ₯‡

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Even the smallest lip repairs are never really that easy. 🧐 Especially when a Mohs defect is oriented very close to the vermillion border, I try my best never to cross the junction, unless absolutely necessary. This is because a small step-off can occur unless aligned perfectly. πŸ‘¨‍βš•οΈ Look at the expert job demonstrated here by our incredible Mohs Fellow at DSSC @paulgrubermd — After only a week, we are almost at a near-perfect result. Way to go!! πŸ‘

Here are our suggestions for an excellent outcome after lip reconstruction:

1️⃣ Make sure to dot out the Vermilliocutaneous junction along the entire lip BEFORE administering anesthesia — Lidocaine can quickly obscure important anatomy πŸ’‰
2️⃣ Avoid crossing the Vermilion border when designing your repair. πŸ‘
3️⃣ Commit to your expertly-designed repair and do not be deceived intraoperatively — lidocaine infiltration and procedural swelling can distort markings considerably. Don’t second-guess yourself πŸ™
4️⃣ Counsel your patients: post surgical swelling can last for up to 2 weeks, and a perfect result will need 2 months of healing. βŒ›οΈ
5️⃣ Icing in 20 minute cycles (protecting the skin from direct contact with a cloth) can greatly aid in minimizing swelling and pain. πŸ™
6️⃣ Valtrex for ALL patients with even a remote history of cold sores or fever blisters πŸ’ŠπŸ’Š
7️⃣ antibiotic prophylaxis πŸ’ŠπŸ’Š
8️⃣ Aquaphor is my HERO for postoperative wound care πŸ₯‡
#doctorsofinstagram #skin #yogalife #yogi #yogaeverydamnday #doctor #medicine #happyweekend #yogainspiration #songwriter #musician #singersongwriter #healthylifestyle #dermatology #skincare #creative #health #piano #healthyskin #healthybody #healthy #surgeon #doctorlife #americanamusic #americana #nyc #countrymusic #popmusic #nashville #creativity

February is Black History month. ❀️ In addition to celebrating πŸŽ‰ all of the achievements, heritage and cultural accolades within the African American community, it is also important to raise skin cancer awareness in this population of patients. πŸ‘¨‍βš•οΈ . . Although cancer develops much less frequently on skin of color, large, aggressive skin cancers do occur, and it is very important to discuss any new or changing lesion with your doctor immediately, so cancerous lesions can be identified, diagnosed and treated promptly. πŸ‘ . . This patient presented with an ill-defined, non tender, subcutaneous nodule that seemed to be growing within a prior scar from a motor vehicle collision, 2 years earlier. A biopsy was performed and microscopic exam demonstrated Dermatofibrosarcoma Protuberans (DFSP). πŸ‘¨‍βš•οΈ . . DFSP is a rare form of skin cancer, but is the most common form of cutaneous soft tissue sarcoma—a cancer composed of malignant spindle cells derived from soft tissue. DFSP arises in the deep layers of skin and is characterized by microscopic tentacles that project in a haphazard fashion through soft tissue, invading into bone, cartilage and muscle. DFSP is most commonly found on the trunk, but can also be seen on the arms, legs, head and neck. DFSP has a 5% rate of distant metastasis; however local recurrence is much more common. This is why Mohs micrographic surgery is the treatment of choice for definitive margin control and simultaneous tissue conservation. πŸ’‰πŸ§¬ . . Because this patient’s DFSP grew within a scar, it mimicked a keloid or hypertrophic scar, which is why clinical history is so important. Trauma is an associated causative factor in the development of DFSP, but because scar tissue can look identical to DFSP clinically and microscopically, diagnosis can be challenging. 🧐 . . . Make sure to see a local board-certified dermatologist πŸ‘¨‍βš•οΈ for the evaluation of any new or changing skin lesions, regardless of age, race or demographics. We are all unfortunately susceptible to cancers of the skin. πŸ™ . . . #mohs #skin #drjoe #surgery #blackhistory #blackhistorymonth #dermatology #dermatologist #surgeonslife #surgeon #doctor #doctorslife #health #healthy

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February is Black History month. ❀️
In addition to celebrating πŸŽ‰ all of the achievements, heritage and cultural accolades within the African American community, it is also important to raise skin cancer awareness in this population of patients. πŸ‘¨‍βš•οΈ
.
.
Although cancer develops much less frequently on skin of color, large, aggressive skin cancers do occur, and it is very important to discuss any new or changing lesion with your doctor immediately, so cancerous lesions can be identified, diagnosed and treated promptly. πŸ‘
.
.
This patient presented with an ill-defined, non tender, subcutaneous nodule that seemed to be growing within a prior scar from a motor vehicle collision, 2 years earlier. A biopsy was performed and microscopic exam demonstrated Dermatofibrosarcoma Protuberans (DFSP). πŸ‘¨‍βš•οΈ
.
.
DFSP is a rare form of skin cancer, but is the most common form of cutaneous soft tissue sarcoma—a cancer composed of malignant spindle cells derived from soft tissue. DFSP arises in the deep layers of skin and is characterized by microscopic tentacles that project in a haphazard fashion through soft tissue, invading into bone, cartilage and muscle. DFSP is most commonly found on the trunk, but can also be seen on the arms, legs, head and neck. DFSP has a 5% rate of distant metastasis; however local recurrence is much more common. This is why Mohs micrographic surgery is the treatment of choice for definitive margin control and simultaneous tissue conservation. πŸ’‰πŸ§¬
.
.
Because this patient’s DFSP grew within a scar, it mimicked a keloid or hypertrophic scar, which is why clinical history is so important. Trauma is an associated causative factor in the development of DFSP, but because scar tissue can look identical to DFSP clinically and microscopically, diagnosis can be challenging. 🧐
.
.
.
Make sure to see a local board-certified dermatologist πŸ‘¨‍βš•οΈ for the evaluation of any new or changing skin lesions, regardless of age, race or demographics. We are all unfortunately susceptible to cancers of the skin. πŸ™
.
.
.
#mohs #skin #drjoe #surgery #blackhistory #blackhistorymonth #dermatology #dermatologist #surgeonslife #surgeon #doctor #doctorslife  #health #healthy

Nailed it!!! Hahahahaha — love my work family ❀️❀️❀️ #fun #ilovemyjob #werk #germaindermatology #drjoe #doctor #dermatology #skincare #skin #dreamteam #work #surgery #dermatologist

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Nailed it!!! Hahahahaha — love my work family ❀️❀️❀️ #fun #ilovemyjob #werk #germaindermatology #drjoe #doctor #dermatology #skincare #skin #dreamteam #work #surgery #dermatologist

Super Bowl fun! Love my friends! πŸŽ‰πŸ˜˜@lauren.exelby @xlb81 @bigbensedona #superbowl #drjoe #doctor #dermatology #surgery #skincare #skin #friends #party #fun #celebration

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Super Bowl fun! Love my friends! πŸŽ‰πŸ˜˜@lauren.exelby @xlb81 @bigbensedona #superbowl #drjoe #doctor #dermatology #surgery #skincare #skin #friends #party #fun #celebration

Acrochordons (or fibroepithelial polyps) come in all shapes and sizes. This one was quite impressive although a cinch to excise with the help of my beautiful assistant @jennarojek πŸ’‰πŸ‘¨‍βš•οΈ . . Fibroepithelial polyps are pedunculated, exophytic proliferations of fibrovascular tissue that are 100% benign thank goodness. πŸ™πŸ™ However they can become inflamed and dilated as a result of torsion within the very narrow fibrovascular stalk. As a result, it’s best to get them removed to avoid inflammation and/or infection, especially when they get to be this size. 😎😎 @germaindermatology . . #drjoe #extreme #surgery #dermatology #mohs #skincancer #skin #skincare #healthy #healthybody #health #physician #dermatologist #doctor

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Acrochordons (or fibroepithelial polyps) come in all shapes and sizes. This one was quite impressive although a cinch to excise with the help of my beautiful assistant @jennarojek πŸ’‰πŸ‘¨‍βš•οΈ .
.
Fibroepithelial polyps are pedunculated, exophytic proliferations of fibrovascular tissue that are 100% benign thank goodness. πŸ™πŸ™ However they can become inflamed and dilated as a result of torsion within the very narrow fibrovascular stalk. As a result, it’s best to get them removed to avoid inflammation and/or infection, especially when they get to be this size. 😎😎 @germaindermatology .
.

#drjoe #extreme #surgery #dermatology #mohs #skincancer #skin #skincare #healthy #healthybody #health #physician #dermatologist #doctor
Check out @bluelizardsun and @eltamdskincare for powerful #sunprotection all day long 😎🌞 #paradise #stjohn #usvirginislands #skincancer #skincancerawareness #coralreef #snorkeling #dermatologist #skin #skincare #sunscreen #wearsunscreen

Dr. Joe’s #sunsafety secret for powerful #uvprotection in #stjohn #usvirginislands = #matteperfection @germaindermatology πŸ‘πŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒž Matte Perfection is a naturally tinted physical blocker providing #spf 50. Enriched with nourishing antioxidants like #resveratrol and green tea polyphenols, this suprapotent zinc oxide #sunscreen is free of harmful chemicals including oxobenzone, which can damage the beautiful coral reef here in St. John. 😎 So PROTECT your skin and SAVE the environment by saying NO to harmful chemicals on your skin and in the the ocean. ❀️🌈❀️ #dermatology #skincare #usvi #coralreef #surgeon #mohs #skincancer

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Dr. Joe’s #sunsafety secret for powerful #uvprotection in #stjohn #usvirginislands = #matteperfection @germaindermatology πŸ‘πŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒžπŸŒž Matte Perfection is a naturally tinted physical blocker providing #spf 50. Enriched with nourishing antioxidants like #resveratrol and green tea polyphenols, this suprapotent zinc oxide #sunscreen is free of harmful chemicals including oxobenzone, which can damage the beautiful coral reef here in St. John. 😎

So PROTECT your skin and SAVE the environment by saying NO to harmful chemicals on your skin and in the the ocean. ❀️🌈❀️ #dermatology #skincare #usvi #coralreef #surgeon #mohs #skincancer
#vacation #family #usvirginislands #stjohn #love #grateful #happy #skincare #sunsafe #sunsafety
#sunday #sundayfunday #usvi #usvirginislands #stjohn #drjoe #skin #skincare

Dr. Joe’s #sunsafety tips: 1️⃣ wear sunscreen everyday and reapply every hour 2️⃣ avoid peak UV exposure from 11 am to 4 pm 3️⃣ wear a sunscreen (spf 30 or higher) that contains a physical blocker like Zinc and protects against UVA and UVB 4️⃣ take heliocare 5️⃣ wear a UV protective broad-brimmed hat and UV protective clothing #upf 6️⃣ if you have a new or existing skin lesion that is dark, bleeds or is growing, please see a board-certified dermatologist ASAP #mohs #skin #spf #drjoe #beforeandafter #dermatology #dermatologist #surgeonslife #surgeon #doctor #doctorslife #health #healthy #healthyskin #sunscreen #uvprotection #cancerprevention #skinsurgery #cancersucks #healthylifestyle

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Dr. Joe’s #sunsafety tips:

1️⃣ wear sunscreen everyday and reapply every hour
2️⃣ avoid peak UV exposure from 11 am to 4 pm
3️⃣ wear a sunscreen (spf 30 or higher) that contains a physical blocker like Zinc and protects against UVA and UVB
4️⃣ take heliocare
5️⃣ wear a UV protective broad-brimmed hat and UV protective clothing #upf
6️⃣ if you have a new or existing skin lesion that is dark, bleeds or is growing, please see a board-certified dermatologist ASAP

#mohs #skin #spf #drjoe #beforeandafter #dermatology #dermatologist #surgeonslife #surgeon #doctor #doctorslife  #health #healthy #healthyskin #sunscreen #uvprotection #cancerprevention #skinsurgery #cancersucks #healthylifestyle

Thank you @drmeganmorrison for these great photos of perineural SCC! #Repost @drmeganmorrison with @get_repost ・・・ #SquamousCellCarcinoma is the second most common type of skin cancer, and can rarely involve nerves and blood vessels if left untreated. πŸ”¬ When this occurs it is referred to as perineural and intravascular, which portends a poorer prognosis. These aggressive skin cancers can be exquisitely painful πŸ˜– Aggressive squamous cell carcinomas can be treated outpatient with #mohssurgery , and often require adjuvant radiation after clearance of all margins. #drmeganmorrison #stonesriverdermatology #perineuralscc #intravascularscc #pathology #histology #dermatopathology #skincancer #basalcellcarcinoma #boardcertifieddermatologist #fellowshiptrainedmohssurgeon #smyrnatn #murfreesborotn #nashville

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Thank you @drmeganmorrison for these great photos of perineural SCC! #Repost @drmeganmorrison with @get_repost
・・・
#SquamousCellCarcinoma is the second most common type of skin cancer, and can rarely involve nerves and blood vessels if left untreated. πŸ”¬ When this occurs it is referred to as perineural and intravascular, which portends a poorer prognosis. These aggressive skin cancers can be exquisitely painful πŸ˜– 
Aggressive squamous cell carcinomas can be treated outpatient with #mohssurgery , and often require adjuvant radiation after clearance of all margins. #drmeganmorrison #stonesriverdermatology #perineuralscc #intravascularscc #pathology #histology #dermatopathology #skincancer #basalcellcarcinoma #boardcertifieddermatologist #fellowshiptrainedmohssurgeon #smyrnatn #murfreesborotn #nashville

Thank you @jenamartinmd for this important review of Extramammary Paget’s disease - #Repost @jenamartinmd with @get_repost #skincancer #skin #skincare #dermatology #mohs #skincancerawareness ・・・ This cancer carpets the underside of your skin. It grows over, up, down and sometimes out. β € _β € β € It’s called Paget’s disease and it’s always seemed to me to be the sneakiest of cancers. β € _β € β € On your skin it will look like a red raw rash. It can arise almost anywhere but usually on the breast or genitals. Only under the microscope do we see it’s true nature. β € _β € β € The most sinister part of Pagets? It may come from either the underlying organs or be native to the skin. We can’t tell by looking. And the cell of origin in the skin (the Toker cell) is also mysterious, rarely seen on routine sections. We do immunohistochemical stains to determine the origin. β € _β € _β € _β € β € Pictured : extramammary Pagets of the scrotum. β € Immunohistochemical stains indicated a primary skin tumor. β € Cause: unknown β € Prevention: unknownβ € Next step: complete removal with negative margins. β € .β € .β € .β € .β € .β € .β € #dermatopathology #Pagets #pathology #histology #pathologist #doctor #md #skin #diagnosis #biopsy #medicine #womeninmedicine #philosopherbehindthemicroscope #meetmeatthemicroscope β € #noprevention #cancersucks #knowledgeispower #healthcare #somedocs β €

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Thank you @jenamartinmd for this important review of Extramammary Paget’s disease - #Repost @jenamartinmd with @get_repost #skincancer #skin #skincare #dermatology #mohs #skincancerawareness ・・・
This cancer carpets the underside of your skin. It grows over, up, down and sometimes out. β €
_β €
β €
It’s called Paget’s disease and it’s always seemed to me to be the sneakiest of cancers. β €
_β €
β €
On your skin it will look like a red raw rash. It can arise almost anywhere but usually on the breast or genitals. Only under the microscope do we see it’s true nature. β €
_β €
β €
The most sinister part of Pagets? It may come from either the underlying organs or be native to the skin. We can’t tell by looking.  And the cell of origin in the skin (the Toker cell)  is also mysterious, rarely seen on routine sections.  We do immunohistochemical stains to determine the origin. β €
_β €
_β €
_β €
β €
Pictured : extramammary Pagets of the scrotum. β €
Immunohistochemical stains indicated a primary skin tumor. β €
Cause: unknown β €
Prevention: unknownβ €
Next step: complete removal with negative margins. β €
.β €
.β €
.β €
.β €
.β €
.β €
#dermatopathology #Pagets #pathology #histology #pathologist #doctor #md #skin #diagnosis #biopsy #medicine #womeninmedicine #philosopherbehindthemicroscope #meetmeatthemicroscope β €
#noprevention #cancersucks #knowledgeispower #healthcare #somedocs β €

The keystone island flap is a fasciocutaneous flap that offers robust vascularity to large, deep distal leg🦡defects by providing a rich network of perforator arteries which prevent tissue ischemia and optimize wound healing. β€οΈβ­οΈπŸ‘¨‍βš•οΈ This patient presented with a rapidly-growing hemorrhagic nodule on the calf. Biopsy results confirmed a moderately differentiated SCC. Subsequent Mohs micrographic surgery provided cancer-free margins after three stages. The resultant defect extended down to fascia and a bilateral keystone flap was performed. Here’s how we did it:πŸ‘¨‍βš•οΈπŸ‘ @paulgrubermd 1️⃣ The defect is converted to elliptical shape for proper closure without standing cutaneous deformity. The length and maximum width of the defect is measured intraoperatively. ⭐️ 2️⃣ The side of the defect with greater tissue laxity is chosen as the flap donor area. If a single flap is not sufficient to cover the defect, another flap from the opposite side of the ellipse is marked and kept ready. An incision at 90* at either end of the ellipse meets the curvilinear line of the flap outer margin. ✍️✍️ 3️⃣One side of the elliptical defect serves as the inner arc of the keystone. The width of the flap equals the width of the defect. The flap length depends upon the length of elliptical excision.πŸ‘ 4️⃣ An incision is made along the flap boundary as marked before. The incision is deepened until deep facia, which is also divided along the outer border, providing a fasciotomy to minimize wound tension. πŸ”ͺ 5️⃣ Undermining of the flap border should not be done to prevent injury to fasciocutaneous and musculocutaneous perforators. βœ‚οΈ 6️⃣ Minimum undermining can be done on the other side of the defect if there is any tension in the suture line. βœ‚οΈ 7️⃣ First suture is placed at the center of the flap where there is maximum tension. The remaining flap is then sutured, beginning with the ‘Y’ limb and continuing along the outer border using standard technique. πŸ‘¨‍βš•οΈ 8️⃣ 7 Day course of antibiotics; topical antibiotics (bactroban and gentamicin ointment); suture removal in 14 daysπŸ’‰πŸ’ŠπŸ’Š 9️⃣ Pressure wrap using telfa pads, coban wraps and rolled gauze to prevent postop bleeding βœ‚οΈπŸ’‰πŸŒ‘ . . #mohs #skincancer

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The keystone island flap is a fasciocutaneous flap that offers robust vascularity to large, deep distal leg🦡defects by providing a rich network of perforator arteries which prevent tissue ischemia and optimize wound healing. β€οΈβ­οΈπŸ‘¨‍βš•οΈ This patient presented with a rapidly-growing hemorrhagic nodule on the calf. Biopsy results confirmed a moderately differentiated SCC. Subsequent Mohs micrographic surgery provided cancer-free margins after three stages. The resultant defect extended down to fascia and a bilateral keystone flap was performed. Here’s how we did it:πŸ‘¨‍βš•οΈπŸ‘ @paulgrubermd 
1️⃣ The defect is converted to elliptical shape for proper closure without standing cutaneous deformity. The length and maximum width of the defect is measured intraoperatively. ⭐️
2️⃣ The side of the defect with greater tissue laxity is chosen as the flap donor area. If a single flap is not sufficient to cover the defect, another flap from the opposite side of the ellipse is marked and kept ready. An incision at 90* at either end of the ellipse meets the curvilinear line of the flap outer margin. ✍️✍️
3️⃣One side of the elliptical defect serves as the inner arc of the keystone. The width of the flap equals the width of the defect. The flap length depends upon the length of elliptical excision.πŸ‘
4️⃣ An incision is made along the flap boundary as marked before. The incision is deepened until deep facia, which is also divided along the outer border, providing a fasciotomy to minimize wound tension. πŸ”ͺ
5️⃣ Undermining of the flap border should not be done to prevent injury to fasciocutaneous and musculocutaneous perforators. βœ‚οΈ
6️⃣ Minimum undermining can be done on the other side of the defect if there is any tension in the suture line. βœ‚οΈ
7️⃣ First suture is placed at the center of the flap where there is maximum tension. The remaining flap is then sutured, beginning with  the ‘Y’ limb and continuing along the outer border using standard technique. πŸ‘¨‍βš•οΈ
8️⃣ 7 Day course of antibiotics; topical antibiotics (bactroban and gentamicin ointment); suture removal in 14 daysπŸ’‰πŸ’ŠπŸ’Š
9️⃣ Pressure wrap using telfa pads, coban wraps and rolled gauze to prevent postop bleeding βœ‚οΈπŸ’‰πŸŒ‘
.
.
#mohs #skincancer
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