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Patients presenting for excision of squamous cell carcinomata, including Bowen's disease, in sun-damaged skin often present with poorly defined, morphoeic or multifocal neoplasms, the extent of which can be difficult to identify intraoperatively. Use of vital staining has been commonly used to aid identification and appropriate excision of squamous lesions of the oral cavity and upper aerodigestive tract but has not been readily adopted for cutaneous lesions. We report a case of a morphoeic squamous cell neoplasm of the web space and fingers to illustrate the merits of vital staining cutaneous squamous neoplasms with the simple dye Carmoisine E122. This assists with intraoperative tumour identification and facilitates adequate oncological resection and appropriately planned reconstruction. By comparison with other methods such as Mohs, it is a simple, cheap, and rapid aid that may be used by surgeons of all grades to improve identification of the extent of the neoplasm, without special equipment.

The arterial anatomy of the anteromedial thigh was investigated in ten fresh cadavers that had been systemically injected with a lead oxide-gelatin mixture. The arteries accompanying the great saphenous vein and the anterior cutaneous branches of the femoral nerve were found to have branches not only to the cutaneous vein and nerve, but also to the skin. On the basis of the anatomy of these accompanying arteries, a pedicled fasciocutaneous flap containing them was developed consisting of an adipofascial pedicle and a skin island. This flap has been named the femoral veno-neuroaccompanying artery fasciocutaneous flap (the femoral V-NAF flap, the great saphenous-femoral V-NAF flap) and has been applied in three cases of vaginal reconstruction., (Copyright 1999 The British Association of Plastic Surgeons.)

In order to preserve the anal function after ano-perianal skin excision for malignancy, we have reconstructed a deep, symmetrical natal cleft using a V-Y advancement of bilateral gluteus maximus musculocutaneous flaps thinned medially and sutured to the ooccyx, anococcygeal ligament and the central tendon of the perineum. This technique was applied in three cases of Bowen's disease and two cases of Paget's disease. In all five cases, postoperative anal functions such as comfortable defecation and sensation, were well preserved, the perianal skin and underwear stayed clean, and there was no disturbance of walking or exercise.

Five successful cases of transversely designed dorsal metacarpal V-Y advancement flaps for reconstructing defects on the dorsum of the hand are reported. The flaps were supplied by dorsal metacarpal vessels. Proximally based flaps were used in 2 cases, one of which was supplied by two dorsal metacarpal arteries. Distally based flaps were used in 3 cases. All flaps survived completely.

Two cases of dorsal foot reconstruction using dorsal metatarsal V-Y advancement flaps based on dorsal metatarsal vessels are presented. The flap is useful for the repair of small to moderate sized dorsal foot defects.