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New Trends In Medical Education. The Clinical Skills Laboratories, Abdulaziz M. Sebiany
New Trends In Medical Education. The Clinical Skills Laboratories, Abdulaziz M. Sebiany
Saudi Medical Journal
A clinical skills laboratory or center is a facility in which students, physicians, nurses and other health care professionals learn clinical, communication and information technology skills to a specified level of competence prior to or coordinated with direct patient contact. The purpose of the clinical skill laboratory is to support the acquisition, maintenance and enhancement of the clinical skills of students in health care professions. Within this non-threatening environment, patient volunteers, simulated patients, mannequins and information technology are employed to provide hands-on learning experiences for the practice of the essential clinical skills. The skills laboratory helps to ensure that all …
Peripartum Cardiomyopathy Searching For A Better Understanding, Mostafa Q. Al-Shamiri, Mansour M. Al-Nozha
Peripartum Cardiomyopathy Searching For A Better Understanding, Mostafa Q. Al-Shamiri, Mansour M. Al-Nozha
Saudi Medical Journal
Congestive heart failure is an uncommon complication of pregnancy with potentially life-threatening consequences. Peripartum cardiomyopathy (PPCM) is a disease of unknown cause in which severe left ventricular dysfunction occurs during late pregnancy or the early puerperium. In the past, the diagnosis of this entity was made on clinical grounds; however, modern echocardiographic techniques have allowed more accurate diagnoses by excluding cases of diseases that mimic the clinical symptoms and signs of heart failure. Risk factors for peripartum cardiomyopathy include advanced maternal age, multiparity, African descent, twinning, and long-term tocolysis. An extensive search for the causes of peripartum cardiomyopathy has been …
Imported Malaria Infections Diagnosed At The Malaria Referral Laboratory In Riyadh, Saudi Arabia, Ibrahim S. Alkhalife
Imported Malaria Infections Diagnosed At The Malaria Referral Laboratory In Riyadh, Saudi Arabia, Ibrahim S. Alkhalife
Saudi Medical Journal
OBJECTIVE: To determine epidemiological characteristics of imported malaria infections in Riyadh, Kingdom of Saudi Arabia, based on retrospective analysis of laboratory records within the Central Laboratory. METHODS: Records of the Malaria Referral Laboratory in Riyadh, Kingdom of Saudi Arabia (KSA) were reviewed for the past 6 years: 1416-1421 Hejri inclusive (1996-2001 Gregorian). The dates of blood films were converted to Gregorian calendar in addition to the Hejri dates already used in the records. Data collected included the date of film, age, sex, nationality and parasitological findings in the film. All data was entered and analyzed using statistical package for social …
Pattern Of Admission To Hospitals During Muslim Pilgrimage (Hajj), Saeed M. Al-Ghamdi, Hisham O. Akbar, Yousif A. Qari, Omer A. Fathaldin, Rahed S. Al-Rashed
Pattern Of Admission To Hospitals During Muslim Pilgrimage (Hajj), Saeed M. Al-Ghamdi, Hisham O. Akbar, Yousif A. Qari, Omer A. Fathaldin, Rahed S. Al-Rashed
Saudi Medical Journal
OBJECTIVE: The pattern of medical conditions necessitating admission differs according to the weather condition in that particular year. Previous studies had been conducted during the hot weather, none over the last 10 years, were carried out during, the milder weather we are experiencing. The aim of this study is to establish the pattern of admission during this mild weather and to elucidate the possible risk factors. METHODS: A prospective study was performed in 4 hospitals in 2 different locations in Al-Mashaer, Kingdom of Saudi Arabia. Data were collected during one working shift in 2 hospitals in Arafat on the 9th …
Response Of Sudanese Doctors To Domestic Violence, Awad M. Ahmed, Mohy E. Abdella, Elsading Yousif, Ahmed E. Elmardi
Response Of Sudanese Doctors To Domestic Violence, Awad M. Ahmed, Mohy E. Abdella, Elsading Yousif, Ahmed E. Elmardi
Saudi Medical Journal
OBJECTIVE: The aim of this study was to assess the awareness, and response of the Sudanese doctors to domestic violence. METHODS: The study was carried out among the doctors of the Police University Hospital, Khartoum, Sudan. Self-administered questionnaires were distributed to all doctors who were attendants at the hospital, one morning in July 2002. The information required from the surveyed doctors included their familiarity, and views on domestic violence as a health problem, number of cases of abuse encountered, barriers to diagnose or screen cases, their views on intervention beyond physical treatment and if they had been taught or trained …
The Knowledge And Practices Of Oral Hygiene Methods And Attendance Pattern Among School Teachers In Riyadh, Saudi Arabia, Khalid Almas, Thamir M. Al-Malik, Mohammed A. Al-Shehri, Nils Skaug
The Knowledge And Practices Of Oral Hygiene Methods And Attendance Pattern Among School Teachers In Riyadh, Saudi Arabia, Khalid Almas, Thamir M. Al-Malik, Mohammed A. Al-Shehri, Nils Skaug
Saudi Medical Journal
OBJECTIVE: The aim of this study was to find out the knowledge and practices of oral hygiene methods among primary and secondary school teachers in Riyadh, Kingdom of Saudi Arabia (KSA). METHODS: The study was carried out using a self-administered questionnaire. Four hundred and seventy teachers, male 236 (50.2%) and female 234 (48.8%) responded with a response rate of 85.5%. The study was conducted during October to December 2001 at primary and secondary schools in Riyadh City, KSA. RESULTS: Almost 86% of male and 90% of female teachers felt that dental caries is due to the wrong method of tooth …
The Pattern Of Developmental Dysplasia Of The Hip, Mamoun K. Kremli, Ahmed H. Alshahid, Khalid I. Khoshhal, Mohammed M. Zamzam
The Pattern Of Developmental Dysplasia Of The Hip, Mamoun K. Kremli, Ahmed H. Alshahid, Khalid I. Khoshhal, Mohammed M. Zamzam
Saudi Medical Journal
OBJECTIVE: This study was conducted to enlarge the knowledge of developmental dysplasia of the hip (DDH) in the Kingdom of Saudi Arabia (KSA), and to compare its presentation among Saudi population to known international figures. METHODS: A prospective study of Saudi patients with DDH that presented to King Khalid University Hospital, Riyadh, KSA over 5 years starting September 1996. The information needed was obtained directly from one or both parents. RESULTS: Six hundred Saudi children were included in this study. The diagnosis of DDH was delayed in most patients. The results give an impression that parents9 consanguinity, positive family history, …
Mesenteric Cystic Lymphangioma, Abdullatif A. Al-Arfaj, Hakam A. Yaseen
Mesenteric Cystic Lymphangioma, Abdullatif A. Al-Arfaj, Hakam A. Yaseen
Saudi Medical Journal
Abdominal cystic lymphangioma is a very rare congenital tumor of lymphatic origin. It usually appears in the pediatric age and frequently presents with non-specific symptoms and deceptive signs causing, at times, diagnostic dilemmas. Ultrasonography and computer tomography imaging are considered the diagnostic modalities of choice. Two cases of mesenteric cystic lymphangioma, one presenting as perforated appendicitis and the other as recurrent gastritis, are reported. Infection in the first and volvulus in the second case is behind the mode of presentation. The diagnostic approach and treatment are described, with emphasis on the operative tactic applied for upper jejunal resection. A high …
Sextuplets In Oman, Mariam Mathew, Pmc Nair, Zenaida Reyes, Rafique Himani, Andrzej Krolikowski
Sextuplets In Oman, Mariam Mathew, Pmc Nair, Zenaida Reyes, Rafique Himani, Andrzej Krolikowski
Saudi Medical Journal
Use of ovulation inducing agents has increased the incidence of high order multifetal gestation. Such pregnancies are associated with increased maternal morbidity and poor perinatal outcome especially due to prematurity. Here, we report a case of sextuplet pregnancy following ovulation induction with gonadotrophins. This is the first reported case of sextuplets from Oman.
The Effects Of Cardiac Rehabilitation In Patients With Coronary Artery Disease, Abbas Afrasiabi, Mehrnoosh Toofan, Leila Pirzad, Susan Hassanzadeh, Habib Pirzad
The Effects Of Cardiac Rehabilitation In Patients With Coronary Artery Disease, Abbas Afrasiabi, Mehrnoosh Toofan, Leila Pirzad, Susan Hassanzadeh, Habib Pirzad
Saudi Medical Journal
No abstract provided.
Outcomes Of Neurodevelopmental And Genetic Disorders, Pinar Ozand
Outcomes Of Neurodevelopmental And Genetic Disorders, Pinar Ozand
Saudi Medical Journal
No abstract provided.
Electives During Medical Internship, Shyam K. Parashar, Abdulmohsen A. Al-Ghamdi
Electives During Medical Internship, Shyam K. Parashar, Abdulmohsen A. Al-Ghamdi
Saudi Medical Journal
OBJECTIVE: The purpose of the study was to find out the reasons for selecting elective rotations during a rotating medical internship. METHODS: One hundred and seventy-eight medical interns in the College of Medicine, King Faisal University, Dammam, Kingdom of Saudi Arabia during the period March 2001 to August 2002 completed a questionnaire for their selection reasons with responses on a scale of 1-5. RESULTS: The study comprised 60% males and 98.3% Saudis. The most frequently chosen electives are dermatology 28.1%, radiology 20.8%, anesthesia 9.6% and otorhinolaryngology (ear, nose and throat [ENT]) 9%. Significantly, more males (89.2%) chose radiology rotation and …
Osteoporosis In Postmenopausal Saudi Women Using Dual X-Ray Bone Densitometry, Mahmoud I. El-Desouki
Osteoporosis In Postmenopausal Saudi Women Using Dual X-Ray Bone Densitometry, Mahmoud I. El-Desouki
Saudi Medical Journal
OBJECTIVE: A pilot study to estimate the prevalence of osteopenia and osteoporosis in postmenopausal Saudi women. METHODS: Lumbar spine bone density was measured in 830 postmenopausal Saudi women 50-80 years of age (average 59 years), using dual x-ray absorptiometry (DXA) at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 1989 and 1999. RESULTS: The results of the bone mineral density (BMD) in gm/cm2 were compared to the peak bone density (PBD) in healthy young women (T-score). Based on the definition of World Health Organization (WHO), the T-score value was considered for analysis. Accordingly, 248 (29.9%) subjects showed …
Incidence And Risk Factors Associated With The Patency Of Ductus Arteriosus In Preterm Infants With Respiratory Distress Syndrome In Kuwait, Majeda S. Hammoud, Hassan A. Elsori, Emad-Aldeen M. Hanafi, Adel A. Shalabi, Ibrahim A. Fouda, Lakshmi V. Devarajan
Incidence And Risk Factors Associated With The Patency Of Ductus Arteriosus In Preterm Infants With Respiratory Distress Syndrome In Kuwait, Majeda S. Hammoud, Hassan A. Elsori, Emad-Aldeen M. Hanafi, Adel A. Shalabi, Ibrahim A. Fouda, Lakshmi V. Devarajan
Saudi Medical Journal
OBJECTIVE: Patent ductus arteriosus (PDA) is considered to be an important cause of morbidity and mortality among preterm infants. The aim of this study is to determine the incidence of PDA in ventilated preterm infants with respiratory distress syndrome (RDS) and to evaluate the role of some antenatal risk factors on its occurrence in our population. METHODS: The case records of the preterm infants of <34 weeks gestational age, who were ventilated for RDS at the neonatal intensive care unit of Maternity Hospital, Safat, Kuwait, between March 1998 and February 1999, were reviewed. Diagnosis of PDA was based on echocardiographic findings. The association between the risk factors chosen and the PDA was also evaluated. RESULTS: A total of 101 infants whose gestational ages ranged between 25-33 weeks, and birth weights between 685-1580 grams were included. Fifty-four had a significant PDA (53.4%). Maternal diabetes and antepartum hemorrhage (APH), birth weights, gestational ages, multiplicity and gender of the infants were found to be related to the incidence of PDA. CONCLUSION: The incidence of PDA in our ventilated preterm infants with RDS is similar to those reported from other neonatal units outside Kuwait. There are some factors that may identify babies, who are prone to develop PDA, which need to be confirmed by further prospective studies using a larger population.
Prevalence Of Hepatitis B Virus And Hepatitis C Virus In Health Workers In 3 Major Hospitals In Aden, Republic Of Yemen, Ahmed S. Al-Jarba, Waleed M. Al-Sayyari
Prevalence Of Hepatitis B Virus And Hepatitis C Virus In Health Workers In 3 Major Hospitals In Aden, Republic Of Yemen, Ahmed S. Al-Jarba, Waleed M. Al-Sayyari
Saudi Medical Journal
No abstract provided.
Blood Lead Levels And Y-Glutamyl Transferase Activity In Battery Factory Workers In Jordan, Mohamad K. Nusier, Zeyad J. El-Akawi, Ibrahim Bani-Hani
Blood Lead Levels And Y-Glutamyl Transferase Activity In Battery Factory Workers In Jordan, Mohamad K. Nusier, Zeyad J. El-Akawi, Ibrahim Bani-Hani
Saudi Medical Journal
OBJECTIVE: The aim of this study is to investigate blood lead levels in workers of lead acid battery factories and the relationship between those levels and the activity of y-glutamyl transferase (y-GT). METHODS: Samples of blood were collected during the period from July 2001 to August 2001 from 95 workers of the 2 lead-acid battery factories in Amman, Jordan. They were categorized into 2 groups based on the nature of their work: direct (high exposure) and indirect contact (low exposure) groups. Lead concentration in whole venous blood and y-GT activity was measured. RESULTS: Mean blood lead levels were 51.4 +/- …
Effects Of Nibbling And Gorging On Lipid Profiles, Blood Glucose And Insulin Levels In Healthy Subjects, Mohammad R. Rashidi, Soltanali Mahboob, Reza Sattarivand
Effects Of Nibbling And Gorging On Lipid Profiles, Blood Glucose And Insulin Levels In Healthy Subjects, Mohammad R. Rashidi, Soltanali Mahboob, Reza Sattarivand
Saudi Medical Journal
OBJECTIVE: Although there is some evidence indicative of some beneficial effects of an increased meal frequency on the lipid profiles, the results published are controversial. The aim of the present study is to investigate the effects of feeding frequency on blood lipids, glucose and insulin. METHODS: The subjects of this study were 15 healthy non-smoker males aged 27.2 +/- 6.4 years. All subjects were placed on 2 identical diets in which they consumed the same food either as 3 meals at 7-hours intervals (gorging diet) or as 9 snacks at 2 hours intervals (nibbling diet). Each diet was of 2 …
Low Carbohydrate Diet. Its Effects On Selected Body Parameters Of Obese Patients, Faisal A. Alnasir, Bahaa E. Fateha
Low Carbohydrate Diet. Its Effects On Selected Body Parameters Of Obese Patients, Faisal A. Alnasir, Bahaa E. Fateha
Saudi Medical Journal
OBJECTIVE: This pilot study, which involved 13 obese patients, was conducted to determine the effect of a low carbohydrate diet on the body weight and other body parameters, including blood pressure and selected biochemistry indicators. METHODS: The study was carried out in Naim Health Center, Bahrain during the period March 2002 to April 2002. Each individual was followed for 6 weeks while on a low carbohydrate diet, with careful monitoring during the study period. RESULTS: Paired t-test showed statistically significant reduction of waist circumference (p<0.00) and body weight (p<0.00) of the sample population after 6 weeks from the commencement of the diet. The body mass index also showed statistically significant reduction during the study period (p<0.01). Furthermore, blood cholesterol level was reduced (p<0.012). Although there was a statistically significant decrease in the fasting blood sugar levels (p<0.01), the mean readings remained within the normal range of blood sugar levels. There were no statistically significant changes in the levels of urate, creatinine, urea, triglyceride, and in systolic or diastolic blood pressure readings (p>0.05). CONCLUSION: Low carbohydrate diet could help in reducing body weight without any significant harmful …
Awareness During Surgery, Farouk M. Messahel, Ali S. Al-Qahtani
Awareness During Surgery, Farouk M. Messahel, Ali S. Al-Qahtani
Saudi Medical Journal
OBJECTIVE: Patients who experience awareness under surgery may suffer from the post-traumatic stress disorder with its long-lasting psychological damage. Furthermore, there are also media attention and legal consequences. In spite of understanding its causes, it is still occurring worldwide and there are no reports of awareness in the Saudi medical literature. This prospective study was conducted to determine the incidence of awareness when its causes are eliminated and to record patient satisfaction. METHODS: Surgical patients >4 years old (ASA I-III) admitted to the Armed Forces Hospital, Wadi Al-Dawasir, Kingdom of Saudi Arabia, between October 1998 and November 2002 were included …
High Bile Duct Injury Following Laparoscopic Cholecystectomy, Mohammed I. Al-Sebayel
High Bile Duct Injury Following Laparoscopic Cholecystectomy, Mohammed I. Al-Sebayel
Saudi Medical Journal
OBJECTIVE: Laparoscopic cholecystectomy is now widely applied in hospitals throughout the Kingdom of Saudi Arabia (KSA). Iatrogenic bile duct injury occurs rarely. It is a serious complication with long term consequences on patients. This paper describes our experience in dealing with this complication and the eventual outcome of the patients. METHODS: Between July 1993 and December 1999, 17 patients with high bile duct injury were referred to the Hepatobiliary Unit of King Khalid University Hospital and King Fahad National Guard Hospital, Riyadh, KSA. Their charts were reviewed retrospectively. Once a patient was referred, a clinical evaluation with particular attention to …
Pregnancy Outcomes Among Palestinian Refugee Women With Sickle Cell Trait In Damascus, Syria, Asma A. Abdulsalam, Hyam N. Bashour, Fawza S. Monem, Fathi M. Hamadeh
Pregnancy Outcomes Among Palestinian Refugee Women With Sickle Cell Trait In Damascus, Syria, Asma A. Abdulsalam, Hyam N. Bashour, Fawza S. Monem, Fathi M. Hamadeh
Saudi Medical Journal
OBJECTIVE: The results on pregnancy outcomes of mothers afflicted with sickle cell trait are still contradictory. This study aimed to examine the fetal and maternal outcomes among a cohort of pregnant women. METHODS: This is a prospective cohort study that examined the fetal and maternal outcomes among 98 women with sickle cell trait (HbAS) and 402 women with normal hemoglobin (HbAA). The study was carried out in 4 health centers serving Palestinian Refugees in Damascus, during the period November 2000 to May 2002. Hemoglobin electrophoresis was carried out for all newly registered pregnancy women. Women were then followed up until …
The Decline Of Hepatitis B Viral Infection In South-Western Saudi Arabia, Ayobanji E. Ayoola, Mohsen S. Tobaigy, Mohammed O. Gadour, Basher S. Ahmad, Margani K. Hamza, Abdurahim M. Ageel
The Decline Of Hepatitis B Viral Infection In South-Western Saudi Arabia, Ayobanji E. Ayoola, Mohsen S. Tobaigy, Mohammed O. Gadour, Basher S. Ahmad, Margani K. Hamza, Abdurahim M. Ageel
Saudi Medical Journal
OBJECTIVE: Hepatitis B virus (HBV) infection is endemic in the Kingdom of Saudi Arabia (KSA). The Jizan region in the South-Western area of the country was noted for a high prevalence of hepatitis B surface antigen (HbsAg) carrier rate. The study was carried out to determine the prevalence of HBsAg and other markers of HBV among residents of Jizan and evaluate the impact of the measures adopted in the last decade, to control HBV. METHODS: The study was carried out between 1995 and 1998. The subject were studied in 4 groups: Group A consisted of voluntary blood donors (n=14883) tested …
Trial Of Lamivudine In Hepatitis B Surface Antigen Carriers With Persistent Hepatitis B Core Igm Antibody, Hisham Y. Ali
Trial Of Lamivudine In Hepatitis B Surface Antigen Carriers With Persistent Hepatitis B Core Igm Antibody, Hisham Y. Ali
Saudi Medical Journal
OBJECTIVE: The persistence of hepatitis B core immunoglobulin M (HBc IgM) antibody in hepatitis B surface antigen (HBsAg) carriers is a risk factor with hidden dangers and forecasts the existence of liver damage. A trial of lamivudine in such subset of carriers was carried out for the first time in this study. METHODS: A total of 62 HBsAg with hepatitis e antibody individuals (age range, 25-45 years) with persistent HBc IgM antibody were randomized to receive either 100 mg lamivudine (32/62) or placebo (30/62) daily for 6 months. The study was performed from June 2000 to October 2002. The carriers …
Acute Myeloblastic Leukemia In A Patient With Primary Antiphospholipid Syndrome, Shiv K. Saxena, Ahmed H. Al-Jizeeri, Osman A. Kheir
Acute Myeloblastic Leukemia In A Patient With Primary Antiphospholipid Syndrome, Shiv K. Saxena, Ahmed H. Al-Jizeeri, Osman A. Kheir
Saudi Medical Journal
Antiphospholipid syndrome is characterized by venous and arterial thrombosis, recurrent pregnancy loss and the presence of the lupus anticoagulant, anticardiolipin antibodies or both. Antiphospholipid syndrome may occur as a primary disease or in patients with systemic lupus erythematosus or other autoimmune, infectious or neoplastic disorders. In this paper we report a 29-year-old Saudi female, a known case of antiphospholipid syndrome, presented with complaints of fever, breathlessness and generalized fatigue. Further investigations confirmed her as a case of myeloblastic leukemia (M1, French-American-British classification). Acute myeloblastic leukemia is not described to be associated with primary antiphospholipid syndrome in the literature to date. …
Superior Mesenteric Vein Thrombosis Complicating Appendicular Masses, Salma S. Echtibi, Masoud O. Bashir, Misbah U. Ahmed, Frank J. Branicki, Fikri M. Abu-Zidan
Superior Mesenteric Vein Thrombosis Complicating Appendicular Masses, Salma S. Echtibi, Masoud O. Bashir, Misbah U. Ahmed, Frank J. Branicki, Fikri M. Abu-Zidan
Saudi Medical Journal
Mesenteric vein thrombosis (MVT) is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography (CT) scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical …
Accuracy Of Self-Reporting Of Diabetes Mellitus And Hypertension And Its Determinants Among Omani Adults, Asya A. Al-Riyami, Mustafa M. Afifi
Accuracy Of Self-Reporting Of Diabetes Mellitus And Hypertension And Its Determinants Among Omani Adults, Asya A. Al-Riyami, Mustafa M. Afifi
Saudi Medical Journal
No abstract provided.
Residents Perception Of The Journal Club, Shabih Manzar
Residents Perception Of The Journal Club, Shabih Manzar
Saudi Medical Journal
No abstract provided.
Improving Foot Examination Of Diabetics In Primary Care, Mohammed H. Al-Doghether
Improving Foot Examination Of Diabetics In Primary Care, Mohammed H. Al-Doghether
Saudi Medical Journal
No abstract provided.
Values, Qualifications, Ethics And Legal Standards In Arabic (Islamic) Medicine, Kamel M. Ajlouni
Values, Qualifications, Ethics And Legal Standards In Arabic (Islamic) Medicine, Kamel M. Ajlouni
Saudi Medical Journal
Many historians claim that the Western world pioneered in the setting of ethical, legal and professional standards in the practice of medicine. Informed medical consent is proposed by some as an American invention. Others claim that patient rights and legal protection propose have stated in the early decades of the 20th century. This review is an attempt to uncover the facts regarding the way Arabs practiced medicine during the golden era of Islam. Eight hundred to fifteen hundred AD this includes the qualification of physicians according to a well designed curricula covering the science and humanity of medicine. The rules …
Lipomatosis Of The Parotid Gland In Children, Abdullatif A. Al-Arfaj, Roopa K. Arora, Roshdi R. Al-Metwalli
Lipomatosis Of The Parotid Gland In Children, Abdullatif A. Al-Arfaj, Roopa K. Arora, Roshdi R. Al-Metwalli
Saudi Medical Journal
Parotid lipomatosis is extremely rare in children. Only 4 cases have previously been reported in the English language medical literature. Surgical excision is frequently complicated by recurrence. We report, a fifth case, on a 5-month-old girl with rapidly progressive parotid lipomatosis. Emphasis is laid on the importance of preserving the unusually delicate tumor capsule to prevent tissue spillage and recurrence. The creation of an appropriate cleavage between the mass and the expanded skin with sparse subcutaneous fat, safeguarding the tumor capsule on one side and the skin blood supply on the other, represents a rewarding technical challenge.