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EXCISION OF THE SKIN IN RADICAL MASTECTOMY

HOWARD D. COGSWELL, M.D.
Arch Surg. 1950;61(2):305-311. doi:10.1001/archsurg.1950.01250020309012.
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IT IS GENERALLY agreed that the operation of choice for carcinoma of the breast is radical mastectomy based on most of the concepts of Halsted and of Willy Meyer. No general agreement exists, however, on the amount of skin that should be removed in the performance of the operation. There are those who advocate removing a large amount of skin and covering the raw areas with skin grafts and those who allow enough skin to remain for a primary closure. The first group, or the "Halsted group," apparently believe that the cancer is spread by permeation and embolism into the lymphatic vessels to the skin. The second group subscribes to the conclusion of Handley,1 who believed that the spread of cancer was through the vertical lymphatic vessels. Both groups agree that embolism, permeation and, more rarely, vascular routes are available for dissemination of the carcinoma. Since the exact route

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