The dog ear is a common skin deformity resulting from attempted closure of unfavorably shaped defects or from transfer of many local flaps. Prevention is possible in many instances and surgical correction is usually feasible when the deformity appears.

We describe the case of a young patient who contracted fatal herpes simplex virus hepatitis following neoadjuvant chemoradiotherapy and anterior resection for rectal cancer. The rarity and non-specific presentation of this treatable disease, which masqueraded as the sequelae of postoperative sepsis, resulted in a diagnosis following death. Features that should prompt inclusion of herpes simplex virus hepatitis in the differential diagnoses are suggested and the case is a reminder of how neoadjuvant therapy may subtly alter a patient's immunocompetency.

Large defects of the thick, immobile lower nasal skin are most optimally reconstructed by use of the single stage, reliable and cosmetically acceptable subcutaneous pedicle flap. Skin incisions are minimized and are easily placed in natural skin lines. The donor defect is closed directly. Grafts, other local flaps or regional flaps present the disadvantages of less ideal color or contour match, reduced flap mobility, restricted available skin, additional or more obvious donor site scarring or distortion, or unnecessary complexity.

used to pick up and incise the posterior rectus sheath and the parietal peritoneum. The port is screwed into place with the polyglactin stay sutures fixed over its wings. DISCUSSIONThis simple technique of spooning the Langenbeck retractors over each other through the same split in the muscle fibres provides an avascular, relatively atraumatic technique for placement of the robotic camera port. The technique may be used for other laparoscopic procedures where a port needs to be placed through the rectus muscle.

Depressed scars of the head and neck can be predictably and satisfactorily revised by the combination of local subcutaneous flaps with the accepted techniques of superficial scar revision.