Dermatologic Surgery Tips and Techniques

Dermatologic Surgery Tips and Techniques

By Stuart Salasche, MD, Clinical Professor, University of Arizona Health Sciences Center, Research Scientist, University of Arizona, Cancer Center, Tucson, AZ; Ida F. Orengo, MD, Director of Dermatologic Surgery, Associate Professor, Department of Dermatology, Baylor College of Medicine, Houston, TX, USA; and Ronald J. Siegle, MD, Center for Surgical Dermatology, Columbus, OH, USA


Section 1: Assisting at Surgery

Pearl 1: Surgical Assistant: Counter-Traction and a Clear Visual Field
Pearl 2: Placement of the Simple Interrupted Stitch
Pearl 3: Surgical Assistant: Help with Surface Sutures
Pearl 4: Surgical Assistant: Twisted Knot and Cutting Suture at Correct Length
Pearl 5: Surgical Assistant: Help with the Subcuticular Stitch

Section 2: Suture Techniques

Pearl 6: How to Break the Memory of Suture Material without Breaking the Suture
Pearl 7: Hemostasis: Suture Ligature
Pearl 8: Proper Placement of the 3-Cornered Stitch
Pearl 9: Delayed Closure of Buried Sutures When Closing Small Excisions
Pearl 10: Percutaneous Buried Vertical Mattress Suture
Pearl 11: The Running Locked Suture as an Aid for Hemostasis
Pearl 12: Maximal Skin Edge Eversion with the Running Hybrid Mattress Suture
Pearl 13: The Short String Tie off

Section 3: Closures and Procedures

Pearl 14: Circular Incisions as a Guide for Optimal Aesthetic Removal
Pearl 15: The Crescentic Ellipse for Curving Relaxed Skin Tension Lines
Pearl 16: Serial Excision
Pearl 17: S-Plasty for Excision on Convex or Concave
Pearl 18: Pruning the Proud Flesh
Pearl 19: Hydro-Dissection (Hydroplaning) with Anesthetic Fluid
Pearl 20: Second Intention Healing Over Bare Cartilage
Pearl 21: A User-Friendly Surgical Dressing
Pearl 22: Minimizing the Dogear
Pearl 23: In Pursuit of the Perfect Punch Biopsy
Pearl 24: The Split Punch Biopsy: The power of two
Pearl 25: Saucerization Biopsy
Pearl 26: ?Off-Set Bias Suturing? to Favorably Alter the Tension Vector of Closure
Pearl 27: Have I Cut the Temporal Nerve or Just Anesthetized It?
Pearl 28: Electrodesiccation and Curettage for Warts
Pearl 29: Cysts and Lipomas, Oh My
Pearl 30: Drainage of Inflamed/Liquefied Cyst
Pearl 31: Transection of Pigmented Lesion
Pearl 32: The Retraction Suture for Cyst Removal

Section 4: Flaps

Pearl 33: Flap Components
Pearl 34: The Tension Vector of Closure
Pearl 35: Tension Vector of Rotation/Advancement Flaps
Pearl 36: Determining the Final Scar Lines and Tension Vector of the Rhombic Flap
Pearl 37: The Suspension Suture: Partial Closure of Defect Near Free Margin
Pearl 38: Contour Maintenance with Suspension Sutures
Pearl 39: Reconstruction of the Alar-Facial-Lip Sulcus
Pearl 40: ?Mercedes Flap?: Multiple Flap Closure of Large Defects

Section 5: Grafts

Pearl 41: Trimming Fat Off of Full-Thickness Skin Grafts
Pearl 42: Free Hand Harvesting of a Small Split-Thickness Skin Graft
Pearl 43: Basting Suture for FTSG under Direct Visualization
Pearl 44: Continuous Tie-Over Bolster Dressings for Skin Grafts
Pearl 45: M-Plasty FOR Dog Ear
Pearl 46: Dog-Ear as Graft; Don?t Throw That Tissue Away
Pearl 47: Dermabrasion for Surgical Scars and Grafts
Pearl 48: Manual Dermabrasion of Full-Thickness Grafts
Pearl 49: Post-surgical dermabrasion

Section 6: Safety

Pearl 50: Maintaining an Orderly Surgical Tray
Pearl 51: Surgical Waste Disposal
Pearl 52: Safety: The Medicine Cup: Behold the Lowly cup
Pearl 53: Safety: Corneal Eyeshield
Pearl 54: Safety: The Sheathed Syringe
Pearl 55: Geometric Pattern Excision for Histological Margin Control of Tumors
Pearl 56: Control of the Surgical Lamp: In the Best Light
Pearl 57: Electrosurgical Unit Safety

Section 7: Instruments

Pearl 58: Instruments for Special Occasions: The Mini-Scalpel System
Pearl 59: Razor Blade Surgery for Benign Lesions
Pearl 60: Razor Blade Excision for Shallow Basal Cell Carcinomas of the Nose
Pearl 61: Alternate Use of a Forceps: A Freeze With a Squeeze
Pearl 62: Towel Clamp Assisted Closure for Wounds under Significant Tension
Pearl 63: The Cotton-Tipped Applicator (CTA): The Ever-Ready, Multi-Purpose Superstar
Pearl 64: The Tongue Depressor: More than say ?Ah? (Sept pearls)
Pearl 65: The Universal Paper Clip: There?s always one in the desk drawer
Pearl 66: The Hyfrecator: Low-Tech, Yet Efficient Benign Lesions
Pearl 67: The Punch Used as a Curette

Section 8: Nail

Pearl 68: Nail Matrix Exploration and Retraction Suture for Exposure of the Proximal Nail Groove.
Pearl 69: Obtaining an Adequate Biopsy of the Nail Matrix/Bed
Pearl 70: Compressive Dressing for the Nail Unit
Pearl 71: Use of a Sterile Surgical Glove to Create a Sterile Field
Pearl 72: The Proximal Nail Plate Avulsion
Pearl 73: Post-phenol Matricectomy Injection to Prolong Anesthesia and Prevent Lymphangitis
Pearl 74: Decompression of a Subungual Hematoma

Section 9: Regional Tips

Pearl 75: Pinwheel flap for the scalp vertex and direct galeotomy
Pearl 76: Tips for Scalp Surgery: Keeping Hair Out of the Field
Pearl 77: Tips for Scalp Surgery: Collodion Dressing
Pearl 78: Pearls Around the Mouth
Pearl 79: Suturing on the Lip to Minimize Patient Discomfort
Pearl 80: Labial Mucocele Removal
Pearl 81: Dental Roll for Nasal Packing
Pearl 82: Cotton Plug in the Ear Canal
Pearl 83: Testing Lower Eyelid Strength
Pearl 84: Second Intention Healing of Ear Defects