Ebook Requisites in dermatology - Dermatologic surgery: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Requisites in dermatology - Dermatologic surgery: Part 2
Ebook Requisites in dermatology - Dermatologic surgery: Part 2
ChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2.•Performed for diagnostic or therapeutic purposes, it is a relatively simple procedure that one should master.•Knowledge of surgical anatomy IS of utmost importance!•There are variations in the ellipse that are particularly useful in certain anatomic regions of the skin, such as the crescent. S-pla Ebook Requisites in dermatology - Dermatologic surgery: Part 2sty and M-plasty excisions.•If proper surgical technique and meticulous hemostasis are maintained, surgical complications can be minimized and a cosmeEbook Requisites in dermatology - Dermatologic surgery: Part 2
tically elegant scar can result.IntroductionThe simple excision is the foundation of cutaneous surgery. Though seemingly complex to a novice, it shoulChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2r biology, local anesthetics, instrumentation, and suturing techniques is crucial prior to performing any cutaneous surgery. In addition, a thorough preoperative evaluation is essential to help minimize postoperative complications. When performed properly and meticulously, a fine cosmetically accept Ebook Requisites in dermatology - Dermatologic surgery: Part 2able scar results.ApplicationThe simple excision is designed to remove entire lesions for histopathologic examination, as well as surgical cure. WhethEbook Requisites in dermatology - Dermatologic surgery: Part 2
er it is a benign lesion that is troublesome (eg. cyst, lipoma, or dermatofibroma) or cosmetically bothersome (e.g. nevus on the chin or cheek), or a ChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2efinitive histopathologicdiagnosis, as well as complete removal. On the other hand, a surgical excision can be the definitive treatment of choice for selected malignant lesions that have been diagnosed on a prior biopsy. However, in this case, margins for cure, as well as cosmetic and functional cha Ebook Requisites in dermatology - Dermatologic surgery: Part 2llenges regarding the final scar, must be taken into consideration, making the excision a bit more challenging. For example, a well demarcated basal cEbook Requisites in dermatology - Dermatologic surgery: Part 2
ell carcinoma on the extremity' can usually be excised with a 4-5-mm margin of normal appearing skin around the circumference of the lesion. A superfiChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 210-1 for general recommendations on margins of excision.TechniquesOrienting the ellipseWhether one is working on the head and neck region, or the trunk and extremities, a working knowledge of anatomic danger zones (see Chapter 1) and surface anatomy, with regard to relaxed skin tension lines, contou Ebook Requisites in dermatology - Dermatologic surgery: Part 2r lines, and cosmetic units is essential (Figs 10-1 & 10-2). Planning your incision lines along relaxed skin tension lines, natural skin lines, cosmetEbook Requisites in dermatology - Dermatologic surgery: Part 2
ic units, and boundaries can increase the likelihood of a cosmetically acceptable scar, by providing optimal camouflage and allowing the wound to be cChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2the overlying skin. In general, the skin creases form in a pattern that is perpendicular to the direction of the underlying muscle contraction. Wounds oriented parallel to the skin creases or skin tension lines close under less tension, and result in well camouflaged, thin scars. Although Figures 10 Ebook Requisites in dermatology - Dermatologic surgery: Part 2-1 and 10-2 show these lines124Dermatologic SurgeryTable 10-1 General rules for margins ot excisionType of lesionMargin (mm)Benign lesions0-2AtypicalEbook Requisites in dermatology - Dermatologic surgery: Part 2
nevi44989Nonmelanoma skin cancer (not an indication for Mohs surgery)45022Melanoma (Breslow level simm)10Melanoma (Breslow level >1mm)20-30in general,ChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2uals, asking them to make an exaggerated facial expression or pinching the skin and identifying the natural skin lines will aid in determining the axis of orientation. If there is question as to optimal suture line orientation, the lesion should first be removed in a circular fashion, and undermined Ebook Requisites in dermatology - Dermatologic surgery: Part 2. This maneuver allows the skin’s inherent elasticity to determine along which axis it will form an oval. The surgeon can then extend the incision aloEbook Requisites in dermatology - Dermatologic surgery: Part 2
ng this axis to form an ellipse.Cosmetic subunit junction lines are formed at the borders of fixed structures on the face, and divide the face into coChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2ed and contained within a single cosmetic unit and resultant scars planned so that they lie within cosmetic subunit junction lines. This best maintains the normal anatomy of the face, in particular, as well as making the scar less conspicuous than one that crosses multiple cosmetic units. Some surge Ebook Requisites in dermatology - Dermatologic surgery: Part 2ons even enlarge their excisions so that the resultant scar will lie along a subunit junction line, emphasizing the importance of these boundary linesEbook Requisites in dermatology - Dermatologic surgery: Part 2
over relaxed skin tension lines.As a general rule, the length of the ellipse should be three to four times the width, and the tips drawn at an angle ChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2pse, and that the scar will lay down flat against the skin. If possible, the length of the ellipse should be drawn along the length of the lesion, to minimize the length of the scar. However, there are times when a longer, well placed scar, such as one that is oriented within a contour line or along Ebook Requisites in dermatology - Dermatologic surgery: Part 2 skin tension lines, will result in a more cosmetically acceptable scar than a shorter, more conspicuous, one.Preparing for the excisionPlanning the eEbook Requisites in dermatology - Dermatologic surgery: Part 2
xcision should be done with the patient upright, to minimize apparent distortion of the relaxed skin tension lines. Marking of the planned excision shChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2o marking, the area should be cleansed with 70% isopropyl alcohol. Any hair in and around the operative site that will interfere with the surgical procedure should be secured away from the operative field or clipped with scissors. Preoperative shaving creates microabrasions in the skin and should be Ebook Requisites in dermatology - Dermatologic surgery: Part 2 avoided due to increased risk of wound infection.Lines of planned excision may now be drawn using a skin marking pen, fine-tipped permanent marker, oEbook Requisites in dermatology - Dermatologic surgery: Part 2
r a wooden applicator dipped in gentian violet. The surgical site is then anesthetized, including a sufficient margin to allow for wide undermining (FChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2e should be used with caution around the eye, as it can cause corneal ulceration, and avoided completely around the ear if there is chance of a tympanic membrane perforation. Povidone-iodine should be avoided in patients with known allergy to iodine. Universal precautions should be employed at this Ebook Requisites in dermatology - Dermatologic surgery: Part 2point, including the use of sterile gloves, masks, and eye protection for surgical personnel. The surgical field is then draped with sterile towels, oEbook Requisites in dermatology - Dermatologic surgery: Part 2
r disposable sheets, and the excision carried out under aseptic conditions.Performing the excisionFor the majority' of basic excisional surgery, a no.ChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2hould be held vertically like a pen. For larger excisions, it may be preferable to hold it horizontally, like a steak knife. Prior to starting the incision, traction should be placed on the wound edges by the surgeon's nondominant hand or by a surgical assistant. Next, the skin is incised at a 90° a Ebook Requisites in dermatology - Dermatologic surgery: Part 2ngle, starting at the distal tip of the ellipse. The incision should be carried out toward the surgeon, ideally with enough pressure to incise the skiEbook Requisites in dermatology - Dermatologic surgery: Part 2
n up to the subcutaneous fat. The angle of the scalpel is decreased to about 45° when incising along the curvature of the ellipse, with the belly of tChapterBasic excisional surgeryChristine Poblete-LopezKey Points•The simple excision is the bread and butter of any dermatologist's surgical practice. Ebook Requisites in dermatology - Dermatologic surgery: Part 2he other apex of the ellipse (Fig. 10-6). The incision is repeatedGọi ngay
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