Dermatologic Surgery Tips and Techniques

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