05-16-2007, 07:14 AM
Basic Surgical Procedures
Excisional Biopsy
Excision axis depends on skin creases / Langer™s lines and its margins on the lesion. Once the skin is numbed with local anesthetic, the skin is incised vertically down to the subcutaneous fat with the scapel, in a smooth continuous manner to complete both arcs of the ellipse. Using simple interrupted skin sutures, the wound is apposed and slightly everted. Absorbable subcutaneous sutures are used for big excisions.
Incisional Biopsy
Performed for diagnostic purposes. The technique is comparable to an excision, but less tissue is taken.
Punch Biopsy
A punch (normally about 4 mm in diameter) is twisted into the skin: resulting cylinder of skin is removed and the defect cauterized or sutured.
Shave Biopsy
Used for benign lesions, usually intradermal nevi or seborrheic keratosis. The lesion is shaved parallel to and slightly above the skin™s surface. Cautery may be used to achieve hemostasis. Skin tags are removed by using scissors to snip them off followed by cauterization to any bleeding points.
Curettage
After local anesthetic, the lesion is removed by a gentle scooping motion with the curette. The base is then cauterized. Curettage may be used in seborrheic keratosis, pyogenic granulomas, keratoacanthomas, single facial viral warts, but not nevi.
Cautery
Provides hemostasis and destroys tissue. The classic cautery machine has an electrically heated wire and is self sterilizing. Silver nitrate sticks or 35% aluminum chloride in 50% isopropyl alcohol provide chemical cautery.
Cryotherapy
Liquid nitrogen (- 196 °C) is delivered by cotton wool bud or spray gun and injures cells by ice formation. After immersion into liquid nitrogen, the cotton wool bud is applied to the lesion for 10-15 seconds until a thin frozen halo appears at the base. The spray gun is used at a distance of 10 mm for a similar amount of time. Longer freezing times are given for malignant tumors. Blisters may develop within 24 hours. These are punctured and a dry dressing applied. Side effect may include hypopigmentation of pigmented skin, ulceration (especially on the lower legs of the elderly). Treatment may be repeated in 4 weeks if warranted.
Cryotherapy may be used for viral warts, seborrheic keratosis, molluscum contagiosum, intraepidermal carcinoma.
Mohs™ Surgery
Excision of malignant tumor which is mapped and microscopically examined to define its extent and the completeness of the excision.
Dermabrasion
A rotating mechanical head wounds the skin down to the dermis.
Laser (Light Amplification by Stimulated Emission of Radiation)
High intensity light energy is applied to the tissue. Laser surgery is a rapidly changing field in which new types of lasers, as well as the conditions amenable to treatment, are continually being introduced. Lasers vary from a continuous-wave carbon dioxide laser to a short-pulsed pigment Q-switched ruby laser. Uses for lasers are equally varied and include: port wine stain nevi, telangiectasia, viral warts, some tumors, and tattoos.
Excisional Biopsy
Excision axis depends on skin creases / Langer™s lines and its margins on the lesion. Once the skin is numbed with local anesthetic, the skin is incised vertically down to the subcutaneous fat with the scapel, in a smooth continuous manner to complete both arcs of the ellipse. Using simple interrupted skin sutures, the wound is apposed and slightly everted. Absorbable subcutaneous sutures are used for big excisions.
Incisional Biopsy
Performed for diagnostic purposes. The technique is comparable to an excision, but less tissue is taken.
Punch Biopsy
A punch (normally about 4 mm in diameter) is twisted into the skin: resulting cylinder of skin is removed and the defect cauterized or sutured.
Shave Biopsy
Used for benign lesions, usually intradermal nevi or seborrheic keratosis. The lesion is shaved parallel to and slightly above the skin™s surface. Cautery may be used to achieve hemostasis. Skin tags are removed by using scissors to snip them off followed by cauterization to any bleeding points.
Curettage
After local anesthetic, the lesion is removed by a gentle scooping motion with the curette. The base is then cauterized. Curettage may be used in seborrheic keratosis, pyogenic granulomas, keratoacanthomas, single facial viral warts, but not nevi.
Cautery
Provides hemostasis and destroys tissue. The classic cautery machine has an electrically heated wire and is self sterilizing. Silver nitrate sticks or 35% aluminum chloride in 50% isopropyl alcohol provide chemical cautery.
Cryotherapy
Liquid nitrogen (- 196 °C) is delivered by cotton wool bud or spray gun and injures cells by ice formation. After immersion into liquid nitrogen, the cotton wool bud is applied to the lesion for 10-15 seconds until a thin frozen halo appears at the base. The spray gun is used at a distance of 10 mm for a similar amount of time. Longer freezing times are given for malignant tumors. Blisters may develop within 24 hours. These are punctured and a dry dressing applied. Side effect may include hypopigmentation of pigmented skin, ulceration (especially on the lower legs of the elderly). Treatment may be repeated in 4 weeks if warranted.
Cryotherapy may be used for viral warts, seborrheic keratosis, molluscum contagiosum, intraepidermal carcinoma.
Mohs™ Surgery
Excision of malignant tumor which is mapped and microscopically examined to define its extent and the completeness of the excision.
Dermabrasion
A rotating mechanical head wounds the skin down to the dermis.
Laser (Light Amplification by Stimulated Emission of Radiation)
High intensity light energy is applied to the tissue. Laser surgery is a rapidly changing field in which new types of lasers, as well as the conditions amenable to treatment, are continually being introduced. Lasers vary from a continuous-wave carbon dioxide laser to a short-pulsed pigment Q-switched ruby laser. Uses for lasers are equally varied and include: port wine stain nevi, telangiectasia, viral warts, some tumors, and tattoos.