Daniel Stulberg MD Prof of Family and Community Medicine University of New Mexico Suspicious Lesion Options Shave biopsy Punch biopsy Punch excision Elliptical excision Electrosurgery ID: 601511
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Slide1
Basic Suturing Techniques
Daniel Stulberg, M.D.
Prof. of Family and Community Medicine
University of New MexicoSlide2
Suspicious Lesion - Options
Shave biopsy
Punch biopsy
Punch excision
Elliptical excision
Electrosurgery
?
CryosurgerySlide3
Approach to Suspicious LesionsSlide4
Procedures
Clean for most
Sterile for excisions with suturing
Consent
Time out
Follow up instructionsSlide5
Shave Excision – Cancer or
cosmesis
Scalpel 15 or 10 blade
Personna
Gillette
DermabladeSlide6
Suspicious Lesion
Daniel
Stulberg
, MDSlide7
Possible BCC
Daniel
Stulberg
, MDSlide8
Local Anesthesia
1% lidocaine with epinephrine
local anesthesia not needed for:
telangiectasias
small cherry angiomas
small skin tags
Daniel
Stulberg
, MDSlide9
Epinephrine Effect
Daniel
Stulberg
, MDSlide10
Shave Set Up
Daniel
Stulberg
, MDSlide11
Shave – Scalpel or Flexible Blade
Daniel
Stulberg
, MDSlide12
Flip Over’s
Daniel
Stulberg
, MDSlide13
Stabilize Lesion
Daniel
Stulberg
, MDSlide14
Complete Transection
Daniel
Stulberg
, MDSlide15
Daniel
Stulberg
, MDSlide16
Dab and Fulgurate/Cauterize
Daniel
Stulberg
, MDSlide17
Metal is Not Hot – Sparks at the Gap – Light touch for Fulguration
Daniel
Stulberg
, MDSlide18
Courtesy Richard
Usatine
, MDSlide19
©
Dr
Richard
Usatine
Courtesy Richard
Usatine
, MDSlide20
Punch
Biopsy
Diagnosis of:
inflammatory skin
disease
Psoriasis
Vasculitis
lupus
Infiltrative
diseases
Sarcoid
mycosis
fungoides
Skin cancers – unless EDC
Courtesy Richard
Usatine
, MDSlide21
Suturing Set Up
Daniel
Stulberg
, MDSlide22
Daniel
Stulberg
, MDSlide23
Daniel
Stulberg
, MDSlide24
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Stulberg
, MDSlide25
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Stulberg
, MDSlide26
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Stulberg
, MDSlide27
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Stulberg
, MDSlide28
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Stulberg
, MDSlide29
Daniel
Stulberg
, MDSlide30
Daniel
Stulberg
, MDSlide31
Daniel
Stulberg
, MDSlide32
Daniel
Stulberg
, MDSlide33
Daniel
Stulberg
, MDSlide34
Figure 8 and InvertedSlide35
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Stulberg
, MDSlide36
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Stulberg
, MDSlide37
Daniel
Stulberg
, MDSlide38
Daniel
Stulberg
, MDSlide39
Daniel
Stulberg
, MDSlide40
Courtesy Richard
Usatine
, MDSlide41
Courtesy Richard
Usatine
, MDSlide42
Courtesy Richard
Usatine
, MDSlide43
Courtesy Richard
Usatine
, MDSlide44
Evert skin edgesSlide45
Daniel
Stulberg
, MDSlide46
Daniel
Stulberg
, MDSlide47
Cutting an
ellipse -Three to one ratio
Courtesy of Dermatologic and Cosmetic Procedures in Office PracticeSlide48
Placement of the Incision
Line
Relaxed skin tension
lines
Stretch/pinch
the skin
Circle and observe elongation
Courtesy of Dermatologic and Cosmetic Procedures in Office Practice.
Adapted from Richard Usatine, MDSlide49
Facial Skin Tension Lines
Courtesy of Dermatologic and Cosmetic Procedures in Office Practice.
Courtesy Richard
Usatine
, MDSlide50
Closing Ellipses
Deep suture w inverted knots
Running simpleSlide51
Daniel
Stulberg
, MDSlide52
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Stulberg
, MDSlide53
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Stulberg
, MDSlide54
Daniel
Stulberg
, MD
Pull across then turnSlide55
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Stulberg
, MDSlide56
Daniel
Stulberg
, MDSlide57
Skin tension and fragile skin
Vertical mattress
Horizontal mattress
Adhesive tapesSlide58
Daniel
Stulberg
, MD
Far - far - near - nearSlide59
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Stulberg
, MDSlide60
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Stulberg
, MDSlide61
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Stulberg
, MDSlide62
Daniel
Stulberg
, MDSlide63
Daniel
Stulberg
, MDSlide64
Daniel
Stulberg
, MDSlide65
Daniel
Stulberg
, MDSlide66
Vertical Mattress + Adhesive Strips
Daniel
Stulberg
, MDSlide67
Avoiding dog ears
Rule of halves
Unequal sidesSlide68
Rule of halvesSlide69
Unequal
sidesSlide70
Courtesy of Dermatologic and Cosmetic Procedures in Office Practice
UnderminingSlide71
Resources
Usatine R,
Pfenninger
J,
Stulberg
D, Small R. Dermatologic and Cosmetic Procedures in Office Practice. 2012. With DVD.
App available at:
www.usatinemedia.com
Robinson, et al. Surgery of the Skin. 2010.
Mayeaux
EJ, The Essential Guide to Primary Care Procedures. 2009.