Techniques in dermatologic surgery Glenn D Goldman
INDEX
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
Ablating rhytides 144
Ablative laser 134 see also Carbon dioxide laser
Abobotulinum toxin A 149, 151
Absorbable gelatin sponge 35 see also Gelfoam
Acetaminophen 57, 170
Acne 143
scars 131, 132, 132
vulgaris 143
Acneiform eruptions 135
Actinic damage 3
Actinic keratoses 55, 56, 58, 59, 61, 64
cryosurgery of 57
thick 64
Adjacent tissue transfer 105
advancement flaps 108
banner flap 109
bilobed flap 109
complications 114
equipment 107
indications 105
island flaps 112
operative suite 107
patient selection 105
pedicle flaps 112
postoperative management 113
preparation and execution 108
rhombic flap 109
rotation flaps 108
short term 113
surgical technique 107
tissue motion 107
transposition flaps 108
Adson forceps 107
Alcohol 7, 80
combination of 8
entail 49
Alice clamp 21, 23, 107
Allergic reaction 141
Allergies 2
Aluminium chloride 32, 33
Amateur tattoos 123
Ambulatory vein treatments 137
Anaphylaxis 11
Anesthesia 80
equipment 11
indications 11
patient consent 11
patient selection 11
techniques 12
types of 11
Anesthetics, injectable local 12
Anti-bruising medications 157
Anticoagulants, multiple 105
Anti-inflammatory agents 154 see also Neuroleptic agents
Anti-microbial spectrum 7
Antiseptic agents 7
alcohols 7
iodine complexes 7
Antiseptic skin preparations 7
Apixaban 31
Arnica forte 157
Arnicare gel 157 see also Arnica forte
Artificial compartment syndrome 13
Aseptic technique 7, 10
Aspirin 31, 145, 159
Atrophic philtrum 163, 164
Atrophic skin 45
Atypical nevi 79
Automatic implantable defibrillator 34
B
Bacteria, cell walls of 7
Bacterial infection 167
Bactericidal agents 9, 17
Basal cell carcinoma (BCCs) 55, 61, 66, 69, 79, 90
curettage of 61
multiple 70
superficial 63
Baseline frontalis function 156
BCCs see Basal cell carcinomas (BCCs)
Becker's nevus 123
Belotero 159
Benign nevi 79
Bilobed flap 109, 111
Biopsy 49
incisional 52
melanoma 81
site 52
specimens, loss of 53
type of 49, 49, 52
Bipolar cautery 34
tips 34
Bishop's forceps 22, 41, 51, 107
Biterminal cautery 34
Biterminal electrocautery devices 34
Biterminal units 34
Black tattoo 123
Bleeding
complications 31, 35
intraoperative 31
postoperative 31, 35
surface 35
Blood spatter 9
Botox 154 see also Xeomin
cosmetic 151 see Onabotulinum toxin A
injecting 151
Botulinum toxin (BTX) 149, 150, 150
dilution of 150
injection 149
BTX see Botulinum toxins (BTX)
Bulky rhinophyma 169
treatment of 171
Bupivacaine 12
Buried dermal suture 41
Buried sutures 39
monocryl 39
vicryl 39
C
Café au lait macules 123
Cancerous lesions 1
Carbon dioxide laser 134, 167, 169
Cardiopulmonary resuscitation (CPR) 17
Castroviejo scissors 21, 22
Cerebrovascular events 142
Chamber technique 57
Cheek 163
lower 164
Chemical exfoliant, application of 143
Chemical irritants 139
Chemical matricectomy 175
Chemical peels 143, 167
complications 147
equipment 145
indications 143
inexpensive 3
patient selection 144
positioning of equipment 146
postoperative management 147
preparation 145
surgical technique 146
technique 143
Cherry hemangioma 4, 115
CHG see Chlorhexidine gluconate 7
Chin 164
Chlorhexidine 80
Chlorhexidine gluconate (CHG) 7, 8, 49
isopropanol 7
Chlorhexidine-alcohol 168
Chloride 51 see Ferric subsulfate
Chromated glycerine 139
Classic banner flap 109
Classic rhombic flap 109
Classic transposition flap 110
Clinical laboratory improvement amendments (CLIA) 87
Clopidogrel 31
Clostridium difficile 9
Cobblestone chin 156
Cold sores 131
history of 132
Compressor naris 156
Conceal erythema 119
Corticosteroid, injection of 107
Cosmetic expectations 105
Cosmetic patient 2
evaluation of 2
Cosmetic procedures 141
Crow's feet 3, 149, 154
treatment of 155
Cryoembedder 90
Cryosurgery 55
equipment for 56, 56
indications 55
lesion selection 55
open surgical technique 56
patient selection 55
possible complications 58
postoperative management 57
preparation 56
principle of 55
surgical technique 56
technique 55
Curettage 61
equipment 62
indications 61
patient selection 61
positioning 62
possible complications 65
postoperative management 64
preparation 61
surgical technique 62
technique 61
Curette biopsy 52
Cutaneous surgery 21
Cyanoacrylate 80
tissue 83
glue 40, 82
Cyst 73
anesthesia 75
hemostasis 75
inflamed 77
procedure 75
skin marking 73
surgical closure 75
uncommon 73
Cyst, removal of 73
complications 77
equipment 73
indications 73
patient selection 73
postoperative management 77
surgical technique 73
technique 73
D
Dabigatran 31
Deep perioral rhytides 135
Deep venous disease, treatment of 140
Dental chair model 17
Depressed scar 77, 82
Dermabrasion 167
Dermal lesions 123
Dermal sutures, pearls 41
Dermatitis 132
Dermatologic surgery
grafts in 97
uncomplicated 52
Dermis 39
superficial 93, 118
Dermoepidermal junction lesions 123
Diazepam 133
Diffuse sun damage 3
Digital nerve 13
Dilator nasalis 156
Dog ears 51, 80, 105, 108
Donor-site morbidity 98
Doppler ultrasonography 140
Dychromia 146
Dynamic facial rhytides, moderate-to-severe 149
Dynamic rhytides 3
treatment of 4
Dysport 151
E
Ecchymosis 154, 157
EIC see Epidermal inclusion cysts (EIC)
Electrodesiccation 61
Electrosurgical units 18
Elliptical excision 79
Epidermal closure, types of 45
Epidermal cyst 73
removal of 74
Epidermal inclusion cysts (EIC) 73
Epidermal injury 118
Epidermal lesion 22, 123
Epidermis 39, 83, 93, 118
Epinephrine 12, 50
Erosive pustular dermatosis 29
Erythema 85, 135
and edema, mild 117
background of 4
protracted 61
Erythematous scars 115
Erythrotelangiectatic rosacea 115
Ethmoidal nerve, external 13
Ethyl alcohol 7
Excision 10
concept of 79
Excisional biopsies 50, 52
Excisional surgery 11
Extreme pain, fear of 1
Eye
protecting 146
protection 134
Eyebrow 152, 156
Eyelid 108, 154
lesions, removing 22
margin 59
ptosis 152
skin 147
F
Facial and body hair, unwanted 4
Facial erythema 115
Facial herpes infection 131
Facial lesions, complex 2
Facial telangiectasia 115
FAPG see Fast-absorbing plain gut (FAPG)
Fascia, superficial 82
Fast-absorbing plain gut (FAPG) 96
Ferric subsulfate 32, 51
Fitzpatrick skin 123
Flap failure 107
Flaps, advancement 105, 105
Fluid hyaluronic acid 163
Fractional lasers 131
Fractional resurfacing lasers 131
ablative lasers 132–134
anesthesia 133
equipment 132
indications 131
nonablative lasers 133
operative suite 132
patient consent 131
patient selection 131
postoperative management 135
potential complications 135
preoperative management 133
procedure technique 133
short-term management 135
supplies 132
surgical technique 133
technique 131
tray preparation 132
Fraxel 133
Full-thickness skin grafts (FTSG) 97, 102
Fungicidal soap 9
Fusiform 79 see also Elliptical excision
G
GA see Glycolic acid (GA)
Gelfoam 35
Geometry, appreciation of 105
Gingko biloba 159
Glabellar 3
Glabellar complex 153
injections for 150
Gloves 8
and handwashing 9
newer latex 9
non-sterile 9
Glycerin 138
Glycolic acid (GA) 143
Gowns 9
Gradle scissors 21
Graft failure 98
partial 103
Graft harvesting, technique of 101
Graft, healing of 102
Grasp tissue 20
H
Haemostasis 18
Hair
dark 4
follicles 143
unwanted 4
Halsey needle drivers 20
Handwashing 9
Head cushion 18
Hematoma 35, 37, 83, 114, 152
acute 35
expanding 36
formation 77
minor postoperative 37
Hemorrhage
intraoperative 31
postoperative 31
Hemostasis
anatomy 31
and electrosurgery 31
surgical equipment 32
topical compounds 32
Hemostatic agents 35, 112
Herpes simplex virus (HSV) 167
HIV see Human immunodeficiency virus (HIV)
HSV see Herpes simplex virus (HSV)
Human immunodeficiency virus (HIV) 8
Hyaluronic acid 159, 160
fillers 162
Hyaluronic filler agents and techniques 159
anesthesia 160
charting and consent 161
complications 164
filler injection 161
inappropriate placement 165
indications 159
lateral malar eminence 164
malar cheek 164
management 164
melolabial folds 161
nasolabial folds 161
overcorrection 165
postoperative care 164
site-specific treatment strategies 161
superficial injection 164
supplies 160
surgical techniques 160
tear trough 164
technique 159, 163
Hyaluronidase 166
Hyperpigmentation, high-risk of 145
Hypertonic saline 137, 138, 141
Hypertrophic actinic keratosis 63
treatment of 58
Hypertrophic scar 29, 30, 61, 67, 71
mild 65
Hypopigmentation
cost of 144
lower risk of 123
Hypopigmented scarring 116
I
Ibuprofen 57, 159 see also Acetaminophen
Incobotulinum toxin A 149, 151
Infection, risk of 39
Inflammatory diseases 49
Inflammatory disorders 49
Infraorbital nerve
anesthesia of alar branch of 13
block 14
Infraorbital region, volumization of 165
Initial incision 81
Injection
intra-arterial 152
intravascular 166
Instrument
sterilization 8
supply of 17
International normalized ratio (INR) 1
Iris scissors 21
Island flaps 112
Isolated lesion, surgery for 2
cost and insurance coverage 2
difficulty level 2
esthetic expectation 2
medical necessity 2
Isopropanol 7
Isopropyl alcohol 51 see also Povidone
Isposable skin marking pen 10
Itching 135
J
Jessner's solution 146
Juvederm voluma XC 159
Juvederm XC 159, 160
K
Kaposi's sarcoma 55
Keloidal healing 2
Keratitis, severe 7
Keratotic lesions, benign 67
Kirby scale 123
Knurled scalpel handle 22
L
Labial artery 32
Labial herpes infection, reactivation of 135
Large tumors, debulking of 91
Laryngeal papillomas 9
Laser
fully-ablative 131
procedures 124
safety goggles 132
skin resurfacing technique 131
treatment gel 116
types 124
vermilionectomy 11
Leg telangiectasia 138
Lentigo maligna 55
Lesion
benign 22
malignant 22
removal 82
Lesion-specific techniques 62
Lidocaine 11, 12, 50, 61
Ligature 34
Lipomas 73, 75
anesthesia 75
hemostasis 77
on shoulder, removal of 76
procedure 75
skin marking 75
surgical closure 77
Lips 162
Liquid nitrogen 56
Liver disease 12
Local anesthesia 11, 13
Loop cautery tips 168
Lorazepam 133
Lower extremity telangiectasia and venulectasia 115
Lunula 173
M
Masks 9
special 9
Mattress sutures 46
Mayo hegar 20
Mayo stand 17
Melanocytes, malignant 92
Melanoma 79
removal of 178
suspected 52
Melanonychia, biopsy for 175
Melasma 131, 145
treatment of 145
Methicillin-resistant Staphylococcus aureus (MRSA) 28
Metzenbaum scissors 21
Microbial proteins, halogenation of 7
Milia formation 167
Mohs histology laboratory 89
Mohs micrographic surgery (MMS) 87, 90, 98
additional stages 93
anesthesia 89
complex reconstruction 96
complications 96
consultation 88
equipment 88
hematoma 96
histology 90
hypertrophic granulation tissue 96
indications 87
lesion removal 89
linear closure with suture 95, 96
neuralgia 96
open wound 95
operative suite 88
pain management 96
patient selection 88
postoperative bleeding from open wound 96
postoperative instructions 95
preoperative preparation 88
reconstruction 95
slide analysis and mapping 92
surgical techniques 89
surgical tray 89
technique 87
tissue processing 90
wound infection 96
Mohs surgery 7, 8, 10, 11, 87, 96
excision 94
histology 92
of nail 176
Molluscum contagiosum 55
Monoterminal electrocautery 32
Mosquito clamp 21, 33
Multiple lentigines 143
N
Nail 52
avulsion 173
biopsy, lateral longitudinal 175
clipping 173
procedures, anesthesia for 174
squamous carcinoma of 176
Nail bed 173
surgery of 174
Nail biopsy and surgery 173
anatomy 173
complications 177
postoperative management 177
technique 173
Nail fold
lateral 173
proximal 173, 175
Nail matrix 173
ablation 176
application to 176
biopsy of 174
Nail plate 173
avulsion 177
surgery of 173
Nail unit 173
demonstrating nail bed, anatomy of 173
en bloc resection of 176
surgeries 177
Nasal telangiectasia, laser treatment for 118
Nasal wounds 112
Nasociliary nerve 13
Nasolabial folds 162
Nasolabial pedicle flap 113
Nd:YAG see Neodymium-doped yttrium aluminium garnet
Necrosis injection 166
Needle
driver 107
phobia of 1
types of 40
Neodymium-doped yttrium aluminium garnet (Nd:YAG) 4
lasers 115, 118
Neuroleptic agents 154
Neuromodulator 149
agents 159
bunny lines 156
complications 157
contraindications 149
crow's feet 154
direct injection versus directed injection 151
glabellar lines 151
indications 149
patient selection 149
postoperative management 157
preparation 150
preparation of syringes 151
site-specific techniques 151
surgical techniques 151
technique 149
Night of peel 145
Nitrile gloves 8
No wound care 27
Nonabsorbable sutures, remove 113
Nonsebaceous nose 101
Non-stick gauze 26
Nose pedicle flap 113
Numbness 79
O
Occasional infection 49
Ocular injury 120, 126
ophthalmology for 126
Oculoplastic surgery 88
Onabotulinum toxin A 151
Open spray technique 56
Open wound 25
Oral anticoagulants, properties of common 31
Oral mucosa 52
Osmotic agents 138
Oval scar, hypopigmented 65
Ovidone-iodine 10
Oxidized cellulose 35
P
Pacemaker 34
defibrillator 88
Pain 79
type of 96
Panniculitis 49
Papillary dermis, superficial 143
Para-aminobenzoic acid (PABA) 15
Pedicle flaps 105, 112
Peels
light superficial 145
lighter medium-depth 143
Perineural disease 93
Perioral region, treatment of 146
Perioral rhytides 135
Peripheral nerve branches 13
Petite Halsey needle driver 22
Petrolatum 26, 116 see also Laser treatment gel
Photodamage, treatment of 131
Pigmented lesion 125
and tattoos, laser for 123
lasers 123
Pilar cysts 73
Pincushioning 107
Pinna, anterior and posterior 98
Plasma concentration 15
Plump lips 162
Poikiloderma 115
treatment of 120
Polidocanol 137, 138
Poliglecaprone 39
Polydioxanone (PDS) 39
Polyglactin 39
Polypropylene 40
Port-wine stain 115
advanced 121
treatment of 116, 119
Potassium titanyl phosphate (KTP) 115
Potential complications 15
Povidone 51
iodine 7, 49, 80, 168
Premature skin, common cause of 3
Prilocaine 12
Procaine 12
Proximal nail fold, surgery of 174
Pseudomonas 135
Ptosis 152, 157
mild 150
Pulsatile bleeding 35
Pulse duration 117
Pulse dye laser 115, 116
pearls for 120
Pulse lasers 115
Punch biopsy 10, 50, 51, 51
Purpura 119
and swelling 120
post-treatment 116
substantial 116
R
Reconstructive surgery 11
Regional anesthesia 11, 13
digital nerve block 13
intraoral infraorbital nerve block 14
mental nerve block 14
supraorbital nerve block 14
supratrochlear nerve block 14
transcutaneous infraorbital nerve block 14
Restylane 159
lyft 159, 160
silk 159
Reticular veins 137, 140
Rhinophyma
equipment 167
indications 167
patient consent 167
patient selection 167
technique 167
treatment of 167
Rhinophyma treatment 167
equipment 167
indications 167
operative suite 167
patient selection 167
postoperative management 170
potential complications 171
surgical technique 168
surgical tray 167
technique 167
Rhinopyma-associated telangiectasia 169
Rhombic flap 110
Rhytides 4, 143
ablation of 133
fixed 4
treatment of 131
Ring block 13
Rivaroxaban 31
Ropy telangiectasia 118
Rotation flaps 108
S
Sample dilutions 151
Saphenofemoral reflux 137
Scalpel handles, types of 20
Scar 5
formation 79
free treatment 115
hyperpigmented 141
permanent superficial 120
treatment of 131
Scissors
biopsy 52
excision 49
Sclerosant 138
injection technique 139
Sclerosed vein 142
Sclerosing agents 138
Sclerotherapy 137, 138
carries 137
complications of 141
larger vessel 142
Sebaceous rhinophyma 168, 170
Sebaceous rhinophymatous tissue 168
Seborrheic keratoses 21, 55, 56, 61, 64, 64, 67, 68
Second intention healing 25
Second intention wound care instructions 26
Serial puncture 161
Shave biopsy 50, 50
Shea scissors 21
Silk causes tissue 40
Skin
hooks, two 107
necrosis 141
procedures, advanced 7
tags 55
Skin biopsy 7, 49
complications 52
equipment 49
instruments for 50
patient selection 49
positioning 50
postoperative management 52
preparation 49
record-keeping and location marking 52
surgical technique 50
Skin cancer 57, 69
diagnosis of 5
superficial 68
surgery 105
Skin grafts 97, 99
complications 103
equipment 98
full-thickness 99
indications 97
operative suite 98
patient consent 98
patient selection 97
positioning 99
postoperative management 100
preparation 99
split-thickness 100
surgical techniques 99
Skin surgery 11, 41
contraindication to 1
Slicing tissue 41
Small vessel sclerotherapy 139
Sodium tetradecyl sulfate 137, 138
Soft tissue augmentation 159
Solar lentigo 55, 57, 143
Spark gap 33
Spider veins 137
Split-thickness skin grafts (STSG) 97
Spock’ eyebrow 152
Squamous cell carcinoma 55, 61, 68, 71, 79, 176, 177
isolated 2
Staphylococcus 135, 178
aureus 28, 96, 147
Streptococcus 28, 178
Subcutaneous tissue 4, 81, 81
Substantial bleeding complications 113
Sun damage 3
skin 45
Supra-trochlear 13
nerve block 14
Surface sutures 39
chromic gut 40
cyanoacrylate 40
fast-absorbing plain gut 40
mersilene 40
nylon 40
polypropylene 40
silk 40
skin staples 40
Surgical drapes 8
Surgical equipment 17
electrocautery units 18
safety equipment 17
surgical stands 17
tables 17
trolleys 17
Surgical instruments 17, 20
Adson forceps 20
and suture materials 17
Bishop-Harmon forceps 20
curettes 21
forceps 20
needle drivers 20
O'brien scissors 21
scalpels 20
scissors 21
skin hooks 21
specialized clamps 21
surgery sets 22
Surgical masks 9
Surgical patient
anxiety 1
blood thinners 1
edema 1
evaluation of 1
general health 1
hypertension 1
obesity 1
skin quality 1
smoking 1
Surgical scissors, types of 21
Surgical skin preparations 8
Surgical techniques 9
Surgical tray, bacterial contamination of 10
Surgicel 35
Suture composition 39
Suture material
and needles 80
and suture technique 39
Suture scissors 107
Suture size and strength 39
Suture wound 27, 27, 29, 83, 83
Suture, type of 41
Sutures promptly, remove 43
Suturing technique 40
dermal sutures 41
epidermal closure 42
Swiss-cheese 116
appearance 120
Synthetic monofilament suture 39
Synthetic surface sutures 39
T
Tangential excision (TE) 67
equipment 67
location marking 70
patient selection 67
positioning 67
possible complications 69
postoperative management 68
preparation 67
record-keeping 70
surgical techniques 67
Tattoo 4, 123
dark blue 123
dense professional 127
laser failure 127
professional 128
traumatic 123
treatment of 125
TCA see Trichloroacetic acid (TCA)
Telangiectasia 4, 116, 139, 142
Thrombophlebitis, mild 141
superficial 141
Tie-over bolster 103
Tissue
cones 105
glues 40
types 107
Tolerate skin grafting 97
Toothed Adson forceps 20
Topical anesthesia 11, 12
Topical hemostatic agents 33
Transposition flaps 105, 108
Trichloroacetic acid (TCA) 143, 147
Truncal port-wine stain, treatment of 121
Tumescent anesthesia 12, 14
Tumor removal 95
Typical punch biopsy 51
U
Uni-terminal hyfrecator units 18
Upper lip augmentation 163
Urticarial, acute injection 140
V
Valve insufficiency 137
Valvular insufficiency 137
Varicose veins 137
Vascular lesions 4
laser for 115
laser treatment of 115
treatment of 116
Venulectasia 116, 140
Verrucae 55
Vinegar mixture 170
Viral infection 167
Virucidal agents 9, 17
Volumization 4
W
Warfarin 1, 31
Warts 56, 61
Wound
broad operative 101
classification 25
dehiscence 52, 77, 83
fails 29
first, secondary 109
full-thickness 25
glued 83
healing 25, 26
healing, impediments to 27
Wound care 80
complications 28
cosmetic patient 28
postoperative 25, 26
scarring 29
slow healing 29
standard 27
Wound dressings 27
finger 28
scalp 28
skin biopsy 27
skin grafts 28
special locations and situations 28
surgical excisions and destructions 28
Wound healing process 25
inflammatory phase 25
maturation phase 25
proliferation phase 25
Wound infection 7, 28, 28, 79, 85
postoperative 7
risk of 9
X
Xeomin 151, 154
Z
Zygomatic region first 4
×
Chapter Notes

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