Keep It Simple in Surgery: Closure, Positioning, Tissue Handling, and Pain Control Tips

Conclusions

• Simple, efficient surgical closures are often preferable to more complex reconstruction when they can achieve an acceptable cosmetic and functional result.
• Strategically reducing the size of a defect before closure can expand the options for primary repair, grafting, or even second-intent healing.
• Running horizontal mattress sutures can be a time-efficient way to improve eversion and hemostasis in selected wounds.
• Second-intent healing can produce surprisingly strong outcomes in appropriately chosen sites and may sometimes avoid the need for grafting or flaps.
• In some patients, especially those with limited prognosis or high treatment burden, less surgery—or no surgery beyond symptom-relieving debulking—may be the best option.
• Good surgeon ergonomics are essential because musculoskeletal injury is common and can threaten both job satisfaction and career longevity.
• Positioning both the surgeon and the patient to minimize strain can improve access, reduce fatigue, and make procedures safer and more sustainable.
• Patient positioning should be adjusted for the phase of the procedure so that tension is increased for excision and reduced for closure.
• Sutures should approximate tissue rather than strangulate it, because excessive tightness can compromise wound edges and healing.
• Undermining should be used judiciously, since primary closures often do not benefit from excessive dissection and blunt techniques may reduce tissue trauma.
• Tranexamic acid appears to be a useful adjunct for controlling bleeding in selected dermatologic surgery cases, particularly higher-risk or longer procedures.
• Pain control is improved by thoughtful technique, including slow infiltration, awareness of nerve anatomy, and minimizing the pace of tissue expansion.
• A comfortable environment and careful local anesthesia can reduce anxiety and improve patient trust during office-based surgery.
• Finding a mentor and staying receptive to feedback are important for improving surgical performance and continuing professional growth.
• Coaching and mentorship are presented as key drivers of surgical excellence, reinforcing that technical skill improves further with guidance and critique.