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- Presentation
Practical Surgical Pearls: Tools, Preparation, and Suturing Techniques
Description
Frankie Lambert shares practical surgical tips learned from mentors and colleagues, focusing on tools, prep, and suturing methods that improve efficiency and outcomes. She recommends a handheld battery-powered Wood’s lamp for identifying biopsy sites and mapping pigmentation or scar boundaries, especially when documentation is unclear. She also discusses versatile uses of cyanoacrylate glue: protecting second-intention wounds, reinforcing fragile atrophic skin, helping secure linear closures and skin grafts, reducing bleeding on flap pedicles, and possibly lowering infection risk. For surgical preparation, she emphasizes positioning patients in neutral anatomy to better identify relaxed skin tension lines, then marking incisions with alignment and pathology hashes and adjusting incision orientation slightly more vertical when gravity or laxity could increase spread. Finally, she explains the modified buried vertical mattress suture (GAM suture), which adds approximation, eversion, and strength, describing how to place it in the center of a wound, reverse the needle through a superficial plane, and secure it with a slip knot; she prefers monofilament and larger needles when appropriate to reduce spitting and improve efficiency.
View moreConclusions
- A handheld Wood’s lamp can be a practical, portable tool for identifying biopsy sites and clarifying pigment extent during dermatologic surgery.
- Cyanoacrylate glue appears useful beyond basic wound closure, including reducing wound care needs, reinforcing fragile skin, protecting grafts and flaps, and possibly lowering bleeding and infection risk.
- Preparing the patient and marking while standing in a neutral position helps better capture relaxed skin tension lines and improves incision planning.
- Adding simple orientation hashes to markings can improve closure alignment and help communicate pathology orientation.
- Incisions may be better placed slightly more vertical than classic relaxed skin tension lines when gravity and wound spreading are concerns.
- The modified buried vertical mattress, or GAM suture, provides added approximation, eversion, and strength for challenging closures.
- Using a larger needle, monofilament suture, and a slip knot makes the GAM technique easier and more secure.
- These practical operative ‘pearls’ are presented as small workflow changes that make dermatologic surgery easier for the surgeon and potentially better for patients.
- Sung CC, Marwalla K. Use of 2-octyl cyanoacrylate to obviate daily wound care after Mohs surgery. Dermatol Surg. 2015 Feb;41(2):294-6. doi:10.1097/DSS.0000000000000272#10.1097/DSS.0000000000000272
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