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  • Presentation

Simple Tricks and Practical Tips to Optimize the Surgical Experience for You and Your Patients

Description

The presentation offers practical tips to optimize surgical experiences for both surgeons and patients, emphasizing the importance of patient care and emotional considerations in medicine. Key insights include the use of curettage alone for skin cancer treatment, which can yield similar cure rates to other methods but with reduced post-operative complications. The speaker advises thorough curettage techniques and emphasizes the need for proper technique to improve outcomes. Additional surgical tips include using a pulley suture for scalp wounds and purse strings for various closures, which can significantly enhance healing and reduce scarring. The discussion covers managing unexpected large defects after excision and the benefits of allowing certain wounds to heal by secondary intention. Lastly, the importance of patient-centered care is highlighted, noting that decisions should align with patients' preferences concerning their scars and recovery.

Conclusions

  • Curettage alone for skin cancer treatment results in similar cure rates to combined methods with less postoperative complications.
  • Thorough curettage should extend beyond the visible tumor edges to reduce recurrence risk.
  • Purse string closures are effective for circular wounds, providing good cosmetic results and minimizing the need for healthy skin excision.
  • Pulley sutures can significantly reduce closure time and costs, especially for scalp wounds.
  • Second intention healing can be a viable option for certain wound types, offering benefits in healing time and cost but may have scarring and longer healing duration.
  • Using tranexamic acid (TXA) can effectively manage bleeding during dermatologic surgeries and enhance patient outcomes.
  • McDaniel WE. Therapy for basal cell epitheliomas by curettage only: further study. Arch Dermatol 1983;119:901-903.
  • Barlow JO. Et al. Treatment of basal cell carcinoma with curettage alone. J Am Acad Dermatol 2006;54:1039-1045.
  • Yakish K, Graham J, Hossler E. Efficacy of curettage alone for invasive cutaneous squamous cell carcinoma: A retrospective cohort study. JAAD 2017;77:582-584.
  • Dirk M. Elston, MD. Letter from the Editor: Treatment of basal cell carcinoma with curettage alone. J Am Acad Dermatol 2025;92:37-38.
  • Kannan S, Mehta D, Ozog D. Scalp closures with pulley sutures reduce time and cost compared to traditional layered technique - A prospective, randomized, observer-blinded study. Dermatol Surg 2016;42:1248-1255.
  • Peters JD, Xie JD. The Purse String Pulley Stitch: Enhancing the Purse String With a Simple Modification. Dermatol Surg 2023;49(11):1044-5.
  • Gloster H. et al. The efficacy of second-intention healing in the management of defects on the dorsal surface of the hands and fingers after Mohs micrographic surgery. Dermatol Surg 2012;38(4):647-653.
  • Kumar EA et al. Tranexamic Acid in Mohs Micrographic Surgery: Systematic Review. Dermatol Surg. 2025;51:17-19.
  • Freeman SC et al. Tranexamic acid prevention of hemorrhagic complications following interpolated flap repair: a single-center, retrospective cohort study. Dermatol Surg 2023;49:1139-1142.
  • Zilinsky et al. Subcutaneous injection of tranexamic acid to reduce bleeding during dermatologic surgery: a double-blind, placebo controlled, randomized clinical trial. Dermatol Surg 2019;45:759-67.