Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Six Practical Tips for Improving Surgical Technique, Site Identification, and Specimen Handling
Description
The speaker presents six practical tips to improve dermatologic surgery and specimen handling. First, buffered lidocaine can reduce injection pain, speed anesthesia, and may improve antimicrobial activity; when compounded in-office in a proper segregated area, it can be used longer than traditionally assumed if stored correctly, with attention to single-use bicarbonate vials, labeling, and secure syringe caps. Second, for cyst excisions or abscesses, unused lidocaine with epinephrine can be irrigated into the wound to avoid waste while still providing antimicrobial benefits. Third, biopsy site identification is especially difficult on the scalp, so good preoperative photos, landmark measurements, and looking for short regrowing hairs after shave biopsy can help locate the site. Fourth, to preserve specimen orientation, dye on excised tissue can be fixed with a brief isopropyl alcohol rinse or by protecting a single dyed tip with gauze, preventing diffusion in formalin and helping identify unexpected additional tumor. Fifth, gentian violet skin marks can smear during chlorhexidine prep, but applying povidone iodine around the marks can fix the dye and keep it visible. Finally, a smartphone-to-microscope adapter can produce clear, high-quality intraoperative photos for documentation and teaching.
View moreConclusions
- Buffered lidocaine can be prepared safely in-office if strict compounding, labeling, storage, and timing rules are followed, and it may remain usable for up to 12 hours at room temperature or seven days refrigerated.
- Local anesthetics appear to provide meaningful antimicrobial benefit in addition to pain control, making buffered lidocaine a practical dual-purpose adjunct during dermatologic surgery.
- Unused lidocaine with epinephrine can be repurposed to irrigate cyst or abscess wounds, reducing waste while adding bactericidal, fungicidal, and sporicidal activity.
- Careful biopsy-site localization on the scalp requires preoperative photos, landmarking, and searching for short regrowing hairs, because scalp sites are otherwise easy to miss.
- Fixing tissue dye with a brief alcohol dip before formalin preserves specimen orientation and prevents dye diffusion, which improves margin assessment and may reveal incidental second tumors.
- Marking one specimen tip with dye is an effective way to preserve orientation in excisions so that unexpected pathology findings can be targeted for re-excision without removing unnecessarily large amounts of tissue.
- Applying povidone-iodine around gentian violet markings helps prevent chlorhexidine from wiping away the dye during skin preparation.
- A smartphone adapter mounted to the microscope can produce clearer pathology images than hand-held phone photography, making documentation and teaching easier.
- Adler DMT et al. Vet J. 2017.