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- Presentation
Tips for Improving Dermatologic Surgery Scar Outcomes
Description
The talk shared practical tips for improving dermatologic surgery scar outcomes. Key advice included preparing patients for the true scar size, especially on areas they cannot easily see, and emphasizing that contour matters more than scar length. Marking orienting lines should be done with the patient sitting upright in a neutral position because tension lines change when lying down. The speaker recommended adding microdosed clindamycin to local anesthetic to reduce infections and avoid oral antibiotics in many cases, and checking syringes for rubber stopper coring when drawing up medications. Comfort during numbing was highlighted as important because patients remember pain, so cold spray, vibration devices, and nitrous oxide can help. For closure technique, the speaker suggested assistant-assisted pinching for high-tension wounds, using a slip knot technique when working alone, choosing longer-lasting sutures like PDS or Maxon for trunk and extremities, and using buried vertical mattress or “heart-shaped” setback sutures to improve eversion and reduce tension. Running subcuticular sutures were recommended for trunk and extremities for better cosmesis and no suture removal, and forceps should be flipped overhand for better needle handling in thick skin. Finally, a running horizontal mattress suture was strongly endorsed for areas like the forehead and nose because it offloads tension and improves cosmetic results, though patients should be counseled that temporary hyper-eversion can make the scar look ropey for a period before it fades.
View moreConclusions
- Patient education and precise preoperative marking improve expectations and help avoid dissatisfaction with scar size and location.
- Orienting closure lines with the patient seated neutrally can improve wound alignment and final cosmetic results.
- Adding microdosed clindamycin to local anesthetic may reduce surgical site infections and often avoids the need for postoperative oral antibiotics.
- Minimizing pain during injection and surgery is important because patients strongly associate comfort with surgical skill and quality.
- Using an assistant or a slip-knot technique can make closing high-tension wounds easier, even when working alone.
- High-tension wounds need longer-lasting absorbable sutures such as PDS or Maxon because early scar strength is still low after suture removal.
- Set-back or heart-shaped buried dermal sutures improve eversion and reduce tension on the epidermis, which helps scars heal better.
- Running subcuticular closures on the trunk and extremities can provide good cosmetic outcomes while reducing wound care and eliminating suture removal.
- Flipping the forceps into a more overhand position can help grasp the needle better in thick skin or with small needles.
- Running horizontal mattress sutures are especially useful in high-tension facial areas because they offload tension and produce superior cosmetic scars.
- Alikhan and Hocker. Review of Dermatology. 2016.
- Clindamycin for Intraincisional Antibiotic Prophylaxis in Dermatologic Surgery (2002).#10.1001/archderm.138.9.1133
- Effect of Microdoses of Incisional Antibiotics on the Rate of Surgical Site Infections in Skin Cancer Surgery (2023).#10.1001/jamasurg.2023.1201
- Set-back versus buried vertical mattress suturing: Results of a randomized blinded trial.#10.1016/j.jaad.2014.07.018
- Enhanced Cosmetic Outcome with Running Horizontal Mattress Sutures.#10.1016/s0093-3619(08)70677-4