Minor Skin Surgery Research Articles

Environmentally Sustainable Skin Surgery: Staff Perception, Attitude and Practices at a Dermatology Department in the United Kingdom

Introduction: The National Health Service (NHS) has set the goal of reaching net zero emissions by 2040. Within dermatology, minor skin surgery is particularly energy- and resource-intensive. As we approach the 1-year mark since the publication of the British Society for Dermatological Surgery (BSDS) sustainability guidance 2022, there is a need to assess dermatology staff’s awareness, attitudes and practice towards environmentally sustainable minor skin surgery. Methods: A single-centre service evaluation study was conducted at South Warwickshire University NHS Foundation Trust (SWFT). A 12-question structured questionnaire was distributed to all medical and nursing staff that undertake skin surgery (n = 14 medical and n = 5 nursing staff) between 10 and 21 July 2023, with a response rate of 11 out of 19 (58%). The skin surgery waste disposal practices were evaluated between 14 June and 11 July 2023 where the weights of waste generated from seven skin surgery lists (each lasting 4 h) involving a total of 29 procedures were evaluated using a digital scale accurate to the nearest 100 g. Results: Out of 11 respondents, 9 (82%) stated that they were aware of the BSDS sustainability guidance 2022, but only 4 (36%) respondents had read the guidance. Seven (64%) stated that they used absorbable and non-absorbable sutures for surface wound closure, whereas 4 (36%) respondents stated that they exclusively used non-absorbable sutures for surface wound closure. Eight (73%) stated that they exclusively used sterile gloves for skin surgery, and 3 (27%) stated using a mixture of sterile and non-sterile nitrile gloves depending on the situation. In the free text responses, 8 (73%) respondents stated they exclusively used sterile gloves for all skin surgery procedures, and 3 (27%) stated using both sterile and non-sterile nitrile gloves depending on the situation. Waste generated per procedure averaged 0.54 kg (0.05 kg sharps waste, 0.36 kg clinical waste, and 0.13 kg recycling waste). The recycling rate averaged 24.0%. Conclusions: Our study identified a high level of awareness of the BSDS sustainability guidance, but few had actually read the guidance itself. Staff is engaging with recycling of waste from minor skin surgery. Staff education on National Institute for Health and Care Excellence (NICE) guidance on hand disinfection in minor procedures and the BSDS sustainability guidance could further promote staff transition into more environmentally sustainable minor skin surgery practices.

Environmental Sustainability in Curette and Cautery Skin Surgery: A Quality Improvement Project on Single-Centre Transformation to Sustainable Practices

In this sustainability quality improvement project, we proposed a new lean pathway for performing curette and cautery minor skin surgery and evaluated our project’s social, patient, economic, environmental and population outcomes. If the new lean pathway is embedded into routine clinical practice, this could potentially lead to £4.08 (excluding VAT) and 1.24 kgCO2e per procedure of costs and carbon emissions savings, respectively. Surgical site infection rates for procedures performed with sterile gloves (n = 12) and non-sterile nitrile gloves (n = 8) were both at 0%. Our small single-centre study demonstrated that transforming to sustainable practices for curette and cautery procedures can lead to significant triple-bottom-line benefits with no obvious adverse postoperative infection risks. We encourage dermatology staff from the public and private sectors, as well as staff from other specialties, to consider adopting the recommendations from the British Society of Dermatological Surgery sustainability guidance when performing curette and cautery procedures.

1002 Outcomes and Documentation of Minor Skin Surgery at a General Practice

Abstract Aim This audit aimed to evaluate outcomes and documentation of minor skin surgery at a general practice. The basis of the audit was the National Health Service Directed Enhanced Service Specification for Minor Surgery 2021-22 (Minor Surgery DES SLA 2021/22). Method The scope included all minor surgery procedures coded as incisions and excisions on the EMIS electronic patient records system carried out at the practice between 25th January 2021 and 25th January 2022. All included records were evaluated for documentation of written consent, comprehensive surgery note, complications, all excised material sent for history, histology results recorded, malignancy reported on histology, and accordance of clinical and pathological diagnoses. The audit standard was set at 80% by consensus of senior clinicians. Results The initial search yielded 104 patient records. Following deduplication, 100 cases were included in the audit (8 incisions, 92 excisions). 86% had signed written consent and comprehensive note uploaded to the electronic patient records system (86/100). Complications, including infection, were recorded in 10% of cases (10/100). 92% of cases had all excised material sent for histology and results recorded on the electronic system (85/92) with some material sent in 100% of excisions (92/92). No malignancy has been reported on histology results. The accordance of clinical and pathological diagnoses was confirmed in 79% of excisions (73/92). Conclusions Minor skin procedures completed in the evaluated period met the audit standards. Minor surgery documentation could be further improved by introducing a dedicated electronic note template.

One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey.

Introduction. “See and treat” one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.

User interface evaluation of a multimedia CD-ROM for teaching minor skin surgery

Expert operative information is a prerequisite for any form of surgical training. However, the shortening of working hours has reduced surgical training time and learning opportunities. As a potential solution to this problem, multimedia programs have been designed to provide computer-based assistance to surgical trainees outside of the operating theatre. Few studies, however, have focused on the interface features of surgical multimedia programs, the successful design of which could be conducive to the evaluation of the effectiveness of learning. This study evaluated a multimedia CD-ROM designed for teaching minor skin surgery. A questionnaire, based on an existing user interface rating tool, was administered to 20 trainees (both junior and senior) in plastic surgery. Findings from the study revealed trainees' high rating of the CD-ROM on a scale of 1–10 (mean = 8); the analysis of which contributes towards an understanding of both the characteristics of the learning material and the learners in the evaluation of the user interface.

Complex regional pain syndrome after dermatological surgery

We report a case of complex regional pain syndrome developing in a 57-year-old woman after minor skin surgery in the sole of her right foot. This was diagnosed and treated in its early phase with sympathetic blockade using guanethedine with complete recovery of symptoms.

Complications of Minor Skin Surgery Performed under Local Anesthesia

Complications of Minor Skin Surgery Performed under Local Anesthesia

Complications of Minor Skin Surgery Performed under Local Anesthesia

Minor surgical procedures performed under local anesthesia are the most common surgical procedures routinely carried out in every plastic surgical practice. The objective was to evaluate the prevalence of immediate local and systemic complications of such procedures. Records of 2,600 procedures performed under local anesthesia on 2,431 patients between November 2001 and May 2004 were reviewed. Local anesthetic complications and all surgical-related complications were recorded. Procedure-related complications were 51 presyncope (1.9%), 4 true syncope (0.16%), 2 minor burns (0.08%), and 1 facial laceration (0.04%). True allergic reaction to lidocaine is extremely rare and none was noted in our study. Most patients who claimed that they had suffered from such a reaction were probably experiencing symptoms related to intravenous injection administration, a reaction to the added vasoconstrictor (adrenaline), or a vasovagal reaction, which is a common trait among young adults.

Early Bathing after Minor Skin Surgery in Dermatology Outpatients: Evaluation of its Influence on Surgical Site Infection

Early Bathing after Minor Skin Surgery in Dermatology Outpatients: Evaluation of its Influence on Surgical Site Infection

Factors Influencing Surgeons' Decisions in Elective Cosmetic Surgery Consultations

Current guidelines for surgeons' decisions about whether to offer cosmetic surgery are ineffective. Therefore, surgeons have to make difficult decisions on a case-by-case basis. The authors sought to identify the patient variables that influence surgeons' decisions in practice. A qualitative study first delineated, from observation of consultations and interviews with surgeons and other staff, variables that might influence their decisions. Then, in a cross-sectional survey of patients seeking cosmetic surgery, the authors measured these variables and tested whether they predicted the surgeons' decisions to offer surgery. Participants were 6 consultant plastic surgeons who assess cosmetic surgery referrals and 276 new patients aged 16 years or older referred to these surgeons. The qualitative study suggested that, as well as clinical factors (the probability of a satisfactory surgical outcome and the risks v. benefits of surgery), surgery was more likely to be offered where it was of low cost (i.e., minor skin surgery), physical symptoms or dysfunction were present, and abnormality of appearance was extreme. The role of patients' quality of life was unclear. The quantitative study confirmed that the probability of surgery was increased where requests were for minor skin procedures and by abnormality of patients' appearance. In patients seeking major body procedures, surgery was less likely when patients reported poor quality of life. Surgeons' decisions about whether to offer elective cosmetic surgery follow systematic rules. By incorporating the factors that surgeons use in their decision making, more effective guidelines about elective cosmetic surgery provision than are presently available could be developed.

Surgical Pearl: Surgical tape for dressing of epidermal grafts in lip vitiligo

tissue heating, thus avoiding unintended injury. For larger surgical defects, local, uniform pressure can be applied with the locked jaws of the hemostat parallel to the wound edge while holding the instrument at its base, which is at a safe distance from the wound (Fig 2). If bleeding is likely fed from a vessel with a known path, the pressure may be directed closer towards that vessel’s origin and at an even greater distance from the wound (eg, at the eyebrow to block the supra-orbital artery). In addition to improved safety, other advantages of this technique include the fact that it is nearly universally applicable, is easy to perform for even an untrained assistant, and does not require additional instruments on the surgical tray. An important limitation exists in that deeper layers must offer some resistance to the pressure. Various articles have described similar techniques of temporary hemostasis using pressure from firm devices; however, these either used specially-made instruments or were anatomically limited in their scope of application. In summary, this technique offers a fast and convenient method for temporary hemostasis that is safely and easily performed by assistants with little experience, and therefore may be especially helpful in a training environment. REFERENCES 1. Yen A, Braverman IM. Ultrastructure of the human dermal microcirculation: the horizontal plexus of the papillary dermis. J Invest Dermatol 1976;66:131-41. 2. Grabb WC. A concentration of 1:500,000 epinephrine in a local anesthetic solution is sufficient to provide excellent hemostasis. Plast Reconstr Surg 1979;63:834. 3. Rudolph H, Gartner J, Studtmann V. Skin lesions following the use of a tourniquet. Unfallchirurgie 1990;16:244-51. 4. Sawchuk WS, Friedman KJ, Manning T, Pinnell SR. Delayed healing in full thickness wounds treated with aluminum chloride solution. A histologic study with evaporimetry correlation. J Am Acad Dermatol 1986;15:982-9. 5. Armstrong RB, Nichols J, Pachance J. Punch biopsy wounds treated with Monsel’s solution or a collagen matrix. A comparison of healing. Arch Dermatol 1986;122:546-9. 6. Boyer JD,Maino KL, Zitelli JA. Surgical pearl: hemostasis assisted with two skin hooks. J Am Acad Dermatol 2002;47:938-9. 7. Fante RG, Fante RL. Perspective: the physical basis of surgical electrodissection. Ophthal Plast Reconstr Surg 2003;19:145-8. 8. Hafner J, Hohenleutner U. Surgical pearl: A flat plastic cylinder derived from a disposable syringe effectively achieves hemostasis in carbon dioxide laser surgery. J Am Acad Dermatol 2001;45:277-8. 9. Wheeland RG, Gilmore WA, Morgan RJ. Use of a nonconductive acrylic ring for control of bleeding during minor skin surgery. J Dermatol Surg Oncol 1983;9:18-9. 10. Sharquie KE, Al-Rawi JR. Sharquie’s metal ring in skin surgery. Dermatol Surg 2000;26:163-4. 11. Harahap M. Excision of small skin lesions on the scalp. In: Robins P, editor. Surgical gems in dermatology. Vol 1. New York: Journal Publishing Group; 1988. pp. 73-4. J AM ACAD DERMATOL SEPTEMBER 2005 498 Pearls

Influence of lidocaine on leukocyte function in the surgical wound.

The inflammatory response of the wound is mediated to a large extent by leukocytes, which play an important role in the wound healing process. Local anesthetics, which are routinely administered before minor skin surgery and for postoperative pain relief, have been shown to have diverse effects on wound healing. Local anesthetics have also been reported to induce potent inhibition of leukocytes in vitro, although their effects on leukocyte activity in the surgical wound have not been elucidated. The present study investigated the in vivo effects of lidocaine on leukocyte function in the surgical wound of rats by sampling leukocytes from hollow titanium implants. The surgical wound was treated with lidocaine or placebo after implantation of the titanium chamber and before skin closure. Leukocyte metabolic activity was measured by chemiluminescence. Cell count was analyzed in a Bürker chamber. Results showed progressive increase in leukocyte counts in the wounds of control animals and significantly lower cell counts in the wounds of lidocaine-treated animals 48 h (P less than 0.05) and 72 h (P less than 0.05) after surgery. A pronounced inhibition of the metabolic response to serum-opsonized zymosan was seen after 8 h in the lidocaine-treated animals versus controls (P less than 0.05). After 24 h, leukocyte metabolic activity decreased dramatically in the control group and remained at a low level until 72 h after surgery. In the lidocaine-treated group, the leukocyte response to zymosan remained constantly low throughout the study. The effects of lidocaine were not a result of impaired leukocyte viability.(ABSTRACT TRUNCATED AT 250 WORDS)

Does EMLA reduce the discomfort associated with local-anaesthetic infiltration?

The effectiveness of EMLA cream in relieving the discomfort associated with percutaneous infiltration of lignocaine was assessed in a double-blind, placebo-controlled study. Patients undergoing minor skin surgery were divided into two groups, according to the number of lesions requiring surgery. The first group had a single lesion and were randomized to apply either EMLA or placebo cream 1 h prior to infiltration, whilst the second group received EMLA to one and placebo to the other of two lesions treated at the same clinic attendance. In neither group was there a clinically useful reduction of discomfort, probably due to inadequate dermal anaesthesia, and we would not, therefore, recommend the routine use of EMLA for this purpose. The most recent evidence suggests that a 2-h application time may give more effective dermal anaesthesia, but this would probably limit its use to occasional problematical cases.