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  • Surgical instrument choice may have a direct impact on outcomes, and certainly leads to less traumatic and faster procedures.

  • Investing in high-quality instruments is generally a wise decision.

  • The highest-quality instruments are the longest lasting, provide the best surgical outcomes, and allow for optimal comfort and speed. Using inadequate instrumentation may lead to need for frequent replacement, poor performance, and tissue damage.

  • While the majority of procedures may be completed with a few basic instruments, there is a wide array of available instruments that may be used for specialty procedures.

image Beginner Pearls

  • Consider purchasing instruments at conferences in order to both sample the range of choices and save on costs.

  • Surgical packs do not require an exhaustive array of instruments.

  • When training staff, including a laminated photograph of the surgical pack above the area where instruments are washed and packaged is a helpful training tool.

image Expert Pearls

  • Consider color-coding instrument packs for ease of organization and consistency.

  • Maintain basic surgical packs and add specialized instrumentation as needed. Instruments used in less than 25% of cases may be kept in separate packs as long as they are easily accessible.

  • When using larger suture needles, such as those on 2-0 suture, be sure to use larger and heavier needle drivers, as fine needle drivers may be loosened by clamping on more robust needles.

  • Supercut scissors are denoted by black handles. The upper blades of these scissors are honed with a double, rather than single, bevel, similar to the blade of a high-quality knife or scalpel and the lower jaw is serrated. These scissors optimize tissue cutting in most circumstances, but the sharp blade is easily dulled.

  • Some surgeons use a skin hook in place of forceps for skin reflection during suturing to minimize the risk of tissue strangulation.

image Don’t Forget!

  • Beware the temptation to create overly comprehensive surgical packs. Many accomplished dermatologic surgeons work with a basic set of high-quality instruments.

  • Suture-tying platforms are extremely helpful; it is always preferable to use toothed forceps with platforms rather than nontoothed forceps, as the latter increase the risk of tissue strangulation.

image Pitfalls and Cautions

  • Always autoclave instruments in the open position to avoid buckling.

  • Avoid using supercut scissors to cut anything but tissue.

  • Staff should always be responsible for their own sharps disposal, which should be performed before the used instruments are removed from the room.

  • The jaws of a needle driver may be smooth or have fine teeth or ridges. Small teeth may assist in gripping the needle, but may also damage the suture material during handling and tying.

  • The most common risk to both surgeon and assistant in dermatologic surgery is needle puncture, though the risk of disease transmission is low when using closed-bore sewing needles.


Optimal outcomes in dermatologic surgery ...

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