Ends of ellipse (Apical angles): Dimension of ellipse: Axis of ellipse: Margin of excision: Lesion type Surgical margin Uncertain Consider shave or punch biopsy to delineate prior to elliptical excision or start with 1- to 2-mm margins to avoid unnecessary tissue removal. Benign Visible lesion removed BCC 3–5 mm SCC 3–6 mm…
Category: Surgical Skills
Surgical instruments and surgical techniques
Surgical Skills 
Swashbuckler (Modified Anterolateral) Approach to Distal Femur
Advantages: Patient position: Supine with a roll under the knee to allow knee flexion Tourniquet: Not used unless required Incision: Superficial dissection: 1. Fascia is incised in line of incision & sharply dissected off the vastus lateralis muscle laterally to its inclusion with the iliotibial band, to expose the quadriceps…
Surgical Skills 
Shoelace technique for Delayed Primary Closure
Indication: Delayed primary closure of fasciotomy wounds Sutures that can be used: Anchors: Staples (can apply 2 staples) or Metal clips Knotting pattern: The suture is attached to one side and passed through the incision to be attached on the opposite side, in a sequence that resembles a zigzag from…
Surgical Skills 
Biomechanics in MIPO (Minimally Invasive Plate Osteosynthesis)
1. Provides optimal environment for fracture healing: 2. Relative stability of fracture: 3. Acts as internal fixator: 4. Plate length and Number of screws in Bridge plate function: 5. Plate working length: References:
Surgical Skills 
Syringe Suction Vacuum Drain : Technique
1. A small stab incision is made on skin with a no. 11 Blade where the drain is anticipated. 2. A feeding tube of an appropriate size or IV set tube with side holes is placed through the skin incision site to the desired site. 3. The tube is fixed…
Emergency Medicine 
Circumferential Periosteal Block (CPB)
Use: Alternative to hematoma block in reduction of distal radius and ulna fractures Advantage: Providing distance from the fracture hematoma (no theoretical risk of converting closed fracture into open fracture) Disadvantage: Risk of neurovascular injury on volar surface of forearm Local anesthetic and volume: 10–15 ml of 1 % plain lidocaine…
Surgical Skills 
Anteromedial Ankle Hematoma Block
Mechanism of action of Hematoma Block Indications of Anteromedial Portal Injection Landmarks Technique
Surgical Skills 
Bilateral V-Y (Kutler) flap for finger stump closure
Indications Classically, this flap is indicated in patients with transverse or volar oblique amputations. In actuality, the patient in whom this flap is useful generally will have an amputation where there is more tissue on the radial and ulnar margins of an amputation and exposed distal phalanx. Limitations Generally, the…