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Anatomy of the Skin Basics of Cutting and Suturing.pptx
- 1. Anatomy of the Skin, Basics of Cutting & Suturing Dermatologic Surgery Didactics Dr. Charlene Ang-Tiu Dr. Wendilyn Barba Mejia
- 2. • No financial disclosure or any conflict of interest Disclosure
- 3. • Fitzpatrick 9th ed Chapter 201 :: Cutaneous Surgical Anatomy • JRMMC Derm Webinar on Derm Surgery 2021 • https://dermnetnz.org/ • Suture Techniques Course Video: https://www.youtube.com/watch?v=Akyr4zlBS9E References:
- 4. Introduction - SKIN Form a barrier between the organism and the external environment Protects our bodies from physical damage caused by desiccation, physical stress, infection, overheating or heat loss, and ultraviolet (UV) irradiation.
- 5. Topic outline What we'll discuss this afternoon: Cutaneous surgical anatomy in head and neck anatomy Basics of cutting Basic of suturing techniques
- 6. Superficial Musculoaponeurotic System (SMAS) • Continuous fibromuscular layer investing and interlinking the muscles of facial expression • Functional biomechanical unit • Guide where important NVS are
- 8. • Cosmetic units: zones of tissue that share cutaneous features such as color, texture, pilosebaceous quality, pore size, degree of actinic exposure • Best to reconstruct a surgical defect within a cosmetic unit or subunit • Scar lines can be hidden easily in junction lines between the cosmetic units Topographic anatomy and cosmetic units
- 9. ⚬ Trichion ⚬ Glabella ⚬ Root of the nose ⚬ Nasal tip ⚬ Ala nasi ⚬ Columella ⚬ Vermillion ⚬ Nasolabial crease ⚬ Labiomental crease ⚬ Mental Crease ⚬ Menton ⚬ Medial and lateral canthus of the eyes ⚬ Corner of the mouth ⚬ Mid pupillary line Topographic anatomy and cosmetic units
- 11. Facial motor nerves CN VII and CN XI Temporal branch of the facial nerve Marginal mandibular branches of the facial nerve Spinal accessory nerve
- 14. Sensory nerves
- 15. Sensory nerves
- 16. Vascular anatomy
- 17. Lymphatics • Eventually drain into a terminal series of nodes (deep cervical nodes) and finally into the lateral internal jugular chain.
- 18. Significance???
- 20. SURGICAL INCISION • GOAL: To achieve OPTIMAL COSMETIC AND FUNCTIONAL outcome • Healing Wound contraction and scarring • Surgeon knowledge • Planning • Tissue and skeletal assessment
- 23. Relaxed skin tension lines • Help guide surgical reconstruction and allow the structural camouflage of scar lines • Creases on the face that form over time ⚬ loss of elastic tissue tone ⚬ lengthening of the collagenous fibrous septae that connect the dermis to the underlying facial muscles ⚬ excessive skin, gravity and UV exposure • Most obvious on the face • Induced by facial muscle movement • Run perpendicular to the underlying muscles • Excision should be placed PARALLEL (within) to RSTLs
- 27. The basic suturing kit includes: • needle holder • fine suture scissors • toothed tissue forceps +/- skin hook • appropriate suture material THE TOOLS
- 28. • Absorbable – lose the majority of their tensile strength in less than 60 days. They are generally used for buried sutures and do not require removal. • Non-absorbable – maintain the majority of their tensile strength for more than 60 days. They are generally used for skin surface sutures and do require removal postoperatively. SUTURE MATERIAL
- 29. GRIP
- 30. KNOT TYING (SQUARE KNOT)
- 36. Buried suture
- 37. Suture removal
- 39. CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, and infographics & images by Freepik Please keep this slide for attribution THANKS!
Hinweis der Redaktion
- The skin (the interface between humans and their environment) is the largest organ in the body. It weighs an average of 4 kg and covers an area of 2 m2. The skin has two layers: 1. The epidermis, outer epithelial layer. 2. The dermis, inner connective tissue containing most of the skin appendages, with 2 layers more superficial is the papillary and then then the reticular layer with more compact collagen. Beneath the dermis is, the subcutis/hypodermis which usually contains abundant fat. Functions are as follows: it forms a barrier…
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- The significance of knowing the cutaneous surgical anatomy is of course to OPTIMIZE SURGICAL RESULTS
- Fusiform incision is performed with longitudinal axis running parallel to the RSTLs The ratio of length to breadth is kept at 3-4:1, sometimes depending on the case. But the angles should be about 30 degrees or less, and this is to have an accurate coaptation if skin edges without dog ear formation.
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- These lines have important implications for the design and placement of surgical incisions, as well as for the patterns of spread of some skin disorders.
- Despite strict adherence to wound geometry, IT IS NOT ALWAYS POSSIBLE TO PREVENT DOG-EAR FORMATION. What’s important is you learn from your mistakes. haha
- YT: https://www.youtube.com/watch?v=Akyr4zlBS9E
- The needle holder should be held with the palm grip as illustrated in Figure 1. This allows superior wrist mobility than if the fingers are placed in the handle loops. The needle should be grasped between 1/3 to 1/2 of the distance between the suture attachment and the needle tip.
- The long end of the suture is wrapped around the tip of the closed needle holder twice before grasping the short end of the suture with the needle holder. The first double knot is then pulled gently tight. Two (or three) further single throws are then added in a similar fashion to secure the knot. Each throw is pulled in the opposite direction across the wound edge.
- Using a continuous suture rather than multiple interrupted sutures offers a significant time saving. However,it is not as strong as interrupted sutures, and can strangulate the blood supply in wounds under more than minimal tension.
- This suture provides excellent wound support, decreases dead space, and provides superior wound edge eversion.
- This suture is especially good for distributing wound tension across larger wounds particularly for the initial sutures.
- The benefit of this suture is the minimal epidermal puncture points allowing the suture to be left in place longer without suture-track scarring.
- This suture is extremely important for distributing wound tension to the dermis rather than the epidermis and also for closing dead space. It provides longer-term support to the healing wound and improves the cosmetic result.
- The time to suture removal depends on the location and the degree of tension the wound. As a guide, on the face, sutures should be removed in 5-7 days; on the neck, 7 days; on the scalp, 10 days; on the trunk and upper extremities, 10-14 days; and on the lower extremities, 14-21 days.