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Appendix G lists the instruments included in a standard skin surgery tray.
Suggested suture removal times are listed in Appendix J.
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
Lesion removal next to linear structures that should not be pulled
Lesion removal on the upper lip
Closure of defects on the chin or beneath the chin
Closure of large forehead defects (especially if just above the eyebrows or near the hairline)
Repair of scalp defects
Closure of defects in temple region, lateral face beneath the ear, or along the mandible
Closure of defects on breast tissue (use a running intracutaneous suture closure)
Widely separated wound edges that are better approximated with deeply buried sutures
Severe bleeding disorders
Extreme illness that would make wound healing difficult
Cellulitis in the tissues to be incised
Conditions that may interfere with wound healing (collagen vascular diseases, smoking, diabetes)
Concurrent medications that may increase the likelihood of intraoperative bleeding (aspirin, other nonsteroidal anti-inflammatory drugs, warfarin)
PITFALL: Make sure the incision arms are on opposite sides of the central line! Many novice practitioners unintentionally incise both arms on the same side of the central line, necessitating performance of a fusiform excision or an advancement flap technique.
PEARL: Prep a wide area so that an undraped area is not inadvertently exposed if the drape slides a little.
PEARL: The center island containing the lesion may be excised first, although smoother excision lines occur when all of the excision is made at once. The corners of the central island are squared (if the island is removed first) to facilitate approximation of the flaps.
PITFALL: If the flaps are well undermined and still do not close with minimal pressure, check the overall length of the flaps. If the length-to-width ratio is <3:1, it is difficult to close the flaps, and there will be a greater risk of necrosis of all or part of the flaps due to lack of blood flow.
Pain, infection, and bleeding
Nonunion of skin edges
Incomplete excision of lesion