Achieving hemostasis in dermatology - Part 1: Preoperative, intraoperative, and postoperative management

The Origins and Development of Pre-emptive Dermatologic Anesthesia: A Systematic Review

This study delves into the historical trajectory of dermatological anesthesia, tracing its roots from ancient civilizations to modern times. It emphasizes the relentless pursuit of pain relief in dermatologic procedures and the transformative impact of anesthesia on surgical practices. A comprehensive analysis was conducted through an extensive literature review, employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review model on the PubMed and Embase databases. A total of 1304 articles were initially identified, with six publications from these databases and 10 additional sources from the World Wide Web included in the study. This systematic approach allowed for a thorough examination of the historical journey of dermatological anesthesia. The historical trajectory outlined in this study highlights the progress in dermatological anesthesia, showcasing its impact on contemporary procedures with a continual emphasis on patient comfort and safety. As medical knowledge expands, the ongoing quest for enhanced pain control in dermatology remains a central focus.

Physico chemical characterisation of pectin incorporated gelatin sponge and its functional evaluation in modulating contact activation haemostasis

Even though it is a common occurrence in practice, maintaining haemostasis can sometimes become a challenging issue in case of trauma, perioperative period, coagulation disorders, cancers, etc. Hemostatic materials are extensively used to assist in the cessation of bleeding. However, the definition of efficiency of haemostasis varies between intended procedures. This paper explores the feasibility of incorporating agents to increase the efficiency of local haemostasis. Pectin or β -D galacto hexopyranuronic acid/β Gal A, a structural polysaccharide widely present in terrestrial plants having an intrinsic hemostatic potential, is blended with gelatin and is explored in modulating passive haemostasis. The sponges are physico chemically characterized, and their hemostatic efficiency is evaluated in vitro using various assays. Biocompatibility evaluation is done by in vitro cytotoxicity assay. The results suggest that this biopolymer combination is a promising candidate for hemostatic control.

Assessment of Dilute Epinephrine and Mechanical Pressure for Prevention of Feline Postoperative Scrotal Hematoma: A Randomized Controlled Trial

To determine whether two immediately postoperative preventive procedures, dilute epinephrine (1:400,000) as a scrotal wash or application of controlled mechanical pressure to the scrotum, reduce the risk or severity of scrotal hematoma following routine castration. Male cats with two descended testicles presenting to Midwestern University's Trap Neuter Return program were eligible for inclusion. Cats were assigned via block randomization to control, dilute epinephrine wash, or controlled mechanical pressure groups. For the epinephrine group, 0.2 ml (0.008 mg) of epinephrine diluted with sterile saline was instilled inside the scrotum. In the case of mechanical pressure, a broad-based clip generating less than 0.5 kg of pressure was applied for 10 minutes. Cats were evaluated for scrotal hematoma and the need for treatment by a veterinarian blinded to treatment group. Multivariable logistic regression was used to determine if the incidence of scrotal hematoma or scrotal hematoma requiring treatment was different between groups while controlling for other variables. There were 276 cats with a median age of 30 months (IQR 12,48) and a mean weight of 3.5 kg (SD 1.2). Scrotal hematomas were noted in 15 of the 92 (16%) control cats, as compared with 12 of the 92 (13%) epinephrine and nine of the 92 (10%) pressure cats. Treatment was required for 10 (67%) control, six (50%) epinephrine, and three (33%) pressure hematomas. Regression demonstrated a decreased risk of scrotal hematoma requiring treatment for cats in the pressure group (OR = 0.2, P = .044) controlling for weight (OR = 2.2, P = .006) and surgical duration (OR = 1.1, P = .026). Weight was the only significant variable for the presence of scrotal hematoma (OR = 2.2, P < .0001). Controlled mechanical pressure applied immediately after routine castration can help decrease the proportion of scrotal hematomas that require treatment.

Biopsy Techniques for Skin Disease and Skin Cancer: A New Approach

Skin biopsies provide physicians with valuable information in the evaluation of many dermatologic diseases. It becomes increasingly important for physicians to be proficient at performing skin biopsies because of the prevalence of skin malignancies and other dermatologic diseases in general population. The most common techniques include the punch, shave, excisional, and incisional biopsies. Each procedure has advantages and disadvantages, depending on the dermatologic diseases. The choice of biopsy type depends on the suspected disease's pathology and lesion location. Performing time-saving and economically convenient techniques is more favorable for both physicians and patients. For this purpose, for the past 10 years, we used a technique that provides hemostasis and substitute suturing without using any suture material for patients who are suitable for punch and incisional biopsies. We aim to share this easy, cheap, and time-saving procedure.

First Safety and Performance Evaluation of T45K, a Self-Assembling Peptide Barrier Hemostatic Device, After Skin Lesion Excision

BACKGROUND

The self-assembling peptide barrier T45K (SAPB-T45K) is an oligopeptide that rapidly forms a biocompatible hemostatic barrier when applied to wounds.

OBJECTIVE

Evaluate safety and performance of SAPB-T45K in cutaneous surgery.

MATERIALS AND METHODS

In this single-blind study, after sequential shave excision of 2 lesions, wounds were randomized (intrapatient) to SAPB-T45K or control treatment. Safety was assessed at treatment, Day 7, and Day 30. Performance was evaluated using time to hemostasis (TTH) and ASEPSIS wound scores, with a subgroup analysis for patients with or without antiplatelet therapy.

RESULTS

Each of 46 patients (10 [22%] with antiplatelet therapy) received randomized SAPB-T45K or control treatment for 2 wounds. Safety assessments were similar, and ASEPSIS scores reflected normal healing in both wound groups. SAPB-T45K demonstrated significantly faster median TTH (24.5 [range, 7–165] seconds) compared with control (44 [10–387] seconds), for a 41% median TTH reduction (18 [95% confidence interval, 7–35] seconds, p < .001). SAPB-T45K provided an identical median TTH of 24 seconds, regardless of antiplatelet therapy. Control median TTH was 90 and 40 seconds for patients taking or not taking antiplatelet therapy, respectively.

CONCLUSIONS

SAPB-T45K provided significantly faster median TTH versus control, especially with antiplatelet therapy, and safety profiles were similar.

Semi-Autonomous Electrosurgery for Tumor Resection Using a Multi-Degree of Freedom Electrosurgical Tool and Visual Servoing

This paper specifies a surgical robot performing semi-autonomous electrosurgery for tumor resection and evaluates its accuracy using a visual servoing paradigm. We describe the design and integration of a novel, multi-degree of freedom electrosurgical tool for the smart tissue autonomous robot (STAR). Standardized line tests are executed to determine ideal cut parameters in three different types of porcine tissue. STAR is then programmed with the ideal cut setting for porcine tissue and compared against expert surgeons using open and laparoscopic techniques in a line cutting task. We conclude with a proof of concept demonstration using STAR to semi-autonomously resect pseudo-tumors in porcine tissue using visual servoing. When tasked to excise tumors with a consistent 4mm margin, STAR can semi-autonomously dissect tissue with an average margin of 3.67 mm and a standard deviation of 0.89mm.

One-Per-Mil Tumescent Infiltration Technique for Vascular Malformation Surgery in Hand and Upper Extremity

Background: To present the efficacy of 1:1,000,000 tumescent solution for resection of vascular malformation in hand and upper extremity without tourniquet application.

Methods: Four patients with five slow flow vascular malformations were retrospectively reviewed. Prior to incision, 1:1,000,000 tumescent solution was infiltrated subcutaneously surrounding the lesion until the skin turned pale. Amount of tumescent solution injected, the length of surgery, the clarity of the operative field, and the complications were recorded. Clarity of operative field was categorized as totally bloodless, minimum bleeding, acceptable bleeding, and bloody. In the surgeries under local anesthesia, we also recorded self-reported intra-operative pain using VAS score, onset of pain, and conversion of anesthesia.

Results: The injected amount of the tumescent solution ranged from 4.5 to 200 mL, with the length of surgery ranged from 60 to 150 minutes. One out of 5 cases was totally bloodless, 3 cases were minimum bleeding and 1 case was acceptable bleeding. Minor skin necrosis was recorded in 1 patient. Neither intra-operative pain nor conversion from local to general anesthesia was reported.

Conclusions: 1:1,000,000 tumescent solution is effective for resection of slow flow vascular malformation in hand and upper extremity without tourniquet application.