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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
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
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
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Notas do Editor
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.
