Biomedical subjects

Thomas J Zuber

Publications and source records attributed to Thomas J Zuber.

9 recordsLinked to original sources

PubMed2003

Fusiform excision.

The fusiform excision technique is commonly used by physicians for removing skin and subcutaneous lesions. The technique requires basic skills in anesthetic administration, lesion excision, and suture closure. Physicians experienced in skin surgery can often perform the procedure unsupervised after two to five precepted sessions. The fusiform excision technique should be used to biopsy any suspicious pigmented lesions because prognosis may depend on the depth of the lesion. A properly designed fusiform excision has a length-to-width ratio of 3 to 1 and produces a 30-degree angulation at both edges of the wound. The skin edges should be everted during the closure to improve final scar appearance. Malignant growths may require a second procedure to provide a wider margin of excision around the lesion. Post-excisional wound infections are uncommon with use of proper aseptic technique.

Ambulatory Surgical Procedures↗

PubMed2002

The mattress sutures: vertical, horizontal, and corner stitch.

The interrupted vertical and horizontal mattress suture techniques are two of the most commonly used skin closure methods. These mattress sutures promote wound edge eversion and less prominent scarring. Vertical and horizontal mattress sutures allow for skin edges to be closed under tension when wound edges have to be brought together over a distance. The corner stitch, a variation of the horizontal mattress suture, is commonly used for closure of angled skin flaps or wounds. Although mattress sutures can produce surface scarring or "railroad marks," early removal of these sutures can limit this damage.

Dermatologic Surgical Procedures↗

PubMed2002

Knee joint aspiration and injection.

Knee joint aspiration and injection are performed to aid in diagnosis and treatment of knee joint diseases. The knee joint is the most common and the easiest joint for the physician to aspirate. One approach involves insertion of a needle 1 cm above and 1 cm lateral to the superior lateral aspect of the patella at a 45-degree angle. Once the needle has been inserted 1 to 1 1/2 inches, aspiration aided by local compression is performed. Local corticosteroid injections can provide significant relief and often ameliorate acute exacerbations of knee osteoarthritis associated with significant effusions. Among the indications for arthrocentesis are crystal-induced arthropathy, hemarthrosis, unexplained joint effusion, and symptomatic relief of a large effusion. Contraindications include bacteremia, inaccessible joints, joint prosthesis, and overlying infection in the soft tissue. Large effusions can recur and may require repeat aspiration. Anti-inflammatory medications may prove beneficial in reducing joint inflammation and fluid accumulations.

Humans↗

PubMed2002

Ingrown toenail removal.

Ingrown toenail is a common problem resulting from various etiologies including improperly trimmed nails, hyperhidrosis, and poorly fitting shoes. Patients commonly present with pain in the affected nail but with progression, drainage, infection, and difficulty walking occur. Excision of the lateral nail plate combined with lateral matricectomy is thought to provide the best chance for eradication. The lateral aspect of the nail plate is removed with preservation of the remaining healthy nail plate. Electrocautery ablation is then used to destroy the exposed nail-forming matrix, creating a new lateral nail fold. Complications of the procedure include regrowth of a nail spicule secondary to incomplete matricectomy and postoperative nail bed infection. When performed correctly, the procedure produces the greatest success in the treatment of ingrown nails. Basic soft tissue surgery and electrosurgery experience are prerequisites for learning the technique.

Ambulatory Surgical Procedures↗

PubMed2002

Dermal electrosurgical shave excision.

The dermal electrosurgical shave excision is a fast and inexpensive method of removing epidermal and dermal lesions. The procedure is ideally suited for pedunculated lesions raised above the level of the surrounding skin. It consists of repetitive, unidirectional, horizontal slicing of a cutaneous lesion with a no. 15 blade followed by electrosurgical feathering to smooth out the wound edges. A smoke evacuator is used during electrosurgery to prevent inhalation of heat-disseminated viral particles. The procedure is followed by histologic evaluation of the shaved specimen. Suspicious pigmented lesions should not be shaved because the long-term prognosis of a malignancy may depend on the thickness of the lesion on histologic analysis. Administration of adequate local anesthesia should make this a painless procedure. Basic general surgery skills are required, and formal training in electrosurgery is highly recommended.

Electrosurgery↗

PubMed2002

Hemorrhoidectomy for thrombosed external hemorrhoids.

External hemorrhoids represent distended vascular tissue in the anal canal distal to the dentate line. Persons with thrombosed external hemorrhoids usually present with pain on standing, sitting or defecating. Acutely tender, thrombosed external hemorrhoids can be surgically removed if encountered within the first 72 hours after onset. Hemorrhoidectomy is performed through an elliptic incision over the site of thrombosis with removal of the entire diseased hemorrhoidal plexus in one piece. Caution must be exercised to avoid cutting into the muscle sphincter below the hemorrhoidal vessels. Infection after suture closure is rare secondary to the rich vascular network in the anal area. Stool softeners must be prescribed postoperatively to help prevent tearing at the suture line. Training and experience in general and skin surgery are necessary before the physician attempts this procedure unsupervised.

Anal Canal↗

PubMed2002

Minimal excision technique for epidermoid (sebaceous) cysts.

Epidermoid cysts are asymptomatic, dome-shaped lesions that often arise from a ruptured pilosebaceous follicle. The minimal excision technique for epidermoid cyst removal is less invasive than complete surgical excision and does not require suture closure. The procedure is easy to learn, and most physicians experienced in skin surgery can perform the procedure after three to five precepted sessions. It involves making a 2- to 3-mm incision, expressing the cyst contents through compression and extracting the cyst wall through the incision. Gauze or a splatter shield should be used to protect the physician from spraying of cyst contents. The rarity of associated cancer makes histologic evaluation necessary only if unusual findings or clinical suspicion of cancer is present. Inflamed cysts are difficult to excise, and it is often preferable to postpone excision until inflammation has subsided.

Epidermal Cyst↗

PubMed2002

Punch biopsy of the skin.

Skin biopsy is one of the most important diagnostic tests for skin disorders. Punch biopsy is considered the primary technique for obtaining diagnostic full-thickness skin specimens. It requires basic general surgical and suture-tying skills and is easy to learn. The technique involves the use of a circular blade that is rotated down through the epidermis and dermis, and into the subcutaneous fat, yielding a 3- to 4-mm cylindrical core of tissue sample. Stretching the skin perpendicular to the lines of least skin tension before incision results in an elliptical-shaped wound, allowing for easier closure by a single suture. Once the specimen is obtained, caution must be used in handling it to avoid crush artifact. Punch biopsies are useful in the work-up of cutaneous neoplasms, pigmented lesions, inflammatory lesions and chronic skin disorders. Properly administered local anesthesia usually makes this a painless procedure.

Biopsy↗

PubMedDate not supplied

The psychological contract: retaining newly employed physicians.

You spend lots of time and money recruiting the best candidates to fill your physician positions. But sometimes you lose those physicians after only a year or two on the job. Discover ways to help stop the turnover and keep valued employees happy.

Contract Services↗