Instruments and devices used in skin surgery

Surgical instruments - skin surgery requires the use of fine instruments which facilitate the so called atraumatic performance. A basic set of instruments enabling the performance of the majority of the procedures involving skin and subcutaneous tissue is composed of:scalpel handle no. 3, scalpel no. 15, surgical forceps with serrated 1 mm tip (e.g. Adson forceps),needle holder 12-14 cm (e.g. Mayo-Hegar needle holder) or alternatively a simple hemostat 13 cm (e.g. Halsted hemostat), straight-bladed suture (Mayo) scissors 13.5 cm (e.g. standard type), small, sharp-tipped, single or double skin hooks, fine straight scissors11.5 cm, straight preparatory scissors 14.5 cm (e.g. Metzenbaum scissors).

Conventional surgical instruments are used in dermatosurgery for a variety of procedures, including excisions of unsightly skin lesions and correction of scars by means of excision with simple suturing, Z-plasty, W-plasty or M-plasty. In the field of aesthetic dermatology, precise and gentle performance of procedures, leaving as little scarring as possible, is of particular relevance. Prior to undertaking any dermatocosmetic surgery, it is advisable to obtain a thorough knowledge of atraumatic procedures and try to comply with them.

Another important factor facilitating good aesthetic results is using proper and accurate suture materials. Today, there is a wide variety of useful materials available. It is always worth trying to use products which are most beneficial for a particular kind of wound. A type of suture used also plays an important role in achieving an aesthetically pleasing result. Though a number of suture techniques for closing wounds of various nature has been described, it seems that especially useful in dermatosurgery is subcutaneous suturing, which prevents the occurrence of the ladder-like stitch marks.Suchsutures are made with modern absorbable monofilament materials of low tissue reaction and tensile strength facilitating proper wound stabilisation. Their application can provide the best healing conditions and prevent scar widening in future.

Additional dermatosurgical tools may include biopsy punches, which allow to excise circular skin samples of a few millimetres in diameter, as well as curettes, which facilitate the superficial removal of less cohesive tissue. A device that proves very useful is dermo-jet® for intradermic administration of drugs, which are injected under high pressureto penetrate the superficial layers of the skin. The device allows to spare the patients the pain of traditional injections and is very useful in situations where administering a conventional injection would be either very difficult (e.g. dense keloids) or associated with the risk of infection. Moreover, the device helps to distribute a drug more evenly over a larger area of the skin.

Devices used for tissue freezing (cryosurgery) - low temperature contributes to the phenomenon of evaporation, i.e. expanding a gas compressed to a liquid form. Devices used in cryosurgery have spray tips, facilitating ¬¬the non-contact tissuefreezing, or contact tips of different shapes and sizes. The most commonly used devices make use of liquid nitrogen evaporation, which lowers the temperature to - 196 ° C.

There is a wide array of such devices. The simplest ones, with a capacity of approx. 500 ml, are 20-25 cm high, which makes them easy to move around. There are also large stationary devices available, which may be filled with a few dozen litres of gas. Their main advantages include the possibility of the precise setting of freezing parameters and the convenience of use. Cryosurgery with liquid nitrogen enables to freeze both small lesions and larger areas of affected skin, which may also be performed for cosmetic reasons (cryopeeling).

Devices used for mechanical abrasion of the skin(dermabrasion) - these essentially include a high-rotation device for skin abrasion (dermabrasion)with the rough surfaced tips coated with diamond or corundum particles.Another type of tips are wire brushes which facilitate deeper abrasion. The tips differ in grain structure (coarse-grained and fine-grained), shape (cylindrical, domed or oval) and size.

There are also devices for a non-contact abrasion of the skin (microdermabrasion)which operate by blasting coarse corundum crystals at the skin via a high-velocity jet of air. These devices gently remove the superficial layers of the epidermis,which produce results comparable with shallow chemical peels.