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Surgical pearl: hands-free tape retraction
PEARLS Stuart J. Salasche, MD Surgical Pearls Editor
Mark G. Lebwohl, MD Medical Pearls Editor
Surgical Pearl: Hands-free tape retraction J. Michael Webb, MD, Michel A. McDonald, MD, and Thomas Stasko, MD Nashville, Tennessee
A
few anatomic sites in dermatologic surgery have small operative fields in which it is difficult to maneuver instruments. Traditional methods of retraction using skin hooks, suture, and manual retraction can be cumbersome, relatively expensive, and often ineffective in these areas. We have devised a method of retraction using adhesive wound dressing tape that addresses these issues, is simple, and inexpensive (on the basis of the current retail price of a 2-in ⫻ 10-yd roll, the cost to generate 1 postauricular tape retractor as described is less than 1 cent). The postauricular, inframammary, and inguinal folds and the perineum, penis, and labia majora are a few areas where the tape retractor can be used effectively. It can be easily configured to meet the surgeon’s needs for each of these areas by varying the length and width. Although any type of adhesive tape can be used to make a hands-free retractor, those with an adhesive backing are easier to cut, shape, and apply. In particular, we have found that the adhesive properties, grid backing, and ability to autoclave Hypafix tape (BSN Medical GmbH & Co KG, Hamburg, Germany) make this brand an ideal choice. This sharpless and tissue-gentle method of retraction provides the surgeon with more room to maneuver while freeing the assistant’s hand or hands to help in other ways. To illustrate the concept of tape retraction, we describe its use for the postauricular area; retracting the pinna in an anterior direction.
From the Division of Dermatology, Department of Medicine, Vanderbilt University Medical Center. Funding sources: None. Conflicts of interest: None identified. Reprint requests: J. Michael Webb, MD, Vanderbilt University Medical Center, Division of Dermatology, Department of Medicine, Nashville, TN 37232-5227. E-mail: tennriverderm@ pol.net. J Am Acad Dermatol 2003;49:288-9 Copyright © 2003 by the American Academy of Dermatology, Inc. 0190-9622/2003/$30.00 ⫹ 0 doi:10.1067/S0190-9622(03)01592-5
288
Fig 1. Postauricular tape retractor ready for application.
Fig 2. Proper application technique. Note that adhesive backing of each finger is not removed until placement.
TECHNIQUE An effective design for the postauricular area has a septated end that is composed of 4 fingers. This requires a 12-cm long piece of 2.5-cm wide tape. The first step in construction involves cutting the backing of the tape across its width at the 6-cm mark. This should be done carefully to avoid cutting the adhesive tape. After this is done, the fingers are created with 3 evenly spaced, 6-cm longitudinal cuts at 1 end. Then, approximately 1 cm should be cut off the center fingers to fit the curve of the helical rim. This allows a more even retraction of the pinna. Finally, removing 2 cm of backing from the nonseptated end will expose enough adhesive for testing while leaving some backing in the middle for nonstick handling (Fig 1). A gentle acetone preparation may improve adhesion of the tape in patients who have particularly oily skin. The fingers of the retractor should be
J AM ACAD DERMATOL VOLUME 49, NUMBER 2
Fig 3. Tape retractor in place.
applied first. The backing of each finger should only be removed just before its placement (Fig 2). This prevents the tape fingers from sticking to each other. After these are placed, pulling the nonpartitioned end can test the shape and vector of retraction. The surgeon can reposition the fingers and retest until a satisfactory effect is obtained. When satisfied, the
Direct all Surgical Pearl submissions to Dr Stuart J. Salasche, 5300 N Montezuma Trail, Tucson, AZ 85750.
Webb, McDonald, and Stasko 289
Fig 4. Relaxed tension between Mohs micrographic surgery stages.
remaining adhesive backing can be removed and the tape applied to the skin (Fig 3). The nonpartitioned end can be repositioned to reduce or increase tension during the procedure as needed. This is particularly useful between Mohs micrographic surgery stages (Fig 4) or as the wound is sutured closed.
Direct all Medical Pearl submissions to Dr Mark G. Lebwohl, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1048, New York, NY 10029.
Mark G. Lebwohl, MD Medical Pearls Editor
Surgical Pearl: Hands-free tape retraction J. Michael Webb, MD, Michel A. McDonald, MD, and Thomas Stasko, MD Nashville, Tennessee
A
few anatomic sites in dermatologic surgery have small operative fields in which it is difficult to maneuver instruments. Traditional methods of retraction using skin hooks, suture, and manual retraction can be cumbersome, relatively expensive, and often ineffective in these areas. We have devised a method of retraction using adhesive wound dressing tape that addresses these issues, is simple, and inexpensive (on the basis of the current retail price of a 2-in ⫻ 10-yd roll, the cost to generate 1 postauricular tape retractor as described is less than 1 cent). The postauricular, inframammary, and inguinal folds and the perineum, penis, and labia majora are a few areas where the tape retractor can be used effectively. It can be easily configured to meet the surgeon’s needs for each of these areas by varying the length and width. Although any type of adhesive tape can be used to make a hands-free retractor, those with an adhesive backing are easier to cut, shape, and apply. In particular, we have found that the adhesive properties, grid backing, and ability to autoclave Hypafix tape (BSN Medical GmbH & Co KG, Hamburg, Germany) make this brand an ideal choice. This sharpless and tissue-gentle method of retraction provides the surgeon with more room to maneuver while freeing the assistant’s hand or hands to help in other ways. To illustrate the concept of tape retraction, we describe its use for the postauricular area; retracting the pinna in an anterior direction.
From the Division of Dermatology, Department of Medicine, Vanderbilt University Medical Center. Funding sources: None. Conflicts of interest: None identified. Reprint requests: J. Michael Webb, MD, Vanderbilt University Medical Center, Division of Dermatology, Department of Medicine, Nashville, TN 37232-5227. E-mail: tennriverderm@ pol.net. J Am Acad Dermatol 2003;49:288-9 Copyright © 2003 by the American Academy of Dermatology, Inc. 0190-9622/2003/$30.00 ⫹ 0 doi:10.1067/S0190-9622(03)01592-5
288
Fig 1. Postauricular tape retractor ready for application.
Fig 2. Proper application technique. Note that adhesive backing of each finger is not removed until placement.
TECHNIQUE An effective design for the postauricular area has a septated end that is composed of 4 fingers. This requires a 12-cm long piece of 2.5-cm wide tape. The first step in construction involves cutting the backing of the tape across its width at the 6-cm mark. This should be done carefully to avoid cutting the adhesive tape. After this is done, the fingers are created with 3 evenly spaced, 6-cm longitudinal cuts at 1 end. Then, approximately 1 cm should be cut off the center fingers to fit the curve of the helical rim. This allows a more even retraction of the pinna. Finally, removing 2 cm of backing from the nonseptated end will expose enough adhesive for testing while leaving some backing in the middle for nonstick handling (Fig 1). A gentle acetone preparation may improve adhesion of the tape in patients who have particularly oily skin. The fingers of the retractor should be
J AM ACAD DERMATOL VOLUME 49, NUMBER 2
Fig 3. Tape retractor in place.
applied first. The backing of each finger should only be removed just before its placement (Fig 2). This prevents the tape fingers from sticking to each other. After these are placed, pulling the nonpartitioned end can test the shape and vector of retraction. The surgeon can reposition the fingers and retest until a satisfactory effect is obtained. When satisfied, the
Direct all Surgical Pearl submissions to Dr Stuart J. Salasche, 5300 N Montezuma Trail, Tucson, AZ 85750.
Webb, McDonald, and Stasko 289
Fig 4. Relaxed tension between Mohs micrographic surgery stages.
remaining adhesive backing can be removed and the tape applied to the skin (Fig 3). The nonpartitioned end can be repositioned to reduce or increase tension during the procedure as needed. This is particularly useful between Mohs micrographic surgery stages (Fig 4) or as the wound is sutured closed.
Direct all Medical Pearl submissions to Dr Mark G. Lebwohl, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1048, New York, NY 10029.