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Surgical Pearl: Manual dermabrasion
PEARLS OF WISDOM Surgical Pearl: Manual dermabrasion Millard Zisser, MD, Baruch Kaplan, MD, and Ronald L. Moy, MD
Los Angeles, California Dermabrasion is an effective procedure that alleviates many facial cutaneous disorders. 1 The main indication for dermabrasion is scarring resulting from surgical procedures, trauma, or acne. Other conditions amenable to dermabrasion include photodamaged or wrinkled skin. In conventional dermabrasion, an electrically powered hand-held abrader with a diamond fraise or wire brush is the cutting tool. 2 However, this technique has several drawbacks and requires both skill and experience. Extreme caution must be taken when the periorbital or perioral areas are treated. Aerosolized blood and skin fragments may pose a risk to operating room personnel and the surgeon. 3 The routine use of skin refrigerants before dermabrasion may cause hypopigmentation from injury to melanocytes.4 We describe a simple and highly effective technique of manual spot dermabrasion that has several advantages over the conventional technique. MATERIAL AND METHODS
The materials used are a drywall/plaster sanding screen, medium grade (3M Corp., St. Paul, Minn.) (Fig. 1), which is cut into strips of about 2 X 3 inches, and autoclave steam sterilized, and a sterile 3 ml syringe with lidocaine. Patients with facial scarring from surgery, trauma, or ache, and patients with actinically damaged skin are suitable candidates. We have treated patients with dark, medium, and light complexions; most are treated after extirpation of skin cancers with Mohs micrographic surgery and reconstruction with primary closure, skin flaps, or skin grafts (Fig. 2). The dermabrasion is usually performed 6 to 10 weeks after the reconstructive procedure. With the patient in a supine position the area of the scar is prepared with Hibiclens solution and then anesthetized with 1% lidocaine and epinephrine. The drywall sanding From the Division of Dermatology, University of California, Los Angeles. Reprint requests: Ronald L. Moy, MD, 100 UCLA Medical Plaza, Suite 590, Los Angeles, CA 90024. J AM ACAD DERMATOL 1995;33:105-6. Copyright © 1995 by the American Academy of Dermatology, Inc. 0190-9622/95 $3.00 + 0 16/74/63416
screen is wrapped firmly around the barrel of the syringe (Fig. 3). The scar is then gently abraded with a backand-forth or circular motion until the area is smoothed down to the papillary dermis where bleeding points can be appreciated (Fig. 4). Hemostasis is achieved with pressure applied by the patient for about 10 minutes; then a standard dressing is applied with antibiotic ointment and a nonstick bandage. The patient is instructed tO cleanse the wound once daily for 10 days. The usual time for epithelial healing is approximately 7 to 10 days. Great improvement of the scar can be achieved by this method (Fig. 5). DISCUSSION Reconstructive surgery with flaps and grafts often results in prominent incision lines. Dermabrasion performed 6 to 10 weeks after the procedure greatly improves the scar and often no visible scar is evident. 5 At times an entire cosmetic unit such as the nose is dermabraded at the same time, providing the additional benefit of eliminating the surrounding actinic damage and diminishing the potential for development of additional cancers. 6 Manual dermabrasion with drywall sanding screen is easy to perform and greatly improves facial scarring. The advantages of this technique compared with the use of a motor-powered abrader are as follows: • Less expensive, without the use of a power instrument • No need for careful maintenance and cleaning of tips, fraises, brushes, and wheels • No skin refrigerant is used and thus less chance of hypopigmentation • No chance of eyelids, vermilion, or gauze being caught in the power instrument • Better controlled depth of abrasion and thus less chance of scarring • Better patient comfort because there is no machine noise or use of skin refrigerant • No aerosolized particles that could infect physician or staff • Easier preparation and clean-up with the use of disposable materials • No blood spatter 105
106
Pearls o f wisdom
Journal of the American Academy of Dermatology July 1995
Fig. 1. Drywall/plaster sanding screen.
Fig. 4. Hand dermabrasion until bleeding is visible.
Fig. 2. Reconstruction with Burow's graft taken from nose just superior to wound.
Fig. 5. Twelve months after manual dermabrasion. No visible scar at graft site although linear incision scar is visible because no dermabrasion was performed in this area.
Direct all submissions to Dr. Stuart J. Salasche, Arizona Health Sciences Center, Section of Dermatology, 1501 N. Campbell Ave., Tucson, A Z 85724. REFERENCES
Fig. 3. Drywall/plaster sanding screen grid wrapped around 3 ml syringe. W i t h m a n u a l dermabrasion, we have not as yet encountered complications reported in the past, such as milia, hyperpigmentation or hypopigmentation, or hypertrophic scarring. Stuart J. Salasche, M D Feature Editor
1. Padilla RS. Dermabrasion. In: Wheeland RG, ed. Cutaneous surgery. Philadelphia:WB Saunders, 1994:479-90. 2. Stegman S J, Tromovitch TA. Dermabrasion equipment. In: Cosmetic dermatologic surgery. Chicago: Year Book Medical, 1984:47-74. 3. Sawchuk WS. Infectious potential of aerosolized particles. Arch Dermatol 1989;125:1689-92. 4. Hanke CW, O'Brian JJ. A histologic evaluation of the effects of skin refrigerants in an animal model. J Dermatol Surg Oncol 1987;31:664-9. 5. Katz BE, Oca MAGS. A controlled study of the effectiveness of spot dermabrasion ('scarabrasion') on the appearance of surgical scars. J AM ACADDERMATOL1991;24:462-6. 6. Field L. Dermabrasion versus 5-fluorouracil in the management of actinic keratoses. In: Epstein I, ed. Controversies in dermatology. Philadelphia: WB Saunders, 1984:62-102.
Los Angeles, California Dermabrasion is an effective procedure that alleviates many facial cutaneous disorders. 1 The main indication for dermabrasion is scarring resulting from surgical procedures, trauma, or acne. Other conditions amenable to dermabrasion include photodamaged or wrinkled skin. In conventional dermabrasion, an electrically powered hand-held abrader with a diamond fraise or wire brush is the cutting tool. 2 However, this technique has several drawbacks and requires both skill and experience. Extreme caution must be taken when the periorbital or perioral areas are treated. Aerosolized blood and skin fragments may pose a risk to operating room personnel and the surgeon. 3 The routine use of skin refrigerants before dermabrasion may cause hypopigmentation from injury to melanocytes.4 We describe a simple and highly effective technique of manual spot dermabrasion that has several advantages over the conventional technique. MATERIAL AND METHODS
The materials used are a drywall/plaster sanding screen, medium grade (3M Corp., St. Paul, Minn.) (Fig. 1), which is cut into strips of about 2 X 3 inches, and autoclave steam sterilized, and a sterile 3 ml syringe with lidocaine. Patients with facial scarring from surgery, trauma, or ache, and patients with actinically damaged skin are suitable candidates. We have treated patients with dark, medium, and light complexions; most are treated after extirpation of skin cancers with Mohs micrographic surgery and reconstruction with primary closure, skin flaps, or skin grafts (Fig. 2). The dermabrasion is usually performed 6 to 10 weeks after the reconstructive procedure. With the patient in a supine position the area of the scar is prepared with Hibiclens solution and then anesthetized with 1% lidocaine and epinephrine. The drywall sanding From the Division of Dermatology, University of California, Los Angeles. Reprint requests: Ronald L. Moy, MD, 100 UCLA Medical Plaza, Suite 590, Los Angeles, CA 90024. J AM ACAD DERMATOL 1995;33:105-6. Copyright © 1995 by the American Academy of Dermatology, Inc. 0190-9622/95 $3.00 + 0 16/74/63416
screen is wrapped firmly around the barrel of the syringe (Fig. 3). The scar is then gently abraded with a backand-forth or circular motion until the area is smoothed down to the papillary dermis where bleeding points can be appreciated (Fig. 4). Hemostasis is achieved with pressure applied by the patient for about 10 minutes; then a standard dressing is applied with antibiotic ointment and a nonstick bandage. The patient is instructed tO cleanse the wound once daily for 10 days. The usual time for epithelial healing is approximately 7 to 10 days. Great improvement of the scar can be achieved by this method (Fig. 5). DISCUSSION Reconstructive surgery with flaps and grafts often results in prominent incision lines. Dermabrasion performed 6 to 10 weeks after the procedure greatly improves the scar and often no visible scar is evident. 5 At times an entire cosmetic unit such as the nose is dermabraded at the same time, providing the additional benefit of eliminating the surrounding actinic damage and diminishing the potential for development of additional cancers. 6 Manual dermabrasion with drywall sanding screen is easy to perform and greatly improves facial scarring. The advantages of this technique compared with the use of a motor-powered abrader are as follows: • Less expensive, without the use of a power instrument • No need for careful maintenance and cleaning of tips, fraises, brushes, and wheels • No skin refrigerant is used and thus less chance of hypopigmentation • No chance of eyelids, vermilion, or gauze being caught in the power instrument • Better controlled depth of abrasion and thus less chance of scarring • Better patient comfort because there is no machine noise or use of skin refrigerant • No aerosolized particles that could infect physician or staff • Easier preparation and clean-up with the use of disposable materials • No blood spatter 105
106
Pearls o f wisdom
Journal of the American Academy of Dermatology July 1995
Fig. 1. Drywall/plaster sanding screen.
Fig. 4. Hand dermabrasion until bleeding is visible.
Fig. 2. Reconstruction with Burow's graft taken from nose just superior to wound.
Fig. 5. Twelve months after manual dermabrasion. No visible scar at graft site although linear incision scar is visible because no dermabrasion was performed in this area.
Direct all submissions to Dr. Stuart J. Salasche, Arizona Health Sciences Center, Section of Dermatology, 1501 N. Campbell Ave., Tucson, A Z 85724. REFERENCES
Fig. 3. Drywall/plaster sanding screen grid wrapped around 3 ml syringe. W i t h m a n u a l dermabrasion, we have not as yet encountered complications reported in the past, such as milia, hyperpigmentation or hypopigmentation, or hypertrophic scarring. Stuart J. Salasche, M D Feature Editor
1. Padilla RS. Dermabrasion. In: Wheeland RG, ed. Cutaneous surgery. Philadelphia:WB Saunders, 1994:479-90. 2. Stegman S J, Tromovitch TA. Dermabrasion equipment. In: Cosmetic dermatologic surgery. Chicago: Year Book Medical, 1984:47-74. 3. Sawchuk WS. Infectious potential of aerosolized particles. Arch Dermatol 1989;125:1689-92. 4. Hanke CW, O'Brian JJ. A histologic evaluation of the effects of skin refrigerants in an animal model. J Dermatol Surg Oncol 1987;31:664-9. 5. Katz BE, Oca MAGS. A controlled study of the effectiveness of spot dermabrasion ('scarabrasion') on the appearance of surgical scars. J AM ACADDERMATOL1991;24:462-6. 6. Field L. Dermabrasion versus 5-fluorouracil in the management of actinic keratoses. In: Epstein I, ed. Controversies in dermatology. Philadelphia: WB Saunders, 1984:62-102.