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Surgical Pearl: The use of the no. 12 scalpel blade for the removal of sutures
PEARLS Stuart J. Salasche, MD Surgical Pearls Editor
Mark G. Lebwohl, MD Medical Pearls Editor
Surgical Pearl: The use of the No. 12 scalpel blade for the removal of sutures Zoltan Trizna, MD, PhD, and Richard F. Wagner, MD Galveston, Texas
R
emoval of sutures is usually performed by holding one of the free tails of the suture and cutting the intracutaneous loop under the loop with scissors. The use of the pointed No. 11 scalpel blade has been described.1,2 Several disposable suture removal kits are also available; however, most offices find it more cost-effective to utilize reusable instruments. In some cases, especially
From the Department of Dermatology, The University of Texas Medical Branch at Galveston. Reprints not available from authors. J Am Acad Dermatol 2000;43:527-8. Copyright © 2000 by the American Academy of Dermatology, Inc. 0190-9622/2000/$12.00 + 0 16/74/106509 doi:10.1067/mjd.2000.106509
when there is edema of the wound or if the skin has healed over the sutures, insertion of the scissors may be difficult for the surgeon and uncomfortable for the patient. In addition, cutting sutures may eventually dull and damage scissors, making future suture removal with the same instruments more difficult. We use a method that is more comfortable for the patient and is less expensive. A forceps is used to hold one of the free tails of the suture, and the tip of a No. 12 disposable blade is inserted into its intracutaneous loop (Fig 1). Because of the semicircular cutting edge of this blade (Fig 2), a gentle forward motion (ie, parallel to the skin) is usually sufficient for cutting the suture. A gentle upward motion (ie, perpendicular to the skin) may be needed for cutting thicker suturing material.
Fig 1. The forceps in the left hand holds one of the free tails of the vertical mattress suture with the tip of the No. 12 disposable scalpel blade inserted into its intracutaneous loop.
527
528 Pearls
J AM ACAD DERMATOL SEPTEMBER 2000
REFERENCES 1. Robinson JK, Arndt KA, LeBoit PE, Wintroub BU. Atlas of cutaneous surgery. Philadelphia: WB Saunders; 1996. p. 87. 2. Bennett RG. Fundamentals of cutaneous surgery. St Louis: Mosby; 1988. p. 405-10.
Fig 2. The semicircular shape of the No. 12 scalpel blade is shown.
Direct all Surgical Pearl submissions to Dr Stuart J. Salasche, 5300 N Montezuma Trail, Tucson, AZ 85750.
Our patients tolerate this procedure well. In our hands it is faster than the traditional suture removal with scissors. The cost of this method may vary depending on the price of the blade (approximately 20-25 cents), but it is definitely less expensive than using disposable suture removal kits (80-90 cents).
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.
IOTADERMA #80 What cardiac disorder occurs in some Mediterranean people with palmoplantar keratoderma? Scott A. Norton, MD Answer will appear in the October issue of the Journal.
AUGUST IOTADERMA (#79) What clinical feature distinguishes erythema multiforme from annular urticaria? Answer: “Careful inspection of the eruption in erythema multiforme discloses fine petechiae, which is the clinical feature that distinguishes erythema multiforme from annular urticaria.” REFERENCE Braverman IM. Skin signs of systemic disease. 3rd ed. Philadelphia: WB Saunders; 1998. p. 354.
Mark G. Lebwohl, MD Medical Pearls Editor
Surgical Pearl: The use of the No. 12 scalpel blade for the removal of sutures Zoltan Trizna, MD, PhD, and Richard F. Wagner, MD Galveston, Texas
R
emoval of sutures is usually performed by holding one of the free tails of the suture and cutting the intracutaneous loop under the loop with scissors. The use of the pointed No. 11 scalpel blade has been described.1,2 Several disposable suture removal kits are also available; however, most offices find it more cost-effective to utilize reusable instruments. In some cases, especially
From the Department of Dermatology, The University of Texas Medical Branch at Galveston. Reprints not available from authors. J Am Acad Dermatol 2000;43:527-8. Copyright © 2000 by the American Academy of Dermatology, Inc. 0190-9622/2000/$12.00 + 0 16/74/106509 doi:10.1067/mjd.2000.106509
when there is edema of the wound or if the skin has healed over the sutures, insertion of the scissors may be difficult for the surgeon and uncomfortable for the patient. In addition, cutting sutures may eventually dull and damage scissors, making future suture removal with the same instruments more difficult. We use a method that is more comfortable for the patient and is less expensive. A forceps is used to hold one of the free tails of the suture, and the tip of a No. 12 disposable blade is inserted into its intracutaneous loop (Fig 1). Because of the semicircular cutting edge of this blade (Fig 2), a gentle forward motion (ie, parallel to the skin) is usually sufficient for cutting the suture. A gentle upward motion (ie, perpendicular to the skin) may be needed for cutting thicker suturing material.
Fig 1. The forceps in the left hand holds one of the free tails of the vertical mattress suture with the tip of the No. 12 disposable scalpel blade inserted into its intracutaneous loop.
527
528 Pearls
J AM ACAD DERMATOL SEPTEMBER 2000
REFERENCES 1. Robinson JK, Arndt KA, LeBoit PE, Wintroub BU. Atlas of cutaneous surgery. Philadelphia: WB Saunders; 1996. p. 87. 2. Bennett RG. Fundamentals of cutaneous surgery. St Louis: Mosby; 1988. p. 405-10.
Fig 2. The semicircular shape of the No. 12 scalpel blade is shown.
Direct all Surgical Pearl submissions to Dr Stuart J. Salasche, 5300 N Montezuma Trail, Tucson, AZ 85750.
Our patients tolerate this procedure well. In our hands it is faster than the traditional suture removal with scissors. The cost of this method may vary depending on the price of the blade (approximately 20-25 cents), but it is definitely less expensive than using disposable suture removal kits (80-90 cents).
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.
IOTADERMA #80 What cardiac disorder occurs in some Mediterranean people with palmoplantar keratoderma? Scott A. Norton, MD Answer will appear in the October issue of the Journal.
AUGUST IOTADERMA (#79) What clinical feature distinguishes erythema multiforme from annular urticaria? Answer: “Careful inspection of the eruption in erythema multiforme discloses fine petechiae, which is the clinical feature that distinguishes erythema multiforme from annular urticaria.” REFERENCE Braverman IM. Skin signs of systemic disease. 3rd ed. Philadelphia: WB Saunders; 1998. p. 354.