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LIVE BLOG: Surgical Jujutsu: Mohs Micrographic Surgery and Reconstruction

In this live blog from the 11th Annual SDPA conference, Dr. Joshua Lane lectures on Surgical Jujutsu: Mohs Micrographic Surgery and Reconstruction. Below are some highlights.

 

Surgical Jujutsu – The Art of Flexibility

The ability to know the antidote for a problem

The ability to find a solution when you make a mistake

The art of design is much more difficult than that task of doing

Once you master the basics there are no rules

Basic Building Blocks

It all comes down to the basics. Perfect your suturing techniques and knowledge of anatomy. Anatomy is key to everything we do with Mohs. Have confidence in what you are doing. And don’t forget that surgical complexity is based on the sum of surgical basics. Trust your gut (unless you don’t know or you’re wrong – then don’t). Always ask when needed and never avoid a biopsy due to anxiety about the anatomical area (such as eyelids). 

Make Sure to Master Instrument Handling

  • Blade up when passing
  • About a 45 degree angle is generally the sharpest part of the blade
  • Learn to palm the instruments 

 

When things don’t go as planned – there is always an answer so please ask.

Document and photographs all before and after of all surgical and cosmetic procedures. Additional reconstruction images help explain the procedure to patients.

Things to consider about “time”

  • How long does it take to perform a procedure?
  • Never rush but work efficiently
  • Room turnover
  • Administration of anesthesia
  • How can you improve your time?

Review of Suturing Techniques

  • simple
  • running
  • running locked
  • vertical mattress
  • running vertical mattress
  • horizontal mattress
  • running horizontal mattress
  • subcuticular (multiple methods)

Measuring Biopsy locations: Know your depth of excision ahead of time and make it clear. There are many methods to take. Photos are ok, but some healthcare providers like measurements better as it’s easier for EMR systems without photo capability. Some providers prefer x,y coordinate system from landmark.

After surgery the most common complication is post op bleeding. Make sure your office has a system in place to handle post op complications.  In Dr. Lane’s office all patients have healthcare provider’s cell phone number, all patients given written wound care that they sign and the office has a back up plan for when MD or PA is not available.

 

 

Image: Instant Vantage