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Speaking today at the 66th Annual Meeting of the American Academy ofDermatology, dermatologist Tri H. Nguyen, MD, FAAD, associate professor ofdermatology, director of Mohs micrographic and dermatologic surgery, andprogram director of procedural dermatology at the University of Texas M.D.Anderson Cancer Center in Houston, discussed how dermatologists are improvingpatient satisfaction by using the newest innovations and techniques tominimize surgical scars from facial skin cancers.
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"For years, dermatologists have used a number of tried-and-true healingoptions for wounds resulting from skin cancer surgery -- from effectivelyallowing Mother Nature to heal wounds without medical or surgical interventionto various closure techniques, surgical flaps and skin grafts," said Dr.Nguyen. "While these methods have proven quite effective in minimizingsurgical scars, dermatologists are drawing on their expertise in how the skinheals to expand the current treatment options and further enhance results."
Barbed Stitch Technique
One relatively new development is the barbed suture (or stitch) technique,reported Dr. Nguyen, which has simplified how dermatologists close difficultwounds. Instead of tying multiple stitch knots in the wound as is common withtraditional closure techniques, Dr. Nguyen explained that a dermatologicsurgeon threads a running "baseball stitch" through the wound -- or acontinuous stitch that weaves in and out similar to the stitching on abaseball -- causing the barbs to catch onto the connective tissue of thewound. In essence, the barbs on the stitches anchor themselves to the deeptissue of the wound and gradually close the wound together without tyingknots.
"The barbed stitch technique was recently introduced and, in myexperience, the technique has proven successful in closing complicated woundsvery quickly and efficiently," said Dr. Nguyen. "Since the patient'soperation time is greatly reduced because multiple stitch knots are avoided,their risk of surgical complications is theoretically less -- as longersurgeries are associated with greater risk of infection and othercomplications."
In addition, Dr. Nguyen explained that since the barbed stitch is thick,it works best for large wounds in areas of thicker skin and with highresistance that are hard to stretch -- such as the rigid scalp area. Thisprocedure is not recommended in areas where the skin is thin, for instance onthe nose or eyelids. He added that patients with thick skin on their cheeksmay also be good candidates for the technique.
Dermabrasion and Lasers
All surgeries will leave scars and a "scar less" surgery is unrealistic.One approach that comes close is immediate sanding (dermabrasion) of theincision line. In this method, which was developed by dermatologists, a woundis closed with deep stitches first to bring the skin edges together. Sandingis then performed with either a mechanical abrasive device or a laser (intensebeam of light energy) to remove the epidermis (the skin's outer layer) allalong the entire incision line. This sanding is done at the time of surgeryrather than several months afterwards, which is when traditional dermabrasionis completed. Once the epidermis is sanded down, the dermatologist places thetop stitches and seals the wound.
Over the course of about seven to 10 days, the
