Dermatosurgery

Dermatologic surgery is as old as dermatology itself and a mainstay of treatment in our specialty. Many tips and tricks can considerably improve the functional and aesthetic outcome of skin operations. Dermatologists combine in-depth knowledge of the skin, its diseases, and tumors with surgical skills developed over at least two centuries, and should perform surgical interventions for the benefit of their patients.

Dermatological surgery is an integral part of the therapeutic armamentarium in dermatology. In the German-speaking countries, this has historical roots, as many of the first chairs of dermatology 150 – 200 years ago came from surgery. In fact, 150 years ago, dermatological surgery was called plastic surgery – 100 years before plastic surgery became a specialty of its own. Dermatologists have considerably developed skin surgery and contributed many tips and tricks to achieve better results.

Special incision and suture techniques were developed to meet particular situations in all varieties of cutaneous surgery.  Incisions can be shortened with special sutures that avoid dog-ear formation.
Tumescent local anesthesia was invented and made liposuction, lipotransfer, large skin excisions, tumor, and vein surgery extremely safe office procedures.
Skin-saving techniques are self-evident, as they reflect the dermatologist’s in- depth understanding of cutaneous tumor biology and skin physiology.
Flaps have been refined to recreate a nasal tip, render rotations flaps safer while reducing skin loss, and grafts have been modified to meet particular requirements, such as their appearance in the oral cavity.
Organ-preserving male genital surgery was developed mainly by dermatologists with the invention of the preputial flap for defects of the glans.
Functional nail melanoma surgery is now almost 50 years old; met first with utmost skepticism, it is now the treatment of choice for early nail unit melanoma.
Tangential nail matrix and bed biopsies are major techniques for the histopathological diagnosis of melanonychia and many superficial nail tumors.

This lecture will present experience-based tips and tricks that may facilitate daily and routine skin operations in the dermatologist’s practice.