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This PRESENT lecture is brought to you
by the generous sponsorship of
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Skin Incision Planning and Hemostasis
by Brian J. Novack, DPM
OCPM, Department of Surgery
Your patient is seen one week status post Austin Bunionectomy. You recall the
anatomic dissection of the soft tissue, the perfect osteotomy and the precision
of your internal fixation technique. Despite the swelling and ecchymosis, you
are thoroughly impressed with the resolution of the deformity. The patients only
response …..”Nice sewing, doc”. This is the benchmark by which patients judge
the success of their procedure. So it behooves us to view Dr. Novack’s lecture
very carefully.
You will recall Dr. Novack’s penchant for preoperative planning in his lecture
on Hallux Abducto
Valgus Deformities. A similar style is exhibited in this lecture as well.
There is no question that Dr. Novack’s residents are VERY familiar with the SKIN
MARKING PEN. You can be sure that they know everything there is to know about
relaxed skin tension lines and “the Pinch Test” (Not to be used on shapely
co-workers).
So much of the work we do as Foot and Ankle Surgeons is elective. Our patients
expect predictable and cosmetically acceptable results. Dr. Novack reviews some
of the methods of avoiding scarring complications. He recommends making the
incision sufficiently long to allow for adequate exposure. This eliminates the
need for overzealous retraction and possible damage to the soft tissue. He
suggests that you try to modify your incision when crossing over joints and bony
prominences. Take great care when planning your incision to know the anatomic
location of neurovascular structures, tendons and other vital structures.
Dr. Novack’s lecture includes a bonus...A review of surgical hemostasis. The
goal here is to use the minimum effective pressure to produce a bloodless field
and facilitate visualization of anatomic structures. Learn how much time
should pass before hyperemic reperfusion of tissues occurs, and what represents
proper tourniquet pressure.
A Note To You Incoming Rookies. Use the belly of
the blade and avoid skiving the skin!!
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