Cutaneous Surgery for the DermPA™

Successful surgeries begin with a close review of notes and plans associated with each patient, according to SDPA Summer Conference speaker James Worry, DHSc, MPAS, PA-C. As he rarely performs surgery on the same day that he first sees a patient, Worry said his plans for each patient are detailed and contain diagnosis, planned surgery and sutures.

COVERAGE: SDPA Annual Summer Dermatology Conference, June 16-19, 2022, Austin, Texas

Confirmation of the surgical site is one of the most crucial first steps. He reports wrong site procedures are the leading error in dermatology surgeries. Worry has observed increased provider errors when providers perform numerous biopsies at one time. When patients have numerous lesions of concern, Worry focuses on prioritizing and scheduling patients to return for follow up appointments. Additionally, proper documentation of surgical sites should use fixed anatomical landmarks with measurements and photography.

To ensure the day of surgery is successful, Worry considers the 3As – anxiety, attitude, and allergies – of each patient. He says antithrombotic drugs rarely need to be discontinued prior to cutaneous surgery and it is not recommended to discontinue anti-platelet medications. If bleeding is a concern, he recommends the provider consider simpler repairs, avoiding large flaps and ensuring adequate application of pressure dressings.  Electrocautery is safe in use of patients with pacemakers or ICDS, however, it is best to use bipolar cautery with low settings, quick bursts of energy. Informed consent should always be obtained to include the nature of the procedure, the risk and benefits of the procedure, alternatives to the surgery and provider assessment of patient’s understanding. Always discuss wound care instructions prior to patient discharge and send them home with written instructions.

Ensuring a successful surgery also requires the right equipment and room set up. Numerous studies reveal there is no difference in infection rates when sterile versus clean gloves are used. Antiseptics can include alcohol, iodine, and chlorhexidine. He stressed the importance of understanding anatomy to avoid damage to motor nerves and sensory nerves.  Worry reminded attendees that the spinal accessory nerve is very superficial and as such it is important to know your skill and anatomy. Additional topics discussed included anesthesia, differentiating types of closures, post-operative complications, and irritant dermatitis.

Byline: Sarah B.W. Patton, PA-C

Pictured: James Worry, DHSc, MPAS, PA-C