Mastering the Surgical Procedure

Faculty: Mike Swann, MD

Dr. Mike Swann presented a lecture on mastering the surgical procedure Friday morning with the comment “ a solid understanding of anatomy is required to do no harm”. He reviewed the “danger zones” of facial anatomy explaining that if “you stay in the subcutis you can stay out of trouble”. This approach can get more challenging in older patients as they tend to have less fat and their fascia can be very thin. He reports damage to the facial nerve is the most devasting permanent result of superficial surgery. Dr. Swann also illustrated the subunits of the nose and lips and expressed accurate anatomical labeling when performing biopsies or surgery on the face. He stressed lymphatic drainage must be understood to evaluate for metastasis.

“A solid understanding of anatomy is required to do no harm.”

Next Dr. Swann discussed various surgical techniques. One tip he mentioned repeatedly is the importance of patient positioning. Ideally patients should be in a position where the area in which you are performing surgery is presented in a flat plane. Additionally, you should be as proximal to the patient as you can be. He mentioned performing good surgery is more about “doing the simple things” really well rather than learning the “fancy things”. He reviewed the ideal length and width ratios for most excisions are 3:1 or 4:1 with longer excisions more commonly needed in the scalp or extremities where “lots of eversion” is needed and “longer is better”. The importance of bevel edge was discussed with Dr. Swann reporting incisions should be done with zero bevel keeping the incision perpendicular to the skin to uniform depth. Dr. Swann illustrated different approaches of the buried vertical mattress deep suture which he reports as “the most important stitch of a good wound closure”.

Dr. Swann ended his lecture with a photo of the 3 physician assistants or the “best PAs” with whom he works.