Gregory J. Fulchiero

Nonverbal Hand Signals: A Tool for Increasing Patient Comfort During Dermatologic Surgery

The use of technical and descriptive language during dermatologic surgery can be a source of discomfort and anxiety for patients. Several investigators have identified poor communication and technical language as consistent elements involved in filing malpractice claims. During dermatologic surgery procedures, patients are universally awake, alert, and aware of the surgeon’s descriptive and technical language when communicating with surgical assistants, particularly dermatologic surgery residents or fellows in training.

Cotton Dental Rolls for Effective and Cost-Efficient Hemostasis

Continuous visualization of the surgical field is a key component of good surgical technique. Removing blood from the field ensures that the surgical dissection remains in the appropriate plane and decreases the risk for inadvertent injury to vital structures. Maintaining a clear surgical field also allows for identification of individual bleeding vessels so that they may be cauterized precisely or ligated. This decreases the need for excessive thermal damage. Standard 6’’ cotton-tipped swabs may be used to more precisely absorb blood from the surgical field, but in all but the most limited of procedures, these small swabs quickly become saturated and ineffective. Two alternatives for precise hemostasis include cotton dental rolls and large cotton rectal swabs (Figure 1). The dental roll can be used by clamping it with a hemostat or placing it at the end of a cotton swab and can even be used to retract tissues within the surgical field (Figures 2 and 3).

Expandable Desiccated Ear Wicks Aid in Skin Graft Reconstruction of the External Auditory Canal After Mohs Micrographic Surgery

Reconstruction of the external auditory canal and conchal bowl after Mohs micrographic surgery is a challenge for the surgeon. The concavity of these structures predispose fulland splitthickness skin grafts to ‘‘tenting’’ and failure of the graft to intimately appose to the recipient site. Bolster dressings composed of foam or cotton wrapped in petrolatum gauze are typically used to compress a skin graft into the recipient site and enhance a graft’s eventual survival during the wound healing phases of imbibition and neovascularization. Bolster dressings also minimize the likelihood of tenting and hematoma formation beneath a graft, which can compromise its survival.

A "triple hit": basal cell carcinomas arising in an organ transplant recipient after venipunctures in irradiated skin.

The delayed development of basal cell carcinoma (BCC) at sites of prior irradiation is well documented. Likewise, BCC may develop at the sites of trauma, or in those receiving long-term immunosuppression, although in these settings squamous cell carcinoma is more likely than BCC. We report a case of multiple BCCs arising in a 35year-old cardiac transplant recipient only at the sites of venipunctures and arterial catheterizations on the forearm that had been treated with local-field irradiation for Ewing’s sarcoma, 28 years prior.