making and using a mouse pad model of skin to practice suturing techniques
TRANSCRIPT
clearly stated that we do not use tangential shave
at these sites (Study Design page 388). It is true
that attempting this method on fragile distal
extremity skin would be challenging, but curettage
at those sites has the same drawback. I have seen
plenty of providers bury a curette right into the
subcutis.
In the body of their comment, the authors note
that 60% to 80% of basal cell carcinomas are nod-
ular. In our study, we noted that 141 of 184
lesions were superficial only (77%). The technique
we use is most effective for superficial lesions or
superficial lesions with minor nodular components.
Also in the body of their letter, the authors note
that “A great advantage of curettage over scalpel
or laser surgery arises from the ability of a semi-
sharp curette to differentiate and remove friable
abnormal tissue from the normal surrounding
tissue.” Many would question the validity of this
statement. There are multiple studies demonstrat-
ing that a dermatologist with a curette cannot
always differentiate tumor by feel.2–4
We cannot agree that curettage offers “great
advantage.” The evidence simply dose not support
this overly strong statement. Small basal cell
carcinomas can be destroyed using curettage,
excised, or removed by shave. All methods have
their advantages and disadvantages. Comparing
them is probably not even necessary, as to each his
own in treating a smaller tumor in a cost-conscious
fashion. I would never claim that the shave
removal method has “great advantage” because
there can be no “great advantage” when treating a
straightforward lesion.
References
1. Taheri A, Mansoori P, Laffer MS, Feldman SR. Tangential
shave removal of basal cell carcinoma. Dermatol Surg
2013;39:387–392.
2. Salasche SJ. Curettage and electrodesiccation in the treatment of
midfacial basal cell carcinoma. J Am Acad Dermatol
1983;8:496–503.
3. Suhge d’Aubermont PC, Bennett PG. Failure of curettage and
electrodesiccation for removal of basal cell carcinoma. Arch
Dermatol 1984;120:1456–1460.
4. Spencer JM, Tannenbaum A, Sloan L, Amonette RA. Does
inflammation contribute to the eradication of basal cell
carcinoma following curettage and electrodesiccation? Dermatol
Surg 1997;25:183–185.
GLENN GOLDMAN
Department of Dermatology
Fletcher Allen Health Care
University of Vermont College of Medicine
Burlington, Vermont
Making and Using a Mouse Pad Model of Skin to Practice Suturing Techniques
The recent article by Olson and colleagues, “Foam
Dressing as a Suturing Model,”1 describes a unique
and valuable model to enable dermatologic sur-
geons to teach or practice suturing techniques.
Another recent article by Nicholas and colleagues,
“Simulation in Dermatologic Surgery: A New Para-
digm in Training,”2 that emphasizes the impor-
tance of simulation training to enhance procedural
skills supports the need for such a model.
Given the myriad suturing techniques available, it
is important that even seasoned dermatologic sur-
geons practice innovative suturing methods before
using them on patients. Likewise, it is imperative
that medical students, residents, and fellows have
the opportunity to practice suturing techniques to
learn and perfect their skills, but it is difficult to
obtain traditional training tools, such as pigs’ feet,
or models of the skin that come close to simulating
human skin and are convenient to use.
Using readily available and inexpensive materials,
it is easy to construct a durable mouse pad model
for skin that imitates the skin’s elasticity, strength,
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39 :12 :DECEMBER 2013 1947
and texture. This mouse pad model can be used
over and over again so that surgeons can practice
and perfect new suturing techniques for optimal
surgical results. For utmost convenience, the mouse
pad model of skin can even be turned over and
used as a traditional mouse pad when not being
used as a training tool.
The materials required to construct a mouse pad
model for skin are two fabric-covered mouse pads
(available at local office supply stores); a scalpel;
hot glue from a hot glue gun; and a cutting board
or similar hard, heat-resistant, scratch-resistant sur-
face. Place one mouse pad fabric side up on the
hard surface. Using the scalpel, make a centrally
located, lengthwise linear incision through the
entire thickness of the pad, being sure to start and
stop the incision no less than one inch from the
edges of the mouse pad. If desired, also make a
widthwise linear incision at each end and perpendi-
cular to the lengthwise incision to form an “H”
pattern that allows for excellent reflection of the
simulated skin and mimics a flap formation. Turn
the second mouse pad fabric side down next to the
first mouse pad. Using the hot glue gun, place hot
glue along the outside edges of the second mouse
pad. Place the first mouse pad fabric side up on
top of the second mouse pad such that the foam
sides of the two mouse pads are in apposition (Fig-
ure 1). Firmly press the edges together.
With the superior (incised) mouse pad representing
the epidermis (fabric) and dermis (foam) and the
inferior mouse pad representing the undermined
subcutaneous fat (Figure 2), the mouse pad model
mimics an undermined incision line in human skin.
When a surgical needle and suture pass through
the makeshift tissue, the mouse pad model mimics
human skin in consistency as well. For best results,
use P-3 or PC needles because the thin foam of a
mouse pad prohibits use of larger needles. The
mouse pad model is intended to be used for prac-
ticing suturing techniques, not tension-
bearing repair techniques such as adjacent tissue
transfers.
Although most dermatologic surgeons close their
surgical defects using simple interrupted or simple
running sutures,3 a wide variety of suturing
techniques can be used in various situations to
achieve outstanding surgical results. Using the
mouse pad model, dermatologic surgeons, fellows,
residents, and medical students are able to practice
closing linear defects using a variety of suturing
techniques (Figure 3), including traditional
subcutaneous and transepidermal sutures, as well
Figure 1. Placement of first (incised) mouse pad oversecond mouse pad.
Figure 2. Demonstration of mouse pad model mimickinghuman skin. On the superior mouse pad, the blue fabricand foam represent the epidermis and dermis, respec-tively. The space between the two mouse pads representsthe undermined space between dermis and subcutaneousfat.
LETTERS AND COMMUNICATIONS
DERMATOLOGIC SURGERY1948
as less common and innovative techniques that,
with practice, may lead to better surgical out-
comes.
References
1. Olson J, Kalina C, Berg D. Foam dressing as a suturing model.
Dermatol Surg 2013;39:952–3.
2. Nicholas L, Toren K, Bingham J, Marquart J. Simulation in
dermatologic surgery: a new paradigm in training. Dermatol Surg
2013;39:76–81.
3. Adams B, Levy R, Rademaker AE, Goldberg LH, et al.
Frequency of use of suturing and repair techniques preferred by
dermatologic surgeons. Dermatol Surg 2006;32:682–9.
CYNDI YAG-HOWARD, MD, FAAD
Advanced Dermatology and Skin Surgery
Specialists, PA
Naples, FloridaFigure 3. Demonstration of how the mouse pad model ofskin can be used to practice stitching techniques.
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