This study supports the view that dermatological surgery, including significant procedures such as Mohs micrographic surgery, flaps and grafts, can be performed on an ambulatory basis in an office-based procedure room setting, with low complication rates.
Digital camera technology now allows for images to be taken directly through an eyepiece of the microscope. These images can be almost instantaneously e-mailed to a pathologist anywhere in the world for an immediate opinion. The technique provides for greater surety where doubt exists about the pathology during Mohs surgery.
BACKGROUND. Mohs surgeons are occasionally confronted by challenging pathology ideally requiring the advice of a dermatopathologist. The Internet transmission of digital images of the pathology (telepathology) allows for such opinions to be easily and rapidly obtained. OBJECTIVE. The objective was to obtain images utilizing a digital camera focused directly through one microscope eyepiece with subsequent e-mail to a pathologist for an immediate opinion. METHODS. The particular area of interest on the slide is selected. The lens of the digital camera is placed directly on one eyepiece of the microscope and using the zoom and autofocus options of the camera a sharp image is obtained. The
The expert use of local anaesthetics is simple and will greatly enhance patients' acceptance of office-based procedures. Correct equipment and techniques will enable all dermatologists to practise local anaesthesia as effectively and painlessly as possible. Suggested equipment varies according to the situation, but in general Luer-Lock syringes of the smallest volume and needles of the narrowest gauge and shortest length appropriate for the procedure are recommended. Making the anaesthetic agent less acidic will minimize the pain. Techniques to minimize pain involve careful explanation to the patient, slow injection of the anaesthetic and making use of the special anatomy of the region to be anaesthetized. The number of needle pricks should be kept to a minimum. Timing of the surgical procedure should take into account the delay in onset of anaesthesia for subcutaneously injected solution and the time for injected adrenaline to produce full vasoconstriction. Planned surgical incision lines drawn out precisely prior to the injection will avoid the problem of distortion caused by tissue expansion. Gloves and appropriate eye protection should be standard and needles and syringes must be disposed of correctly.
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