Versatile Punch Surgery

Abstract

Punch instrument is a circular blade that can be used for many diagnostic and therapeutic purposes in different medical and surgical specialties. Punch surgery (or biopsy) is achieved by using this versatile punch blade under local anesthesia. Basic punch surgery is quick and easy to learn. Complications such as bleeding and infection are minimal. Diagnostic punch surgery can obtain a part of or whole skin lesion for histologic examination. In addition to the skin, nail and mucous membrane tissue can be obtained by punch biopsy. Interestingly, punch biopsy can be used as an adjunctive to fine-needle aspiration to establish the diagnosis of tumors of solid organ such as the breast. Diagnostic punch surgery can be modified to overcome certain problems. The split-punch technique helps avoid crushing the tissue punch when trying to divide it for different examinations. The double-trephine punch facilitates obtaining subcutaneous tissue without the need for full elliptical excision. The string-of-beads technique obviates the need for dissection of tissue into pieces. In other nondermatology and dermatology conditions, such as nerve pathology, arteriosclerosis, melanoma mapping, and eyelid tumors, the diagnosis can be enhanced with the use of punch surgery.Therapeutic punch surgery can be used for excision of unwanted lesions such as nevi, as well as pathologic bone and cartilage tissues. Punch grafting is used in vitiligo surgery and hair transplantion. Punch evacuative surgery can help in the evacuation of unwanted tissue or materials such as lipoma, subungual hematoma, scrotal calcinosis, pseudocyst of the auricle, pilar cyst, and others.Reconstructive punch surgery includes correction of ear lobe defects and acne scars. Enhancement of wound healing can be achieved by use of the punch; therefore, it can help nonhealing ulcers.

Fas‐FasL interaction in cytotoxic T cell‐mediated vitiligo: The role of lesional expression of tumor necrosis factor‐α and interferon‐γ in Fas‐mediated melanocyte apoptosis

“…There has been an increasing number of cases in which patients exhibit newly onset vitiligo and vitiligo progression following anti-TNF therapy. [39][40][41][42] Recently, the incidence rate of newly developed vitiligo was shown to be significantly elevated in patients receiving anti-TNF therapy compared with those treated with conventional medications. [43] Although the pathophysiology is not clarified, anti-TNF therapy may facilitate vitiligo pathogenesis by reversing TNF-α-mediated inhibitory effects on Fas-mediated melanocyte apoptosis.…”

Cicatrices de acné, un reto terapéutico

“…En general, se recomienda dejar espacios entre cada cicatriz de mínimo 4 a 5 mm, para evitar retracciones, y un intervalo de cuatro semanas entre los procedimientos, para permitir una adecuada cicatrización. Los puntos deben retirarse a los siete días 3,42,43,51 .…”

Three Tips for Top Technique: Performing the Perfect Punch

“…For more information about technique and the diagnostic and therapeutic uses of punch biopsy, we recommend review of the article by AlGhamdi and AlEnazi published in the Journal of Cutaneous Medicine and Surgery in April 2011. 1…”