SAN DIEGO – Sewing supplies, tricks of the dental trade, and a nice firm handshake are handy, value-added elements of a smooth-running Mohs surgery practice, speakers said at the meeting sponsored by the American Society for Mohs Surgery.
Many of the pearls offered during 3 days of clinical sessions are cheap, simple, and easy to employ, making life just a bit easier during complex Mohs surgical procedures or in a busy office setting.
Among the suggestions:
• Take a trip to the fabric store. A $10 sewing magnet, sterilized in your office, can grab a needle off a tray or the floor. Buttons can be used as bolsters to distribute tension on a wound, stabilize a graft, or form a scaffold for healing of the helical sulcus following repair, said Dr. Edward H. Yob, a dermatologic surgeon in private practice in Tulsa, Okla.
• Put a fine point on it. Tired of smudged labels on your slides? Order some extra fine permanent markers (offered by Pilot with the code SCA-UF), which can be used on glass, said Dr. Howard Steinman, director of dermatologic and skin cancer surgery at Scott and White HealthCare in Temple, Tex.
• Brush up on your inking technique. Dr. Steinman said he has become a recent convert to small, tissue-marking dye systems by Cancer Diagnostics. These kits come with dyes in seven colors, each with a small brush for precise distribution. The bottles "tend to wobble a little bit" in the case, so Dr. Steinman said he lines the base of the kit with double-sided tape to hold them steady. "They’re certainly more convenient than the wooden sticks," he said.
• Peruse a dental supply catalog. Dr. Yob apparently forgoes the Lands’ End catalog in favor of a veritable shopping spree through pages of products such as LolliCaine topical anesthetic gel (to numb intraoral tissue prior to a needle prick); dental rolls, 2,000 to a box (to shield sharp instruments, pack a nose, or serve as bolsters or pressure points under dressings); and dental syringes and needles.
• Invest in a thermal cautery device. If you’re in a region where you treat a fair number of elderly patients with implanted defibrillators, you’re likely to appreciate having an alternative to an electrocautery unit. "You really don’t want to set them off while you’re doing a procedure," said Dr. Yob.
• Grip and grin. Dr. Yob said he always shakes the hand of a patient following a biopsy or Mohs procedure, not only because it’s a good business practice, but also because he can check for clammy hands or a weak grip. "If that hand is clammy, I’m going to be concerned about that patient getting up quickly," he said.
• Pass the salts. If a patient feels weak, nauseous, or woozy, Dr. Yob, a nurse, or office assistant can grab ammonia salts taped to every paper towel dispenser in the office for a quick antidote.
• Put hair in its place. While Vaseline petroleum jelly is cheap and convenient, patients will appreciate it if you have on hand hair clips, bands, and Dippity-do hair gel, instead of glopping up their hair to clear a surgical field on the scalp, said Dr. Carlos Garcia, director of dermatologic surgery and cutaneous oncology at the University of Oklahoma, Oklahoma City.
• Go one step cheaper than generic. If you love the flexibility and self-adherent qualities of 3M’s Coban wrap, you’ve probably discovered the less-expensive alternative, Co-Flex by Andover Healthcare. But perhaps you haven’t stopped by a feed store lately to discover Vetrap bandaging tape, also by 3M, which is far more affordable than the suspiciously similar human product, said Dr. Yob.
• Introduce yourself to the ENT resident’s friend. While working on a complex Mohs case on a patient’s neck, Dr. Steinman said he learned an important anatomy lesson from his third-year resident, who happens to be a board-certified otolaryngologist. The resident pointed out that Dr. Steinman was in safe territory as long as he stayed above the posterior belly of the digastric muscle, known in ENT circles as "the resident’s friend."
None of the speakers who offered clinical pearls reported having financial disclosures associated with the products they recommended.