Surgical gems in dermatologic surgery I

Woo, Sang Hyuk; Hwang, Eul Sang; Kim, Sang Baik; Yu, Dong Soo; Kim, Il Hwan

Abstract

A bolster, simply defined, is any device used to support or cushion. In surgery, bolsters have been used under sutures to reduce skin and subcutaneous tension. Bolsters function to reduce the potential for necrosis and laceration by distributing the wound closure tension over a broader surface area. Pexing stitich is placed between the mobilized tissue and the deep fascia and periosteum to prevent the secondary motion of closure from disrupting anatomic landmarks and moveable structures. The technique aids in obtaining linear closures, prevents distortion of free margins, prevents tenting across concavities, and fixes the closure line at the junction of cosmetic units. Standard treatment of lipoma commonly includes incision with extrication or elliptical excision. Unfortunately, these treatments often elicit a large scar. Using pressure technique, risk of hemorrhage and infection may be minimized secondary to the decreased degree of invasion. In cosmetically sensitive areas, this technique is an effective and aesthetically pleasing method for removal of lipoma.