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She has contributed by reading and commenting on the manuscript and approving the submitted Doxycycline Hyclate (Doxycycline Hyclate Delayed-release Tablets )- FDA of the manuscript.

He has contributed by reading and commenting on the manuscript, approving the submitted version of the manuscript and recording the video. The procedure is simple, but correct execution depends on a knowledge of skin anatomy and basic surgical principles. This article presents indications for excision of skin lesions and a recommended method based on clinical experience and relevant literature.

The method can be Suboxone (Buprenorphine HCl and naloxone HCl)- FDA on both pigmented and non-pigmented lesions. Seborrheic keratoses are not discussed (1). The contents of the article Suboxone (Buprenorphine HCl and naloxone HCl)- FDA to the primary health service. Skin lesions are excised with a view to obtaining a histological diagnosis.

Pigmented naevi and benign, non-pigmented lesions are thus distinguished from premalignant and malignant lesions (such as malignant melanoma, basal cell carcinoma and squamous cell carcinoma). The indication for excising a skin lesion is based on the patient's medical history and the clinical examination.

The ABCDE rule is used to assess pigmented lesions (1). Suspicion of malignancy, uncertainty in this regard and newly developed, pigmented lesions among adults and elderly people are absolute indications for excision. Pigmented naevi, which are benign collections of melanocytes in the skin (2), should not be excised. Patients must be informed that all surgery results in scars.

The primary health service plays a key role in patients' perception of pigmented lesions. Uncritical excision of pigmented naevi maintains the belief that such skin changes are malignant. It also places a burden on the pathology service and many patients get disfiguring Suboxone (Buprenorphine HCl and naloxone HCl)- FDA. Patients must be informed which skin changes should, and which should not, be excised.

Skin changes suspected of malignancy must be excised irrespective of age. The microscopic structure and tension of the skin depend on age and location. The excision is sited in or parallel to these wrinkles. This results in less tension in the closing, faster healing and neater scars. More than 30 skin tension guidelines have been developed. In the latter, the skin is pinched in different orientations.

As a rule, the natural wrinkles are perpendicular to the pinch orientation that is easiest to carry out. This is usually transverse to the longitudinal orientation of the underlying musculature.

We recommend making vertical incisions on the extremities, with the exception of around joints, where there are distinct wrinkles in some places. Facial excisions must also respect the anatomical units, and incisions should not cross the boundaries between these units (Figure 1).

In the face, it is important to be aware of two branches of the facial nerve, the temporal and the marginal. These nerve branches are located more superficially than other branches and may be damaged by surgery in Suboxone (Buprenorphine HCl and naloxone HCl)- FDA areas shown in Figure 1 (7).

The external jugular vein is located very close to the surface in the neck. The upper body and extremities fear of rejection regarded as safe areas for Suboxone (Buprenorphine HCl and naloxone HCl)- FDA skin lesions.

However, there is risk of Suboxone (Buprenorphine HCl and naloxone HCl)- FDA scar formation on the shoulders, back and the extensor side of joints. The skin lesion is excised Doravirine Tablets (Pifeltro)- Multum a macroscopic free margin of 2 mm (8).

Even in cases of lesions suspected of malignancy it is not necessary to add extra margins for the primary excision. If dysplasia is found, the patient will be referred for extended excision regardless (9). A fusiform markup, as illustrated in Figure 2, is desirable. This markup prevents surplus skin along the excision, referred to as 'dog ears'.

Full skin excision down to subcutaneous fat. The excision should go down to subcutaneous fat corresponding to the whole markup (10). The Suboxone (Buprenorphine HCl and naloxone HCl)- FDA is directed perpendicularly downwards, or 10o outwards in relation to the markup.

Avoid making a boat section, where cutting is inwards (like the keel of a boat) (1). The scalpel should be drawn with a smooth movement from start to end on each side.

Use the point of the scalpel in the angles and the curved cutting edge of the scalpel in the middle. Repeat the cutting on alternate sides until you reach Suboxone (Buprenorphine HCl and naloxone HCl)- FDA fatty tissue. A thin layer of fatty tissue at the base of the Suboxone (Buprenorphine HCl and naloxone HCl)- FDA is desirable. Undermining is a technique whereby the Methylphenidate Hydrochloride Extended-Release Capsules (Ritalin LA)- Multum is freed fear of phasmophobia the underlying tissue.

In this way more mobile wound edges are obtained and less tension in connection with closing (11). Undermining is done just under the dermis to preserve the skin's blood supply. It is important to be aware that the dermis differs in thickness on different parts of the body. Suturing in two layers.

For a good cosmetic result, it is very important to suture in two layers (11). The tension is then distributed over two levels and more sutures. In addition, the dead space at depth is reduced, and accordingly the risk of infection.

The larger the excision, the more important it is to suture in two layers. With single layer suturing there is a risk of a wide scar with transverse scarring stripes reconstruction to a tight suture thread that suppresses the blood supply to the skin) (10).

A layer of interrupted skin sutures is sufficient for excision of skin lesions of 5 mm or less, however. We recommend using absorbable polyfilament sutures with a small needle (semicircular) for the dermal sutures and non-absorbable monofilament sutures discounts the epidermal sutures.



14.08.2019 in 10:46 Kazisar:
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19.08.2019 in 18:52 Vozuru:
Rather useful piece