Brown's Skin and Minor Surgery: A Text and Color Atlas 5E

332 Pages·2014·30.186 MB·English

by  Jonathan Botting, Julia Schofield

This authoritative, highly illustrated text and colour atlas provides FB F I F T H E D I T I O N
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a systematic guide to commonly performed minor surgical and FR
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dermatology procedures. Accompanied by video clips, this critical HO
resource on skin and minor surgery is designed for all trainees and
EW BROWN’S SKIN
practitioners, including experienced surgeons, dermatologists, family D
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doctors, nurses, and the supporting healthcare team. TN
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O
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Divided into four colour-coded sections, the book covers essential NS & MINOR SURGERY
background information including postoperative management and
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aftercare, the key knowledge required for diagnosis and management,
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and the skills necessary to perform procedures step by step.
I A TEXT AND
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• Comprehensive coverage— learn to perform a whole range of

procedures from small skin surgical procedures to vasectomy. &
COLOUR ATLAS
• Step-by-step techniques—see how to perform each technique with M
numerous colour illustrations, animations and video clips.
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• Practical advice, boxes, tables, warnings, and indications of difficulty N
level—achieve success and avoid common pitfalls.
O Edited by
• Authoritative yet contemporary—gain wisdom from this long-
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established, trusted book brought completely up to date by today’s
Jonathan Botting and
practitioners. S
U
Julia Schofield
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Edited by
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Jonathan Botting, MRCGP, GP, Barnes, London SW13; GP Trainer; E
Dermatological Surgeon, Chelsea and Westminster Hospital and Queen R
Mary’s Hospital; Course Organiser for Diploma in Minor Surgery; Y
RCGP Clinical Champion for Minor Surgery 2010–12.
Julia Schofield, FRCP, MRCGP, MBE, Principal Lecturer, Programme
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Lead, MSc Dermatology Skills and Treatment, School of Postgraduate
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Medicine, University of Hertfordshire, and Consultant Dermatologist, t
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United Lincolnshire Hospitals NHS Trust. n
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Cover photograph by Julian Calder. n
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K18335
ISBN: 978-1-4441-3836-8
90000
9 781444 138368
www.crcpress.com
FIFTH EDITION
BROWN’S SKIN
& MINOR SURGERY
A TEXT AND COLOUR ATLAS
JONATHAN BOTTING
EDITED BY
JULIA SCHOFIELD
AND
K18335_C000.indd 1 8/7/14 11:19 AM
CRC Press
Taylor & Francis Group
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© 2015 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
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Version Date: 20140804
International Standard Book Number-13: 978-1-4441-3837-5 (eBook - PDF)
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Contents
FOREWORD v
ACKNOWLEDGEMENTS v
EDITORS vi
CONTRIBUTORS vi
PART 1 ESSENTIAL BACKGROUND INFORMATION 1
CHAPTER 1 FACILITIES 3
CHAPTER 2 INFORMED CONSENT, RECORD KEEPING, DOCUMENTATION,
AND AUDIT 31
CHAPTER 3 INFECTION CONTROL 49
CHAPTER 4 PROFESSIONAL AND LEGAL ISSUES, AND HEALTH AND SAFETY
AT WORK 67
CHAPTER 5 PATIENT ASSESSMENT 75
CHAPTER 6 ANATOMICAL HAZARDS AND PITFALLS 79
CHAPTER 7 LOCAL AND REGIONAL ANAESTHETIC AGENTS 95
CHAPTER 8 POSTOPERATIVE MANAGEMENT 99
PART 2 KNOWLEDGE: DIAGNOSIS AND MANAGEMENT 107
CHAPTER 9 SKIN LESIONS 109
CHAPTER 10 DERMOSCOPY 145
C
CHAPTER 11 CARPAL TUNNEL SYNDROME, DUPUYTREN’S CONTRACTURE, o
n
TRIGGER FINGER, AND GANGLIA: KNOWLEDGE 151 te
n
t
s
CHAPTER 12 VASECTOMY: KNOWLEDGE 161
CHAPTER 13 TOENAIL PROBLEMS THAT MAY REQUIRE SURGERY 169
PART 3 ESSENTIAL GENERIC SKILLS 179
CHAPTER 14 COMMUNICATION 181
CHAPTER 15 LOCAL ANAESTHESIA AND MINOR SURGICAL PROCEDURES 183
CHAPTER 16 RESUSCITATION 191
CHAPTER 17 BASIC SURGICAL TECHNIQUES 197
CHAPTER 18 HAEMOSTASIS 219
CHAPTER 19 DERMATOLOGICAL TECHNIQUES AND TIPS 223
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PART 4 ADDITIONAL SURGICAL SKILLS AND PROCEDURES 235
CHAPTER 20 OTHER SURGICAL PROCEDURES: CYSTS AND LIPOMAS 237
CHAPTER 21 MINOR CASUALTIES 253
CHAPTER 22 CARPAL TUNNEL SYNDROME, DUPUYTREN’S CONTRACTURE,
TRIGGER FINGER, AND GANGLIA: SKILLS 265
CHAPTER 23 VASECTOMY: SKILLS 277
CHAPTER 24 TOENAIL SURGERY 289
CHAPTER 25 ADVANCED SURGICAL PROCEDURES 297
CHAPTER 26 ELECTROSURGERY 313
INDEX 325
VIDEO CLIPS
Video clips are available online to illustrate some of the Once you have downloaded a QR code reader, simply
procedures described in this book. There is a URL in the open the reader app and use it to take a photo of the code.
text wherever a video clip is cited and a panel of QR codes The video will then load on your smartphone/tablet.
at the end of each chapter for which videos are provided. If you do not have a smartphone/tablet, you can view
To use the QR codes to view the videos you will need the videos online by typing in the URL shown for each
a QR code reader for your smartphone/tablet. There are video, or following the hyperlink if you are using the
many free QR code readers available, dependent on the ebook edition.
device you are using. We have supplied some sugges- We are interested in your feedback on the QR codes
s
t tions below of well-known QR readers, but this is not an included with this title. If you have any comments on the
n
e exhaustive list and you should only download software use of QR codes, please send them to zelah.pengilley@
t
n
o compatible with your device and operating system. We tandf.co.uk.
C
do not endorse any of the third-party products listed
below and downloading them is at your own risk:
• iPhone/iPad: Qrafter—http://itunes.apple.com/app/
qrafter-qr-code-reader-generator/id416098700
• Android: QR Droid—https://market.android.com/
details?id=la.droid.qr&hl=en
• Blackberry: QR Scanner Pro—http://appworld.black-
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• Windows/Symbian: UpCode—http://www.upc.fi/en/
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K18335_C000.indd 4 8/7/14 11:19 AM
v
Foreword
Jonathan Stuart Brown, M.D.
When I wrote the first edition of Minor Surgery—A Text The forewords to the first four editions were all
and Atlas in 1986, I remember feeling relieved that, as written by consultant surgeons, two of whom were also
with Gray’s Anatomy, it would need very little updating, presidents of the Royal College of Surgeons, and I have
as minor surgical treatments were unlikely to change to been very privileged to be asked to write the foreword to
any significant degree. this edition.
With each subsequent edition, it became obvious that When I retired from general medical practice, I felt
changes were needed; not only had materials and instru- it was appropriate to ask younger, more up-to-date, and
ments improved, but also many treatments had been experienced colleagues if they would be willing to update
modified and improved, and new legislation and advice the book. To update one’s own book is fairly straight-
had been introduced. forward, but to update someone else’s book is a hugely
Throughout all the editions, the emphasis has been to daunting task, and I am most grateful to Jonathan Botting,
offer the highest standards of care to the patient; thus, Julia K. Schofield, and their small team of experts for the
doctors are recommended to seek advice from surgical huge amount of hard work they have done on my behalf.
colleagues, to attend one or more of the many excel- I could not have anticipated a better end result and I am
lent Minor Surgery courses, and only perform those truly delighted. To them, I express my everlasting thanks,
procedures where they feel completely competent and and I know readers of this edition will find a wealth of
comfortable. information and advice contained within its covers.
Acknowledgements
We gratefully acknowledge and thank those who pro- We are grateful to all who gave permission for the re-use
vided invaluable expertise: of material; most are credited individually, but we
would also like to acknowledge the following:
Richard Baxter—General Practitioner, for editorial The video clips are reproduced with kind permission of
support. Limbs and Things.
Andrew Fleming—Consultant, Plastic Surgeon at St. Much of the text relating to skin lesions and dermato-
F
George’s Hospital, London, for providing images of logical surgery techniques is reproduced from o
r
Dupuytrens. Schofield J, Kneebone R (2006) Skin Lesions: A ew
Rupert Gabriel—General Practitioner, for electrosurgery Practical Guide to Diagnosis, Management and Minor o
r
d
advice. Surgery, 2nd ed., with kind permission of the authors.
Diane Gilmour—Past President of the Association for
Perioperative Practice (AfPP), for her advice on
Chapter 3, ‘Infection Control’.
Soon Lim—General Practitioner, for editorial support.
David Warwick—Consultant Hand Surgeon at
Southampton University Hospitals NHS Trust, for
providing information and images for collagenase
treatment of Dupuytrens.
Matthew Wordsworth—General Practitioner, for providing
carpal tunnel advice.
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vi
Editors
Jonathan Botting, MRCGP, Julia Schofield, FRCP, MRCGP, MBE,
GP, Barnes, London SW13; GP Trainer; Dermatological Principal Lecturer, Programme Lead, MSc Dermatology
Surgeon, Chelsea and Westminster Hospital and Queen Skills and Treatment, School of Postgraduate Medicine,
Mary’s Hospital; Course Organiser for Diploma in University of Hertfordshire; Consultant Dermatologist,
Minor Surgery; RCGP Clinical Champion for Minor United Lincolnshire Hospitals NHS Trust.
Surgery 2010–12.
Contributors
Jonathan Bowling, MBChB, FRCP,
Dermoscopy UK; Consultant Dermatologist and Ian Reilly, FCPodS DMS,
Honorary Senior Clinical Lecturer, Oxford University Consultant Podiatric Surgeon, Northamptonshire
Hospitals NHS Trust, Oxford, UK. Healthcare Foundation NHS Trust; Private Practice:
BMI and Ramsay Hospital Groups.
Simon Eccles, BDS,FRCS,FRCS (Plast),
Consultant Plastics and Craniofacial Surgeon Laurel Spooner, MRCP, MRCPG, DRCOG, DCH, ASPC,
Chelsea and Westminster Hospital, London, UK; Primary Care Surgeon and General Practioner;
President of the Plastic Surgery Section of the Royal Immediate Past President of the Association of Surgeons
Society of Medicine. in Primary Care, London, UK.
Tony Feltbower MB, BChir, LRCP, MRCS, Tim T. Wang, FRCS,
DRCOG, AFOM, Imperial College London; Specialist Plastics Registrar,
General Practitioner and Vasectomist, Chelsea and Westminster Hospital,
Westminster Road Medical Services Ltd., London, UK.
Coventry, UK.
Madeleine Flanagan, RGN,
s
r
o Principal Lecturer, School of Postgraduate Medicine,
t
u University of Hertfordshire, Hertfordshire, UK.
b
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PART 1 1
Essential background
information
CHAPTER 1 FACILITIES
CHAPTER 2 I NFORMED CONSENT, RECORD KEEPING, DOCUMENTATION,
AND AUDIT
CHAPTER 3 INFECTION CONTROL
CHAPTER 4 P ROFESSIONAL AND LEGAL ISSUES, AND HEALTH AND SAFETY
AT WORK
CHAPTER 5 PATIENT ASSESSMENT
CHAPTER 6 ANATOMICAL HAZARDS AND PITFALLS
CHAPTER 7 LOCAL AND REGIONAL ANAESTHETIC AGENTS
CHAPTER 8 POSTOPERATIVE MANAGEMENT
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K18335_S001.indd 2 7/7/14 2:36 PM
Chapter 1 3
Facilities
EQUIPMENT REQUIREMENTS 3 STAFF REQUIREMENTS 27
INTRODUCTION Room requirements
The following important areas will be discussed in rela-
This chapter describes the essential facility and
tion to the operating room as they are considered essen-
resource requirements for performing minor
tial aspects of the provision of a safe minor surgery
surgery. There are two sections as follows:
service:
•• Size.
•• The equipment required to perform minor
•• Surfaces, floor, walls, and doors.
surgery.
•• Storage.
••Staffing needs to support the service.
•• Handwashing facilities.
•• Operating table/stool.
Facilities should be not only fit for purpose, but
•• Illumination and ventilation.
also adaptable to meet future demands. Many of
•• Patient preparation area.
the fixtures and fittings will be expensive, and care
•• Communication needs.
should be taken when choosing these to ensure that
they are fit for the intended purpose. There will be
Readers are directed to their own national guidance and
a range of consumable products (such as sutures
requirements when designing or refurbishing premises
and sterile gloves) for which it will be possible to
to create a minor surgery service. Figure 1.1 shows an
evaluate and change suppliers as necessary.
illustration of a minor surgery room.
E
Size q
u
The first requirement of any room used for minor surgery ip
EQUIPMENT REQUIREMENTS is that sufficient space exists to allow the surgeon uninter- m
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rupted access around the patient. This is more important n
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There are core requirements for equipping all minor than the actual floor size. The recommended size for a r
e
surgery rooms, and optional facilities dependent upon consulting room is 13.5–15 m2 and that for a treatment/ q
u
the level of planned service. It is a mistake to underesti- minor surgery room 18–20 m2. These are the dimensions ir
e
mate the facilities, fixtures, and fittings required. Atten- recommended for NHS premises in the United Kingdom m
e
tion to detail as you set up the service will prevent the and built on the following principles, which should be n
t
surgeon from discovering half way through an operation followed when planning a treatment or minor surgery s
that there is not enough room to move or that a par- room:
ticular instrument, suture, or dressing is missing. This
section considers the following equipment needs:
•• Room requirements such as size.
•• Ancillary equipment, for example electrocautery
equipment.
•• Surgical instruments, including a review of the
advantages and drawbacks of reusable versus dispos-
able equipment.
•• Single-use consumables, such as gloves and sutures.
•• Drugs, including local anaesthetics.
•• Safety equipment.
When considering your facilities and equipment needs,
attention to detail in relation to infection control is
important. Chapter 3 considers this area specifically, but
throughout this chapter there is emphasis on making the
minor surgical facility easy to keep clean.
Figure 1.1 Treatment room.
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