Safety in Office-Based Dermatologic Surgery PDF
Preview Safety in Office-Based Dermatologic Surgery
Jacob O. Levitt Joseph F. Sobanko Editors Safety in Offi ce-Based Dermatologic Surgery 123 Safety in Offi ce-Based Dermatologic Surgery Jacob O. Levitt • Joseph F. Sobanko Editors Safety in Offi ce-Based Dermatologic Surgery Editors Jacob O. Levitt, MD, FAAD Joseph F. Sobanko, MD, FAAD The Icahn School of Medicine at Mount Sinai University of Pennsylvania New York Philadelphia , PA USA USA ISBN 978-3-319-13346-1 ISBN 978-3-319-13347-8 (eBook) DOI 10.1007/978-3-319-13347-8 Springer Cham Heidelberg New York Dordrecht London Library of Congress Control Number: 2015931091 © Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To my patients, who have patience with my students. To my students, who cannot grow without my patients. To my mentor, Dr. Mark Lebwohl, who continues to guide my own growth as a dermatologist. And, of course, to my mother, the beauty queen, my father, the genius, and my sister, the beautiful genius. –Jacob O. Levitt, MD, FAAD To my family (especially my “moms”), whose love and continued support strengthen me in all aspects of life. To my patients, for the fulfi llment they provide in allowing me to help in their care. And to all my mentors and trainees, who inspire and motivate me to continually improve – “call the crib, same number same hood, it’s still all good.” –Joseph F. Sobanko, MD, FAAD About the Authors D r. Levitt is Vice Chairman, Residency Director, and Associate Professor of Dermatology at the Icahn School of Medicine at Mount Sinai. Dr. Levitt has created a website ( http://bit.ly/ dermedu ) for dermatology education that contains videos on how to perform many of the pro- cedures discussed in this book. He has produced a N ew England Journal of Medicine Video in Clinical Medicine [1] on how to perform a punch biopsy. He has also authored articles on the instruction of venipuncture [2] and a survey of safety during dermatologic procedures per- formed by residents [3]. Dr. Sobanko is Assistant Professor of Dermatology and Director of Dermatologic Surgery Education at the Hospital of the University of Pennsylvania. His practice focuses on cutaneous oncology and complex reconstruction. Dr. Sobanko is the senior author of a two-part continu- ing medical education article in the J ournal of the American Academy of Dermatology on surgical techniques [4, 5]. D rs. Levitt and Sobanko bring over 15 years’ combined experience in training residents and medical students to this book. They developed a surgical safety focus session at the American Academy of Dermatology (AAD) annual meetings, in which many of the key points in this book were introduced. The session has become a fi xed part of the AAD meeting curriculum. References 1 . L evitt J, Bernardo S, Whang T. Videos in clinical medicine. How to perform a punch biopsy of the skin. N Engl J Med. 2013;369(11):e13. 2. Pan M, Harcharik S, Luber A, Bernardo S, Moskalenko M, Levitt J. Instructional video for teaching veni- puncture. Clin Teach. 2014;11(6):436–41. 3 . G oulart JM, Oliveria SA, Levitt J. Safety during dermatologic procedures and surgeries: a survey of resident injuries and prevention strategies. J Am Acad Dermatol. 2011;65(3):648–50. 4 . M iller CJ, Antunes M, Sobanko JF. Surgical technique for optimal outcomes. Part I. Cutting tissue: incising, excising, & undermining. J Am Acad Dermatol (in press). 5 . M iller CJ, Antunes M, Sobanko JF. Surgical technique for optimal outcomes. Part II. Repairing tissue: sutur- ing. J Am Acad Dermatol (in press). vii Pref ace W e frequently observed that unfamiliarity with procedures increases the likelihood of occupational exposures. Learning to perform a procedure correctly early in training will rein- force safe habits moving forward. We observed many ways that injuries occur with offi ce- based procedures and have evolved our techniques on the basis of these observations in order to prevent injury. Rather than struggle through trial and error through numerous potentially unsafe techniques, we have composed this textbook to propose safer methods for many offi ce-based procedures T his textbook is intended for use by any healthcare provider who participates in offi ce- based procedures, such as injections, biopsies, excisions, and laser surgery. Common unsafe practices in offi ce-based surgery are highlighted in this textbook. Chapters are divided into individual procedures for easy referencing by students, trainees, as well as seasoned practitio- ners. Figures attempt to illustrate how seemingly innocuous actions and procedures can result in dangerous exposures to healthcare workers. Hazardous scenarios are presented as “Accidents,” which are followed by one or a series of safer “Solutions”. To prevent confusion, we avoided including the accident and solution in the same photo. Injuries are indicated with a red star (“the boom-pow”). W e elected to use nonhuman substrates for many of our photos to provide the clearest depic- tion of our points and did our best not to compromise realism. Where appropriate, we used live patients. The emphasis of the book is on accidents that harm the provider while performing a procedure; however, we highlight some situations that can harm the patient. When pertinent, we describe proper procedural techniques to maximize practitioner safety. It is our belief that raising awareness of unsafe techniques in offi ce-based surgery may allow for improvement in surgical safety and reduction in occupational exposures. While we have attempted to be comprehensive in our description of “Accidents” and “Solutions,” it is possible that you implement safe “Solutions” not found here. We encourage you to share this information with those that work with you in order to promote a culture of safety. We also encourage you to analyze the situation surrounding any personal injuries asso- ciated with procedures to identify the reason why it happened and to modify circumstances and techniques to prevent its recurrence. We welcome your thoughts and suggestions via email and hope you enjoy the book! NY , USA Jacob O. Levitt , MD, FAAD PA , USA Joseph F. Sobanko , MD, FAAD ix
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