Basic principles of eye surgery: Pearls
  • In skin surgery, always use local anaesthesia containing adrenaline to reduce bleeding.

  • (Give the anaesthetic 10 minutes before the incision to allow the adrenaline to achieve its vasoconstrictive effect.)
  • Only cut if you could see the surgical field.

  • (Blind cutting may produce irregular edge and damage important structures; make sure the field is not obscured by blood or shadows etc.)
  • Cut under tension and suture without tension.

  • (Cutting without tension can cause irregular skin wound and suture under tension increases wound dehiscence and scar.)
  • The scar from excising a skin lesion will always be longer than the lesion itself.

  • (Always discuss this with the patient preoperatively to reduce patient's dissatisfaction.)
  • Avoid extending incision outside the periorbital region to reduce scar. 

  • (The thicker skin outside the periorbital region tends to give more prominent scar than the thinner periorbital region.)
  • Do not excise any lacerated periorbital skin during primary repair unless it is necrotic. 

  • (The skin on the face has good blood supply and often survive despite extensive laceration.)
  • Send all excised skin lesion for histology even if it appears clinically benign.

  • (Histology of seemingly benign lesion can yield surprises. Cases of metastasis or sebaceous cell carcinoma may appear benign clinically.)
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