|Year : 2012 | Volume
| Issue : 1 | Page : 48-50
Hemostatic circumferential suture technique for excision of scalp tumors
Ahmad Mai, Garba E Stephen
Department of Surgery, Abuth, Zaria, Nigeria
|Date of Web Publication||22-Sep-2012|
Department of Surgery, Abuth, Zaria
Source of Support: None, Conflict of Interest: None
Background: Many surgical approaches have been devised for a complete scalp tumor excision. The chief aim of all techniques is complete clearance with minimal blood loss. In third world countries where resource is low, scalp tumor excision procedure has been challenging because of inadequate facilities to have a good control of bleeding during excision.
Case Report: The authors described a technique of a scalp tumor excision that guarantees complete excision with minimal blood loss. This approach is specifically suitable for a low-resource setting. It is simple, inexpensive, and easy to learn.
Conclusion: Hemostatic circumferential suture technique for excision of scalp tumors is described. It is suitable for third world nations with low resource. The technique is simple and very effective with minimal blood loss.
Keywords: Tumor, scalp, circumferential suture, hemostatic
|How to cite this article:|
Mai A, Stephen GE. Hemostatic circumferential suture technique for excision of scalp tumors. Arch Int Surg 2012;2:48-50
| Introduction|| |
There are many surgical approaches to scalp tumor excision. All procedures aim to completely excise the tumor with minimal blood loss while ensuring complete surgical excision.  Any approach used must ensure minimal blood loss and less recurrence of tumors.  The best approach must also ensure less operating time with excellent cosmesis. We describe a technique of excision of scalp tumors with minimal blood loss. It is a simple procedure and can be suitable in low resource setting.
| Operative Technique|| |
The scalp is shaved completely before surgery [Figure 1]. Local anesthesia is used, but general anesthesia is preferred especially for large scalp tumors. If local anesthesia is feasible in the patient, 2% lignocaine with epinephrine is administered. The scalp is cleaned and draped. The line of excision of tumor and the line of application of circumferential suture is demarcated. Then, an encircling suture is applied circumferentially about 4 cm away from the tumor edge with nylon 1 suture [Figure 2] and [Figure 3]. A complete excision involving a whole skin thickness is made 2 cm away from the tumor edge and within the encircling suture line [Figure 4]. The tumor is excised completely [Figure 5] and hemostasis is ensured. The wound is dressed with suffratulle and held in position with crepe bandage. (The defect may be reconstructed immediately with a skin graft or done as a two-staged procedure.) The hemostatic sutures are removed 24 h after surgery. The average procedure time is 30 min.
| Discussion|| |
The scalp is a site for tumor growth including congenital types such as congenital extracranial immature teratoma.  In low-resource countries, the expertise of a reconstructive surgeon or even an experienced general surgeon may not be readily available. A technique which an average doctor can successfully perform for scalp tumor excision is highly essential. This technique allows local anesthesia for small scalp tumors and it also minimizes blood loss. Scalp surgical wounds bleed profusely because of poor retraction of the blood vessels.  Occasionally, the hemorrhage may be difficult to control.  In this technique, the initial encircling nylon sutures ensure hemostasis before excision is attempted. It allows complete and rapid excision as the surgical field is clear and the blood loss is very minimal. Excision can, therefore, be done promptly within a few minutes. The technique by these authors ensures complete excision with minimal blood loss. We have followed up some of the patients for up to 5 years. No complication has been noticed in our patients so far.
| Conclusion|| |
This simple technique is inexpensive, causes negligible blood loss, and allows a speedy excision of the tumor. The procedure is easy to learn.
| References|| |
|1.||Corradino B, Di LS, Leto Barone AA, Maresi E, Moschella F. Reconstruction of full thickness scalp defects after tumour excision in elderly patients: Our experience with Integra dermal regeneration template. J Plast Reconstr Aesthet Surg 2010;63:245-7. |
|2.||Isik N, Yildirim S, Onoz M, Aras A. Surgical treatment of huge congenital extra cranial immature teratoma: A case report. Child Nerv Syst 2011:27;833-9. |
|3.||Kim SD, Park JY, Choi WS, Kim SH, Lim DJ, Chung HS. Intracranial recurrence of the scalp dermatofibrosarcoma. Clin Neurol Neurosurg 2007;109:172-5. |
|4.||Bellet JS. Wagner AM. Difficult to control bleeding. Pediatr Dermatol 2009;26:559-62. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]