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A D V E R T I S E M E N T
A D V E R T I S E M E N T
A 32-year-old woman presented with a 3 x 4 cm soft, mobile mass overlying the inferior angle of her right scapula. She was taken to the minor operating room for excision.
A D V E R T I S E M E N T
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A dermal wheal was created over the line of incision. The incision was oriented along natural skin (Langer’s) lines to minimize scarring. A half and half mixture of 1/2% lidocaine and 1/4% marcaine without epinephrine was used. Those who use epinephrine do so for hemostatic effect and to prolong the local action of the anesthetic. The negative side of epinephrine is the potential systemic effect, especially in the face of cardiac disease, the fact that bleeders may not be evident at the time of surgery and not controlled, and the potential rebound vasodilatation when the epinephrine wears off. The latter two factors may lead to hematoma. The injection was made with a 2 1/2” 27g needle. Raising a wide dermal wheal confers immediate skin anesthesia by its stretching effect even before the drug takes effect, allowing immediate incision.
Notes:
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A D V E R T I S E M E N T
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Local was injected radially in the subcutaneous tissue starting from within the wheal. The needle must be withdrawn almost to the skin with each pass to be redirected or it will pass back into the same tract.
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This page was last modified on 6/25/2004.
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