Tutorial: Skin Removal for Scarification

In this tutorial we will use scalpels and forceps to practice the technical details of skin removal. We will create an ergonomic setup,

Equipment

Procedure

First, set up your equipment. Put the artificial skin on your procedure table. If the height of your table isn't adjustable, stack some books underneath it to simulate the height of a person. (We do this to more accurately gauge the ergonomics of the setup.) Put the sharps container and scalpel blades in easy reach. (Ordinarily they'd be outside the sterile field and an assistant would help, but we're simplifying things for now.) Put instrument table/mayo stand on your dominant side. Adjust the height of the instrument table to be between waist height (standing) and shoulder height (seated). We do this to maintain a sterile field, see here for more information.

Open the sterile drape's packaging. Touching only the outer inch of the drape (it should be marked), open it and use it to cover the instrument table. The outer inch is considered non-sterile, so our hands touching it is okay. If you mess up and touch an inner portion, fold it back up and try again.

Don gloves and headlamp. For gloves, practice putting them on TODO

You may notice your gear is uncomfortable. If so, now is a good time to figure out the adjustments you need to make (adding foam pads, abandoning it entirely). This is a better time to learn this than while in the middle of a procedure! You may also notice that your positioning is unergonomic and starts to hurt after a while. Adjust until it's not! Being in pain is distracting and can make you rush.

Next, we will practice scalpel changes. Get a package with a #15 blade. Here is a video of how to do this. In a real procedure, your assistant would open this, and you would extract it with your hemostatic forceps. For now, hold the package with your non-dominant hand and the forceps in your dominant hand. TODO how to hold forceps. Turn your hand upside down and grab the base of the blade with your forceps. Pick up the scalpel handle with your non-dominant hand, and attach the blade. For some handles of inferior quality, it may be necessary to start sliding the blade on, and then move your forceps to the base of the cutting edge to slide it all the way on.

Now, remove the blade. Point the scalpel away from yourself and your subject. Use the forceps to grip the very bottom edge of the blade and push it off. Put it back in the packaging. Repeat putting the blade on and taking off a few times until you are confident in your ability.

Put a #10 and #11 blade on your other two handles. Place all tools back on your instrument table when not in use.

Using the gentian violet pen, draw a small rectangle on the artificial skin, about 2cm by 0.5cm.

TODO how to hold scalpels. https://sites.uw.edu/uwgensurgtechskills/instrument-handling-scalpels/ Using the body of the #15 blade, cut along the longer two sides. Using the #11 blade, cut the two smaller lines. Use the #11 to go inwards towards each corner to ensure we go all the way. Using the splinter forceps, lift a corner and begin... Check the depth of your lining cuts. Were they too deep?

Now we do a bigger rectangle. Since the lines are longer, let's use the #10 scalpel. Focus on clean lines and a consistent depth. ... As you cut, note how much of the hypodermis is stuck on the bottom of the removed dermis. You want this to be as small of an amount as possible.

Now a bigger circle. Use tip of #10 or flat of #15. Get started with #15, use #10 for large sections. Finish with #15 for details.

Todo