Overview of Fusiform Incision
A fusiform incision is a specific type of cut made by a surgeon to remove a piece of tissue during an operation. The cut is designed in such a way that both ends of the tissue removed look like the ends of a spindle or a cone shape. The purpose of this type of incision is to enable the surgeon to close the wound relatively easily and in a straight line. This method also helps to keep the surface of the healing area as smooth as possible.
Anatomy and Physiology of Fusiform Incision
This type of cut or incision can be performed on skin anywhere on the body, but the size and depth depend on how close it is to essential body parts and edges. For instance, it’s generally not feasible to make large, spindle-shaped cuts near the eye, and you should always avoid crossing the eye’s free edge – the eyelid. Moreover, stitching these wounds back together can create some tension. Therefore, it’s important to consider the direction of the stitching process so that it causes the least amount of strain on vital body parts or on the free edges. This helps avoid creating cosmetic or functional issues.
Why do People Need Fusiform Incision
A type of cut called a “fusiform incision” might be used by doctors to take out the whole lesion (an abnormal growth or area of damaged tissue), or just to remove a part of it. After the incision, the pointed ends of the cut can help in neatly closing the wound, and also help in avoiding any unwanted lumpy skin or ‘dog ear’ formations at the ends of the cut. The technique can be adjusted, as needed, to avoid crossing sensitive areas, such as the edge of the eyelid or the border of the lip.
When a Person Should Avoid Fusiform Incision
Doctors need to be careful when dealing with patients who are taking blood-thinning medication, have bleeding problems, or have ongoing skin infections. If there’s any doubt, it’s a good idea for the doctor to check with a specialist.
Equipment used for Fusiform Incision
When you need to undergo a surgical procedure, there is some basic but crucial equipment that is used before, during, and after the operation. Let’s look at what you might encounter throughout the process.
Before the Surgery:
- A local anesthetic is typically used. This is a medicine called lidocaine that helps numb the area that will be operated on. Epinephrine is added to it to slow down the absorption of the anesthesia ensuring it lasts longer. It’s then buffered with sodium bicarbonate to lessen any burning sensation you might have.
- A 3 cc syringe is used to provide the right dosage of a drug or treatment.
- A 30 gauge needle, which is a slim, pointed piece of stainless steel, is used to draw or inject fluids.
- Antiseptic scrub, a liquid soap that’s used to clean surgical areas before a procedure.
During the Surgery:
- A sterile drape is placed over you to maintain a clean, germ-free environment.
- A scalpel with a #15 blade is used for making precise cuts.
- Toothed forceps, which are like tweezers with teeth, help with gripping tissues or objects.
- Suture scissors are for cutting the stitches.
- A needle holder, a tool that helps in handling and guiding the needle during stitching.
- Normal saline, a sterile salt-water solution, is used for wound cleaning or irrigation.
- Sterile gauze, which is a type of bandage for absorbing fluids and protecting the wound.
- Absorbable sutures are used for deep stitches that are inside your body and dissolve over time.
- Cutaneous suture, which could be absorbable or non-absorbable, is used to stitch up the skin.
- Another ideal tool to have is an electrosurgical device that controls bleeding by sealing blood vessels.
After the Surgery:
- A nonstick dressing, which is a special type of bandage that won’t stick to your wound, making it easier and less painful to remove.
- A sterile ointment is applied to the wound to maintain its cleanliness. Sterile petrolatum is preferred because it triggers fewer allergies compared to antibiotic ointments.
- A bulky pressure dressing made of gauze or other material is used to protect the wound and to help control the bleeding.
- An adhesive dressing that is stretchy and hypoallergenic (unlikely to cause an allergic reaction) is applied over the wound to protect it.
Who is needed to perform Fusiform Incision?
While a type of surgical cut called a fusiform incision can be done by a surgeon alone, having a surgical assistant present can be very beneficial. The assistant can aid the surgeon by managing any bleeding that may occur, cutting stitches, and applying a bandage after the surgery. This team effort ensures that the operation runs smoothly and allows the patient to be cared for in the best possible way.
Preparing for Fusiform Incision
Before starting the surgical procedure, the doctor will examine the area where the surgery will be conducted while the patient is sitting normally or in a natural position. The direction of the surgical cut, or incision, is usually chosen to follow the natural lines of relaxed skin tension. This helps the wound to heal better and results in a less visible scar. Doctors then clean the skin with alcohol to sanitize the area and avoid infection. They’ll mark the planned surgical cut with a special marker. After the site is properly prepared, the patient is placed in a position that is both comfortable for them and allows the surgeon the best access to perform the surgery.
How is Fusiform Incision performed
The tissue is first numbed with a local anesthetic. For the best look after surgery, the surgeon usually aims to make the incision along the lines that naturally appear in your relaxed skin. The surgeon will stretch and hold your skin steady, and then begin cutting. To make sure the wound is the same depth all the way through, the surgeon will start and end the cut at the same level. Often, the skin is initially punctured with the pointed end of the scalpel, and then the rest of the incision is made using the curved part of the blade. It’s important that the scalpel is held at a right-angle to the skin to avoid a slanted cut that might result in a scar that’s turned inwards.
After the affected tissue has been removed, the wound is prepared to be sealed up. Any bleeding is stopped using a tool that uses heat. Most often, the wound is closed in stages, starting with stitches that are placed inside the body and that will dissolve on their own over time. If needed, the skin around the wound may be slightly separated from the underlying tissues to allow for stitches that are hidden under the skin surface and to make the tissues somewhat looser. However, extra separation of the skin from the tissues is generally avoided as it can create more space for a collection of blood or body fluids to form. The strength of the wound closure comes from the deep stitches, while the surface stitches hold the skin edges together as healing begins. The surface stitches can dissolve on their own or may need to be removed at a later time. In some cases, especially for very small or narrow cuts with little tension, only surface stitches are used. Alternatively, a special kind of glue can be used on your skin.
Once the wound is sewn up, a clean dressing that applies pressure to the wound is placed over the incision for 1-2 days to reduce chances of bleeding. A sterile petroleum jelly is applied to the cut which is better than antibiotic ointments that have not been shown to decrease the chances of infection after the operation, and can in fact cause an allergic skin reaction. Dressings made from gauze or cotton balls form the main part of the dressing that applies pressure under the bandage. Strips of stretchy bandage material are used to hold these dressings in place, which also help bring the skin edges together, reducing strain on the stitches.
Where it’s been possible to place buried stitches, surface stitches on the face can usually be removed after a week, or even sooner in some cases. On the body and the limbs, it is generally safer to leave the stitches in place for 10-14 days, depending on how much strain there is on the wound and the patient’s level of activity. If the surface closure made use of stitches that dissolve over time, the type of stitch used should be one that will stay in place for an adequate amount of time.
Possible Complications of Fusiform Incision
Like other surgeries involving a cut or incision, the main risks are bleeding, formation of a scar, and infection. There’s also the risk that important structures beneath the skin, like nerves, could be unintentionally damaged. The surgery might also leave you with changes to your appearance or affect how your body functions. However, detailed preparation and focus during the operation can help keep these risks as low as possible.
What Else Should I Know About Fusiform Incision?
Fusiform incision is a common surgical technique used for removing round or oval-shaped skin growths. For this procedure, the doctor will first outline the area around the growth, forming a circle or an oval with a marker. This marked area, plus a bit more on the ends for reshaping, will be part of the incision.
Two main types of fusiform incisions exist. One resembles a football shape, with rounded ends. The other looks more like a diamond, with straight sides and only the middle being curved. This choice helps reduce any extra skin that might stick out, or “dog ear,” after the incision is closed. It also helps minimize discomfort and reduce scarring.
One thing to note is that the outline will be about three times longer than the width of the area removed. This ensures the right angle for the incision (about 30 degrees) and easier healing. However, this can change based on the type and location of the skin.
Sometimes, a doctor may use a fusiform incision for examining a larger area of skin. This is typically done when they want to look at a transition from healthy to diseased skin or examine the structure of a large skin growth. In these cases, a longer and more narrow skin sample may be taken to offer the pathologist a better look, without leaving a large wound. This approach can be seen when checking skin lesions, like keratoacanthoma, or when examining large pigmented areas. As a result, the doctor can make a more accurate diagnosis while causing minimal discomfort for the patient.
