Dermatologic surgery encompasses a wide range of procedures necessitating an even larger variety of surgical tools. Use of the best instruments and proper maintenance of all surgical supplies can help the surgeon achieve optimal results while capitalizing on their investment. Consistently organized surgical trays help minimize the risk of accidental injuries and maximize efficiency in the procedure room.
Instruments used for dermatologic surgery are typically small, easy to maneuver, and allow for delicate handling of tissues. The most commonly used tools include curettes, scalpels, scissors, skin hooks, hemostats, needle holders, and forceps. All these tools are available in a variety of qualities and costs, and it is in the surgeon’s best interest to select the most economical tools that will aid in delivering the desired results. In general, higher quality instruments are more durable, easier to use, and longer lasting, and are usually covered by a warranty that ranges from 1 to 5 years. Modern instruments are most commonly made from surgical stainless steel with carbon alloy, chromium, nickel, and tungsten carbide.
Curettes are used for tumor removal, to better define tumor margins prior to excision, and for tumor debulking prior to Mohs micrographic surgery. They are available in disposable or nondisposable forms, or as a single-use curette blade that may be used on a scalpel handle. Ideally, a curette will remove more friable tumor-infiltrated tissue while leaving behind normal skin. Curette heads are either round or oval and vary in size from 1 to 9 mm (Fig. 8-1). A surgeon can normally purchase approximately 50 disposable curettes for the price of a single nondisposable curette. The disposable curettes have lightweight plastic handles, whereas the reusable curettes are made of stainless steel. A reusable curette may seem more cost-efficient, but it is important to remember that these instruments need to be sharpened periodically to prevent dulling of the sharp scraping edge. A dull curette may result in unnecessary damage to tissue.1
Curettes in three different sizes with round and square handles.
Scalpel handles may be flat or round, thin or thick, textured or smooth. The most commonly used handles in dermatologic surgery include the Bard–Parker #3 and Beaver handles. The Bard–Parker #3 handle may be flat or round and is available with an etched ruler. This inexpensive scalpel holds a variety of scalpel blades, including the most popularly used #10, #11, and #15 blades. The smaller, mini-Beaver handle is available in a hexagonal or round shape (Fig. 8-2). This handle is used for more delicate work around the eye or ear. It is not as versatile as the Bard–Parker #3 handle because it must be used with certain blades, such as the #64 and #67 ...