Subcutaneous incision

The full description of the deep chemical peel procedure is found in Chapter 8. Before the peeling, the subcision (subcutaneous incision) technique is used to free the fibrous bands from the base of the scars. For this purpose we use an i8-gauge 1.5-inch NoKor Admix needle (Becton Dickinson and Co). This needle has a triangular tip similar to No. 11 blade (Fig. 9.5). it allows smooth separation of fibrous cords. The needle is inserted through a skin surface, and its sharp edges are maneuvered under the defect to make subcutaneous cuts or incisions. The depression... 

Placement of vascular access ports is similar to that of a long-term indwelling arterial catheter. A small incision is made over the selected vein and a second incision is made lower in the anterior chest to create a pocket to house the port. The catheter is tuimeled subcutaneously from its entry point into the vein with the tip inside the right atrium. The final position of the catheter is verified by fluoroscopy, secured with sutures, and the subcutaneous pocket is closed. The port septum is easily palpable transcutaneously, and the system may be used immediately. A surgeon typically inserts the vascular access port in an outpatient setting. 

SSIs are defined and reported according to Centers for Disease Control and Prevention (CDC) criteria.5 SSIs are classified as either incisional or organ/space. Incisional SSIs are further divided into superficial incisional SSI (skin or subcutaneous tissue) and deep incisional SSI (deeper soft tissues of the incision). Organ/space SSIs involve any anatomic site other than the incised areas. For example, a patient who develops meningitis after removal of a brain tumor could be classified as having an organ/space SSI. An infection is considered an SSI if any of the above criteria is met and the infection occurs within 30 days of the operation. If a prosthetic is implanted, the timeline extends out to 1 year. 

SSIs are classified as either incisional (such as cellulitis of the incision site) or involving an organ or space (such as with meningitis). Incisional SSIs may be superficial (skin or subcutaneous tissue) or deep (fascial and muscle layers). Both types, by definition, occur by postoperative day 30. This period extends to 1 year in the case of deep infection associated with prosthesis implantation. 

Silastic capsules, consisting of 10 mm silastic tubing packed with drug or hormone with sealed ends (insertion of 3 mm glass beads), can be implanted through a small incision over the dorsal thoracic midline into the subcutaneous fat (57, 58). A number of companies will formulate drugs into various pelleted implants and these companies can be found online (e.g., Brookwood Pharmaceuticals). 

Wakamatsu et al. (1999), Ohtake et al. (2000), Oka et al. (2001) studied the effects of intrathecally administered local anesthetics on glutamate release and neuronal injury in rabbits. New Zealand white rabbits were anesthetized with isofluorane. With the rabbits in prone position, midline skin and subcutaneous fascia were incised between the third lumbar and the first... 

Subcutaneous sebaceous cysts must be removed by total excision, because simple incision usually results in recurrence. 

Each type of film was then implanted subcutaneously and intramuscularly in rabbits to assess tissue reaction and rate of resorption. The film was carefully cut into a circle with a diameter of 10 mm. Sham incisions were also made in each rabbit as controls for the amount of infiammation resulting from surgical trauma alone. The animals were killed after 7 to 180 days. The implants were examined grossly for infiammation, changes in size, and appearance of the films. Histologic preparations were also made of each film to examine the cellular reaction. By 7 days, infiammatory cuffs had encircled the implants. The control films showed evidence of being digested they were swollen, weaker, and usually thinner. 

The drug is injected subcutaneously to paralyse the sensory nerve endings around the area to be rendered insensitive, e.g., an area to be incised or for tooth extraction. 

Goatskin Model A layer of paraffin wax was molded into the bottom of polypropylene containers. The goatskin was dissected from the subcutaneous tissue, stretched to its original dimensions, and pinned onto the wax layer. The container was then filled with a saline solution (0.9% w/vol. NaCl and 0.05% w/vol. NaNg) until the skin was totally submerged. The sample was stored in a freezer at -10°C. Prior to use, the sample was removed from the freezer and thawed at room temperature. The saline was poured from the container. A lint-free tissue was used to remove excess moisture. A 19-cm incision was made down the length of the sample. The skin around the incision was approximated and 400 pL of a cyanoacrylate tissue adhesive... 

Wound strength and scar formation in skin may depend on the type of incision made. If the subcutaneous muscles in the fatty tissue are cut and the overlying skin is closed with tape, then the muscles retract This, in turn, increases the scar area, causing poor cosmetic appearance when compared to a suture closure. Tapes also have been used successfully for assembling scraps of donor skin for skin graft. 

Make a 4-5 mm skin incision (as small as possible) and dissect to create a subcutaneous tunnel. 

Push a 1-cm segment of intravenous catheter with its associated bioluminescent bacterial biofilm (e.g., Xen) through the incision into the tunnel (subcutaneous tunnel usually created is 1.5 cm in length). One catheter segment is inserted on each side of each animal. 

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