Dermatologic surgery: An update on Secondary Intention Healing and Adjuncts: Part 2.

Secondary intention healing (SIH) is utilised by various surgical specialities. The formation of granulation tissue is crucial for initiating the healing process, necessitating robust support at this stage. Numerous adjunct therapies are available, with new developments aimed at treating both acute and chronic wounds undergoing SIH.

A review of Secondary Intention Healing in Dermatology and Dermatologic Surgery: Part 1.

Secondary intention healing (SIH) describes wounds healing from the base upwards, without direct closure. This starts with granulation of the wound, followed by re-epithelialisation and contraction. The surgeon and patient need to weigh up advantages and disadvantages of SIH versus other reconstruction methods.

National Dermatological Surgery Sustainability Survey: An Evaluation of Healthcare Professional Beliefs and Practices.

Background: Dermatological surgery contributes to the large environmental impact of healthcare, but to date there are no data on the current sustainability practices, attitudes, or behaviours of UK and Republic of Ireland health professionals involved in skin surgery.

Objectives: We sought to evaluate this using a national sustainability questionnaire, organised by the British Society for Dermatological Surgery.

Methods: Over 12-weeks, a 17-item online questionnaire was distributed nationally to healthcare professionals involved in skin surgery.

A review of consent policies in Dermatological Surgery in the United Kingdom and the impact of leaner pathways and teledermatology on consent.

Obtaining valid consent is an ethical and legal requirement in clinical practice, ensuring patients are adequately informed about their treatments. Recent updates in consent policies, including GMC guidance, the Patterson inquiry report, and key legal rulings like Montgomery, emphasise a shift towards patient-centred care and the importance of a comprehensive patient-clinician dialogue. Budget constraints and increasing NHS demand have led to the adoption of digital solutions and streamlined pathways, such as teledermatology and direct booking to surgery, potentially compromising the consent process.

Environmental Sustainability in Dermatological Surgery. Part 2: Reducing Activity and Future Ecological Strategies.

This two-part review addresses the pressing need for environmental sustainability in dermatological surgery, driven by the NHS's commitment to net-zero emissions. Part 2 of this review extends the discussion of sustainability in dermatological surgery by focusing on system-wide changes in service delivery and identifying future opportunities for reducing environmental impact. Building on the strategies outlined in Part 1, which explored low-carbon alternatives and operational resource optimisation, Part 2 advocates for a comprehensive shift in the skin surgery service.

Environmental Sustainability in Dermatological Surgery. Part 1: Reducing Carbon Intensity.

This two-part review addresses the pressing need for environmental sustainability in dermatological surgery, driven by the NHS's commitment to net-zero emissions. Part 1 focuses on strategies to reduce the carbon intensity of dermatological procedures by adopting low-carbon alternatives and optimising operational resource usage. Key strategies for a system-wide reduction in environmental impact include using leveraging local suppliers to reduce transport emissions, streamlining care models, promoting efficient waste management, and using mindful prescribing practices.

The natural progression of basal cell carcinomas (BCCs) awaiting surgical intervention.

Basal cell carcinomas (BCCs) are slow growing keratinocyte tumours with limited literature reporting the natural history of untreated BCCs. This study evaluated the natural progression and patient outcomes of BCCs whilst awaiting surgical intervention. Only patients with histologically proven BCCs were included in the data collection.

Appraisal of AI-generated dermatology literature reviews.

Background: Artificial intelligence (AI) tools have the potential to revolutionize many facets of medicine and medical sciences research. Numerous AI tools have been developed and are in continuous states of iterative improvement in their functionality.

Objectives: This study aimed to assess the performance of three AI tools: The Literature, Microsoft's Copilot and Google's Gemini in performing literature reviews on a range of dermatology topics.

Review of infection and bleeding complications in excisional skin surgery.

Skin excision is the primary treatment for skin cancer. Complication rates from skin cancer excision are generally low but rates of complications may vary according to procedural complexity, site and patient factors. It is important that patients are fully informed through the consent process considering individual circumstances, the Montgomery ruling and material risks.

A national clinician survey on the British Society for Dermatological Surgery guidelines on antithrombotic agent use in skin surgery.

Antithrombotic medication is taken by 14-22% patients undergoing skin surgery, with more patients now taking direct oral anticoagulants (DOACs). The latest evidence suggests that the risk of stopping DOACs perioperatively is low in skin surgery, particularly for primary closures, but remains unclear for more complex procedures. The 2016 British Society for Dermatological Surgery (BSDS) guidelines suggest that clinicians could consider stopping DOACs in patients for 24-48 h, based on individual bleeding risk.

Performance of ChatGPT on Specialty Certificate Examination in Dermatology multiple-choice questions.

ChatGPT is a large language model trained on increasingly large datasets by OpenAI to perform language-based tasks. It is capable of answering multiple-choice questions, such as those posed by the Specialty Certificate Examination (SCE) in Dermatology. We asked two iterations of ChatGPT: ChatGPT-3.

A UK-wide study to describe resource consumption and waste management practices in skin surgery including Mohs micrographic surgery.

Background: There is a lack of national guidance specifying how skin surgery, including Mohs micrographic surgery (MMS), should be conducted, leading to a degree of heterogeneity in the set-up of skin surgery services and how skin surgeries are performed.

Objectives: To provide the first UK-wide cross-sectional study reporting real-world data on the set-up and waste management practices of skin surgery, including MMS.

Methods: A UK-wide service evaluation study was conducted between 1 March 2022 and 30 June 2022 using a standardized data collection pro forma.

Skin surgery training: a literature review of methods and their efficacy.

Skin surgery ranges from small biopsies to Mohs micrographic surgery and excisions necessitating complex skin flap design or grafting. For all dermatology doctors in training there is a need to acquire competence to perform skin surgery safely, in an appropriate timeframe and with minimal complication rates. There exist a range of different methods, with varying reliance upon advancing technology, to teach skin surgery and to refine surgical skills before procedures are performed on patients.

International, prospective cohort study comparing non-absorbable versus absorbable sutures for skin surgery: CANVAS service evaluation.

Background: Absorbable or non-absorbable sutures can be used for superficial skin closure following excisional skin surgery. There is no consensus among clinicians nor high-quality evidence supporting the choice of suture. The aim of the present study was to determine current suture use and complications at 30 days after excisional skin surgery.

Local anaesthetics in dermatological surgery: a review of adjuncts and pain reduction techniques.

A variety of adjuncts for local anaesthesia (LA) exists for dermatological surgery, along with many options to reduce the pain of LA. This review aims to summarize the evidence relating to such adjuncts and methods to reduce the pain of LA. Adjuncts to LA can be an important consideration to optimize anaesthetic effect.

A review of the evidence for Mohs micrographic surgery. Part 2: basal cell carcinoma.

Mohs micrographic surgery (MMS) is considered the gold-standard treatment for basal cell carcinoma (BCC) particularly for sites with a high-risk of incomplete excision such as the central face, for tumours with an aggressive growth pattern and consequent unpredictable subclinical extension and for recurrent tumours. However, the process is more time-consuming than for standard excision (SE), and the magnitude of benefit is uncertain. This article aims to provide a more complete picture of current evidence, including a review of cosmetic outcomes, tissue-sparing ability and cost-effectiveness of MMS.

A review of Mohs micrographic surgery for skin cancer. Part 3: Squamous cell carcinoma.

This review presents and discusses the evidence for MMS to treat cutaneous squamous cell carcinoma (cSCC). The MEDLINE, Embase and Cochrane databases were searched; 39 papers were identified for recurrence and 2 papers for cost-effectiveness. We included all clinical trials and observational studies, including retrospective reports, and excluded editorials and systematic reviews or meta-analyses.