Minor Surgical Procedures (Blades and Radio - Waves) Jason D. Duncan, OD, FAAO jduncan@sco.edu I. Introduction and objectives II. Medico legal a. Standard of care b. State laws c. Informed consent i. Available treatments ii. Observation as a treatment iii. Potential risks iv. Potential benefits d. Documentation III. Safety concerns a. OSHA review i. PPE 1. Gloves 2. Shields ii. Hand washing iii. Sharps containers iv. Biomedical waste disposal v. Equipment sterilization b. Asepsis c. Emergency preparedness i. Crash cart ii. Anyphylaxis review 1. Signs 2. Symptoms 3. Medications a. Amounts b. Delivery methods c. Side effects IV. Anesthesia review a. Topical anesthetic review i. Pharmacology ii. Medications available 1. Usage 2. Potential CI 3. Costs b. Local anesthetic review i. Pharmacology ii. Medications available
1. Usage 2. Potential CI 3. Costs V. Injection basics a. Syringe review i. Components 1. Barrel sizes b. Needle sizes/gauge review c. Types of injections to be covered i. Infiltrative/subcutaneous 1. Purpose of injection 2. Medications used 3. Techniques reviewed ii. Intralesional 1. Purpose of injection 2. Medications used 3. Techniques reviewed iii. Intramuscular 1. Purpose of injection 2. Medicaitons used 3. Techniques reviewed VI. Common lesions reviewed a. Benign lesions i. Papilloma 3. Non surgical treatment options 4. Surgical treatment options a. Scissors/blade i. Equipment ii. Techniques iii. Pre op 2. Asepsis 3. Anesthesia a. Topical i. Lidocaine ii. Brief pharmacology review iii. Amount b. Local i. Lidocaine + epinephrine ii. Brief pharmacology review iii. Amount
iv. Delivery method iv. Techniques v. Post op 2. Instructions vi. Follow up visit b. Radiofrequency surgery i. Equipment needed 1. Main unit 2. Attachments ii. Pre op 2. Asepsis 3. Anesthesia a. Topical i. Lidocaine b. Local i. Lidocaine + epinephrine iii. Techniques 1. Videos iv. Post op 2. Post op instructions v. Follow up visit vi. Coding and billing ii. Meibomian inspissation 2. Non surgical management a. Heat b. Medication i. Antibiotic 1. Oral 2. Topical ii. Lid wipes iii. Steroidals 1. Topical 3. Surgical management a. Probing i. Maskin probe 2. Anesthetic a. Topical 3. Pre op a. Asepsis
b. Informed consent 4. Technique 5. Post operative a. Medications b. Instructions 6. Follow up visit 7. Coding and billing iii. Trichiasis 2. Non surgical management 3. Surgical management a. Informed consent b. Epilation c. Radiofrequency surgery i. Pre op 1. Asepsis 2. Anesthetic a. Local b. Topical ii. Technique iii. Post op 2. Instructions iv. Follow up visit v. Coding and billing iv. Hidrocystoma a. Apocrine b. Eccrine 2. Non surgical management 3. Surgical management a. Needle/blade drainage i. Informed consent ii. Equipment iii. Pre op 1. Asepsis 2. Anesthetic a. Local b. Topical iv. Technique 1. Video 2. Pictures
v. Post op 2. Instructions vi. Follow up visit vii. Coding and billing v. Cysts of Zeiss a. Epidermoid cyst 3. Non surgical management b. Heat 4. Surgical management a. Equipment i. Blade ii. Cotton applicators iii. Gauze b. Pre operative i. Informed consent ii. Asepsis iii. Anesthetic 1. Local 2. topical c. Technique i. Picture ii. Video d. Post op i. Medications ii. Instructions e. Follow up visit f. Coding and billing vi. Epidermoid cysts 2. Non surgical management 3. Surgical management a. Equipment needed b. Pre op i. Informed consent ii. Asepsis iii. Anesthetic 1. Local 2. Topical c. Technique
i. Picture ii. Video d. Post op i. Medications ii. Instructions e. Follow up visit f. Coding and billing vii. Conjunctival lymphangiectasia 3. Non surgical management b. Steroids i. Topical 4. Surgical management a. Needle drainage i. Pre op 2. Asepsis 3. Anesthetic a. Topical ii. Technique iii. Post op 2. Instructions iv. Follow up visit v. Coding and billing viii. Chalazion 1. Differentials a. Hordeolum b. Sebaceous cell carcinoma c. Lipoma d. Tarsal plate 2. Non surgical treatment options a. Supportive b. Topical c. Oral d. Intralesional injection i. Rule of 6 ii. Medications 1. Kennalog 2. Depo Medrol 3. Amount of medication given iii. Asepsis
iv. Technique 3. Surgical options a. Incision and curettage/drainage i. Equipment needed 1. Surgical tray a. Medication b. Sterile gauze c. Cotton tip applicators d. 11 gauge blade e. Clamp f. Curette g. Tape h. Eye pads i. Syringe j. Local anesthetic k. Alcohol pads l. Cautery stick ii. Pre op 2. Asepsis 3. Anesthesia a. Local i. Lidocaine + epinephrine ii. Brief pharm review iii. Amount iv. Potential complications b. Topical i. Lidocaine ii. Delivery methods iii. Procedure 1. Techniques a. Videos iv. Post op 1. Hemostasis 2. Medication depot a. Combo ointment 3. Pressure patch 4. Post op instructions v. Follow up visit vi. Coding and billing b. Radiofrequency incision and drainage i. Equipment ii. Review pre op and post op iii. Technique
1. Video iv. Follow visit v. Coding and billing ix. Dermolipoma 3. Management b. Surgical referral x. Molluscum 2. Treatment options a. Non surgical b. Surgical i. Radiofrequency surgical ablation 1. Equipment needed 2. Pre op a. Informed consent b. Asepsis c. Anesthesia i. Topical ii. Local 3. Procedure a. Techniques 4. Post op a. Medication b. Post op instructions 5. Follow up visit 6. Coding and billing b. Malignancies i. Basal cell carcinoma 3. Management options ii. Squamous cell carcinoma 3. Management options iii. Conjunctival intraepithelial neoplasia 3. Management options iv. Sebaceous cell carcinoma
VII. 3. Management options Concluding remarks a. Questions