Surgical pearl: The use of endarterectomy scissors in dermatologic surgery

Abstract

Surgical scissors are a necessary component of the surgical tray. It is optimal to maintain one plane of cutting or dissection when excising a lesion or undermining tissue. This is particularly important when removing a melanoma, large lesion, or Mohs micrographic surgery layer. Traditionally iris, gradle, and Stevens tenotomy scissors have been the preferred instruments for cutaneous surgery in small shallow areas. These instruments accommodate more delicate anatomic areas well. Many dermatologic surgeons use Metzenbaum or Mayo scissors when undermining larger, deeper defects and cutting thicker, more resilient skin (such as that on the scalp, back, or extremities). These scissors have a longer shank and tips than the aforementioned instruments and are more efficient in cutting and manipulating deeper tissue and larger lesions. In certain situations, however, their long tips may feel clumsy and provide less precise cutting and undermining. When used to cut the subcutaneous tissue, these scissors tend to catch a nodule of fat deep in the defect instead of maintaining a level, even cutting surface through the fat.