Atlas of Primary Care Procedures - download pdf or read online
By Thomas J. Zuber MD MPH MBA, E. J. Mayeaux Jr MD
Atlas of fundamental Care Procedures is a complete, hands-on source at the scientific systems most ordinarily played in an place of work environment. The textual content provides practitioners with step by step directions for acting greater than 70 systems. greater than seven-hundred photographs absolutely illustrate every one approach. Plus, universal pitfalls are mentioned in addition to ideas to prevent them while appearing definite methods. each one bankruptcy contains: ordering details for worthwhile fabrics or apparatus, CPT codes, and standard charges for every procedure.
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Additional resources for Atlas of Primary Care Procedures
Baltimore: Williams & Wilkins, 1999. Zuber TJ. Punch biopsy of the skin. Am Fam Physician 2002;65:1155–1158, 1161–1162, 1164, 1167–1168. Zuber TJ. Skin biopsy techniques: when and how to perform punch biopsy. Consultant 1994; 34:1467–1470. ; Mayeaux, E. J. Title: Atlas of Primary Care Procedures, 1st Edition C opyright ©2004 Lippincott Williams & Wilkins > Table of Contents > Dermatology > 11 - Shave Biopsy 11 Shave Biopsy Shave biopsy is one of the most widely used procedures performed in primary care practice.
1) Small lesions can be removed with sharp iris scissors. PITFALL: The scissors must be flush with the skin surface to prevent leaving a residual stump, but no extra skin should be included within the scissor blades to prevent unintentional cutting of surrounding skin. For removal of a flat (sessile) lesion, local anesthetic is placed beneath the lesion in subdermal and intradermal locations (Figure 2A). The fluid raises the lesion upward, allowing easier removal (Figure 2B). Administration of local anesthetic thickens the skin, making it less likely that the shave will penetrate the dermis into the subcutaneous fat (Figure 2C ).
Physicians should be aware of the underlying anatomy when performing a punch biopsy. C ertain areas of the body where there is little subcutaneous tissue pose the greatest threat of damaging underlying structures such as arteries, tendons, or nerves. Punch biopsy on the upper cheek can damage the facial or trigeminal nerves, and punch biopsy of the lateral digits or of the thin eyelids should be approached with great caution. , trephine) has a plastic, pencil-like handle and a circular scalpel blade.