Week Three - Questions

Question 1

What issues does informed consent imply that the patient completely understands?

Answer 1

• The nature of the treatment
• All material risks for the treatment
• The possibility of risk(s)
• Alternative treatment(s) available and associated risks of those treatments
• Consequences of going untreated

Question 2

What does PARQ mean?

Answer 2

• Procedure: a description of the proposed procedure, how it is to be done with as much detail as the patient wants or desires
• Alternative: a description of any and all alternatives (and their risks) to doing the procedure this way (i.e. homeopathy as an alternative to surgery, etc…)
• Risk: a description of any and all possible risks associated with this procedure (i.e. infection, hypopigmentation, etc…)
• Questions: let the patient ask questions about the procedure; write down their questions and the your answer to the questions in the chart

Question 3

How do you use PARQ for “informed consent?”

Answer 3

• To explain the alternatives and risks of the procedure
• Chart that you discussed PARQ with the patient
• It’s best to have a written informed consent and an oral PARQ with the patient prior to surgery

Question 4

*What should you include (and not include) in the Procedure Note portion of the MS report?

Answer 4

• SOAP note
  > Detailed procedure description
  > Justifies the procedure (insurance will want)
• Pre-operative diagnosis
• Describe skin prep used, record the amounts of anesthesia and bicarbonate mixed and used
• Describe the suture type(s), size(s), location, and number
• List the duration of the procedure and the amount of blood lost
• If using epic: remove any unused procedure’s wording
• Indicate if an oral PARQ was done
• Write a brief description of the actual procedure
  > Do NOT include the details already recorded in the upper sections of the form
• Include as much detail as possible, especially if the procedure is complicated
• Indicate how well the patient tolerated the procedure
• Some physicians include an “operative report” with more extensive narrative

Question 5

What is a “free margin” on a pathology report?

Answer 5

• That means that there were no pathological cells present at the edge of the resected area
• Ideal is “free and clear”
• If it isn’t “free and clear,” then you must go back and cut out the rest of the pathological cells

Question 6

What is “dead space?”

Answer 6

• Large open space inside a deep wound (ex. after removing a lipoma)

Question 7

What is undermining?

Answer 7

• Using a tool to separate the skin and subcutaneous tissues in order to free the wound edges for better/easier closure
• Can use surgical blade or sharp iris scissors
• Blunt dissection is preferred so as to not damage nerves or blood vessels
• Should undermine each side 1/2 the length of the incision
• If wound edge tension persists, undermine further before sututring

Question 8

Why is undermining important?

Answer 8

• It allows the skin to slide over the subcutaneous tissue more easily and stretch enough to close the opening with less tension, resulting in less scarring

Question 9

How do you remove sutures?

Answer 9

• Grasp one end of the suture or knot, shift it back and forth to free it up so you can clearly see where to make your cut
• Cut the suture with a scissors or scalpel blade and pull the freed knot across the suture line
• Pulling the suture out in this manner helps reduce wound “stress” and helps avoid dehiscence

Question 10

What are the four reasons for/advantages of using the Subcutaneous Suture (Buried Stitch)?

Answer 10

• Provide wound stability
• Close dead space
• Help to evert the edges
• Relieve tension on the wound edges

Question 11

*What type of subcutaneous suture would you typically use?

Answer 11

• Upward knot placement for deep wounds

- Buried knot placement for dermal wounds