another method of tie-over dressing for surgical wounds of hair-bearing areas

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© 1999 by the American Society for Dermatologic Surgery, Inc. Published by Blackwell Science, Inc. ISSN: 1076-0521/99/$14.00/0 Dermatol Surg 1999;25:893–894 SURGICAL GEM Another Method of Tie-Over Dressing for Surgical Wounds of Hair-Bearing Areas Alex Ginzburg, MD* and Sharad Mutalik, MBBS, DVD *Department of Dermatology and Dermatologic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Maharashtra Medical Foundation, Pune, India background. We describe a modified tie-over dressing for any kind of surgical wound in the hair-bearing areas. methods. The long ends of the sutures are tied over the gauze pad to secure it. conclusions. This modified technique of tie-over dressing can be utilized for the majority of surgical wounds in hair-bear- ing areas, such as the scalp. The dressing can be removed 1 or 2 days postoperatively by the patients, and the wound can be washed thereafter. The dressing helps ensure hemostasis, is sim- ple to perform, looks tidy, and is well accepted by the patients. DRESSING SURGICAL WOUNDS in hair-bearing areas is cumbersome and difficult, and securing the gauze pad with a turban or barrel bandage is usually insufficient. Several authors have recently reported on the use of the hair itself, with a rubber band, to secure dressings over Mohs surgical wounds. 1 We describe a simple modified tie-over dressing that is applicable for hair-bearing areas such as the scalp. Methods After suturing the subcutis, the wound edges are approxi- mated with either 3-0 or 4-0 nylon or prolene sutures (Fig- ure 1). The sutures are cut at a distance of 6–8 cm from the wound. Antibiotic ointment is applied to the wound and a rolled gauze pad is placed over it. The long ends of the su- tures are then tied over the gauze pad. This acts as a pres- sure dressing and helps to achieve hemostasis. Because the dressing is small, it can be concealed under the hair. After 1 or 2 days, the gauze pad can be removed by the patient by cutting the tied-over knots. Thereafter the wound can be washed. Discussion We believe that this modification of the well-known tie-over dressing may be used for any kind of surgical wound in the hair-bearing areas, such as the scalp. It is easy to perform and is well accepted by the patients. Most patients can wash their hair on the first postop- erative day. Acknowledgments We are grateful for the editorial and secretarial help of Gloria Ginzach and Melanie Kawe. References 1. Langtry JAA, Carruthers A. Hair tie-over dressing. Dermatol Surg 1998;24:679–80. Commentary Anyone performing surgery on the scalp has experienced the dif- ficulty and frustration in bandaging this area. Even bandages placed with the greatest of care have a tendency to come off, are often ineffective as pressure dressings, and are usually quite con- Address correspondence and reprint requests to: Alex Ginzburg, MD, Department of Dermatology and Dermatologic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel. Figure 1. Two tie-over dressings on the scalp after excision of two epidermal cysts.

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Page 1: Another Method of Tie-Over Dressing for Surgical Wounds of Hair-Bearing Areas

© 1999 by the American Society for Dermatologic Surgery, Inc. • Published by Blackwell Science, Inc.ISSN: 1076-0521/99/$14.00/0 • Dermatol Surg 1999;25:893–894

SURGICAL GEM

Another Method of Tie-Over Dressing for Surgical Wounds of Hair-Bearing Areas

Alex Ginzburg, MD* and Sharad Mutalik, MBBS, DVD

*

Department of Dermatology and Dermatologic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and

Maharashtra Medical Foundation,

Pune, India

background.

We describe a modified tie-over dressing forany kind of surgical wound in the hair-bearing areas.

methods.

The long ends of the sutures are tied over the gauzepad to secure it.

conclusions.

This modified technique of tie-over dressing

can be utilized for the majority of surgical wounds in hair-bear-ing areas, such as the scalp. The dressing can be removed 1 or 2days postoperatively by the patients, and the wound can bewashed thereafter. The dressing helps ensure hemostasis, is sim-ple to perform, looks tidy, and is well accepted by the patients.

DRESSING SURGICAL WOUNDS in hair-bearingareas is cumbersome and difficult, and securing thegauze pad with a turban or barrel bandage is usuallyinsufficient. Several authors have recently reported onthe use of the hair itself, with a rubber band, to securedressings over Mohs surgical wounds.

1

We describe asimple modified tie-over dressing that is applicable forhair-bearing areas such as the scalp.

Methods

After suturing the subcutis, the wound edges are approxi-mated with either 3-0 or 4-0 nylon or prolene sutures (Fig-ure 1). The sutures are cut at a distance of 6–8 cm from thewound. Antibiotic ointment is applied to the wound and arolled gauze pad is placed over it. The long ends of the su-tures are then tied over the gauze pad. This acts as a pres-sure dressing and helps to achieve hemostasis. Because thedressing is small, it can be concealed under the hair. After 1or 2 days, the gauze pad can be removed by the patient bycutting the tied-over knots. Thereafter the wound can bewashed.

Discussion

We believe that this modification of the well-knowntie-over dressing may be used for any kind of surgicalwound in the hair-bearing areas, such as the scalp. It is

easy to perform and is well accepted by the patients.Most patients can wash their hair on the first postop-erative day.

Acknowledgments

We are grateful for the editorial andsecretarial help of Gloria Ginzach and Melanie Kawe.

References

1. Langtry JAA, Carruthers A. Hair tie-over dressing. Dermatol Surg1998;24:679–80.

Commentary

Anyone performing surgery on the scalp has experienced the dif-ficulty and frustration in bandaging this area. Even bandagesplaced with the greatest of care have a tendency to come off, areoften ineffective as pressure dressings, and are usually quite con-

Address correspondence and reprint requests to: Alex Ginzburg, MD,Department of Dermatology and Dermatologic Surgery, Rabin MedicalCenter, Beilinson Campus, Petah Tiqva 49100, Israel.

Figure 1. Two tie-over dressings on the scalp after excision of twoepidermal cysts.

Page 2: Another Method of Tie-Over Dressing for Surgical Wounds of Hair-Bearing Areas

894

ginzburg and mutalik: another method of tie-over dressing

Dermatol Surg 25:11:November 1999

spicuous. One way of circumventing some of these problems isto use the hair adjacent to the wound to secure the bandage. Arubber band can be used to bind the hairs together

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or, in pa-tients with long enough hair, the hairs can be tied together to se-cure the dressing. In this issue, Ginzburg and Mutalik describeyet another approach somewhat akin to the bolster dressingused to secure skin grafts. The same sutures used to close thewound are left long and used to tie on a small dressing whichthe patient can easily remove in a few days. This techniquemeets most if not all the criteria for an ideal surgical dressing, ie,it is secure, neat and provides pressure. It takes little imaginationto see how this technique could be adapted to temporary dress-ings for Mohs surgical defects in between stages of surgery. In

terms of the technique, the only modification that comes tomind could be to close the surgical defect in a routine fashionand then use the least expensive suture possible to tie over thedressing. Such a modification hopefully would result in the useof less suture and also save money.

Pearon Lang, MD

Charleston, South Carolina

Reference

1. Langtry JAA, Carruthers A. Hair tie-over dressing. Dermatol Surg1998;24:679–680.