Curettage

Fig. 11.1

Holding the curette improperly. (a). Gripping the instrument with a fist. (b) Holding the curette at too steep an angle to the tissue

Solution

Hold the curette like a pencil, blade-side facing the lesion (Fig. 11.2).

Fig. 11.2

Holding the curette properly. (a) Gripping the instrument like a pencil. (b) Holding the curette at a more acute angle to the tissue

Accidents Happen When

The lesion is not fully treated due to improper positioning of the hand or the curette.

Solution 1

Start with curette blade at the center of the lesion (Fig. 11.3a). Extend radially in the direction of the curette handle, going beyond the lip of the defect (Fig. 11.3b). Each subsequent stroke should be adjacent to the previous stroke (Fig. 11.3b).

Solution 2

Change position of body (Fig. 11.3a, b) to avoid awkward crossing of hands.

Solution 3

For larger circles, treat missed arcs by starting at the half-radius point from the center to get between the rays that originated at the center of the circle (Fig. 11.3c).

Fig. 11.3

Correct curettage technique. (a) Curette starts at center of the lesion, flush with the skin. (b) Iterative adjacent radial strokes systematically treat the entire area. Note change of hand position to maintain surgeon comfort. (c) Skipped arcs (non-red) will be treated with subsequent passes

Accidents Happen When

A tumor is not curetted fully from the underlying normal dermis. Electrosurgery of cancerous tissue is less likely to achieve full hemostasis. Pooling of blood and splatter may occur.

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