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Information from Your Family Doctor
Fusiform Excision Procedure
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Am Fam Physician. 2003 Apr 1;67(7):1553-1554.
What is a fusiform excision biopsy?
The fusiform excision technique is a simple way to remove tumors or growths from the skin or from the tissues below the skin. The word “biopsy” means the removal of tissue for examination under a microscope. This procedure frequently is performed to find out whether a growth is cancerous. The fusiform excision is shaped somewhat like a football—longer in length than width.
Why don't you just cut a circle around the tumor to remove it?
Circular cuts remove less skin than the fusiform excision, but a circle doesn't stitch closed very well. A circle excision will leave elevated skin bunched up at the ends (called dog ears, because the wound looks like the pointed ears on a dog's head). The fusiform excision technique provides a good biopsy tissue specimen and a straight line that usually results in a thin, flat scar.
Are there any complications after this surgery?
Any surgical procedure can result in complications. Bleeding, bruising, or infection can occur in the wound. Despite gentle handling of the skin, the edges of the skin occasionally die and produce a wider scar. Rarely, damage can occur to structures beneath the skin (such as the nerves or arteries). These problems are highly uncommon with this procedure.
Will I feel any pain during this procedure?
Your doctor will numb (anesthetize) the skin under and around the growth before starting the procedure. Every effort will be made to ensure that you will not feel any pain during the procedure. However, you still will have normal feeling in the skin a short distance away from the surgical site. You may feel some tugging of the skin, or even feel the doctor rest a hand on the skin during the procedure. In the rare event that you feel sharp pain, tell your doctor.
Will stitches be needed to close the wound?
Yes. Sutures (stitches) are required to close the wound created by the fusiform excision procedure. Skin sutures are used to improve the scar's final appearance, and they will have to be removed in the days or weeks following the procedure. The timing of skin suture removal varies by body site, and your doctor will tell you when to return. Your doctor may also place absorbable sutures deep inside the wound to control bleeding, but they don't need to be taken out because the body will absorb them.
Following Fusiform Excision Procedure
How to care for a sutured incision
A bandage and some antibiotic ointment will be applied to the incision site. Your doctor may ask you to apply direct pressure with your hand on the bandage covering the incision site. If the bandage becomes bloody, you can replace it with clean, dry gauze or bandage. If the site keeps bleeding, apply direct pressure again for several minutes. This should stop the bleeding. If the wound continues to bleed or bleeds heavily, call your doctor.
You should remove your bandage the day after the procedure. Your doctor may ask you to replace it with a new bandage every day for the next few days. After a few days, most wounds do not need to be bandaged; however, you may decide to wear a bandage to protect your clothing from rubbing the incision site or to absorb any drainage that might occur.
Keep the incision clean and dry for the first 36 hours after the procedure. You should not shower the day of the surgery or the day after the surgery, but you may take a sponge bath. Washing with soap and water is permitted after the second day. Showering is preferred over bathing when you have sutures (stitches) or wound tape covering the incision site. After washing, gently towel-dry the incision site by blotting. Do not rub the site with the towel.
During the healing process, most edges of the incision site become slightly red. Call your doctor's office if the redness increases or extends more than 1/2 inch from the wound. Call your doctor if you have pus from the wound, or if the incision becomes more than mildly tender or painful.
Your doctor may want you to wash the wound gently with soap and water each day after the first 36 hours have passed. Your doctor may ask you to put an over-the-counter (available without a prescription) antibiotic ointment (such as Mycitracin) on the incision. Apply the ointment 2 to 4 times a day until the stitches are removed.
Deep sutures are absorbed by the body and do not need to be removed. Your doctor will remove the sutures that do not absorb. Most skin sutures are taken out in 4 to 21 days, depending on the surgical site. Your doctor will tell you when to return for suture removal.
Your doctor may cover the incision site with skin tape (brand name: Steri-Strips) after the sutures are removed. Skin tape provides extra wound support and reduces tension on the healing wound. The skin tape can be removed 3 to 7 days after it is applied, but it sometimes falls off before this.
Avoid activities that can cause excessive tension (pulling) on your scar. Your doctor may ask you to avoid lifting, straining, or participating in sports for the first month after your surgery.
Call your doctor if the incision site pulls apart.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 2003 by the American Academy of Family Physicians.
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