DS11 Excising lesions on the scalp and temple: a technique to minimize intraoperative haemorrhage

Abstract Surgical excision of lesions located on the scalp and temple can present a challenge due to the potential for substantial intraoperative haemorrhage, especially when operating in close proximity to major blood vessels such as the temporal artery and its branches. We present a surgical pearl that aims to minimize bleeding during surgical excision, allowing for enhanced wound bed visualization, and reduction of associated risk to staff from arterial spray. This technique uses deep epidermal sutures for pre-emptive haemostasis before knife to skin. Preoperative epidermal vessel ligation has been reported previously, although not in this exact context, making this pearl a useful addition to the existing knowledge base and a valuable reminder of its utility. Once local anaesthesia has been achieved, a deep epidermal absorbable suture is placed over and under the artery or arteriole proximal to the lesion. The artery is identified by palpation prior to the procedure, and its path may be marked out and predefined. The aim is to temporarily constrict or ligate the vessel before making an incision. The surgeon should aim to introduce the suture needle 1–2 mm away from the palpated edge of the artery, passing the needle deep and under the vessel, exiting the epidermis on the opposite side. The suture is tied off and cut, and an additional suture may be placed as required. We employ a similar technique for extirpating scalp tumours. A deep epidermal continuous ‘purse string’ suture is placed approximately 5 mm distal in a perimeter around the proposed margin of excision (and then tied) before making an incision. This approach helps achieve the same desired outcome of preoperative vessel ligation. For scalp excisions, the sutures are left in situ. For temporal artery ligation, sutures can either be left in place or removed once the procedure is complete, depending on surgeon preference. While this procedural technique is unlikely to provide complete haemostasis, it often permits sufficient reduction in haemorrhage to facilitate easier wound bed visualization. This allows rapid identification of transected vessels, and minimizes the risk of excessive arterial spray, thus enhancing the overall efficiency and safety of the surgical procedure.