Journal of the Dermatology Nurses' Association:
DEPARTMENTS: What's on Your Surgical Tray?
Reams, Carol A.
Carol A. Reams, BHS, RN, CNOR, Dermatology Associates of Kentucky, Lexington, KY.
No funds have been received for this work.
The author declares no conflict of interest.
Correspondence concerning this article should be addressed to Carol A. Reams, BHS, RN, CNOR, 222 Country Lane, Frankfort, KY 40601. E-mail: email@example.com
This column represents the second in a series of columns that will improve the dermatology nurse’s competency with different surgical instruments. In addition, it provides information regarding the identified instrument’s historical significance and clinical applications.
Which surgical instrument used in dermatology can claim the award for being most versatile? The dermal curette achieves this honor and has been described by some dermatologists to be as valuable as the thumb on their hands.
Curettes are not only used for diagnostic purposes, such as performing biopsies of skin lesions, but are considered important tools for the therapeutic treatment of superficial neoplasms, such as basal cell carcinoma (Madan & Dawn, 2007). These understated, yet effective, instruments have been used by multiple surgical specialties for hundreds of years (Kirkup, 1985). It is not uncommon for curettes to be found on the surgical instrument trays of orthopedics, gynecology, and otolaryngology specialists.
The origin of the term “curette” can be traced to mid-eighteenth century France from curer, which means to cure, and ette, which denotes small or diminutive in size. It is defined as a surgical instrument that has a sharp scoop, ring, or loop at the distal tip of a handle (Encyclopaedia Britannica, 2013).
Dr. Richard von Volkmann, a German surgeon and professor during the 1800s, is recognized for introducing the curette into the practice of dermatology as an alternative to a surgical knife. In addition, he is credited for the invention of a popular hand-held surgical retractor known as the Volkmann retractor (Wigglesworth, 1876; Willy, Schneider, Engelhardt, Hargens, & Mubarak, 2008).
Curettes may be chosen by dermatologists to remove superficial epidermal lesions such as small benign skin tags (Henry, 2012). Various sizes, shapes, weights, and compositions are available, depending on the preference of the practitioner. Their sizes are numbered according to the diameter of the instrument’s ring, which may be round or in oval shape. When selecting an appropriate curette for a surgical procedure, the actual size and location of the identified lesion is important. For instance, a 2-mm curette may be the preferred choice for smaller lesions, whereas a 5-mm curette may be chosen for larger lesions (Figure 1).
The most commonly used dermal curettes are reusable stainless steel instruments. These surgical tools are cleaned and sterilized between patients and typically result in cost savings for the clinical setting. However, single-use, disposable curettes are available as a convenience because they are prepackaged as sterile and discarded after use. The dermal curette is held like a pencil with the sharp side of the ring-shaped tip angled downward upon the skin. The correct technique results from a dorsal flexion motion of the wrist (pulling-down) in a linear or curvilinear fashion to scrape the skin’s surface.
The versatility of a curette is apparent from its use in treating selected nonmelanoma skin cancers as well as benign lesions. Superficial skin cancers, such as primary basal cell and noninvasive squamous cell carcinoma, in some instances, may be effectively treated by performing electrodessication and curettage (Preston & Stern, 1992). A curette is used first to scrape the surface of the lesion down to its base. Then, an electrosurgical device is used to destruct the base of the tumor while also providing hemostasis. This procedure may be repeated multiple times to accomplish tumor removal (Anthony, 2000).
In addition, the surgical excision procedure can benefit from the use of a curette because of its ability to help the surgeon define margins between normal and abnormal tissues. Even the Mohs surgeon frequently utilizes a curette for tumor debulking of skin cancers prior to removing layers for microscopic examination (Shriner, McCoy, Goldberg, & Wagner, 1998).
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