Dermatological Surgery Unit
1- Ibrahim Al-Aradi (Consultant)
2- Eman Al-Masri (Consultant)
3- Nadia Al-Naki (Specialist)
4- Anwar Al Sumait (Specialist)
5- Sara Al-Misallam (Senior Registrar)
6-Tareq M. Karam (Registrar)
7-Ahmed Fekri (Registrar)
The unit is under supervision of a Consultant Dermatologic Surgeon (Dr Ibrahim Al-Aradi) and is helped by:
· Consultant, Dr Iman El-Masry)
· Specialist (Dr Anwar Al Sumait, and Dr Nadia Al Naki), Senior Registrar (Dr Sarah Al Musallam).
· Registrars (Dr Tariq Karam) and Dr Ahmed Fikri)
· Doctors are helped by trained nurses.
The unit works on daily basis as follows:
· Sunday : Dr Ibrahim Al-Aradi, Dr Tariq Karam
· Monday : Dr Ibrahim Al-Aradi and Dr Ahmed Fekri.
· Tuesday : Dr Ibrahim Al-Aradi, and Dr Nadia Al Naki, Dr Sarah Al Musallam
· Wednesday : Dr Ibrahim Al-Aradi, and Dr Tariq Karam, (Mohs microscopic surgery)
· Thursday : Dr Ibrahim Al-Aradi, Dr Iman El Masry , Dr Anwar Al Sumait, and Dr Sarah Al Musallam.
The unit has one room for major procedures, one room for some minor procedures, and one room for preparing the patients for surgery.
The Staff nurse helping the dermatology surgeons are: Praba Haris and Staff nurse Joby Thomas
The unit receives surgical consultations from all dermatology centers in Kuwait and AlBabtain center, and other senior specialists from other specialties.
Working days schedule
Procedures under L/A
· resistant wart surgery
· acne scaring corrective surgery (subcision, excision, dermabrasion)
· chemical peeling for xanthelesma,
· excision of benign tumors etc
· keloid injection
· Hair clinic and general skin biopsies
· General skin biopsies and procedures
· Mohs micrographic surgery for malignant tumors
· Excision of malignant tumors with postoperative flaps & grafts repairs
· Surgical treatment of keloids & adjuvant therapy
· Vitiligo punch transplant surgery
· General skin biopsies
· Doctors from the department or from other dermatology departments who are interested to attend the surgical procedures are permitted to do so according to a time schedule that changes every 3 months and after approval of the Head of the Dermatologic Surgery unit.
· Doctors who want a clinical attachment in the Surgery Unit should follow a certain protocol (Appendix 37b). The doctor has to apply a special form (Appendix 37c), and upon approval of his rotation, the doctor has to use a log book (Appendix 37d). A final report (Appendix 37e) about the performance of the doctor during the attachment will be put by the person-in-charge of the Dermatosurgery Unit.
· Unit receives urgent requests for skin biopsies from hospitals at Sabah area in-patient’s and OPD at As’ad Al Hamad center from at least senior registrar. Otherwise the patients will be assessed as urgent matter by the pathologist and the derm surgeon.
· Any patients who referred from other dermatologists from Kuwait for skin biopsy, should have the skin biopsy pathology request with the patient in order to be seen directly by the derm surgery unit and pathology staff, otherwise if the referring dermatologist wrote a regular consultation letter, that patient will be directed to the OPD at Asa’ad Al Hamad to be assessed by the dermatologist first then fill the skin biopsy pathology request in order to be seen by the derm surgery and pathology unit
· Any patient on Aspirin, Plavix can get skin biopsy without stopping it. Any patients on Warfarin, INR should be therapeutic before 48 hours (INR 2-3). Major procedures like Mohs surgery, the surgeon will decide whether to hold anticoagulants or not before surgery. If platelets are under 20,000, then skin biopsy should be postponed until its more than that level, otherwise the hematologist should transfuse FFP and platelets.
· Diabetic patients should check their blood sugar at the derm surgery unit, with our glucometer, if they refused to do so or if the patient insisted to do the biopsy without checking or the derm surgeon wants to do the procedure in spite of high blood sugar, the patient should be aware for any complication and sign a consent.
· The referring Doctor at As’ad AlHamad has to open a file for each patient that belongs to our catchment area before doing a skin biopsy and filling the request form for dermatopathology (appendix 4)
· The derm surgeon will open a file if the patient is referred from other specialist
· Photography is obligatory for selected cases
· Nurse will do assessment and give the patient a questionnaire to fill (appendix15B), and measure vital signs
· Patients booked for Mohs surgery will be handed information sheet and consent (Appendix 15C)
· Consent will be signed by the patient before any procedure MR5 ( appendix 30)
· The group of dermatopathologist and the derm surgeon will assess the patient to get the clinico-pathological correlation
· Surgical check list will be attached to file (appendix 30B) and MR10 ( appendix 30 A)
· The results of the biopsy will take 7-14 days, the patient will get the results from the dermatopathology unit.
· Unit members meet every 6 months to improve work
The surgical check list protocol as follows:
“Time out” immediately before starting the procedure, Time out should be conducted in the OP/ procedure room before the incision. It should involve the entire operative team, use active communication, be briefly documented, such as in a check list
a. The correct patient identity ( triple name and CID, and match them to the specimen bottle and request form)
b. Correct side and site ( match identity and site if multiple specimens)
c. Agreement on the procedure to be done (MR5)
How to do it:
· Make the mark at or near the incision site. Do not mark any non operative site(s).
· The mark should be unambiguous, Do Not use X on the site.
· The mark should be positioned to be visible after the patient is prepped and draped.
· The mark should be made using a marker that is sufficiently permanent to remain visible after completion of the skin prep. Adhesives site markers should not be used.
· The method or marking should be consistent through out the organization.
· The marking should be made by individual that is familiar with the patient and is involved with the patient procedure. This individual is encouraged to be the surgeon or individual permitted through residency program to participate in the procedure.
· Marking should take a place with the patient involved, wake and aware, If possible.
· Final verification of the site mark should take a place during Time Out.
· Exception: Cases in which the individual doing the procedure is in continuous attendance with the patient from the time of decision to do the procedure and consent from the patient though to the conduct of the procedure may be exempted from the site marking requirement. The requirement for TIME OUT final verification still applies.
Equipment at the Dermatologic Surgery Unit:
1- Elman Surgitron equipments (1)
2- Diathermy equipments (Hyfrecators 2000) 2 machines
3- Surgical tools for minor surgeries done under local anesthesia. 18 biopsy sets.
4- CryoLab Container and Gun (2)
5- Electrosurgery Vacuum Machines (2)
6- Examination (Operation) Tables (4)
7- Examination (Table) Lights (3)
8- Emergency trolley with Defibrillator (1)
9- Magnifying light (2)
10- Suction apparatus (1)
11- O2 cylinder with flow meter (1)
12- Examination Dental chairs (1)