Punch Incision with Secondary Healing (PISH) Technique for Benign Facial Lesions: An Institutional Experience in 307 Patients

Sudeep Pradeep Yadav; Chandrakant Rambhau Gharwade; Gayatri Nagindas Khatri

doi:10.1055/s-0041-1731257

Indian Journal of Plastic Surgery, Table of Contents

CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(02): 138-143
DOI: 10.1055/s-0041-1731257

Original Article

Punch Incision with Secondary Healing (PISH) Technique for Benign Facial Lesions: An Institutional Experience in 307 Patients

Authors

Sudeep Pradeep Yadav

¹Department of Plastic & Reconstructive Surgery, Balaram Building, Grant’s Government Medical College & Sir J.J. Group of Hospitals, Sir J.J. Marg, Mumbai, Maharashtra, India
Chandrakant Rambhau Gharwade

¹Department of Plastic & Reconstructive Surgery, Balaram Building, Grant’s Government Medical College & Sir J.J. Group of Hospitals, Sir J.J. Marg, Mumbai, Maharashtra, India
Gayatri Nagindas Khatri

²Department of Dermatology and Cosmetology, Khatri Clinic, Pune Camp, Pune, Maharashtra, India

Abstract

Background Multiple or solitary facial lesions pose a unique challenge to the attending surgeon in terms of delivering the best cosmetic outcome. There are various methods in dealing with them and the preference of using them is based on the surgeon’s experience, patient expectations, and availability of instruments. One such tool, skin-punch, primarily designed for a biopsy can play a very important therapeutic role in this era of keyhole surgery. In this paper, we assess the technique of punch incision with its combination of secondary healing for various facial lesion.

Methods This observational study, a total of 307 patients with solitary or multiple benign facial lesions were treated with punch incision technique using 2 to 6 mm sterile, disposable skin biopsy punches. Subsequently, the wounds were managed with healing with secondary intention.

Results In our series all superficial wounds epithelized by 7 to 14 days while the deeper lesions epithelized by 14 to 28 days. We had three recurrences which were managed by fusiform excision and one patient had surgical site infection which was managed conservatively. On application of our self-devised facial scar scoring system (SCAR or Scar Cosmesis Assessment and Rating)³ on all the scars, the mean score was 6 at 1 year followup.

Conclusion Punch incision with healing by secondary intention is a relatively easy, effective, single-stage office procedure. This method can be considered as an alternative method for the removal of various skin lesions, especially on face, thus providing a simple solution to complex problems.

Keywords

punch incision - healing by secondary intention - facial lesions - skin biopsy punch - PISH - SCAR

Full Text

References

References
1 Ngaage M, Agius M. The psychology of scars: a mini-review. Psychiatr Danub 2018; 30 (07) 633-638
2 De Sousa A. Psychological issues in acquired facial trauma. Indian J Plast Surg 2010; 43 (02) 200-205
3 Heffelfinger R, Sanan A, Bryant LM. Management of forehead scars. Facial Plast Surg Clin North Am 2017; 25 (01) 15-24
4 Lima M. The Book of Circles: Visualizing Spheres of Knowledge. New York, NY: Princeton Architectural Press 2017
5 Jin W, Jin S, Li Z, Jin Z, Jin C. Second intention healing of nasal ala and dorsum defects in Asians. J Dermatolog Treat 2019; 1 (04) 1-4
6 Lee HE, Yang CH, Chen CH, Hong HS, Kuan YZ. Comparison of the surgical outcomes of punch incision and elliptical excision in treating epidermal inclusion cysts: a prospective, randomized study. Dermatol Surg 2006; 32 (04) 520-525
7 van der Eerden PA, Lohuis PJFM, Hart AA, Mulder WC, Vuyk H. Secondary intention healing after excision of nonmelanoma skin cancer of the head and neck: statistical evaluation of prognostic values of wound characteristics and final cosmetic results. Plast Reconstr Surg 2008; 122 (06) 1747-1755
8 Lam TK, Lowe C, Johnson R, Marquart JD. Secondary intention healing and purse-string closures. Dermatol Surg 2015; 41 (10) S178-S186
9 Borges A. Linear scar revision techniques. In: Borges AF, Monroe C, eds E lective Incisions And Scar Revision. 1st ed. Boston: Little, Brown and Co 1973; 35-60
10 Zitelli JA. Wound healing by secondary intention. A cosmetic appraisal. J Am Acad Dermatol 1983; 9 (03) 407-415
11 Chadwick S, Heath R, Shah M. Abnormal pigmentation within cutaneous scars: a complication of wound healing. Indian J Plast Surg 2012; 45 (02) 403-411
12 El M Alami, Ghufoor K, Dilkes M. Laser marsipulization of epidermal cysts: avoiding linear scars. J Clin Laser Med Surg 2003; 21 (03) 161-163
13 Funayama E, Oyama A, Furukawa H, Hayashi T, Sugino M, Yamamoto Y. A new modified technique for removing epidermal cysts using a trepan in one stage with a smaller postoperative scar and no recurrence. Dermatol Surg 2010; 36 (12) 2050-2052
14 Kim KT, Sun H, Chung EH. Comparison of complete surgical excision and minimally invasive excision using CO2 laser for removal of epidermal cysts on the face. Arch Craniofac Surg 2019; 20 (02) 84-88
15 Shah S, Alster TS. Laser treatment of dark skin: an updated review. Am J Clin Dermatol 2010; 11 (06) 389-39