Dr. Geoff Butler

Squamous Cell Cancers are the second most common skin cancers so they are relatively common. Their metastatic rate is quite low but still, significantly higher than basal cell cancers. This case was interesting because it showed what cartilage looks like when you run into it. This area will heal well, but in particular because it revealed SCC this will be referred for additional treatment.

Link to watch on Facebook: https://www.facebook.com/61550652328626/videos/316919080945275/?mibextid=zDhOQc Doing facial procedures certainly demand a little more attention to detail but you can have really good results when things have a chance to heal. I've attached two follow up videos and while you can still appreciate a line where the surgery was, I think that if you weren't aware that something had been done, your eye wouldn't be drawn to that area. Anyway, feel free to comment. Take care.

It is hard to work in this area at the best of times but when there has already been an attempt to remove something, you'll also have to deal with scar tissue, which is never easy. However, so long as you progress slowly and consistently things shouldn't be overly complicated. Regrettably, the anaesthesia at the posterior aspect of this lesion wasn't great and despite adding extra, the hyfrecation was still uncomfortable for the patient. Had I needed to do extra work in that area, I would have had to do additional blocks of some kind before I progressed. This healed nicely and without incident.

Please follow Dr. Butler on Facebook: https://www.facebook.com/profile.php?id=61550652328626 The main reason for posting anything like this is to encourage medical personnel to consider that this could be cancerous. Two things typically have this growth pattern. The much more common verruca (or wart) or an underlying cancer. When something presents that is this extensive I'd encourage everyone to do a biopsy as this rapid level of growth is a bit unusual. Thankfully this did turn out to be viral (or warty) in origin and we'll have to follow this up with further treatments.

To comment your questions or join our Facebook community view here: https://fb.watch/nsfqkex7Xr/ This is an established saying that has a deeper meaning but on its surface, it’s a lot like taking out foreign bodies. What seems like a small puncture can simply be a hint of a much larger fragment buried deeper in the tissues. As long as there is a track to open up and you can feel where the offending foreign body may be, then you have a chance. This went on to heal without complication.

This is the second one of this format so you'll have to let me know whether you find this worthwhile or interesting at all. I find it interesting to see what I've done well and also see where I've come up short. Overall the procedures get accomplished but there is always room to be more polished or attentive.

Pilar cysts are the perfect ones to 'learn' on if you are a resident or just getting back into doing procedures. The current 'Dr. Jane' that I'm working with had assisted on a number of these but this is her first relative solo effort. I always remind residents that a successful procedure is the removal of the lesion with appropriate reapproximation of tissues, without complications. How long this takes is not a marker of success, barring really long delays. She did a great job!!

I will reiterate that while I will continue to post on YouTube, if you'd like to see more content, and sooner, please head over to my Facebook page: https://www.facebook.com/profile.php?id=61550652328626 This is also an ideal place for your questions and discussion as YouTube frequently blocks my comment section as of late. This procedure was simple in its design but more challenging in its execution. Working in a tight area, especially on the face, just requires diligence and attention to detail but these should heal quite nicely.

To see the most up-to-date post, please click here: https://fb.watch/n1_C8jwZRU/ I apologize for the confusion, as this is now the full video. This React series is a new style of video for me, so you'll have to let me know what you think. Though I will continue to post on YouTube, I am going to be releasing videos onto the Facebook platform first, as it is here that I can interact more with the community and answer any questions you may have. If you want to leave a comment and join the discussion, head over to our Facebook page: https://fb.watch/n1-dc5oVdE/

Apologies in advance but please follow this link to watch the whole video: https://fb.watch/mXtoGAVX9T/

After struggling with YouTube restrictions for the last few months, we are officially transitioning over to a Facebook page to host the majority of this content. Please visit this link: https://fb.watch/mSa3uTCBJt/ ...to watch, engage and follow along. It is my hope to grow this other platform and use Facebook's additional features to create more of a community discussion including a variety of post types. Thank you for your patience and for embracing the change to come. Now onto the video at hand. There was nothing complicated about this case at face value. Trauma to the big toe may often result in the need to take off the toe nail. Discovering maggots underneath the nail bed, however, requires the clinician to maintain their cool and proceed as per usual so as not to frighten the patient. In the elderly, you need to keep alert for signs that may indicate they are having trouble caring for their own personal hygiene and approach these gently and respectfully. This is certainly one of those cases.

Try not to freeze for this week's pop quiz and check out my TikTok or Instagram for a bonus question about anesthetic allergies!!

Here's a different format I've been trying out on my new Instagram and TikTok channels to share some quick teaching points. Let me know what you think, and give me a follow if you'd like to add an educational challenge to your social media feeds! Instagram: https://www.instagram.com/dr.geoffbutler/?igshid=OGQ5ZDc2ODk2ZA%3D%3D TikTok: https://www.tiktok.com/@dr.geoffbutler?_t=8eXe2UbA3c6&_r=1

This is certainly an area where you certainly want to minimize incision size and be as precise as possible. It can be daunting to work on the face but as long as you have attention to detail and are comfortable doing these procedures they can heal really well. I've attached a follow up visit at about the two week mark and this healing is pretty good considering the time frame. In a few months, it should look really excellent.

While this is basically a large biopsy, the reason I'm showing this video is to show how well the lip can heal, especially when the damage is from cautery as opposed to stitching things closed. My preference in cases like these, would be to simply have the specialist see these directly but in Canada, at least where I work, they won't see the cases unless you have a tissue diagnosis confirming the disease. As a result, a lot of practitioners can delay on these cases as they are not comfortable for fear of creating a bad outcome. Procedures like this one should show you how well these can heal.

This is one of those cases where we've caught a cyst just as it is heading into inflammation/infection and likely removed enough or even all of the capsule to the point where this won't recur. This is not typical. Most of the time, once the inflammation/infection settles in, the capsule becomes so thin and friable that all we can do is drain it, let it settle down and remove the cyst, capsule and all, a few months later. Cases like this one, though, are refreshing, because they are infrequent and a pleasant surprise! I have seen this patient in follow up and it looks like we won't need to do anything else. Everything has settled.

As you may have noticed, Youtube has restricted my videos lately and I'm no longer able to have comments. It is fairly frustrating and I apologize in advance but I'm not sure what I can do about it. At any rate, this case is more in line with what 'traditional' pimple poppers are looking for. This is a cyst that has just started to become infected so you end up getting a certain amount of purulent material but also solid keratin underneath. Since this field is infected, it is not possible to remove the capsule and this will have to heal and then be properly removed in a few months. I packed this overnight to encourage loculations to break down and achieve hemostasis but the following day this way removed and allowed to heal by secondary intention. I also swabbed this after I'd packed the wound. I had meant to do it before I packed the area, but it really won't matter. So long as I've cleaned the area out, the swab will be effective. At any rate, I hope everyone is well.

This removal can seem quite daunting but so long as you avoid the vermilion border these actually heal quite well. Pyogenic granulomas will usually form in response to fairly mild traumas and then grow quite quickly. Sometimes they'll respond to caustic treatments, like liquid nitrogen or silver nitrate, but many cases, like this one, will not and a removal will be necessary. I've attached follow videos from just 5 days later to show how nicely this had healed already.

This was actually really hard. Working under the chin is difficult at the best of times but this lipoma was adhered to the underlying tissues really quite firmly. I wish it was somehow possible to make the viewer appreciate that but I guess, unless you are working in the room, that is obviously impossible. Regardless, the firmness of the adhesion made this take a bit longer but that isn't a big deal in the grand scheme of things. At the end of the day, as long as you progress slowly and efficiently, you'll get there and have a good result.

I always feel for these patients as pilonidal cysts are quite frustrating and tend to get recurrently infected and also tend to recur after removal. Unlike epidermal cysts or pilar cysts, this doesn't have a defined thick membrane, but is rather an inflammed/infected track that will need to be removed. As this video demonstrates, that space can be quite large and can therefore hold a lot of infected material. This one was quite tense and the patient must have been quite uncomfortable, likely for days, before I saw him. This is a delicate and sensitive area and I am grateful that he allowed us to tape this video.

This was a great case. It shows how well things can go if you just take you time and move along methodically. You always want to be most careful along the back end of the cyst as that is where the deeper structures lie. Beyond that, things should proceed in a fairly straightforward fashion. This was without complication and healed beautifully.

This was a good teaching case. The resident had seen this patient first and, with his foot flat against the ground, diagnosed him with cellulitis. However, closer inspection revealed a pressure ulcer underneath and if that is at all fluctuant, it likely has pus inside, as this one did. You have to debride these areas or they will never heal. Antibiotics alone will be insufficient. There was no local anaesthetic used during this procedure and typically you won't need any. The tissues are under such pressure and usually macerated for so long that removing the dead tissue is not uncomfortable, as was the case here. This was simply a result of a long term pressure ulcer that hadn't been dealt with properly. In PART 2 I will follow this wound over the next few weeks and hopefully we can heal this more completely.

Once the cysts get inflamed to this level, you are forced to drain them or they won't settle down. Oral or even IV antibiotics will not fix these. Unfortunately, they are also so far gone that you cannot remove the cyst capsules at this stage. The membranes are too thin and friable and some degree will be retained and the chance of recurrence is high. Therefore, these are drained in the infected stage, allowed to settle down and then removed fully and correctly about 2-3 months later. This lesion was packed overnight, but the following day this was removed and then allowed to heal by secondary intention.

This was an uninfected field and the cyst wasn't large so the anesthesia here should have been better. Obviously, when the patient describes pain or you see them withdraw then you need to add more but for the viewer or young clinicians learning these procedures, this could have been better. It is only with large cysts/lipomas or infected fields that there can be some expected poorly anesthetized areas that you should be on the lookout for. Outside of that, this procedure went well. The entire cyst was excised so recurrence should not be an issue. This ended up healing well, without incident.

While this wasn’t completely ‘unexpected’, this patient had endured foot pain for months before I saw him in clinic. Remarkably this wasn’t overly red or hot but clearly once this was incised it was an obvious abscess. Unfortunately, anaesthesia wasn’t great, likely secondary to the infection but despite that, the procedure went well and this healed nicely. I was hoping for a follow up video but I didn’t see him afterwards. Have a good day!