What Are Minor Surgeries And When Are They Required?

If your perception of surgery only involves a doctor operating on a patient’s body in a hospital’s operating theatre, think again. Though it’s less commonly known, minor surgical procedures can also be performed in clinics.

Woodlands Parkway Shenton Medical Clinic, helmed by General Practitioner Dr Vikneswaran V Paranjothy, is one such clinic providing more than the usual gamut of medical services. Besides consulting patients who are unwell, conducting medical examinations, and administering vaccinations, Dr Vikneswaran is skilled in the field of general surgery and trained to perform a wide variety of minor surgical procedures as well as wound care.

Read on as he shares his responses to 6 common questions about minor surgical procedures, the conditions that may necessitate a minor surgical procedure and the minor surgeries he performs for patients.

Q1. What exactly is a minor surgical procedure?

Minor surgical procedures refer to surgery performed on superficial tissue, usually under local anaesthesia and using minimal equipment. These procedures can be performed safely and quickly with few or no complications, and while the patient is conscious throughout the procedure.

Q2. What are the conditions that would require a minor surgical procedure?

Minor surgeries can be performed to treat a wide range of conditions, including ingrown toenails and sebaceous cysts. Some of the more commonly performed procedures include removal of ingrown toenails, removal of lumps and bumps such as lipoma, sebaceous cysts, and stitches for open wounds and nasty cuts.

Ingrown Toenails

Ingrown toenails occur when the corner or side of a toenail grows into the flesh, which can cause pain and discomfort, and may also cause the skin of the toe to be inflamed, swollen or infected.

The condition could be a result of wearing footwear that is too tight around the toes, cutting your nails too short or injuring the toe or toenail. If at-home care does not work or the ingrown toenail is recurring or severe, minor surgery to partially remove or totally remove the nail along with the nail bed can help address the problem.

Sebaceous Cysts

Due to various causes such as a scratch or surgery, the sebaceous gland which coats our hair and skin with oil may experience trauma. As a result, a sebaceous cyst may develop from the sebaceous (oil) glands, appearing as a lump on the body.

If a sebaceous cyst grows large and causes discomfort, it can be treated by surgical removal. This also reduces the chances of the cyst returning.

Q3. What are the minor surgical procedures that can be performed at Woodlands Parkway Shenton Medical Clinic?

The full list of minor surgical procedures performed at the clinic can be found below. To find out more about the costs of these procedures, you may reach out to the clinic through the contact details listed here.

Minor Surgical Procedures

Nail

These are the procedures that can be carried out for nail-specific conditions:

• Nail Avulsion: This refers to when a section of the nail or the entire nail is separated from the nail bed
• Trephination of subungual hematoma: This involves creating one or more holes in the fingernail or toenail to allow accumulated blood under the nail to be drained.
• Wedge resection of ingrown toenail: This involves the removal of a section of the toenail so it stops biting into the skin.
• Reconstruction of nail bed: This allows the appearance and function of the nail bed to be improved after significant damage.

Excision of Cutaneous lumps

This refers to the removal of a skin lump, such as:

• Sebaceous cyst: A small lump that emerges on the skin and may cause inflammation and redness in the area.
• Dermoid cyst: A lump containing hair, fluid, teeth and skin glands, found in or on the skin.
• Lipoma: Lumps of fat, formed beneath the skin that may be painful.
• Mucocoele of the lip: A cyst that is situated on the lip, gums, the roof of the mouth or under the tongue.
• Papillomas: Benign lumps that do not spread but may sometimes cause discomfort.
• Plantar warts: Rough, hard growths that appear on the underside of the feet and may also grow beneath the skin as a result of human papillomavirus (HPV) infection.
• Superficial wrist ganglion: Lumps that form along the tendons or joints of your wrists

Excision biopsies

This refers to the removal of a skin lesion, such as a:

• Mole
• Cutaneous lesion: A section of the skin that has an abnormal growth or appearance
• Dermal lesion: Alteration in the natural condition of the skin

Incision and curettage of chalazion

This refers to a surgical removal of a cyst or lump which develops on the eyelid as a result of a blocked gland.

Abscess incision and drainage

This involves a surgical cut and drainage of a tender mass filled with pus, bacteria, and debris as a result of infection

Cauterisation

This involves the use of heat, electricity or chemicals to destroy:

• Warts: Small skin growths caused by human papillomavirus (HPV) infection
• Skin tags: Small, soft, hanging skin attached by a small thin stalk

Toilet and suturing (T&S)

This refers to the closing of a wound with stitches.

• Single and double layer closure
• Facial wounds
• Deep wounds

Removal of a foreign body

• Simple or complex removal of foreign body from the hand, foot, ear, throat or genitals
• Removal of Implanon / IUCD / Mirena (Birth control devices)

These non-surgical procedures are also performed at the clinic:

Non-Surgical Procedures

Aspiration

This refers to removing fluid from a cavity of the body for these conditions:

• Pseudocyst of the auricle: The non-inflammatory cystic swelling of the upper ear
• Hemarthrosis of knee: Bleeding into the knee joint
• Knee effusion: Excess fluid in or around the knee joint.
• Ganglion: Non-cancerous lumps filled with fluid. They usually form along the tendons or joints of the wrists or hands
• Bursa: A fluid-filled sac that reduces friction between tissues of the body.

Cortisone H & L Injections

These injections relieve pain and inflammation in your body for conditions including:

• De Quervain’s Tenosynovitis: A condition where the tendon on the side of the wrist is affected
• Plantar fasciitis: Inflammation of the tissue that links the heel bone to the toes, resulting in heel pain.
• Trigger finger: Inflammation of the tendons in the fingers resulting in fingers fixated in a bent position
• Kelloids: A firm scar tissue that develops at the site of injured skin.

Hyaluronic Acid Injection

This refers to the administering of the Monovisc injection, which acts as a lubricant and shock absorber of the joints used to treat knee pain caused by osteoarthritis of the knee.

In all cases, the attending doctor will assess the patient’s condition and medical history before any surgical procedure, however minor. Some instances where minor surgery may not be possible include:

• Malignant skin lesion where a more serious condition is suspected
• Allergy to local anaesthetics
• Lesions involving sensitive areas such as the neck, genitals and perianal conditions
• Uncooperative patients
• Patients who refuse to give their consent for the procedure
• Patients with psychiatric disorders
• Pregnant patients
• Patients on medication, such as anti-coagulants

Q4. What can I expect if I wish to undergo a minor surgical procedure at Woodlands Parkway Shenton Medical Clinic?

Should your doctor advise that your condition warrants a minor surgical procedure, it can be performed as soon as the same day at the clinic or at the patient’s or clinic’s next availability.

Before the procedure

Your consent will be taken and all precautions and likely complications will be discussed.

During the procedure

During most procedures, local anaesthesia would be administered.

After the procedure

You would be provided information on after-care and the clinic’s contact number should there be a need for urgent medical attention. Additionally, a follow-up medical appointment would be recommended so the doctor can assess your recovery and whether any next steps are required.

Q5. Where are these minor surgical procedures performed in Woodlands Parkway Shenton Medical Clinic?

Minor surgical procedures are conducted in a dedicated surgical procedure room that is well-ventilated, air-conditioned, and cleaned and mopped after every surgical procedure. Before any procedure, the doctor will don single-use disposable surgical gowns, gloves and a pair of goggles.

Q6. Is special equipment used in the surgical procedure room in Woodlands Parkway Shenton Medical Clinic?

These are the equipment and surgical tools that you would find in the surgical room:

Operating table

The surgical room is equipped with an operating bed that is height-adjustable, hence giving the operator access from all sides and the ability to operate comfortably while sitting or standing

Doctor’s stool

This is a height-adjustable stool with wheels

Surgical lamp

Mounted from the ceiling, the surgical lamp illuminates bright light. It can be focused to facilitate precision in the surgical field

Showcase, containers and cupboard

Allows surgical equipment and consumables to be stored neatly

Autoclave

The autoclave machine in the room sterilises all surgical equipment after use. Subsequently, the surgical equipment is individually packed and sealed to maintain sterility.

Surgical instruments

As with most surgical procedures, the basic tools such as scalpel blade, needle holder, mosquito or artery forceps, Adson forceps with teeth and mayo scissors are used.

Electrocautery

This machine is able to coagulate and cut through different tissues with the help of a current, enabling the operating doctor to operate safely without worrying about needing to control bleeding.

Tissue adhesives or glue

These are known as cyanoacrylates which bind the superficial layer of the skin called the epidermis together, holding the two wound edges for 7 – 14 days. This process enables rapid healing time for the patient, is pain-free, and does not require suture removal. Additionally, it is safer than sutures as it avoids needle stick injuries.

Resuscitation equipment

This is an emergency kit that has vascular access – allowing the chemicals or devices to be inserted or removed from the bloodstream. It also consists of resuscitation drugs like atropine and adrenaline, normal saline drips with airway equipment and a nearby defibrillator.

While less common, minor surgical procedures can address a wide range of conditions that range from ingrown toenails to sebaceous cysts. If any of these conditions are experienced with worrying symptoms, consulting a doctor promptly will allow you to receive the appropriate treatment and prevent the condition from worsening.