Surgery, Dermatology and Anaesthetics

Our Surgical and Dermatology Services include -

  • A skin cancer /dermatology diagnostic and treatment service
  • Excision of skin cancers by primary closure, skin graft or skin flap as needed (note highly cosmetic locations or invasive skin cancers are referred)
  • Vasectomy and Mirena IUD insertion for gynaecological problems
  • Treatment of haemorrhoids by band ligation and sigmoidoscopy
  • Iron infusion (Ferinject) for anaemia, ACLASTA infusions for severe osteoporosis and venesection for haemachromatosis
  • Ocular examination, including removal of foreign bodies and burr hole debridement by operating microscope
  • External ear canal cleaning by operating microscope for severe outer ear infections
  • Fracture management and reduction of simple fractures
  • Open wound assessment and repair
  • Carpal tunnel surgery in selected cases, and steroid injection for carpal tunnel compression
  • Ultrasound guided joint injections (selected cases)
  • Steroid injection for scar treatment

Procedures are recorded in an audit log for follow up and review of complications. All instruments are sterilized according to required legislation, and individually recorded in the notes. Patients referred from other practices will receive a letter to their GP detailing the care received. Aftercare is provided by our nursing staff who are very familiar with the nature of the work performed. Our pathology provided is Sydney Adventist Hospital Pathology/Douglass Hanly Moir.

It’s important that your consent for a procedure be fully informed, and that you have a good understanding of the likely outcomes, risks and complications of the operation. Every procedure is a careful decision, and the doctors and staff make every effort to minimise the risks to achieve the best possible result. Feel free to contact the surgery at any time if you have a question or a problem before or after the operation.  Each doctor in the practice has a list of procedures they do or don't do, according to training and experience.  A student or training doctor may observe with patient permission.

The nursing staff will provide specific, and if needed, written advice relating to wound care and any limits to activities in the post operative period. Their advice is born of long experience and is worth taking.

Anaesthetic Options

Topical Anaesthesia

This is done using EMLA cream, which is occluded for 40 minutes or so, and is suited to children, removal of superficial foreign bodies, injections, or sensitive genital procedures.

Local Anaesthetic

Involves injection with lignocaine (short acting over 1 hour) or Marcaine (lasting 12 hours) either singly or in combination. Local anaesthetic may also be used as a nerve block for any superficial nerve in the body, and may give pain relief in situations such as chronic headaches (greater occipital nerve block). Additional nerve block combination with injectable steroids such as Celestone may prolong the chronic pain relief of some interventions.

Joint Injections

In specific situations joints can be injected with steroids or even anaesthetic to provide pain relief, diagnosis and treatment. The reasons for each injection are very specific to the illness and would need to be discussed with the doctor. Specific sites are best injected under imaging guidance and the patient can be referred for this purpose.

Inhalational Anaesthesia

The practice has facilities for simple inhalational pain relief using Penthrox (methoxyflurane). This is suited to nervous or frightened patients and is very similar to the nitrous oxide gas used in the late stages of labour. There are specific limitations on the use of Penthrox, including age and liver function. Intranasal midazolam is used infrequently but may be an option to sedate a younger child. The dose is calculated, and specific monitoring and supervisory standards must be met.

Procedural Intravenous Sedation

The practice offers procedural sedation to adults and if necessary children over the age of 12. The patient must be without food or drink for 6 hours, and be in good general health.

The patient is given Maxolon for nausea, followed by Midazolam in small amounts over 4 minutes or so until a comfortable “rousable” sleepy state is achieved, in which the patient is able to guard their own airway. Additional pain relief can be obtained with the use of fentanyl (a short acting narcotic), prior to the use of local anaesthetic.

The patient must be personally attended throughout by a staff member independent of the surgical procedure and trained in airway management. The patient will have intravenous fluids, and is monitored for heart rate, blood pressure and oxygen saturation throughout. Supplementary nasal oxygen is supplied throughout. This option is very helpful for more major outpatient surgery such as vasectomies, skin grafts and so on. Sedation can also be helpful in painful fractures if reduction is required, or where large volumes of local anaesthetic are needed.

The practice carries full facilities for airway management, including intubations, as well as reversal drugs for both narcotic and benzodiazepine based agents.

Postoperative Pain Relief

Some procedures will require postoperative pain relief, varying from paracetamol right through to major oral or topical (skin patch) pain medication. Please ask your doctor what the likely pain relief circumstances may be after your surgery.