by Roger I. Ceilley, MD, FAAD, FCMS, and Shandhan Sureshbabu, CDT
Dr. Ceilley and Mr. Sureshbabu are with Dermatology P.C. in West Des Moines, Iowa.
FUNDING: No funding was provided for this article.
DISCLOSURES: The authors declare no conflicts of interest relevant to the content of this article.
ABSTRACT: Optimizing ergonomics and patient positioning is essential for enhancing patient safety and improving outcomes in dermatologic surgery. Proper patient positioning can prevent provider strain, improve surgical accuracy, and increase overall efficiency. Key strategies include maintaining a neutral body plane, providing neck and knee support, and shielding the eyes to reduce patient stress. Adjustments in limb positioning can enhance skin laxity and tension management, facilitating better wound closure and healing. Equally important is the surgeon’s ergonomics, with proper posture, adjustable seating, and strategic breaks to reduce fatigue and improve performance. Attention to these factors supports both patient comfort and long-term sustainability of high-quality care.
Balancing technical demands with patient safety is critical in dermatologic surgery. Optimizing ergonomics and patient positioning is a straightforward approach that can significantly enhance patient outcomes and provider wellbeing. Small adjustments in these areas can prevent provider strain, improve accuracy, and contribute to a safer, more efficient practice. Attention to posture and patient positioning is beneficial not only for enhancing patient safety but also for supporting the sustainability of high-quality care over time.
For most procedures, the patient should be placed relatively flat and parallel to the floor. Neck support with an adjustable headrest or cushion is essential. Using a pillow or rolled-up blanket below the knees helps to relax the back and keep the patient more comfortable and less restless. Having the body plane parallel to the floor, in the neutral position, allows for easier excision, undermining, and repair.1
We like to cover their eyes with moist gauze when operating on a patient in the supine position (Figure 1). This helps to keep the bright light from the ceiling and surgical lamp out of their eyes. This also seems to help relax many patients, as they are unable to see the movements, specimens, and bloody gauze that will be passed about. We consider the vertical plane above the eyes as a “no-fly zone” and are very careful to not pass any instruments, sharps, or solutions that could potentially injure the eyes if spilled or dropped.
Proper patient positioning is especially important in areas subject to high tension or repetitive motion. For example, knee flexion during excisions on the anterior lower leg can relieve tension and improve skin laxity, allowing for simpler closures. Conversely, straightening the leg during closure enhances efficiency and comfort. This approach reduces complications like wound dehiscence and improves healing.
Equally important to patient positioning is the ergonomics of the surgeon and assistants. With proper posture and mechanics, a well-fitted, adjustable surgical chair is essential. Footstools may also help to accommodate those with a shorter stature so all the members of the surgical team can work at a comfortable level. A break with some stretching every 15 to 20 minutes, and between cases, is helpful. Simple stretches, such as neck tilts, shoulder rolls, wrist extensions, back extensions, and standing wall exercises can relieve tension and improve posture. Adequate space around the table is important to allow unobstructed movement around the patient.
Ensuring proper lighting (ceiling and moveable surgical lamp) in the surgical suite is important not only visually but also physically, as it can limit the amount of movement of the surgeon, assistants, and patient (Figure 2).
Optimizing body position also assists in excision as well as eversion and wound closure. Positioning of the posterior neck and superior back into forward flexion for excision and backward extension for repair allows for mechanical assistance in reducing tension lines and achieving better wound eversion.2 Rotation of the lateral neck away from the surgical site during the excision and rotation toward the surgical site for the repair phase allows for proper head positioning, which can improve skin laxity, reducing strain on the surgical team. Forward extension of the mid-back and shoulders for excision, and then arms to the side with shoulders back (ie, “military” position) for the repair allows for proper arm positioning, reduces the potential for empty spaces left in the tissue after surgery, and ensures optimal tissue alignment to facilitate easier and more effective closure. Extension of the lower extremity for excision and knee flexion for the repair optimizes both excision and closure in lower leg procedures.3 Flexion of the wrist during excision and dorsiflexion for the repair reduces tension; using wrist adjustments strategically can improve wound closure outcomes, especially on the dorsal hand. Fingers fully extended and spread apart during repairs of the dorsal hand ensures maximum laxity, preventing complications during repair.2
Proper positioning is most important for safety, comfort, and efficiency. The patient position is also a useful technique to centralize tension across the surgical site during excision and closure. This is especially important for areas with high tension and repetitive motion such as the hand, neck, back, upper, and lower extremities.4 The surgeon and assistants will improve their efficiency and quality by utilizing ergonomic positioning, posture, and stretching.
References
Chan J, Kim DJ, Kassira-Carley S, et al. Ergonomics in dermatologic surgery: lessons learned across related specialties and opportunities for improvement. Dermatol Surg. 2020;46(6):763–772.
Lin RR, Bray ER, Rosen Aigen AC. Optimizing body positioning in dermatologic surgeries. J Am Acad Dermatol. 2024;91(3):e77–e78.
Fitzgerald LA, Hamel RK, Hall EL, et al. Surgical pearl: linear closures on the anterior lower leg. J Am Acad Dermatol. 2024;90(2):e62–e63.
Powell E, Guidry J, Orengo I. Optimizing patient positioning during dermatologic surgery. Cutis. 2021;107(1):43–44.
Positioning and Protecting the Patient is Essential for Safe, Quality, Efficient Surgery
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J Clin Aesthet Dermatol. 2025;18(4):21–22.
by Roger I. Ceilley, MD, FAAD, FCMS, and Shandhan Sureshbabu, CDT
Dr. Ceilley and Mr. Sureshbabu are with Dermatology P.C. in West Des Moines, Iowa.
FUNDING: No funding was provided for this article.
DISCLOSURES: The authors declare no conflicts of interest relevant to the content of this article.
ABSTRACT: Optimizing ergonomics and patient positioning is essential for enhancing patient safety and improving outcomes in dermatologic surgery. Proper patient positioning can prevent provider strain, improve surgical accuracy, and increase overall efficiency. Key strategies include maintaining a neutral body plane, providing neck and knee support, and shielding the eyes to reduce patient stress. Adjustments in limb positioning can enhance skin laxity and tension management, facilitating better wound closure and healing. Equally important is the surgeon’s ergonomics, with proper posture, adjustable seating, and strategic breaks to reduce fatigue and improve performance. Attention to these factors supports both patient comfort and long-term sustainability of high-quality care.
Keywords: Patient safety, ergonomics, patient positioning, patient/surgeon posture, excisions, closures, stretching
Balancing technical demands with patient safety is critical in dermatologic surgery. Optimizing ergonomics and patient positioning is a straightforward approach that can significantly enhance patient outcomes and provider wellbeing. Small adjustments in these areas can prevent provider strain, improve accuracy, and contribute to a safer, more efficient practice. Attention to posture and patient positioning is beneficial not only for enhancing patient safety but also for supporting the sustainability of high-quality care over time.
For most procedures, the patient should be placed relatively flat and parallel to the floor. Neck support with an adjustable headrest or cushion is essential. Using a pillow or rolled-up blanket below the knees helps to relax the back and keep the patient more comfortable and less restless. Having the body plane parallel to the floor, in the neutral position, allows for easier excision, undermining, and repair.1
We like to cover their eyes with moist gauze when operating on a patient in the supine position (Figure 1). This helps to keep the bright light from the ceiling and surgical lamp out of their eyes. This also seems to help relax many patients, as they are unable to see the movements, specimens, and bloody gauze that will be passed about. We consider the vertical plane above the eyes as a “no-fly zone” and are very careful to not pass any instruments, sharps, or solutions that could potentially injure the eyes if spilled or dropped.
Proper patient positioning is especially important in areas subject to high tension or repetitive motion. For example, knee flexion during excisions on the anterior lower leg can relieve tension and improve skin laxity, allowing for simpler closures. Conversely, straightening the leg during closure enhances efficiency and comfort. This approach reduces complications like wound dehiscence and improves healing.
Equally important to patient positioning is the ergonomics of the surgeon and assistants. With proper posture and mechanics, a well-fitted, adjustable surgical chair is essential. Footstools may also help to accommodate those with a shorter stature so all the members of the surgical team can work at a comfortable level. A break with some stretching every 15 to 20 minutes, and between cases, is helpful. Simple stretches, such as neck tilts, shoulder rolls, wrist extensions, back extensions, and standing wall exercises can relieve tension and improve posture. Adequate space around the table is important to allow unobstructed movement around the patient.
Ensuring proper lighting (ceiling and moveable surgical lamp) in the surgical suite is important not only visually but also physically, as it can limit the amount of movement of the surgeon, assistants, and patient (Figure 2).
Optimizing body position also assists in excision as well as eversion and wound closure. Positioning of the posterior neck and superior back into forward flexion for excision and backward extension for repair allows for mechanical assistance in reducing tension lines and achieving better wound eversion.2 Rotation of the lateral neck away from the surgical site during the excision and rotation toward the surgical site for the repair phase allows for proper head positioning, which can improve skin laxity, reducing strain on the surgical team. Forward extension of the mid-back and shoulders for excision, and then arms to the side with shoulders back (ie, “military” position) for the repair allows for proper arm positioning, reduces the potential for empty spaces left in the tissue after surgery, and ensures optimal tissue alignment to facilitate easier and more effective closure. Extension of the lower extremity for excision and knee flexion for the repair optimizes both excision and closure in lower leg procedures.3 Flexion of the wrist during excision and dorsiflexion for the repair reduces tension; using wrist adjustments strategically can improve wound closure outcomes, especially on the dorsal hand. Fingers fully extended and spread apart during repairs of the dorsal hand ensures maximum laxity, preventing complications during repair.2
Proper positioning is most important for safety, comfort, and efficiency. The patient position is also a useful technique to centralize tension across the surgical site during excision and closure. This is especially important for areas with high tension and repetitive motion such as the hand, neck, back, upper, and lower extremities.4 The surgeon and assistants will improve their efficiency and quality by utilizing ergonomic positioning, posture, and stretching.
References
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