0:00

Challenge number eight, skin tethering.

0:04

And this is something that's gonna really be more

0:07

of a problem if, um, your breast is under compressed

0:11

if your skin nick is too small,

0:14

and if you don't have good contact between the grid

0:17

and the breast tissue.

0:18

And what happens is, as you put in that fiduciary,

0:22

we put in the cannula, it's going to push away from you

0:25

and you are not gonna be as deep as you think.

0:27

You can see how the tip

0:28

of the fiduciary here is shy of the lesion.

0:32

This is what it can look like in a patient.

0:34

This is after biopsy. That's why we have all

0:36

this post biopsy change.

0:37

You can see how the skin is tethered in, in that place.

0:44

So what do you do? You make sure

0:45

that you have good skin contact with the grid,

0:49

be generous with your skin.

0:50

Nicks, you know, we don't, you know, it's not kind

0:53

of plastic surgery here.

0:54

It's better to have, you know,

0:56

you don't wanna centimeter skin nick,

0:58

but the same time you don't want to be fighting the skin.

1:01

You make a skin like too big,

1:02

you're then gonna get troubles with vacuum.

1:04

But you know, if I'm using the regular green scalpel blade

1:07

that I think is used most places, you go up to the plastic,

1:11

the little plastic tongue that comes down, that fixates it.

1:13

And that's about right. So I'm a little bit more generous

1:16

with the size I use for this and with stereos

1:19

or ultrasound where I can kind of see what I'm doing

1:21

and I can manipulate it better.

1:24

As I described before when we were talking about trying,

1:27

dealing with superficial lesions, I only insert the block

1:31

after the cannulas through the skin.

1:33

So I put the cannula through the block,

1:36

but I don't put the block into the grid until I've,

1:40

I've sort of rotated that introducer, wiggled it a bit,

1:43

and made sure that plastic is safely

1:45

through the skin without any tethering.

1:48

And then I advance my block into the grid

1:51

and then I continue on with putting it

1:54

to the right position.