Welcome back to the journal review. This is our August 2026 rundown from the Journal of the American Academy of Dermatology, and it's a short but useful one — two surgical pearls, both from the JAAD Online section, both squarely in the MacGyver-in-the-OR tradition that this segment does so well. No original research, no statistics to teach today — just two practical fixes worth stealing for your own suite. Let's get into them.

First up is a surgical pearl titled "1-mL Syringe Barrel as a Substitute Suction Tip for Cutaneous Surgery," out of Zhejiang University's Sir Run Run Shaw Hospital. This is a pure technique piece — a clinical challenge and a solution, no cohort, no outcomes data, so we'll just walk through the problem and the fix.

The problem they're addressing is one you've almost certainly run into: your suction tip fails you mid-case. Not because suction itself is unavailable, but because the tip specifically becomes unusable — it's dropped on the floor, it clogs, it cracks, the connector doesn't mate with what's on the field, or in lower-resource settings, you simply run out of stock. The authors frame this explicitly as a supply-chain vulnerability, citing prior work on fragility in the global surgical supply chain, and the consequence they care about is lost efficiency and workflow disruption when you have to stop and hunt down a replacement.

Their fix is almost embarrassingly elegant. Take a sterile 1-milliliter syringe — the kind sitting in every procedure tray — strip it down to just the barrel by removing the needle, the cap, and the plunger. Using scissors, you flush-trim the finger flanges at the shoulder so you have a smooth proximal segment, then knock off any sharp edges. That trimmed barrel has an outer diameter of about 7 millimeters. Meanwhile, standard suction tubing is 28 French, with an inner diameter of about 6.9 millimeters. Do the math and you'll see the trick: the barrel is just fractionally larger than the tubing's inner bore, so when you cut the molded connector off the tubing to expose a plain straight end and jam the trimmed barrel in, you get an interference fit — a friction seal tight enough to be airtight and to sustain real suction for hemostasis and smoke evacuation. The luer end becomes your working tip, and because it's narrow, it actually gives you nice access into tight spaces, arguably better than some stock tips.

There's no outcomes data here, no bench testing of flow rates reported beyond the qualitative claim that it provides "adequate" suction — this is a bench-to-bedside pearl based on physical dimensions and clinical experience, not a validated study. The takeaway is practical rather than practice-changing in any guideline sense: this is a zero-cost, thirty-second contingency to keep in your back pocket for the day your suction tip fails, clogs, or simply isn't in the room — worth mentioning to your surgical staff so it's institutional knowledge, not just a party trick you personally know.

Second article, also a surgical pearl: "Intraoperative Transillumination Dermoscopy Technique for Subungual Glomus Tumors," from a group in Istanbul. Again, this is a technique piece structured as challenge-and-solution, not a study — so no methods-versus-results architecture, just the clinical problem and their workaround.

The clinical challenge will be familiar to anyone who does nail unit surgery: subungual glomus tumors are small, deep, exquisitely painful vascular neoplasms, and even with proximal nail fold retraction and nail plate avulsion, they can be maddeningly hard to localize — obscured by the fold itself or by a semi-opaque nail plate. Conventional transillumination helps, but the authors note it can still fail to reveal the lesion clearly, and if you don't nail the localization, you risk an incomplete excision and recurrent pain, which is the exact failure mode that makes glomus tumor surgery unforgiving.

Their solution layers two light sources rather than relying on one. First, they do standard intraoperative dermoscopy under the usual room lighting after nail fold retraction and plate avulsion — in their case example, this revealed a bluish macule in the distal matrix, which is your typical glomus tumor dermoscopic clue. But then they add a second maneuver: they slide a smartphone flashlight underneath a sterile drape covering the field, turn off the dermoscope's own light, darken the room, and rest the finger directly over that hidden flashlight. Now the tumor is being visualized purely by light transmitted through the volar soft tissue of the digit, essentially turning the whole finger into a light box. In their case, this transillumination-dermoscopy combination revealed the tumor with a clarity the standard lit exam didn't achieve. And critically, they didn't just use it for localization — they repeated the same maneuver after excision to visually confirm complete tumor removal in real time, before closing.

Again, this is a single case-based technique description, not a validated series — no data on sensitivity, no comparison group against standard transillumination alone, so we should be careful not to over-claim reproducible accuracy. But the underlying logic is sound and the barrier to trying it is essentially nil: a smartphone flashlight and a sterile drape, tools already in the room. The practical takeaway is that this is a nice adjunct to consider intraoperatively, especially in cases where the lesion is proving elusive on standard exam or where you want extra reassurance on margin completeness before closure — not something that changes your overall approach to glomus tumor surgery, but a low-cost maneuver that could meaningfully reduce the risk of an incomplete excision in a tricky case.

So, two quick, low-cost pearls this month — one for keeping your suction running when supplies fail you, one for finding and confirming clearance of a notoriously sneaky little tumor. Both cost you nothing but a pair of scissors or a phone you're already carrying, which is exactly the kind of pragmatic contribution this pearls section exists for. That's it for this episode — thanks for listening, and I'll see you next month.