1 / 113

Plastics and Reconstructive Procedures

Plastics and Reconstructive Procedures. Plastics Operative Sequence. Rhytidectomy. Rhytidectomy. Overall Purpose of Procedure : To improve the appearance of the patients face and neck area. Rhytidectomy Rhytid =‘s medical term for a wrinkle. Define the procedure :

Download Presentation

Plastics and Reconstructive Procedures

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Plastics and Reconstructive Procedures

  2. PlasticsOperative Sequence Rhytidectomy

  3. Rhytidectomy • Overall Purpose of Procedure: • To improve the appearance of the patients face and neck area.

  4. RhytidectomyRhytid =‘s medical term for a wrinkle • Define the procedure: • Rhytidectomy can mean many different types of procedures dealing with the head and neck. • Facelift • Browift • Eyelid lift • Chin Implants • Malar implants (mid-face cheek implants)

  5. Rhytidectomy- Facelift -

  6. Rhytidectomy- Anatomy - • The Platysma muscle is a flat, thin muscle that lies uderneath the skin of the anterior and lateral neck. • Deep to the muscle lies the superficial layer of the deep cervical fascia.

  7. Rhytidectomy • Wound Classification: 1

  8. Operative Sequence • 1- Incision • 2- Hemostasis • 3- Dissection • 4- Exposure • 5- Procedure (Specimen Collection possible) • 6- Hemostasis • 7- Irrigation • 8- Closure • 9- Dressing Application

  9. Rhytidectomy • Instrumentation: Plastics Tray • Positioning: The patient can be in supine position, arms on arm boards. Can also be in Fowlers. • Prepping: Surgeon preference. Hibiclense or a Betadine Prep Kit. Must clean and comb hair away from incision site • Draping: Head drape.

  10. RhytidectomyBegin your Operative Sequence • Prior to incision, must have pre-op photos in room! • Incisions are marked bilaterally and injected with local • Incision: 15 kb on #3 handle for incision. • Made around the ear, under the earlobe and extends into the hairline. • One side is done at a time.

  11. Rhytidectomycont. Operative Sequence • Hemostasis: Handheld Bovie and hemostats.

  12. Rhytidectomycont. Operative Sequence • Dissection and Exposure: • The skin is undermined to the nasolabial fold, area of the mental foramen and to the midline of the neck to the thyroid cartilage. • Use of Metz, Double and Single Skin hooks, Adsons, and Stevens scissors.

  13. Rhytidectomycont. Operative Sequence • Exploration and Isolation: • Care is taken not to damage the Facial nerve and artery. • If a tighter lift is desired, the Platysmal and SMAS (Superficial Musculoaponeurotic System) is dissected and lifted.

  14. Rhytidectomycont. Operative Sequence • Surgical Repair: • Excess fat is removed and skin flap edges are grasped with Allis’s. • The skin is drawn upward and redraped to the proper degree of tension. The excess skin is excised along the angle of the clamps. • Excellent Facelift Video

  15. Rhytidectomycont. Operative Sequence • Hemostasis and Irrigation: • All bleeding is controlled with cautery, possibly Bi-polar. • Use of warm Saline to irrigate.

  16. Rhytidectomycont. Operative Sequence • Closure: • Incisions are usually closed with a 4-0 Nylon behind the ear and a 5-0 in front of and around the ear. • Staples may be used in the hairline. • The circulator will prepare the local for the opposite side. • Repeat procedure on the opposite side.

  17. Rhytidectomy • Major Arteries: • External Carotid Artery • Facial

  18. Rhytidectomy • Major Veins: • Internal Jugular Vein • Major Nerves: • Cranial Nerve VII - Facial Nerve

  19. Blepharoplasty Fact: According to the American Society for Aesthetic Plastic Surgry, in year 2008 more than 195,000 people in the United States underwent cosmetic eye surgery. Blepharoplasty has become the most sought-after facial plastic surgery procedure, surpassing facelift, rhinoplasty, facial implants, and forehead lift.

  20. Blepharoplasty Visit: http://www.drmeronk.com/videos.html

  21. Plastic ProceduresOperative Sequence Lipectomy

  22. Lipectomy • Overall Purpose of Procedure: • To remove excess fatty deposits from many different areas of the human body. • Areas include: • Hips and Thighs • Abdomen • Breast • Face • Buttocks • Anywhere there is bulk fatty deposits

  23. Lipectomy • Define the procedure: • Liposuction, also known as lipoplasty ("fat modeling"), liposculpture or suction lipectomy ("suction-assisted fat removal") is a cosmetic surgery operation that removes fat from many different sites on the human body.

  24. Lipectomya 12-year old girl who at 5-foot-5 weighed 230 pounds.

  25. Lipectomy • Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring with significant risksand is not a weight loss method. The amount of fat removed varies by doctor, method, and patient, but is typically less than 10 pounds. • There are several factors that limit the amount of fat that can be safely removed in one session. • Ultimately, the operating physician and the patient make the decision. There are negative aspects to removing too much fat. Unusual "lumpiness" and/or "dents" in the skin can be seen in those patients "over-suctioned". The more fat removed the higher the surgical risk.

  26. Lipectomy • Wound Classification: 1

  27. Operative Sequence • 1- Incision • 2- Hemostasis • 3- Dissection • 4- Exposure • 5- Procedure (Specimen Collection possible) • 6- Hemostasis • 7- Irrigation • 8- Closure • 9- Dressing Application

  28. Lipectomy • Instrumentation: Plastics tray. Assortment of liposuction cannulas. Liposuction machine and tubing. • Positioning: Depends on the area of fat removal. • Prepping: Surgeon preference. Duraprep, Hibiclense or a Betadine Prep Kit. • Draping: Also depends on area prepped.

  29. LipectomyBegin your Operative Sequence • Prior to Incision: • Some MDs inject a solution to “melt” the fatty deposits. This is usually Lidocaine and LR or NACL This makes removal easier. • Mark the site and have the surgeon pick out the appropriate size cannula. • ST will connect the cannula to the suction tubing and throw end to circ. • Incision: 15 kb on #3 handle for incision. Incision is only ½ inch at most.

  30. Lipectomycont. Operative Sequence • Hemostasis: Handheld Bovie

  31. Lipectomycont. Operative Sequence • Dissection and Exposure: • All dissection is made with the lipo cannual that the surgeon has previously chosen.

  32. Lipectomycont. Operative Sequence • Exploration and Isolation: • A tunnel is created by passing the cannula underneath the skin. • The suction is off at this point.

  33. Lipectomycont. Operative Sequence • Surgical Repair • Once the tunneling process is done a few times, the suction is turned on. This allows the surgeon to “break up” the fatty deposits before attempting suctioning. • The surgeon removes the desired amount of fat, checking the area periodically. • The tubing will need cleaning with NACL during the procedure. • Lipo video

  34. Lipectomycont. Operative Sequence • Hemostasis and Irrigation: • All bleeding is controlled with cautery. • Use of warm Saline to irrigate.

  35. Lipectomycont. Operative Sequence • Closure: • The small incision is closed with a 4-0 or 5-0 Nylon. The dressing that you apply will need to be a pressure dressing, applied depending on area of Lipectomy.

  36. Lipectomy • Major Arteries: • Depends on area of Lipectomy

  37. Lipectomy • Major Veins: • Depends on area of Lipectomy • Major Nerves: • Depends on area of Lipectomy

  38. Abdominoplasty Plastic ProceduresOperative Sequence

  39. Abdominoplasty Overall Purpose of Procedure: A.K.A. Tummy Tuck To remove excess fat and tighten abdominal skin.

  40. Abdominoplasty Define the procedure: The tightening of the abdominal skin through an incision jut above the pubic hair line. Can be combined with Liposuction. Can also include a Thigh Lift.

  41. Abdominoplasty • Indications for Abdominoplasty • Loss of muscle tone in the lower abdominal region • Lose skin and fat in the abdominal region resulting from weight loss.

  42. Abdominoplasty Wound Classification: 1

  43. Operative Sequence 1- Incision 2- Hemostasis 3- Dissection 4- Exposure 5- Procedure (Specimen Collection possible) 6- Hemostasis 7- Irrigation 8- Closure 9- Dressing Application

  44. Abdominoplasty Instrumentation: Major/Minor tray depending on patient size. Positioning: Supine with arms on arm boards. Prepping: Surgeon preference. Duraprep, Hibiclense or a Betadine Prep Kit. Draping: Can be as many as 8 towels.

  45. AbdominoplastyBegin your Operative Sequence Prior to Incision: MD will mark incision. It will be necessary to flex the able to aid in closure. Incision: 10 KB across pubic line, from Iliac crest to Iliac crest. Can be made from north to south, from umbilicus to pubis.

  46. Abdominoplastycont. Operative Sequence Hemostasis: Handheld Bovie

  47. Abdominoplastycont. Operative Sequence Dissection and Exposure: The abdomen is dissected through the subcutaneous tissue and fat down to the rectus muscle using the bovie.

  48. Abdominoplastycont. Operative Sequence • Exploration and Isolation: • The abdomen is also dissected up towards the chest. • This creates a flap that will be pulled down towards the pubis once the excess skin is excised. • Have Volkmans and Deavers available.

  49. Abdominoplastycont. Operative Sequence Surgical Repair: Both of the Rectus muscles are tightened using a 0 Ticron. The skin flaps are pulled together, excess skin and fat is removed. The table is flexed and the abdomen is closed. Video: Abdominoplasty Surgery Video

  50. Abdominoplastycont. Operative Sequence Hemostasis and Irrigation: All bleeding is controlled with cautery. Use of warm Saline to irrigate.

More Related