Differences

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--- resident:david_mathes [2021/10/20 09:11] – [Thighplasty] jonathan
+++ resident:david_mathes [2023/08/21 13:55] (current) – [Tissue Expander] ally
@@ Line 131: / Line 131: @@
 ==== Tissue Expander ===
 Intraoperative antibiotics. Antibiotics for home\\
-Sutures: 3-0 PDS for TE and alloderm, 3-0 monocryl deep dermal, 4-0 monocryl subcuticutlar, mastisol and steris\\
+Sutures: 3-0 PDS for TE and alloderm, 3-0 monocryl deep dermal, 4-0 monocryl subcuticutlar, Dermabond\\
-If going pre-pectoral, make sure that there are 2 pieces of alloderm in the room per side.\\
-Pre-Pec- 2 pieces of alloderm sew into IMF and circumferentially at Breast "SFS" dont really sew into muscle
-Horizontal mattress sutures to secure alloderm, make sure expander is as low as can go the lower the better. Sew alloderm in first superior and inferior than place TE secure inferior and lateral and if can get medial as well. then sew both alloderms together. Place drain. Close\\
+Pre-Pec- Duracell (16x20, cut to breast foot print) sew into IMF and circumferentially at Breast "SFS" don't really sew into muscle
+Horizontal mattress sutures to secure Duracell, make sure expander is as low as can go, the lower the better. Sew Duracell inferiorly first. Then place TE secure medially, then inferiorly (6 o'clock tab has bump). Then once TE's secured, sew Duracell superiorly/laterally. Place drain. Fill TE. Close with 3-0 and 4-0 Monocryl\\
 Placing the alloderm at the edge at the sternal edge of the pectoralis muscle may be a good option for Dr. Mathes' cases. Remember that the alloderm should be placed at the, at the IMF and the breast surgeon will violate the IMF on a regular basis. So you should be actually sewing the alloderm to the top of the flap, not to the chest wall. \\
@@ Line 141: / Line 141: @@
 Places central tab at the breast meridian.\\ Only sews in 2 tabs for the TE.\\
-UPDATED INSTRUCTIONS 7/30/21:\\
-Hemostasis was first obtained. The base-width of the pocket was measured as 11 cm and a Mentor Artoura High Profile 300 cc tissue expander was chosen. A piece of alloderm was cut in the shape of the inferior aspect of the breast and sutured into place with 3-0 PDS interruped sutures. Next, a piece of alloderm was cut in the shape of the superior aspect of the breast and sutured into place with 3-0 PDS interrupted sutures. The tissue expander was then placed and the meridian, medial and lateral tabs sutured with 3-0 PDS interrupted sutures. The superior alloderm piece was draped over the inferior piece and the inferior piece was trimmed. The alloderm was than sutured together with 3-0 PDS interrupted sutures. A 15 french round drain was placed with the exit point in the lateral fold of the breast. The incision was closed with 3-0 monocryl deep dermal sutures followed by 4-0 monocryl running subcuticular sutures. The incision was dressed with benzoin and steri-strips along the direction of the incsion.
+Hemostasis was first obtained. The base-width of the pocket was measured as 11 cm and a Mentor Artoura High Profile 300 cc tissue expander was chosen. A piece of alloderm was cut in the shape of the breast footprint and sutured into place with 3-0 PDS interrupted sutures. The tissue expander was then placed and the meridian, medial and lateral tabs sutured with 3-0 PDS interrupted sutures. A 15 french round drain was placed with the exit point in the lateral fold of the breast. Tissue expander was filled. The incision was closed with 3-0 monocryl deep dermal sutures followed by 4-0 monocryl running subcuticular sutures. The incision was dressed with Dermabond.
 ==== Tissue Expander to Implant Exchange====