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resident:tae_chong [2019/12/11 21:26] – [Bilateral Breast Reduction] melissaresident:tae_chong [2021/02/22 09:36] (current) – [Facial Artery Dissection] michael
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 Interests and Activities: Marathons, obstacle races, soccer, and martial arts. Interests and Activities: Marathons, obstacle races, soccer, and martial arts.
  
-Operations below. He very much enjoys asking [[resident:pimp_questions|Questions]]. Here are Dr. Chong's [[resident:expectations|Expectations]] and tips for meeting them. + 
 +=====Operating Reports===== 
 + 
 +General Tips:\\ 
 +[[medical_student:diep_post-op_protocol|Dr. Chong's DIEP Post-Op Protocol]]\\
  
  
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-=====Operating Reports=====+
  
 ==== Latissimus Muscle Flap ==== ==== Latissimus Muscle Flap ====
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 <WRAP half column> <WRAP half column>
  
-{{:resident:latissimus2.jpg|}} +{{:resident:screen_shot_2020-04-13_at_4.11.34_pm.png?400|}}
- +
-lkjfdsalkfj;lkdsajf;ldsakj +
  
 </WRAP> </WRAP>
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 <WRAP half column> <WRAP half column>
 +
 +{{:resident:img_4931.jpg?400|}}
  
 Tourniquet: No\\ Tourniquet: No\\
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: No\\
 +Sutures: 4.0 chromic sutures, 3-0 moncryl for the deep dermal layer and 4-0 monocryl for the superficial layer, 3-0 and 4-0 monocryl sutures\\
 +Dressing:Steristrips, dermabond\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: No\\
 +Sutures: 6-0 prolene sutures \\
 +Dressing: No\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: 15 blake\\
 +Sutures: 2-0 vicryl followed by a 3-0 monocryl for the deep dermal layer, 4-0 monocryl\\
 +Dressing: ???\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: 15 blake\\
 +Sutures: 2-0 vicryl in an interrupted fashion, 3-0 and 4.0 monocryl suture, 4-0 monocryl deep dermal sutures\\
 +Dressing: Dermabond\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +
 +
  
 </WRAP> </WRAP>
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 ==== STA Dissection ==== ==== STA Dissection ====
  
-<WRAP Group>+<WRAP>
 <WRAP half column> <WRAP half column>
  
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +{{:resident:screen_shot_2020-04-13_at_4.11.50_pm.png?400|}}
 +
 +{{:resident:screen_shot_2020-04-13_at_4.18.29_pm.png?400|}}
 +
 +{{:resident:screen_shot_2020-04-13_at_4.52.26_pm.png?400|}}
  
 </WRAP> </WRAP>
 </WRAP> </WRAP>
 +
 +
 +
  
 ==== Facial Artery Dissection ==== ==== Facial Artery Dissection ====
  
-<WRAP Group> +<WRAP> 
-<WRAP half column>+<WRAP Half Column>
  
 An incision was placed 1.5 cm caudal the the inferior mandibular border along a skin crease.  This was centered over the anterior edge of the masseter and at the palpable site of the facial artery.  Lidocaine with epi 1% was infiltrated into the wound.  A 15 blade was used to make the skin incision and the platysma was divided with electrocautery.   An incision was placed 1.5 cm caudal the the inferior mandibular border along a skin crease.  This was centered over the anterior edge of the masseter and at the palpable site of the facial artery.  Lidocaine with epi 1% was infiltrated into the wound.  A 15 blade was used to make the skin incision and the platysma was divided with electrocautery.  
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +{{:resident:screen_shot_2020-04-13_at_4.52.58_pm.png?400|}}
 +
 +Technique:\\
 +Incision: 1 finger breadth inferior to mandible anterior to masseter\\
 +Divide platysma\\
 +Deep fascia (bluntly)\\
 +Node of Star - submandibular lymph node which lies superficial to facial artery at the masseter\\
 +Marginal mandibular nerve will be superior to the incision\\
  
 </WRAP> </WRAP>
 </WRAP> </WRAP>
 +
  
 ==== Gracilis Muscle Flap to Perineum ==== ==== Gracilis Muscle Flap to Perineum ====
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 <WRAP half column> <WRAP half column>
  
-Operative Report+Operative Report:\\ 
 The patient was brought into the operating room and placed in the lithotomy position. All bony prominences were padded and the SCDs were on and functioning prior to the induction of anesthesia. All lines were obtained and secured and the patient was intubated and sedated as per protocol. The patient received preoperative antibiotics prior to surgical incision. A timeout was performed with the entire team and the patient was then prepped and draped in the standard fashion.  The patient was brought into the operating room and placed in the lithotomy position. All bony prominences were padded and the SCDs were on and functioning prior to the induction of anesthesia. All lines were obtained and secured and the patient was intubated and sedated as per protocol. The patient received preoperative antibiotics prior to surgical incision. A timeout was performed with the entire team and the patient was then prepped and draped in the standard fashion. 
  
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 Procedure: gracilis muscle flap to perineum, SPY indocyanine green fluorescence angiography\\ Procedure: gracilis muscle flap to perineum, SPY indocyanine green fluorescence angiography\\
 Markings: Frog leg patient. Adductor longus should be bowed out muscle and mark entire course to knee. Mark gracilis 2 finger breadths below\\ Markings: Frog leg patient. Adductor longus should be bowed out muscle and mark entire course to knee. Mark gracilis 2 finger breadths below\\
 +
 +The patient is to be transferred with the Right leg ADDUcted at all times and a dry abd pad on the perineum and sacrum at all times (changed qid).\\
 +
 +</WRAP>
 +
 +<WRAP half column>
 +
 +{{:resident:whatsapp_image_2020-05-10_at_5.32.20_pm.jpeg?400|}}
 +
 +
 +Tourniquet: No\\
 Drains: 15 blake in thigh and 10 blake in the perineum\\ Drains: 15 blake in thigh and 10 blake in the perineum\\
 Sutures: Thigh: 3-0 monocryl, 4-0 monocryl, Perineum 3-0 PDS to parachute in muscle, 3-0 vicryl to close perineum (because it is less prickly than PDS)\\ Sutures: Thigh: 3-0 monocryl, 4-0 monocryl, Perineum 3-0 PDS to parachute in muscle, 3-0 vicryl to close perineum (because it is less prickly than PDS)\\
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 Restrictions: POD#0 bedrest. ABduction pillow while in bed. POD#1 okay to mobilize with PT/OT. Should walk with legs shoulder width apart. No ABduction of surgical extremity.\\ Restrictions: POD#0 bedrest. ABduction pillow while in bed. POD#1 okay to mobilize with PT/OT. Should walk with legs shoulder width apart. No ABduction of surgical extremity.\\
  
- 
-The patient is to be transferred with the Right leg ADDUcted at all times and a dry abd pad on the perineum and sacrum at all times (changed qid).\\ 
  
 Questions you will be asked:\\ Questions you will be asked:\\
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 6. What is the Insertion of the gracilis muscle? Medial surface of the tibia via the Pes Anserinus "goose foot".\\ 6. What is the Insertion of the gracilis muscle? Medial surface of the tibia via the Pes Anserinus "goose foot".\\
 7. What other muscles insert at the pes anserinus? sartorius, gracilis, semitendinosus.\\ 7. What other muscles insert at the pes anserinus? sartorius, gracilis, semitendinosus.\\
- 
-</WRAP> 
- 
-<WRAP half column> 
  
  
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: 15 blake\\
 +Sutures: 3-0 monocryl deep dermals followed by a 4-0 monocryl subcuticular suture\\
 +Dressing: Dermabond, ace bandage\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: 15 blake\\
 +Sutures: 3.0 pds suture, 2-0 mylon, 4-0 nylon suture, 4-0 chromic\\
 +Dressing: bio occlusive, bacitracin and adaptic\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet:  arm\\ 
 +Drain: No\\
 +Sutures: 11-0 nylon, 4-0 nylon\\
 +Dressing: No\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: Leg\\
 +Drain: 10 blake\\
 +Sutures: 3-0 pds, 2-0 nylon, 4-0 chromic\\
 +Dressing: bio occlusive, bacitracin and adaptic\\
 +
  
 </WRAP> </WRAP>
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 <WRAP Group> <WRAP Group>
 <WRAP half column> <WRAP half column>
- 
  
 Preop Dx:  Sternal wound infection Preop Dx:  Sternal wound infection
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: 15 blake\\
 +Sutures: 0 PDS sutures in figure of 8 fashion, 2-0 nylon, 3-0 monocryl suture for the deep dermal layer and then 3-0 nylon for the skin\\
 +Dressing: No\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: Leg\\
 +Drain: No\\
 +Sutures: 3-0 pds suture,4-0 chromic\\
 +Dressing: Bio occlusive, bacitracin and adaptic\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: 15 blake\\
 +Sutures: 3-0 pds\\
 +Dressing: No\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: No\\
 +Sutures: 4-0 chromic sutures\\
 +Dressing: Tegaderm, Adaptic, bacitracin\\
 +
  
 </WRAP> </WRAP>
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 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: No\\
 +Sutures: 4-0 chromic sutures, 3-0 monocryl deep dermal layer followed by 4-0 monocryl suture\\
 +Dressing: Adaptic, bacitracin\\
 +
  
 </WRAP> </WRAP>
 </WRAP> </WRAP>
resident/tae_chong.1576117594.txt.gz · Last modified: 2019/12/11 21:26 by melissa
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