Plastics

User Tools

Site Tools

Trace:
resident:tae_chong

Differences

This shows you the differences between two versions of the page.

Link to this comparison view

Both sides previous revisionPrevious revision
Next revision		Previous revision
resident:tae_chong [2019/12/11 21:39] – [Facial Artery Dissection] melissaresident:tae_chong [2021/02/22 09:36] (current) – [Facial Artery Dissection] michael
Line 24: Line 24:
 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]]\\
  
  
Line 36: Line 40:
  
  
-=====Operating Reports=====+
  
 ==== Latissimus Muscle Flap ==== ==== Latissimus Muscle Flap ====
Line 52: Line 56:
 <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>
Line 630: Line 631:
  
 <WRAP half column> <WRAP half column>
 +
 +{{:resident:img_4931.jpg?400|}}
  
 Tourniquet: No\\ Tourniquet: No\\
Line 973: Line 976:
 <WRAP half column> <WRAP half column>
  
-Tourniquet: Medial Malleolus +
-Drain: No\\ +
-Sutures: No\\ +
-Dressing: No\\+
  
  
Line 985: Line 985:
 ==== STA Dissection ==== ==== STA Dissection ====
  
 +<WRAP>
 +<WRAP half column>
  
 The STA was chosen based on the donor site location and prior scars.  I infiltrated the pretragal region and scalp with sterile saline to facilitate hydrodissection.  A 15 blade was used to make the scalp incision which was made in continuity with the defect.  Scalp flaps were raised.   The distal superficial temporal artery and vein (STA and STV) were identified and dissected circumferentially.  The dissection was carried down to the pretragal region until we had vessels that were suitable in diameter for microsurgical reconstruction.   The STA was chosen based on the donor site location and prior scars.  I infiltrated the pretragal region and scalp with sterile saline to facilitate hydrodissection.  A 15 blade was used to make the scalp incision which was made in continuity with the defect.  Scalp flaps were raised.   The distal superficial temporal artery and vein (STA and STV) were identified and dissected circumferentially.  The dissection was carried down to the pretragal region until we had vessels that were suitable in diameter for microsurgical reconstruction.  
 +
 +</WRAP>
 +<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>
 +
  
  
  
 ==== Facial Artery Dissection ==== ==== Facial Artery Dissection ====
 +
 +<WRAP>
 +<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.  
  
 The superficial cervical fascia was divided sharply and the facial vein was identified.  This was dissected proximally and a second large branch was identified.  They were dissected circumferentially and controlled with vessel loops.  Superficial lymph nodes were then removed to facilitate identification and dissection of the facial artery.   This was dissected circumferentially and controlled with vessel loops.  A lidocaine soaked neuropattie was placed on the vessels until the microvascular anastomosis. The marginal mandibular nerve was identified during the dissection and preserved.   The superficial cervical fascia was divided sharply and the facial vein was identified.  This was dissected proximally and a second large branch was identified.  They were dissected circumferentially and controlled with vessel loops.  Superficial lymph nodes were then removed to facilitate identification and dissection of the facial artery.   This was dissected circumferentially and controlled with vessel loops.  A lidocaine soaked neuropattie was placed on the vessels until the microvascular anastomosis. The marginal mandibular nerve was identified during the dissection and preserved.  
 +
 +</WRAP>
 +<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>
  
  
Line 1001: Line 1034:
 <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. 
  
Line 1016: Line 1050:
 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)\\
Line 1021: Line 1066:
 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:\\
Line 1032: Line 1075:
 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> 
  
  
Line 1066: Line 1105:
 </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>
Line 1098: Line 1143:
 </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>
Line 1138: Line 1189:
 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet:  arm\\ 
 +Drain: No\\
 +Sutures: 11-0 nylon, 4-0 nylon\\
 +Dressing: No\\
 +
  
 </WRAP> </WRAP>
Line 1171: Line 1228:
 </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>
Line 1182: Line 1245:
 <WRAP Group> <WRAP Group>
 <WRAP half column> <WRAP half column>
- 
  
 Preop Dx:  Sternal wound infection Preop Dx:  Sternal wound infection
Line 1223: Line 1285:
 </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>
Line 1261: Line 1329:
 </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>
Line 1296: Line 1370:
 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: 15 blake\\
 +Sutures: 3-0 pds\\
 +Dressing: No\\
 +
  
 </WRAP> </WRAP>
Line 1328: Line 1408:
 </WRAP> </WRAP>
 <WRAP half column> <WRAP half column>
 +
 +Tourniquet: No\\
 +Drain: No\\
 +Sutures: 4-0 chromic sutures\\
 +Dressing: Tegaderm, Adaptic, bacitracin\\
 +
  
 </WRAP> </WRAP>
Line 1346: Line 1432:
 </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.1576118390.txt.gz · Last modified: 2019/12/11 21:39 by melissa
Donate Powered by PHP Valid HTML5 Valid CSS Driven by DokuWiki