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resident:tae_chong [2020/04/13 18:12] – [Latissimus Muscle Flap] jonathanresident:tae_chong [2021/02/22 09:36] (current) – [Facial Artery Dissection] michael
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 +=====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:img_4931.jpg?400|}}
  
 Tourniquet: No\\ Tourniquet: No\\
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 <WRAP half column> <WRAP half column>
  
-Tourniquet: Medial Malleolus +
-Drain: No\\ +
-Sutures: No\\ +
-Dressing: No\\+
  
  
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 ==== 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>
  
  
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 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).\\ 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:\\ 
-1. What superficial vein may you encounter during dissection? Greater saphenous vein\\ 
-2. What is the blood supply to the gracilis muscle? It is a type II muscle flap. Dominant pedicle is branch of medial femoral circumflex artery. It cannot survive off SFA perforators. Pedicle AND skin perforator approximately 10 cm from pubic symphsis.\\ 
-3. Describe course of medial femoral circumflex artery? Between adductor magnus and longus.\\ 
-4. What nerve supplies the gracilis muscle? anterior branch of obturator.\\ 
-5. What is the Origin of the gracilis muscle? The pubic symphysis and the inferior pubic ramus.\\ 
-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.\\ 
  
 </WRAP> </WRAP>
  
 <WRAP half column> <WRAP half column>
 +
 +{{:resident:whatsapp_image_2020-05-10_at_5.32.20_pm.jpeg?400|}}
 +
  
 Tourniquet: No\\ Tourniquet: No\\
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 Dressings: Dermabond or steristrips depending on if Dr. Chong wants to hide scar for thigh. Tegaderm biopatch for drains, ace wrap for thigh, but don't go too high to compress tunnel. Bacitracin and ABD for perineum\\ Dressings: Dermabond or steristrips depending on if Dr. Chong wants to hide scar for thigh. Tegaderm biopatch for drains, ace wrap for thigh, but don't go too high to compress tunnel. Bacitracin and ABD for perineum\\
 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.\\
 +
 +
 +Questions you will be asked:\\
 +1. What superficial vein may you encounter during dissection? Greater saphenous vein\\
 +2. What is the blood supply to the gracilis muscle? It is a type II muscle flap. Dominant pedicle is branch of medial femoral circumflex artery. It cannot survive off SFA perforators. Pedicle AND skin perforator approximately 10 cm from pubic symphsis.\\
 +3. Describe course of medial femoral circumflex artery? Between adductor magnus and longus.\\
 +4. What nerve supplies the gracilis muscle? anterior branch of obturator.\\
 +5. What is the Origin of the gracilis muscle? The pubic symphysis and the inferior pubic ramus.\\
 +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.\\
 +
  
 </WRAP> </WRAP>
resident/tae_chong.1586815976.txt.gz · Last modified: 2020/04/13 18:12 by jonathan
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