Plastics

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==== Dr. Greyson Introduction ====
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==== Operative Reports ====


====Carpal Tunnel Release====

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Operative Report:\\
1. Carpal Tunnel Release:\\
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The patient was identified in the holding area and the operative sites were marked.  He was brought to the operating room and placed supine. The extremity was prepped and draped in standard sterile fashion. A preoperative time-out was taken to ensure the patient's identity, the operative procedure, as well as the operative location.
  
Local anesthesia was achieved with 1% lidocaine mixed with 0.5% Marcaine. The arm was exsanguinated with an esmarch bandage, and the well padded tourniquet was inflated to 250 mmHg. 
 
A longitudinal incision was made over the transverse carpal ligament at the level just distal of the volar wrist crease, in line with the 3rd webspace. We dissected through the subcutaneous tissue and palmar fascia, and the palmaris brevis muscle fibers.  Care was taken to protect the ulnar neurovascular bundle in Guyon's canal.  Next we identified the transverse carpal ligament which was divided longitudinally from the palmar fat pad and proximally into the antebrachial fascia. Complete release was ensured and the wound was irrigated with normal saline. The skin was closed using 4-0 nylon stitch.  

A soft dressing was applied. The tourniquet was released. He tolerated the procedure well. There were no complications.  Final instrument count was correct.  He left the operating room in stable condition. 

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Photos\\

Tourniquet: finger / forearm / arm\\
Drain: Type of drain and placement\\
Sutures: List all layers\\
Dressing: What's preferred?\\

Anatomy: Pertinent anatomy should be listed\\

Post-operative care: Include restrictions, splints, etc...\\

Attending Pearls (Learning points/Pimp Questions):\\
OR tips: Local w/ sedation. Upper arm tourniquet w/ webrill, tourniquet, foam tape. Uses scalpel only to "scratch" into the carpal tunnel, then scissors to divide proximally/distally. Close w/ 4-0 Nylon. \\
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====Panniculectomy====

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Operative Report:\\
1. Panniculectomy:\\
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The patient was identified in the holding area and the operative sites were marked.  He was brought to the operating room and placed supine. The abdomen was prepped and draped in standard sterile fashion. A Foley catheter was placed. The arms were abducted and secured. A preoperative time-out was taken to ensure the patient's identity, the operative procedure, as well as the operative location.
  
Local anesthesia (0.25% Marcaine with epinephrine) was injected at the proposed incision and around the umbilicus.
 
...Drains were placed at the lateral aspect of the incisions and secured with 2-0 Nylon sutures. Incisions were closed with 3-0 PDS, 3-0 Monocryl deep dermal sutures, and 3-0 Stratafix sutures. The umbilicus was closed with 3-0 Monocryl and 4-0 FAS...

Prineo and Dermabond was applied to the abdominoplasty incision. Dermabond was applied to the umbilicus. 

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Photos\\

Drain: Type of drain and placement\\
Sutures: List all layers\\
Dressing: What's preferred?\\

Anatomy: Pertinent anatomy should be listed\\

Post-operative care: Include restrictions, splints, etc...\\

Attending Pearls (Learning points/Pimp Questions):\\
OR tips: 2" umbilicus (males) inset with inverted "U" with inferior "V" \\
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