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Chest Wall Recon after sternal dehisence of sternectomy
Dr. Chong likes to take these
Back Recon after spinal infection or dehisence
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Sacral Decub
Following criteria must be met prior to flap reconstruction:
Nutrition: albumin > 2.5 gm/dl Prealbumin: normal >16 mg/dl. In general patients with osteo and inflammatory processes do not have a normal prealbumin. (negative acute phase reactant). However, if they can show consistent elevation in prealbumin over 3 weeks, they can be considered candidates for reconstruction.
The patient must have Source control: Adequate debridement and staged reconstruction after several weeks of IV antibiotics.
Flap reconstruction may be scheduled after the debridement with the patient managed with a wound vac.
Control of any spasms or release of fixed contractures that may impair flap mobilization.
Bowel regimen well established and urinary control. If necessary, diversion prior to surgery.
Plan for postoperative disposition: pressure relieving surface obtained prior to debridement, medical management and rehabilitation plan.
The patient is to follow up with Dr. *** in outpatient clinic.
OR
.PLASTICSPRESSURESORECONSULT
Distal radius fracture
Is it intraarticular or extra articular?
Is the patient neurovascularly Intact? (Check ulnar and radial pulses, sensation in radial, medial, and ulnar distributions) Motor exam as much as pain limits
The ED should have hand, wrist AND forearm X-rays ordered Ask the ED to have a mini C-arm ready, Ask them for Finger traps.
Be sure there is Lidocaine 1% without epi, and 18 G needle to draw, 27 or 30 G needle to inject, two 10 mL syringe, alcohol wipe.
Gather plaster roll (normally will fold into two sets 13-15 sheets each for a dorsal-volar splint, webril, a basin for warm water, bias wrap and an ACE to splint the patient after the reduction