Plastics

Why isn't the bovie working? Because we infilitrated with local and it's too wet.

Loupe magnification for ALL cases. Yes, even breast reductions.

OR
Very particular so pay attention

arm out and turned 90
tourniquet upper arm- with lots of web well unless stated otherwise

Draping-he will have an xtra large sheet that he cuts
arm in stockinette
1. mayostand on hand table (paper side down)
2. half of the xtra large drape on hand table
3. blue towel wrapped around arm help by penetrating towel clamp
4. long sheet over patient - held in place by 4 non penetrating towel clamps

“If there is pus always collect culture data Uses loupes for all cases”

Pilar syndrome for post-CTR pain

arm out and turned 90
tourniquet on forearm- with lots of web well unless stated otherwise

Draping-he will have an xtra large sheet that he cuts
arm in stockinette
1. mayostand on hand table (paper side down)
2. half of the xtra large drape on hand table
3. blue towel wrapped around arm help by penetrating towel clamp
4. long sheet over patient - held in place by 4 non penetrating towel clamps
-He will mark the incision.
-Uses Knife to cut until fat is seen, 2 ski hooks
-Bovie and smooth pickup to buzz vessels
-then he uses ragnels and sens and you use litler scissors to dissect doen to transverse carpal ligament.
-start proximal, sweep ulnar–> radial with freer
-litler to push cut the proximal transverse carpal ligament
then distal- litler until Kaplan's line

USES VICRYL TO CLOSE DEEP DERMAN
then 5-0 nylon interupted

Special equipment: Bone anchor
Sutures: 2-0 fiber wire for tendon reconstruction, 5-0 nylon for skin closure
Notes: Removes trapezium whole. (ie. does not use rongeur unless a piece breaks)

Suture: 4-0 vicryl deep dermal, 4-0 Monocryl subcuticular
Dressing: Steristrips crossing wound with benzoin, pressure dressing

After induction of general anesthesia, the patient was placed into a prone position with padding and had her back prepped and draped. Preoperative skin markings consisted of a 5 cm transverse skin incision directly over the palpable mass. The scalpel was then used to incise along the marked lines going down through the skin into subcutaneous tissues, whereafter the rest of the dissection was performed with loupe magnification using a combination of electrocautery as well as gentle blunt dissection to dissect the mass from the surrounding tissues. Once in the subcutaneous plane, there appeared to be a multilobulated lesion that was contained in this space that was felt to be likely to be consistent with a lipoma. Gentle blunt dissection was then performed at the periphery of the mass, but the mass was poorly encapsulated from the surrounding tissues and dissection was slow to proceed. The mass was eventually isolated from the surrounding tissues and no further presence of the mass was noted on clinical exam. The mass seemed to extend all the way down to the fascia. After verifying complete excision of the mass, the wound was meticulously checked for hemostasis with electrocautery, and then closure of the cutaneous wound was accomplished with multiple deep dermal sutures of 4-0 Vicryl, followed by a running 4-0 Monocryl subcuticular stitch in the skin. Dressings consisting of benzoin, Steri-Strips, and Tegaderm were applied, followed by a modest compressive bandage with 4 x 4's and Medipore tape.

Dr. Gordon's Purple Sheet Hand Exam

Injections pure kenalog into proximal phalanx at 45 degree angle between finger and palm. (ie. the needle is pointing distally in the direction of the distal finger tip.) Go all the way down to bone and inject WITHOUT resistance. Place a bandaid dressing.