Plastic Surgery Operative Reports For Medical Transcriptionists:
OPERATION PERFORMED: Bilateral reduction mammoplasty.
DESCRIPTION OF OPERATION: The patient was marked in my office in a sitting position and marked according to the inferior pedicle technique. She was brought back to the operating room where she was placed in the supine position on the operating room table and general endotracheal anesthesia was performed. Ancef 1 gram was given IV piggyback and antithrombotic boots were placed below the knees. A solution of 0.025% Xylocaine with 1:400,000 epinephrine was then infiltrated into the breast tissue and subcutaneous tissue, using approximately 100 mL on each side for hemostasis. The patient was then prepped and draped in the usual sterile fashion. A 7.5 cm pedicle was drawn along the midline of the inframammary folds extended up around the nipple-areolar complex at the apex of her preoperative markings. The nipple-areolar complex was reduced to 42 mm. I then de-epithelialized the inferior pedicle beginning at the inframammary fold and going up around the nipple-areolar complex to the apex of her preoperative markings. The inferior pedicle was then isolated by beveling medially and laterally on either side using a #10 blade. Triangular portions of the skin and subcutaneous tissue and breast tissue were then removed from either side of the pedicle. Two Allis clamps were placed on the upper skin flaps and held in a vertical direction as we thinned the upper skin flap with a #10 blade. All redundant tissue superior to the nipple-areolar complex was removed with a #10 blade as well. Hemostasis was achieved using the Bovie coagulator. I then checked for the adequate amount of reduction by bringing the upper skin flaps together in the midline inframammary fold. When I was pleased with the amount of reduction, I then irrigated the tissues with bacitracin and saline. A #19 French Blake drain was placed through a separate stab wound in the axilla and sutured to the skin using 2-0 silk. The upper skin flaps were then closed to the lower skin flaps using 3-0 Vicryl in an interrupted buried knot fashion followed by a 4-0 Monocryl in a running subcuticular fashion. The new position of the nipple-areolar complex was then marked at 5.6 cm from the inframammary fold along the vertical limb. A #38 cookie cutter was used to mark the location. The skin and subcutaneous tissue were removed from that location. The nipple-areolar complex was brought up on the inferior pedicle through the defect and then was inset using 3-0 Vicryl in an interrupted buried knot fashion followed by 5-0 nylon in the skin. I took off 1630 grams on the left side and 1360 grams on the right side. The incisions were dressed with Steri-Strips, Xeroform and fluffs. A surgical bra was then placed. The patient tolerated the procedure well and left the operating room extubated and in good condition.
OPERATION PERFORMED: Circumferential abdominoplasty.
DESCRIPTION OF OPERATION: With the patient positioned in the standing position preoperatively, preoperative markings were performed. She was then taken to the operating room where general endotracheal anesthesia was instituted while in her bed. After this was completed, she was transferred to the prone position on the operating room table positioning her on chest rolls. Foam pads were placed under the axilla on each side. Significant care was taken with her left shoulder because of the previous rotator cuff injury, and arm was positioned gently at her side at right angle, resting on the arm board. The same was done with the right arm. Attention was then turned to protecting the feet over pillows and Thromboguards were placed on the lower extremities. Attention was turned to prepping the lower back and buttocks region with Betadine gel and draped in a sterile manner. Attention was turned to placing tumescent solution using a liter of Ringer's lactate and adrenaline for hemostasis. This was placed in the bilateral buttocks region, lower back and flank regions. After adequate hemostasis was obtained as evidenced by blanching the skin, attention was turned to the lower markings. Incisions were made with a 10 blade, carried down to the level of the lumbar fascia. Dissection was carried superiorly to the level of the superior markings and then undermined for approximately an additional 8 cm superiorly into the flank and lower back regions. Hemostasis was obtained. The wound was irrigated with bacitracin solution. Attention was then turned to removing the excess skin inferiorly and superiorly and hemostasis was obtained. Temporary tacking sutures were placed in previously marked areas and attention was then turned to closing the back in layers using 0 Nurolon in interrupted fashion and the Scarpa's fascia. The deep dermis was closed with 0 Vicryl and superficial dermis closed with 3-0 Vicryl followed by subcuticular running 4-0 Monocryl. All areas were cleansed. Coverlet dressings were applied over the top of the Xeroform gauze. The skin was cleansed. The patient was then draped and was transferred to her bed in supine position and was then moved back to the operating room table in the supine position. Her arms were secured at right angle to her side, padded with blankets and Ace wraps. Pillow was placed under the popliteal fossa. Foley catheter was placed in the bladder and Thromboguards were replaced in the lower extremities. The mons pubis area was prepped in preparation for prepping and attention was turned to painting the abdomen and groin area with Betadine gel and draped in a sterile manner. Attention was turned to incision of lower abdomen, which was carried laterally to the level of the previous incisions joining the incision from the back. Once this was completed, attention was turned to undermining the lower abdominal skin up to the level of the umbilicus. The umbilicus was split from the overlying tissue. Further dissection was carried to the level of the xiphoid and a high-tension abdominoplasty was performed undermining the flanks with sponge stick. Hemostasis was obtained and the wound was irrigated with bacitracin solution. Attention was then turned to the repair of the diastasis of the abdomen using double layer repair, continuous running 0 Ethibond double stranded from the xiphoid to the umbilicus and from the umbilicus to the suprapubic region. This was then further imbricated with horizontal mattress sutures of 0 Ethibond. Once this was completed, hemostasis was obtained and the wound was again irrigated with bacitracin solution. Two Hemaduct drains were placed in the mons pubis and secured with 3-0 Vicryl suture and split longitudinally. One arm was laid into the lateral flanks. The other arm was laid superiorly along the rectus repair. Attention was then turned to bring the patient in gentle jackknife position. Excess skin to be resected was marked at 25 cm on each side and resected. Hemostasis was obtained and the wound was irrigated with bacitracin solution once again. Attention was then turned to closure of the abdomen in layers using 0 Vicryl on the Scarpa's fascia, 3-0 Vicryl in the deep dermis, and subcuticular running 4-0 Monocryl. The umbilicus was brought through middle stab wound and secured with 3-0 Vicryl and 5-0 nylon. All areas were cleansed. The half-inch Steri-Strips were applied to the lower abdominal incision. Xeroform gauze was used to dress the incisions and attention was turned to dressing the patient with compressive garment and lower abdominal dressing. The patient tolerated the procedure well. Blood loss was estimated to be approximately 200 mL. The patient received no blood transfusion.
OPERATION: Open capsulotomy of the right breast.
DESCRIPTION OF OPERATION: The patient was positioned in the supine position on the operating room table. A satisfactory level of general endotracheal anesthesia was obtained. The arms were secured to the arm boards with padded blankets and Ace wraps and thromboguards were placed on the lower extremities. The patient's chest was prepped with Betadine gel and draped in a sterile manner. Attention was turned to the inframammary crease incision in the right breast where the scar was excised, dissection carried through the subcutaneous tissue to the capsular pocket. The capsular pocket was opened, and upon removing the saline implant, which was found to be intact, there was found to be no significant inflammatory changes to the capsule, although the capsule was very thick. Starting at the 12 o'clock position in the superior aspect of the breast, a circumferential capsulotomy was performed around the base of the capsular pocket, releasing the capsular pocket completely and undermining the breast tissue approximately 3 cm in all directions. Once this was completed, a small strip of the capsular pocket was taken about 1.5 cm from the 12 to 6 o'clock position and from the 6 o'clock to the 12 o'clock position and hemostasis was obtained. Scoring of the superior capsular pocket was now performed in an umbrella-type fashion. Hemostasis was obtained. The wound was profusely irrigated with bacitracin solution. The implant which had been washed in bacitracin solution was now placed back in the pocket. The pocket was closed using 0 Vicryl in the deep tissue, 3-0 Vicryl suture in the deep dermis and subcuticular running 4-0 Monocryl. The patient tolerated the procedure extremely well. One half-inch Steri-Strips, Xeroform gauze, 4x4s and Tegaderms were applied. The patient was placed in her bra and transferred to the recovery room in excellent condition.
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