Plastic Surgery Nerve repair

Peripheral Nerve Repair

Objective

In case of nerve injury:

•   Anastomosis of a diseased or injured peripheral nerve.

Position

Supine or prone depending on access to nerve.

Anesthesia

General or local.

Procedure

   1.  For upper or lower extremity procedures, general, regional or local anesthesia is employed.

   2.  Most often a pneumatic tourniquet is utilized.

   3.  The course of the involved nerve is marked on the skin.

   4.  An incision extending beyond the anticipated site of mobilization is made.

   5.  The uninvolved nerve proximal and distal to the site of injury is carefully mobilized prior to dissecting the involved segment.

   6.  Care is taken to avoid injury to the local branches.

   7.  Dissection of the nerve trunk is performed.

   8.  Anastamosis is achieved after fascicles are rotationally aligned and approximated.

   9.  Epineurium is sutured to add stability to the repair.

10.  The wounds are closed.

11.  Splinting is applied as necessary.

Instruments

•   General plastic procedure set 

•   Microinstrumentation (Needle holder, scissors, forceps) 

•   Basin set 

•   Sheet wadding 

•   Esmarch bandage 

•   Blades (2) No. 15 

•   Bulb syringe 

•   Marking pen 

•   Nerve stimulator (llocaton) for example, concept

•   Magnification.

Any questions be sent to drmmkapur@gmail.com

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Plastic surgery Digital flexor tendon repair

Digital Flexor Tendon Repair

Objective

In case of tear of flexon tendons:

•   Repair of severed ends of a tendon caused by injury.

Position

Supine hand on hand rest.

Anesthesia

General.

Procedure

   1.  Esmarch bandage.

   2.  Midlateral digital incisions are often employed.

   3.  Care is taken to avoid injury to the neurovascular bundle.

   4.  Pulleys are preserved when possible.

   5.  The proximal tendon end is retrieved.

   6.  If length is not sufficient a graft (e.g. from the palmaris longus tendon) is prepared.

   7.  The tendon ends are approximated.

   8.  If the tendon insertion is involved, suture to the bone may be facilitated using fine drill holes.

   9.  The suture fixing the tendon graft to the insertion is tied over a button on the dorsum of the distal phalanx to prevent soft tissue necrosis.

10.  The wound is closed.

11.  A splint is applied.

Instruments

•   Limited plastic procedure set 

•   Power drill and fine drill points 

•   Microinstrumentation (Neddle holder, scissors, forceps) 

•   Basin set 

•   Sheet wadding 

•   Esmarch bandage 

•   Tube (or impervious) stockinette 

•   Blades (2) No. 15 

•   Bulb syringe 

•   Marking pen 

•   Straight Keith needle and button 

•   Magnification

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew
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Plastic surgery Syndactltaly repair

•   

Repair of Syndactylism

Objective

In cases of congenital fused fingers:

•   Separation of webbed fused digits.

Position

Supine.

Anesthesia

General.

Procedure

1.  Zig-zag or Z-plasty incisions are made in the interdigital space(s).

2.  The neurovascular bundles are protected.

3.  Bony and ligamentous defects if present are corrected.

4.  The incisions are closed.

5.  Full thickness grafts (e.g. skin from the abdomen or the medial aspect of the arm or the thigh) may be required to close defects.

6.  Stents are sutured over the grafts.

7.  A bulky dressing and splint are applied.

Instruments

•   Minor orthopedic procedure set 

•   Basin set 

•   Sheet wadding 

•   Esmarch bandage 

•   Blades (2) No. 15 

•   Bulb syringe 

•   Marking pen 

•   Stents.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew
Thosewho follow may post contributions to the site,please writo tp address above.

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Plastic Surgery Dermoabrasion

Dermabrasion

Ovjective

In cases of minor scars of face:

•   Abrasion of the skin to smooth scars and surface irregularities.

Position

Supine.

Anesthesia

Local.

Procedure

1.  Skin is stretched by hand.

2.  The epidermis is abraded by means of a motor-driven sanding cylinder and/or a wire brush.

3.  The area is irrigated copiously with saline during (and following) the procedure.

4.  The wound may be dressed with nonadherent gauze (e.g. Owens gauze).

5.  Compression bandage may be applied.

Instruments

•   Adson forceps 

•   Straight Mayo scissors 

•   Dermabrader (with wire brush and sanding cylinder) and cord, for example, Stryker 

•   Basin set 

•   Marking pen or methylene blue 

•   Syringes (2) Luer-Lok control, and needles (2) 25 or 27 gauge

•   Local anesthetic with epinephrine

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew
Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com

Also available now on android & smartphones same internet address

Repair