Plastic Surgery Full thickness skin graft

Full Thickness Skin Graft (Wolfe Graft)

Objective

Coverage of small skin defects on face, hand and fingers following surgical excision of benign lesions or traumatic skin loss. 

Position

Depends upon site.

Anesthesia

Local or general.

Procedure

   1.  Clean and drape donor and recipient areas.

   2.  Mark and excise the lesion.

   3.  Secure hemostasis.

   4.  Make a template of the defect.

   5.  Transfer template to donor area. 

   6.  Mark and harvest graft.

   7.  Close donor area.

   8.  Thin out graft to remove fat from undersurface.

   9.  Suture graft in recipient bed.

10.  Apply tie-over dressing. 

Instruments

•   Plastic surgery set 

•   Sterile polyvinyl sheet for patter outline template

•   Vaseline/paraffin impregnated nonadherent gauze (Jelonet, Fairly) 

•   Irrigation syringe 

•   Cotton soaked in betadine or acriflavin solution.

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Plasti surgery split thcnkess graft

Split Skin (Thiersch) Grafting)

Objective

To cover wounds with loss of skin which cannot be closed by approximation of skin edges.

Position

Variable according to the site of wound.

Anesthesia

GA (LA can be used for small wounds).

Procedures

1.  Clean and drape donor and recipient areas.

2.  Take skin graft.

3.  Prepare recipient bed by scraping/excision.

4.  Secure hemostasis.

5.  Apply nonadherent gauze.

6.  Dressing.

7.  Tie over dressing over trunk. Circumferential pressure dressing over limbs.

8.  Splint the limb with Velroc/Gypsona POP slab.

Instruments

Skin grafting set consisting of:

•   Skin grafting knife (Humby, Blair or Electric dermatome)

•   Appropriate blade of skin grafting knife

•   Skin graft boards (wooden or stainless steel)

•   Skin graft mesher (optional)

•   Liquid paraffin (sterile)

•   Vaseline/paraffin impregnated gauze (Fairly, Jelonet)

•   Sterile cotton soaked in betadine or acriflavin

•   Gamjee pads and crepe bandages

•   Adrenalin in saline (1 in 100,000)

•   Syringe for irrigation

•   Velroc or Gypsona for splinting

•   Sutures 3 ‘0’ Nylon/silk on cutting needle.

•           4 ‘0’ chromic catgut on curved cutting needle for children

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 Z plasty

Scar Excision/Revision and Z Plasty

Objective

Patients with ugly scars

•   Require with or without Z plasty 

•   To achieve a fine inconspicuous scar.

Position

Supine or prone to provide access to scar.

Anesthesia

Local.

Procedure

1.  Plan and mark incisions.

2.  Excise scar.

3.  Z plasty incisions if required.

4.  Undermine and advance margins.

5.  Hemostasis.

6.  Closure in layers.

Instruments + Sutures

Limited plastic procedure set.

Any questions be sent to drmmkapur@gmail.com

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Plastic Surgery Liposuction

Liposuction

Objective

In case of excessive fat on thighs and abdomen:

•   Removal of subcutaneous fat deposits employing a high pressure vacuum suctioning device.

Position

Supine.

Anesthesia

General.

Procedure

1.  Surgeon may preinject the areas where liposuction is to be employed with a solution of local anesthesia with epineph­rine, to reduce bleeding and hyaluronidase (Wydase).

2.  To minimize tissue swelling.

3.  Through a 1 cm incision a blunt suction tip is inserted and used to tunnel under the skin.

4.  The excess subcutaneous fat is then suctioned from the pretunneled areas using a high pressure vacuum.

5.  The incisions are closed.

6.  Compression dressing is applied.

Instruments

•   Minor procedure set 

•   Blunt suction tips or blunt cannulas 

•   High pressure vacuum unit 

•   Basin set 

•   Blades (1) No. 15 

•   Marking pen 

•   Sterile, plastic adhesive drape tube 

•   Suction tubing 

•   Syringes (2) 30 ml 

•   Needles (2) 22 gauge

•   Intravenous antibiotic 

•   Local anesthetic with epinephrine 

•   Hyaluronidase (Wydase) 

•   Pressure girdle.

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 addresAny questions be sent to drmmkapur@gmail.com

Plastic surgery Palmer Fasciectomy

Palmar Fasciectomy

Objective

In cases of contracture (Depuytren’s):

•   Excision of the fascia of the palm to correct the deformity.

Position

Supine hand on hand rest.

Anesthesia

General or regional.

Procedure

1.  Short longitudinal palmar incision is next to the contraction band which is resected.

2.  For more extensive disease a longer incision with a Z plasty arrangement.

3.  Care is taken to avoid injury to digital nerves and flexor tendons.

4.  Wound closure may be done by primary suture.

5.  An anterior splint is applied.

Instruments

•   Limited plastic procedure set 

•   Basin set 

•   Tube stockinette 

•   Esmarch bandage 

•   Blades (2) No. 15 

•   Marking pen.

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 addres