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

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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.

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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
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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

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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.

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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

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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.

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