COSMETIC RHINOPLASTY

Cosmetic Rhinoplasty

Objective

Correction of nasal deformities such as:

•   hump nose 

•   deviated nose 

•   long nose, etc. 

Position

Supine, head extended, pillow under shoulders, ring under the head, head end of table elevated to 30°.

Anesthesia

•   General or local.

Procedure

1.  Pack nose with xylocaine 2% with Adrenalin 1 in 100000.

2.  Infiltrate with xylocaine 1% with adrenaline 1 in 100,000.

3.  Incisions and exposure of nasal frame work.

4.  Excision of the hump.

5.  Lateral nasal osteotomies.

6.  Shaping of nasal tip cartilages.

7.  Closure.

8.  Taping of nasal dorsum.

9.  Application of nasal splint.

Instruments

•   Limited plastic procedure set 

•   Rhinoplasty set consisting of nasal speculums 2 

•   Double pronged hook (Kilner) 

•   Periosteum elevator (Joseph) (Fig. 18.21) 

•   Nasal retractor (Aufricht) (Fig. 18.22) 

•   Nasal chisel (McIndoe) (Fig. 18.23) 

•   Double guided nasal osteotome (Cinelli) (Fig. 18.24)

•   Osteotome 2 mm 

•   Dorsal scissors (Cottle) (Fig. 18.25) 

•   Cartilage scissors 

•   Nasal rasp 

•   Glabellar rasp 

•   Sutures:

     a.  5‘0’ Chromic catgut on curved cutting needle 

     b.  5‘0’ Vicryl or PDS in curved round body needle 

     c.  6‘0’ Prolene on curved cutting needle.

Dressing

•   Vaseline gauze 

•   Micropore tape cut into strips 1/4" wide and 4" long

•   Gypsona/Velroc/Aluminum sheet for nasal splint.

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

Reduction mammoplasty

Reduction Mammoplasty/Mastopexy

Objective

•   Reduction of excessively large breasts 

•   Elevation of hanging breasts.

Position

Supine, upper body flexed 20, arms abducted 45.

Anesthesia

General.

Procedure

1.  Marking (done the night before or morning of operation with patient standing errect).

2.  Prepare nipple areola containing pedicle flap.

     3.  Prepare lateral flaps and excise excess fat and skin.

     4.  Hemostasis close over suction drains.

Instruments

•   Plastic surgery set 

•   Suction drains 

•   Sutures:

     a.  4‘0’ Monocryl/chromic catgut on curved cutting needle

     b.  5 ‘0’ Prolene on curved cutting needle 

     c.  6 ‘0’ Prolene on curved cutting needle.

•   Elastoplast for dressing.

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

Augmentation Mammooplasty

Augmentation Mammoplasty

Objective

Increase of breast size by using implants in patients with small breasts.

Position

•   Supine

•   Arms abducted.

Anesthesia

General.

Procedure

1.  Submammary skin crease incision.

2.  Create a pocket by blunt and sharp dissection.

3.  Hemostasis.

4.  Insert implant.

5.  Suction drain (optional).

6.  Close in layers.

Instruments

•   General plastic procedure set 

•   Long Metzenbaum scissors curved on flat (Fig. 8.35)

•   Retractors

•   Deaver 2 (Fig. 8.94) 

•   Long forceps-nontoothed 

•   Suction drains 

•   Mammoplasty prosthesis 

•   Elastoplast for dressing 

•   Sutures:

     a.  4 ‘0’ Monocryl or chromic catgut on curved cutting needle

     b.  5 ‘0’ Prolene on curved cutting needle.

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

Cleft Palate repair

Cleft Palate Repair

Objective

In cases of cleft palate:

•   Repair of congenital defects in the palate.

Position

Supine with head extended with a pillow under the shoulders and ring under the head.

Anesthesia

General with a flexometallic or oxford endotracheal tube secured on the middle of the lower lip.

Procedure

   1.  Place mouthgag.

   2.  General anesthesia through an endotracheal tube.

   3.  A local anesthetic containing epinephrine is infiltrated to aid hemostasis.

   4.  Defect, soft palate margins are incised.

   5.  Layers for oral mucosa, muscle, and nasal mucosa are developed.

   6.  The pterygoid hamulus is fractured.

   7.  Mucoperiosteal flaps are elevated.

   8.  Nasal mucosal flaps are freed and sutured.

   9.  The nasal mucosa of the soft palate is sutured.

10.  Holes may be drilled in the hard palate for suture placement.

11.  Bone grafts may be employed.

12.  Muscle layers, and the oral mucosa are sutured.

Instruments

•   Plastic limited procedure set 

•   Mouthgag-Dingman or Dott (Fig. 18.19) 

•   Long knife handle with No. 12, and No. 15 and No. 11 blade (BP)

•   Freer periosteum elevator (Fig. 14.33)

•   Curved elevators angled right and left

•   Barsky pharyngeal flap elevator (Fig. 18.20)

•   Osteotome 3 mm

•   Mallet

•   Long fine dissecting forceps toothed (Gilles, McIndoe) (Fig. 8.49)

•   Suction tubing with fine suction tip 

•   Sterile gauze cut into halves and quarters.

Sutures

•   4 ‘0’ Vicryl or catgut on curved cutting 5/8 circle needle 

•   4/0 Silk on curved cutting needle for stay sutures.

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

Plastic surgery 1 cleft lip

PLASTIC SURGERY

Cleft Lip

Objective

In cases of harelip:

•   Repair of a congenital deformity of the lips.

Position

Supine with head extended by a pillow under the shoulders and a ring under the head.

Anesthesia

General, use flexometallic or oxford type endotracheal tube secured in the middle of the lower lip.

Procedure

   1.  A local anesthetic containing epinephrine is infiltrated to aid in hemostasis.

   2.  Any of several flaps are isolated and advanced.

   3.  Proper restoration the philtrum and shape of the bow of the lip is required.

   4.  Secondary repairs are performed according to individual situations even months or years later.

   5.  Palatal and alveolar deformities are repaired in due time to commensurate with the patient’s feeding requirements and tissue growth.

   6.  The incision is protected with antibiotic ointment.

   7.  The cheeks are splinted with a Logan’s bow (to counter the effects of crying).

   8.  Mark landmarks and incisions.

   9.  Incise and develop flaps.

10.  Secure hemostasis.

11.  Close in layers.

Instruments

•   Plastic surgery set 

•   Scalpel handle with No. 11 blade (BP).

Sutures

•   6 ‘0’ Prolene on curved cutting needle 

•   5 ‘0’ Monocryl on curved cutting needle 

•   5 ‘0’ Catgut on curved cutting needle 

•   5 ‘0’ Vicryl on round body needle.

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

NeuroSurgical procedure 8 laminectomy

Laminectomy

Objective

In cases of spinal cord pressure (including prolapsed disc) 

•   The removal of one or more vertebral laminae 

•   To decompress the pressure.

Position

•   Cervical sitting 

•   Lumbar throracic prone (or knee elbow).

Anesthesia

General.

Procedure

   1.  A midline incision used.

   2.  The wound is deepened.

   3.  Self-retaining retractors are placed, and fascia is incised.

   4.  The paraspinous muscles and periosteum are reflected.

   5.  Sponges are packed along the vertebrae.

   6.  A larger retractor is placed from exposure.

   7.  Small portions of the laminae overlying the herniated disc are removed with a Kerrison rongeur.

   8.  Small portions of the laminae overlying the herniated disc are removed to provide adequate exposure.

   9.  Nerve roots are retracted exposing the herniated disc.

10.  The wound is irrigated.

11.  The area is examined to ensure that all protruding disc has been removed.

12.  The wound is closed in layers.

Instruments

•   Laminectomy set

•   Kerrison rongeurs and pituitary forceps tray 

•   Power drill, drill bits, cord 

•   Basin set 

•   Blades (3 or 4) No. 10, (1) No. 15 

•   Sterile, plastic adhesive drape 

•   Suction tubing 

•   Asepto or bulb syringes (2) 

•   Cottonoids

•   Gell foam and thrombin 

•   Roller gauze 2" 

•   Bone wax 

•   Antibiotic irrigation.

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

NEURO SURGICAL procedeur 7 Peripheral nerve repair

Peripheral Nerve Repair

Objective

The repair of a severed peripheral nerve to achieve: 

•   Accurate apposition by elimination rotational malposition 

•   Excision of neuroma 

•   Accurate suturing of nerve sheath.

Position

Varies with nerve for repair.

Anesthesia

Local, spinal or general.

Procedure

1.  Skin incision for direct access to severed nerve site.

2.  Muscles split or retracted.

3.  Nerve mobilized to relieve tension.

4.  A large gap in nerve ends may require nerve graft.

5.  Fibrous neuroma excised.

6.  Nerve sheath sutured using non-absorbable suture.

7.  Wrap repaired nerve in silastic sheet cover.

8.  Wound closed.

Instruments

•   General set 

•   Fine dissecting forceps, toothed (Gillies), 2 

•   Fine dissecting forceps, non-toothed (McIndoe), 2 

•   Micro dissecting forceps 

•   Micro artery forceps 

•   Fine artery forceps, curved on flat (Mosquito), 6 

•   Fine artery forceps, sharp points Iris scissors, curved on flat, sharp points 

•   Razor blades breaker and holder 

•   Razor blades 

•   Plastic tubing or tape for nerve traction 

•   Retractor, self-retaining (Mayo) 

•   Plaster of Paris back slab, or similar splint 

•   Nerve sutures for both operation areas 1 or 0.75 (5/0 or 6/0) synthetic non-absorbable on a small curved round-bodied non-traumatic needle 

•   19 Micron metallized synthetic non-absorbable suture 

•   Ligatures and sutures for an arm operation 

•   2 and 2.5 (3/0 and 2/0) plain catgut or synthetic absorbable for ligatures 

•   3(0) Chromic catgut or synthetic absorbable on a medium half-circle cutting needle for skin sutures 

•   2.5 (2/0) synthetic non-absorbable or silk on a medium curved cutting needle for skin sutures 

•   Ligatures and sutures for a leg operation 

•   2.5 and 3 (2/0 and 0) Plain catgut or synthetic absorbable for ligatures 

•   4 or 5 (1 or 2) chromic catgut or synthetic absorbable on a medium or large half-circle cutting needle for muscle sutures.

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