Barbie Without Plastic Surgery

1. Barbie Without Plastic Surgery

2. Plastic and Reconstructive Surgery

3. Objectives • Identify the goal of plastic surgery • Describe categories of plastic surgery • Describe the risks • Describe Perioperative Nursing Considerations

4. Practiced for thousands of years Artificial ears & noses found on Egyptian mummies Evidence that ancient Hindus used skin flaps to reconstruct noses History of Plastic Surgery

5. Categories of Reconstructive Surgery • Correction of Congenital Anomalies • Improvement of appearance • Resection of tumors that leave large soft-tissue defects • Repair of traumatic injuries

6. The goal of Plastic Surgery is to restore normal function and appearance(Cover the hole)

7. Treatment Options • Surgery • Cosmetic • Reconstructive/Revision • Lipectomy • Tissue Expansion

8. Treatment Options • Collagen/Fat/Botox Injection • Skin Resurfacing • Laser • Chemical Peel • Dermabrasion

9. Perioperative Nursing Considerations

10. Assessment • Plastic surgery often results in a change of body image and self esteem • Perioperative nurses must possess: • Respect for the patient • A nonjudgmental attitude • Effective communication skills

11. Nursing Diagnosis • Disturbed Body Image • Anxiety • Deficient Knowledge • Risk For Positioning Injury • Risk For Ineffective Tissue Perfusion • Risk For Infection

12. Outcome 0.280  Patient is free from signs and symptoms of infection Nursing Diagnoses Risk for infection (00004) Nursing Interventions Implements aseptic technique (Im.300) Protects from cross-contamination (Im300.1)

13. Nursing Interventions Minimizes the length of invasive procedure by planning care (Im.760) Administers care to wound sites (Im.290) Administer care to invasive device sites (Im.250) Classifies surgical wound (A.350.1) Reclassify if becomes contaminated

14. Nursing Interventions Evaluates factors associated with increased risk for postop infection at the completion of the procedure (E.320) Modifies wound class if there are major breaks in aseptic technique during the procedure.

15. General Considerations

16. Anesthesia • Local anesthesia is often used in conjunction with sedation, regional and general anesthesia • Epinephrine may be added to prolong anesthetic action & provide hemostasis • Epinephrine generally not used in local on digits (fingers/toes)

17. Positioning • Position patient so that all operative sites appropriately exposed and airway easily observed & accessed • OR bed may be turned for ease of access • Provide comfort measures, such as pillow under knees, as some procedures are long in duration • Always check patient after position changes

18. Skin Preparation • Most skin marking is done prior to patient going to sleep-don’t wash off when prepping • Colorless solution is preferred to observe true skin color • Avoid pooling of prep around or in eyes or ears

19. Draping • Blue towels and medium sheets are used when large amounts of skin must be exposed • Head drape used when working on face, ears & neck • Both sides of body may be exposed for comparison purposes

20. Supplies/Equipment • Marker/Methylene Blue • Undyed suture often used, clear may be used on face • Bipolar • Silastic and Teflon Implants • Available in several sizes and shapes • Contraindicated for use in an infected area

21. Tissue Expanders

22. Breast Implants

23. Facial Implants

24. Dermatome

25. Skin Mesher

26. Skin Mesher

27. Head Light & Light Source

28. Lighted Retractors

29. Jackson Pratt Drain

30. Microscope

31. Suction Assisted Lipectomy

32. Instrumentation

33. Gillies needle holder

34. Stevens scissors

35. Castroviejo Forceps

36. Hartman Mosquito

37. Skin Hook

38. Liposuction Cannulas

39. Medications • Local Injections • Lidocaine (Xylocaine) • Bupivicaine (marcaine) • Topical • Cocaine 4% • Tumescent Anesthesia • 1 liter NS with 500-1000mg lidocaine & 1mg epinephrine

40. Pressure Infuser

41. Dressings • Apply even pressure over wound to prevent dead spacing, seromas & hematomas • Collect drainage • Provide comfort for the patient • Protect wound

42. Brow lift • Minimizes forehead creases, drooping eyebrows, hooding over eyes, furrowed forehead and frown lines by removing excess tissue, altering muscles & tightening forehead skin • Length: 1-3 hours • Risks: facial nerve injury, muscle weakness, asymmetrical look, infection, scarring

43. Open Brow Lift • Hair is tied with rubber bands on either side of incision • Coronal incision is made running ear to ear • Skin of forehead is lifted, excess skin is removed & muscles altered

44. Endoscopic Brow Lift • 3-5 short (1 inch) incisions made • Endoscope inserted to view muscle & tissue • Elevator inserted through different incision to lift skin • Underlying tissue & muscle removed or altered

45. Brow Lift Before & After

46. Rhytidectomy (Face Lift) • Improves sagging facial skin, jowls & loose neck skin by removing excess fat, tightening muscles, & redraping skin. • Length: several hours • Risks: Facial nerve injury, infection, bleeding, poor healing, scarring, asymmetry or change in hairline

47. Rhytidectomy • Incision is made close to or in the hairline • Skin and subcutaneous tissue are mobilized by undermining (separation from their attachments) • Avoid injury to facial & greater auricular nerves

48. Rhytidectomy • After deep tissues are tighten with sutures, the excess skin is pulled up and back, trimmed and sutured into place • Drains may be placed

49. Post-Op Dressing

50. Rhytidectomy Before & After