Plastics and Reconstructive Procedures

1. Plastics and Reconstructive Procedures

2. PlasticsOperative Sequence Rhytidectomy

3. Rhytidectomy • Overall Purpose of Procedure: • To improve the appearance of the patients face and neck area.

4. RhytidectomyRhytid =‘s medical term for a wrinkle • Define the procedure: • Rhytidectomy can mean many different types of procedures dealing with the head and neck. • Facelift • Browift • Eyelid lift • Chin Implants • Malar implants (mid-face cheek implants)

5. Rhytidectomy- Facelift -

6. Rhytidectomy- Anatomy - • The Platysma muscle is a flat, thin muscle that lies uderneath the skin of the anterior and lateral neck. • Deep to the muscle lies the superficial layer of the deep cervical fascia.

7. Rhytidectomy • Wound Classification: 1

8. Operative Sequence • 1- Incision • 2- Hemostasis • 3- Dissection • 4- Exposure • 5- Procedure (Specimen Collection possible) • 6- Hemostasis • 7- Irrigation • 8- Closure • 9- Dressing Application

9. Rhytidectomy • Instrumentation: Plastics Tray • Positioning: The patient can be in supine position, arms on arm boards. Can also be in Fowlers. • Prepping: Surgeon preference. Hibiclense or a Betadine Prep Kit. Must clean and comb hair away from incision site • Draping: Head drape.

10. RhytidectomyBegin your Operative Sequence • Prior to incision, must have pre-op photos in room! • Incisions are marked bilaterally and injected with local • Incision: 15 kb on #3 handle for incision. • Made around the ear, under the earlobe and extends into the hairline. • One side is done at a time.

11. Rhytidectomycont. Operative Sequence • Hemostasis: Handheld Bovie and hemostats.

12. Rhytidectomycont. Operative Sequence • Dissection and Exposure: • The skin is undermined to the nasolabial fold, area of the mental foramen and to the midline of the neck to the thyroid cartilage. • Use of Metz, Double and Single Skin hooks, Adsons, and Stevens scissors.

13. Rhytidectomycont. Operative Sequence • Exploration and Isolation: • Care is taken not to damage the Facial nerve and artery. • If a tighter lift is desired, the Platysmal and SMAS (Superficial Musculoaponeurotic System) is dissected and lifted.

14. Rhytidectomycont. Operative Sequence • Surgical Repair: • Excess fat is removed and skin flap edges are grasped with Allis’s. • The skin is drawn upward and redraped to the proper degree of tension. The excess skin is excised along the angle of the clamps. • Excellent Facelift Video

15. Rhytidectomycont. Operative Sequence • Hemostasis and Irrigation: • All bleeding is controlled with cautery, possibly Bi-polar. • Use of warm Saline to irrigate.

16. Rhytidectomycont. Operative Sequence • Closure: • Incisions are usually closed with a 4-0 Nylon behind the ear and a 5-0 in front of and around the ear. • Staples may be used in the hairline. • The circulator will prepare the local for the opposite side. • Repeat procedure on the opposite side.

17. Rhytidectomy • Major Arteries: • External Carotid Artery • Facial

18. Rhytidectomy • Major Veins: • Internal Jugular Vein • Major Nerves: • Cranial Nerve VII - Facial Nerve

19. Blepharoplasty Fact: According to the American Society for Aesthetic Plastic Surgry, in year 2008 more than 195,000 people in the United States underwent cosmetic eye surgery. Blepharoplasty has become the most sought-after facial plastic surgery procedure, surpassing facelift, rhinoplasty, facial implants, and forehead lift.

20. Blepharoplasty Visit: http://www.drmeronk.com/videos.html

21. Plastic ProceduresOperative Sequence Lipectomy

22. Lipectomy • Overall Purpose of Procedure: • To remove excess fatty deposits from many different areas of the human body. • Areas include: • Hips and Thighs • Abdomen • Breast • Face • Buttocks • Anywhere there is bulk fatty deposits

23. Lipectomy • Define the procedure: • Liposuction, also known as lipoplasty ("fat modeling"), liposculpture or suction lipectomy ("suction-assisted fat removal") is a cosmetic surgery operation that removes fat from many different sites on the human body.

24. Lipectomya 12-year old girl who at 5-foot-5 weighed 230 pounds.

25. Lipectomy • Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring with significant risksand is not a weight loss method. The amount of fat removed varies by doctor, method, and patient, but is typically less than 10 pounds. • There are several factors that limit the amount of fat that can be safely removed in one session. • Ultimately, the operating physician and the patient make the decision. There are negative aspects to removing too much fat. Unusual "lumpiness" and/or "dents" in the skin can be seen in those patients "over-suctioned". The more fat removed the higher the surgical risk.

26. Lipectomy • Wound Classification: 1

27. Operative Sequence • 1- Incision • 2- Hemostasis • 3- Dissection • 4- Exposure • 5- Procedure (Specimen Collection possible) • 6- Hemostasis • 7- Irrigation • 8- Closure • 9- Dressing Application

28. Lipectomy • Instrumentation: Plastics tray. Assortment of liposuction cannulas. Liposuction machine and tubing. • Positioning: Depends on the area of fat removal. • Prepping: Surgeon preference. Duraprep, Hibiclense or a Betadine Prep Kit. • Draping: Also depends on area prepped.

29. LipectomyBegin your Operative Sequence • Prior to Incision: • Some MDs inject a solution to “melt” the fatty deposits. This is usually Lidocaine and LR or NACL This makes removal easier. • Mark the site and have the surgeon pick out the appropriate size cannula. • ST will connect the cannula to the suction tubing and throw end to circ. • Incision: 15 kb on #3 handle for incision. Incision is only ½ inch at most.

30. Lipectomycont. Operative Sequence • Hemostasis: Handheld Bovie

31. Lipectomycont. Operative Sequence • Dissection and Exposure: • All dissection is made with the lipo cannual that the surgeon has previously chosen.

32. Lipectomycont. Operative Sequence • Exploration and Isolation: • A tunnel is created by passing the cannula underneath the skin. • The suction is off at this point.

33. Lipectomycont. Operative Sequence • Surgical Repair • Once the tunneling process is done a few times, the suction is turned on. This allows the surgeon to “break up” the fatty deposits before attempting suctioning. • The surgeon removes the desired amount of fat, checking the area periodically. • The tubing will need cleaning with NACL during the procedure. • Lipo video

34. Lipectomycont. Operative Sequence • Hemostasis and Irrigation: • All bleeding is controlled with cautery. • Use of warm Saline to irrigate.

35. Lipectomycont. Operative Sequence • Closure: • The small incision is closed with a 4-0 or 5-0 Nylon. The dressing that you apply will need to be a pressure dressing, applied depending on area of Lipectomy.

36. Lipectomy • Major Arteries: • Depends on area of Lipectomy

37. Lipectomy • Major Veins: • Depends on area of Lipectomy • Major Nerves: • Depends on area of Lipectomy

38. Abdominoplasty Plastic ProceduresOperative Sequence

39. Abdominoplasty Overall Purpose of Procedure: A.K.A. Tummy Tuck To remove excess fat and tighten abdominal skin.

40. Abdominoplasty Define the procedure: The tightening of the abdominal skin through an incision jut above the pubic hair line. Can be combined with Liposuction. Can also include a Thigh Lift.

41. Abdominoplasty • Indications for Abdominoplasty • Loss of muscle tone in the lower abdominal region • Lose skin and fat in the abdominal region resulting from weight loss.

42. Abdominoplasty Wound Classification: 1

43. Operative Sequence 1- Incision 2- Hemostasis 3- Dissection 4- Exposure 5- Procedure (Specimen Collection possible) 6- Hemostasis 7- Irrigation 8- Closure 9- Dressing Application

44. Abdominoplasty Instrumentation: Major/Minor tray depending on patient size. Positioning: Supine with arms on arm boards. Prepping: Surgeon preference. Duraprep, Hibiclense or a Betadine Prep Kit. Draping: Can be as many as 8 towels.

45. AbdominoplastyBegin your Operative Sequence Prior to Incision: MD will mark incision. It will be necessary to flex the able to aid in closure. Incision: 10 KB across pubic line, from Iliac crest to Iliac crest. Can be made from north to south, from umbilicus to pubis.

46. Abdominoplastycont. Operative Sequence Hemostasis: Handheld Bovie

47. Abdominoplastycont. Operative Sequence Dissection and Exposure: The abdomen is dissected through the subcutaneous tissue and fat down to the rectus muscle using the bovie.

48. Abdominoplastycont. Operative Sequence • Exploration and Isolation: • The abdomen is also dissected up towards the chest. • This creates a flap that will be pulled down towards the pubis once the excess skin is excised. • Have Volkmans and Deavers available.

49. Abdominoplastycont. Operative Sequence Surgical Repair: Both of the Rectus muscles are tightened using a 0 Ticron. The skin flaps are pulled together, excess skin and fat is removed. The table is flexed and the abdomen is closed. Video: Abdominoplasty Surgery Video

50. Abdominoplastycont. Operative Sequence Hemostasis and Irrigation: All bleeding is controlled with cautery. Use of warm Saline to irrigate.