Prior to surgical incision, antibiotic prophylaxis is administered with appropriate intravenous antibiotics. The skin is incised and the posterior incision dissection is done perpendicular, straight down, through the subcutaneous fat. After the skin is incised, the dissection is beveled outward anteriorly. This creates a subcutaneous flap anteriorly. At all locations, the dissection is done down to, but not violating, the clavipectoral fascia. Anteriorly, any axillary creases or folds are obliterated by scoring of the subcutaneous tissue. The axillary breast tissue is then excised, marked for appropriate laterality, and submitted for permanent pathology. The resulting void is copiously irrigated and hemostasis is ensured. Long acting anesthetic is used to infiltrate the regional sites for postoperative analgesia. A 15-French Blake drain is placed posteriorly through a separate stab incision. The skin edges are meticulously aligned at the anterior and posterior edges with redundancy kept in the middle (Figure 6). The incisions are closed in two layers. An absorbable suture is used in interrupted buried fashion followed by an absorbable subcuticular stitch. 2-octyl cyanoacrylate liquid adhesive and self-adhering mesh (Dermabond Prineo) is placed superficially. Video 1 summarizes the technique.
Specialty: Plastic Surgery
Lower Lip Sling Suspension with Bidirectional Fascia Grafts For Isolated Marginal Mandibular Nerve Palsy
The procedure in this video demonstrates a lower lip sling suspension technique for isolated marginal mandibular nerve palsy using bidirectional fascia grafts.
Rectus Abdominis Myocutaneous Flap Harvest
This video highlights the surgical nuances of rectus abdominis myocutaneous free flap harvest.
Thermal Punctal Cautery for Chronic Ocular Surface Disease
In this video, permanent punctal occlusion is performed with high-temperature thermal cautery for the treatment of refractory ocular surface dryness, in this case due to graft-versus-host disease.
Scalp Reconstruction with a Free Anterolateral Thigh Flap: Microvascular Anastomosis
This procedure depicts the microvascular anastomosis between the free anterolateral thigh (ALT) flap and the superficial temporal artery (STA) and superficial temporal vein (STV).
Scalp Reconstruction with a Free Anterolateral Thigh Flap: Flap Inset
This procedure demonstrates the inset of the anterolateral thigh (ALT) flap into a large composite wound after oncologic resection.
Scalp Reconstruction with a Free Anterolateral Thigh Flap: Flap Dissection
This procedure depicts the harvest of the anterolateral thigh flap to be utilized in the reconstruction of a post-extirpative scalp defect.
Sliding Osseous Genioplasty and Coronoidectomy in a Patient with Treacher-Collins Syndrome
Contributors: Andrew Weaver and Kumar Patel, PA-C
18 y.o. female with Treacher-Collins syndrome (patients have micrognathia, underdeveloped facial bones, particularly the cheek bones, and a very small jaw and chin. She is only able to open her mouth to 20mm due to the interference of her coronoid process with her zygoma/
DOI: http://dx.doi.org/10.17797/959yiezvoo
Repair of Tessier 7 Cleft Lip Deformity
The most common of the rare craniofacial clefts, Tessier’s No. 7 cleft is represented by a deficiency of tissue that may span from the oral commissure to the ear. (1) The repair of the cleft of the lip must include especial attention to restoring continuity of the orbicularis oris muscle as well the vermillion. This case is presented as an example of the repair of the Tessier 7 cleft lip deformity.
DOI #: http://dx.doi.org/10.17797/4h2edlts5zz
Plastic Surgery Pearls for basic suturing: instruments & technique
Contributors: Kumar Patel, PA-C
Basic plastic surgery suturing techniques geared towards medical students and residents, including starting position, basic simple suture, deep dermal suture, vertical mattress, horizontal mattress and running subcuticular.
DOI: http://dx.doi.org/10.17797/udwdtpze6v