DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Dermatochalasis of the abdomen and trunk.
POSTOPERATIVE DIAGNOSIS:
Dermatochalasis of the abdomen and trunk.
OPERATION PERFORMED:
Extended abdominoplasty.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal
ESTIMATED BLOOD LOSS: 50 mL.
FLUIDS: Crystalloid.
COMPLICATIONS: None.
DRAINS: Jackson Pratt x4
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female status post 2 pregnancies with dramatic striae and laxity of her abdominal wall and flanks. The patient and I have discussed all options available to her and the risks and benefits related to each. The patient has chosen the extended abdominoplasty, understanding the position and magnitude of the incisions. We have discussed the untoward potential complications and have suggested that she is at a particular risk due to intermittent smoking. The patient additionally understands the risk of deep venous thrombosis and pulmonary embolus. She has signed the informed consent and wishes to proceed.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. SCD hose was in place and functioning prior to the induction of general endotracheal anesthesia. The patient was placed on the operating table in the supine position and rolled into the right side down position on a beanbag. Axillary roll and sufficient padding were placed below the legs and arms. The patient’s flanks were prepped and draped in the usual sterile fashion. Lidocaine 0.5% with 1:200,000 epinephrine was injected into the proposed incision. Further 0.5% lidocaine was injected into the potential location for feathering of the excision with liposuction. Two entrance ports were created with a 15 blade followed by suction-assisted lipectomy of the paramedian back, performed with a 3.0 mm cannula for a total of 50 mL. A 10 blade was used to excise a hemi-ellipse from the flank, with electrocautery used to continue the dissection. Meticulous hemostasis was obtained. Scarpa’s fascia was then closed with 2-0 Vicryl followed by placement of a drain. Further closure was performed with interrupted 3-0 Monocryl followed by a running 4-0 Monocryl. Mastisol, Steri-Strips and an OpSite were placed. The patient was then rolled to the opposite side. The above was repeated.
The patient was then placed in the supine position. The patient was again prepped and draped in the usual sterile fashion. A low abdominal incision was performed, and the umbilicus was circumscribed with a 15 blade. Dissection along the abdominal wall was performed with electrocautery to the xiphoid. Multiple small ventral hernias were identified and repaired after reduction with an interrupted 0 Ethibond. Plication of the abdominal wall was performed with interrupted 0 Ethibond. Final imbrication of the abdominal wall was performed with a running 0 PDS x2. Meticulous hemostasis was obtained and 0.5% Marcaine with 1:200,000 epinephrine was used to inject superficially in the fascial wall. The patient was placed at 20 degrees with the abdominal flap advanced inferiorly. Pilot cuts were performed and closure in Scarpa’s fascia was performed with interrupted 2-0 Vicryl. The redundant skin was excised. Two further drains were placed through separate stab incisions along the pubis. The umbilicus was brought through a vertical ellipse at the level of the superior iliac spine in the midline. A 3-point stitch with 3-0 Monocryl was performed x3. Further interrupted 3-0 Monocryl was performed after further skin incision on the lower abdominal wall, followed by closure with a running 4-0 Monocryl. Mastisol and Steri-Strips were placed. The drains were secured with a 2-0 silk. The umbilicus was inset with a running 4-0 Monocryl.
All sponge and needle counts were correct x2. An abdominal binder was placed. The patient was brought to the postoperative recovery room in stable condition.
