1. Procedures Intermediate Format Abdominoplasty

2. Objectives Assess the related terminology and pathophysiology of the ____________. Analyze the diagnostic interventions for a patient undergoing a _______________. Plan the intraoperative course for a patient undergoing_____________. Assemble supplies, equipment, and instrumentation needed for the procedure.

3. Objectives Choose the appropriate patient position Identify the incision used for the procedure Analyze the procedural steps for Abdominoplasty. Describe the care of the specimen Also: See Objectives MAVCC Unit 9: OBJ 1 - 16

4. Terms and Definitions

5. Definition/Purpose of Procedure Excision of excess fat and abdominal wall skin and tightening of the abdominal musculature Also called Tummy Tuck NOT a surgery for obese patients

6. Pathophysiology Excess Fat

7. Surgical Intervention: Special Considerations Patient Factors –Women of child-bearing age should delay this procedure until all pregnancies are complete Room Set-up Etc

8. Surgical Intervention: Positioning Position during procedure –Supine w/arms abducted 90 degrees on armboards Supplies and equipment Special considerations: high risk areas

9. Surgical Intervention: Special Considerations/Incision Special considerations –Skin prep: remove pubic hair –Parameters: extend from mid-chest to mid-thighs and the entire width of the patient. –Draping: entire abdomen is outlined with towels and laparotomy sheet placed State/Describe incision –Low transverse down to level of fascia (rectus sheath) and it may extend the entire width of the patient.

10. Surgical Intervention: Supplies General: ESU pencil w/blade and extension tip, Skin marker, Basin set, magnet needle holder, suction tubing, marking pen Specific –Suture: heavy absorbable for deep fat & may be subcuticular running suture –Blades: # 10 x 4 –Medications on field (name & purpose) –Catheters & Drains: 1 or 2 closed wound drainage systems (Hemovac or Jackson Pratt)

11. Surgical Intervention: Supplies cont’d Lap sponges Skin staples Dressings: light gauze over umbilicus, pressure dressing over main wound (elastoplast or foam tape), abdominal binder or girdle

12. Surgical Intervention: Instruments General: Basic Plastic Set or Minor set Specific –2 small deaver retractors –Fiberoptic retractor set, umbilical template (cookie cutter) –Extra crile or kocker clamps for grasping

13. Surgical Intervention: Equipment General Specific –Fiberoptic headlight and light source –Table Scales to weigh specimen

14. Abdominoplasty Procedure

18. Counts Initial: Sharps, sponges, instruments First closing Final closing –Sponges –Sharps –Instruments

19. Specimen & Care Identified as abdominal tissue (ask) Handled: routine, etc.

20. Postop Information

21. Which statement regarding abdominoplasty is NOT true? a.Abdominoplasty is the removal of abdominal fat in the obese b.Abdominoplasty requires an overnight stay for the patient c.Abdominoplasty is often performed in conjunction with liposuction d.Abdominoplasty involves the removal of fat from the lower abdominal area

22. Which incision is usually employed for an abdominoplasty? a.Midline b.Lower midline c.Low transverse d.McBurney

23. References STST pp. 708-709 www.plasticsurgery.org www.allrefer.com Goldman p. 430-432

24. Plastic Surgery Terminology Alloplasty, Debridement, Dermatome, Dermis, Donor Site, Epidermis, Erythema, Graft, Lop Ears, Micrognathia, Microtia, Prognathia, Recipient Site

25. Purposes of Plastic Surgery To correct congenital anomalies To correct disfigurements due to trauma or disease To improve aesthetic (cosmetic) appearance