PREOPERATIVE DIAGNOSES:
1. Pannus.
2. Excess skin of arms.
POSTOPERATIVE DIAGNOSES:
1. Pannus.
2. Excess skin of arms.
PROCEDURES PERFORMED:
1. Panniculectomy.
2. Cosmetic brachioplasty.
SURGEON: John Doe , MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 350 mL.
DESCRIPTION OF PROCEDURE: The patient was marked preoperatively in the holding area. The patient was then brought back to the operating room where she was placed in the supine position with both upper extremities abducted on arm boards. The patient was induced and intubated without difficulty. She was sterilely prepped and draped in the usual fashion. We first performed the brachioplasty portion of the case by following our preoperative markings. The skin was first incised along the intermuscular septum and a posteriorly-based skin flap was elevated from the medial humerus to the axilla. This was taken again and elevated along the superficial fascial system of the arm until we had reached the edge of our marked out dissection. We advanced this skin flap anteriorly towards the area of redundancy, marked it, and then resected it. We irrigated copiously and obtained hemostasis using electrocautery. We then closed the wounds over closed suction drains, which were brought out through separate stab incisions in the axilla. They were closed with interrupted 3-0 Vicryl in the subcutaneous and the skin with running subcuticular 5-0 Monocryl. She was dressed with bacitracin, Adaptic, Kerlix, and Ace wraps. The arms were then wrapped and padded on arm boards and the patient was re-prepped and draped for the abdomen.
Again, following our preoperative markings, we elevated from the ASIS on the right to the left just above the mons pubis in a horizontal orientation. I elevated superiorly the skin flap at the level of the anterior abdominal fascia to the costal margins laterally and the xiphoid medially. After this, we made a circular incision on the umbilicus and dissected the umbilical stalk down to the fascia to avoid inadvertently undermining it as well. We then ran a plication stitch from the xiphoid to the pubis with a looped 0-nylon. We irrigated and obtained hemostasis using electrocautery. We then flexed the patient in a semi-Fowler position and advanced the superiorly-based skin flap inferiorly and judged the area of redundancy and resected it. We obtained hemostasis again and then closed over two drains, again brought out through a separate stab incision in the mons pubis, suturing into place with 2-0 silk. The horizontal incision was closed in layers with the Scarpa with interrupted 2-0 Vicryl, the subcutaneous with interrupted 3-0 Vicryl, and the skin with a running subcuticular 4-0 Monocryl. We made a circular incision in the midline, brought the umbilicus through this, and inset it with interrupted 4-0 Monocryl and interrupted 5-0 nylon. The wound was dressed with bacitracin, Adaptic, Kerlix, and paper tape. The patient was extubated and taken to recovery in stable condition.
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