DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Submental lipodystrophy.
2. Abdominal laxity.
POSTOPERATIVE DIAGNOSES:
1. Submental lipodystrophy.
2. Abdominal laxity.
OPERATION PERFORMED:
1. Ultrasonic liposuction, submental.
2. Abdominoplasty with diastasis repair and translocation of umbilicus.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 100 mL.
DESCRIPTION OF OPERATION: The patient was brought to the operating room in the sitting upright position. The submental area was marked for liposuction and the abdomen was marked for abdominoplasty, marking a long, low transverse incision from hip to hip, crossing the pubic hairline and moving onto the opposite side in the identical fashion. The incision was then marked from the edge of that, marking up and around the umbilicus and around to the opposite side. The patient was then placed supine on the operating room table. General anesthesia was administered and the procedure was begun by tumescence of the submental area with 60 mL of normal saline, incorporating 10 mL of 1% lidocaine with epinephrine. After skin blanch was noted, a 3 mm incision was made in the submental area and the ultrasonic catheter was inserted and approximately 2 minutes of ultrasonic energy used in the submental and neck area, emulsifying fat, and then using a 3 mm cannula, the submental area was liposuctioned until the contour desired was achieved and the thickness of the flap was achieved. A single 6-0 nylon was used to close the incision.
Then, attention was directed to the abdomen which was prepped and draped in a routine fashion. A Foley catheter had been inserted preoperatively. SCD boots had been applied preoperatively and 1 gram of Ancef had been given preoperatively. The procedure was then begun, making a low transverse incision as marked below the top of the pubic hairline, extending from hip to hip and actually beyond the inferior iliac crest on each side. The incision was continued through the subcutaneous tissues using electrocautery down to the fascia. The flap was then elevated, releasing the scar adhesions up to the level of the umbilicus. An incision was made around the umbilicus, which was quite retracted and scarred in, releasing the umbilicus. Then, the umbilical stalk was dissected down to the fascia. The flap was then divided from the umbilical opening to the free edge and then the flap was elevated above the umbilicus at the fascial plane, separating the subcutaneous tissue from the fascia up to the xiphoid and extending across the costal margins lateral to the xiphoid. Meticulous hemostasis was achieved. The midline was plicated using #1 Nurolon from xiphoid to pubis and then a second layer was used from pubis to umbilicus using a running locking suture of #1 Nurolon. After this was completed, the wounds were reinspected for hemostasis. Drains were inserted. A drain on the right, lateral to the incision, was brought up and around the upper flap and from the left side across beneath the umbilicus. The bed was then placed into semi-Fowler's position. The flap was retracted inferiorly. The incision was then made as marked, extending from hip to hip above the old umbilical opening and the subcutaneous tissue divided with electrocautery and the lateral corners were defatted. Meticulous hemostasis was achieved and the wound was closed in layers, approximating the midline and restoring the midline, which was deviated from previous scarring.
The Scarpa's fascia was closed with 2-0 Vicryl, the subdermal plane with 3-0 Vicryl and running intracuticular 3-0 Monocryl all the way across. The future position of the umbilicus was marked before wound closure was completed, and this ellipse was then incised and a core of fat was resected. Significant amount of defatting was required to facilitate bringing the umbilicus to the skin level and close the wound, suturing the umbilicus in position with 4-0 Vicryl and a running horizontal mattress of 5-0 nylon. Good contours were achieved. The patient tolerated the procedure well. A chin strap had been applied around the submental area at the conclusion of the liposuction, and at this time, the wounds of the abdomen were dressed with bacitracin ointment, Adaptic, ABD pads and a gently fitting elastic abdominal binder. The patient was moved to a bed in the semi-Fowler's position and returned to recovery in good condition after extubation.
