MODULE 22 Plastic Surgery RPN2023.pdf

MODULE 22: Plastic Surgery Suggested Readings Alexander’s Care of the Patient in Surgery (2022) Chapter 22 Tighe (2015) Instrumentation for the Operating Room Chapter 80 ORNAC Standards 2023 Learning Outc...

MODULE 22: Plastic Surgery Suggested Readings Alexander’s Care of the Patient in Surgery (2022) Chapter 22 Tighe (2015) Instrumentation for the Operating Room Chapter 80 ORNAC Standards 2023 Learning Outcomes Describe relevant anatomy for basic aesthetic and reconstructive plastic surgeries. Compare psychosocial considerations between aesthetic and reconstructive plastic surgeries. Describe the importance and safety precautions of specialty equipment and the use of implants in plastic surgery. Plastic surgery is comprised of two subspecialties: aesthetic and reconstructive surgery. Cosmetic (aesthetic) surgery restores or reshapes normal structures of the body to improve or modify an appearance. Reconstructive surgery treats abnormal structures of the body caused by birth defects, disease processes, injury, and to restore function. Anatomy Plastic and reconstructive surgery is not limited to a single anatomic or biologic system. Operative techniques can be complex and staged to achieve the expected results. Tissues or different parts of the body can be transplanted, reconstructed, reimplanted or re-anastomosed. One example is the use of various types of flaps which transfer the tissue and its intact blood supply. Flaps can be used to cover defects or create new structures such as breasts, digits, or facial structures. There is no specific anatomy to highlight for plastic surgery as it is a broad surgical specialty that covers orthopedic, cosmetic/aesthetic, microvascular, ophthalmologic, and reconstructive principles. This module will review common basic plastic surgery procedures that you will see in the clinical setting. Layers of the Skin Epidermis – upper layer produce pigment cells and protects immune system Dermis – contains nerve endings, oil and sweat glands, and hair follicles Subcutaneous Tissue – made up of fat, connective tissue, and blood cells Module 22: Plastics  Perioperative Nursing Considerations Nursing Assessment Visual assessment of the patient’s overall physical condition, skin integrity, and physical limitations should be noted. It is imperative that sided or site surgery is marked and verified by the entire surgical team. Anesthesia The anesthetic will be determined based on the patient and the surgery. Common anesthesia used in plastic surgery are IV sedation, Local Anesthetic or a GA. Patient Positioning The surgical procedure determines the patient’s intraoperative position. Typically, patients undergoing plastic surgery are placed in the supine or lateral position. Refer to the ORNAC Standards and the positioning performance checklist for appropriate practices. Draping - The draping is dependent on the procedure, surgeon’s preferences, and institutional resources. Burn surgery will require draping for the donor and recipient sites. Instrumentation and Count A minor count is completed for ALL plastic surgeries. Initial (minor) → Final (minor) Common plastic surgery instruments: - Basic plastic instrument tray - Freer elevator - Tenotomy/Stevens scissors - Micro instruments - Bipolar cautery - Fine sutures Equipment Forced-Air Warming Blankets - The large amount of skin exposure required for either a burn surgery or long microvascular surgery presents a risk for hypothermia. Dermatomes – used for removing split thickness skin grafts (STSG) from donor sites. Mineral oil should always be available. Module 22: Plastics Skin Meshers – used to produce uniform slits in a skin graft to stretch the graft to cover more burn surface area Pneumatic-Powered Instruments – electric dills and saws may be used for specific procedures Tourniquet – inflatable cuff (see Orthopedic Module) used to create a bloodless field for limb specific surgery. Cuffs are sized based on the upper or lower limb. Tourniquet pressure is based on the patient’s systolic blood pressure. Inflation time should be no more than 60 minutes. Loupes – are magnifying lenses (glasses) plastic surgeons wear for microsurgery and nerve repairs to improve the view of the defect. Microscope – used for nerve repairs and microsurgical anastomoses – commonly in hand surgery to improve visualization. Sutures – Range from permanent to absorbable and micro sutures (10-0) to larger sutures (3) depending on the type of surgery. Dressings - Extremely important in plastic surgery. Dressings should accomplish 5 goals: 1. Immobilize the surgical part 2. Apply even pressure on the wound 3. Collect drainage 4. Provide comfort to the patient 5. Protect the wound Drains - Apply negative pressure to area and eliminate serous/blood clots (improves healing). Drains are often attached to closed-wound suction devices (negative pressure) i.e. Jackson-Pratt or Hemovac. Surgical Interventions Burn Surgery Majority of burns result from exposure to high temperatures including flame, scalding, or direct contact and are classified as contact, inhalation, or electrical. The patient’s total body surface area (TBSA) burn as well as the depth of burn will determine the treatment. *It is imperative that for burn surgery the room is WARM as the patient is at risk for hypothermia from tissue loss and large tissue exposure for duration of the surgery. Minor Burn – full-thickness burn