Plastic Surgery ppt RPN. 2023.pdf

Plastic Surgery S425: RPN PERIOPERATIVE PROGRAM 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...

Plastic Surgery S425: RPN PERIOPERATIVE PROGRAM 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. Anatomy Layers of the Skin Surgical Approaches Reconstructive Surgery Aesthetic Surgery Treats abnormal structures of the Restores or reshapes normal body structures of the body Birth defects Disease processes Improve or modify an appearance Injury Restore function Perioperative Nursing Considerations Anesthesia: GA or Local Count: Minor Local Infiltration: Tumescent Equipment: Instrumentation: Dressing: Extremely important in plastic surgery! Instrumentation A. Lead hand retractor B. Microvascular scissors C. Tenotomy/Steven’s scissors D. Microbipolar Forcep Equipment Tourniquet and cuff Bier Block Limb surgery Jackson Pratt Drain Dressing Loupes Surgeon uses for magnification Surgical Interventions Skin Cancers Burn Surgery Breast Reconstruction TRAM flap Maxillofacial Surgery Scar Revision Augmentation Mammoplasty Basil Cell Carcinoma Squamous Cell Carcinoma Melanoma Skin Cancers Burn Surgery Thermal or chemical injury Partial thickness – First Degree (epidermis) – Second Degree (epidermis and dermis) Full thickness – Third Degree (epidermis, dermis, subcutaneous) Skin Grafting Skin from donor site is excised and applied to the recipient site Split Thickness Full Thickness Composite Graft Dermatone Mesher Split Thickness Skin Graft Epidermis and part of dermis from donor site Meshed to cover more surface area Stapled in place (not sutured) Donor site can be used again Dressings! Split Thickness Skin Graft Full Thickness Skin Graft Epidermis and Dermis from donor site Skin coverage in wounds healing by second intention Used in areas of flexion and movement Donor site cannot be used again Sutured in place with absorbable suture Breast Reconstruction Mycutaneous flaps are used for breast reconstruction Pedicle Flap – blood supply remains intact Free Flap – original blood supply is severed and reanastomosed microscopically to the recipient’s new site TRAM Flap – Pedicle Flap Blood supply of the rectus abdominus remains intact with the pedicle Incision made in 1) lower abdomen and 2) mastectomy scar Subcutaneous tunnel dissected from distal to proximal incision Muscle is pulled through subcutaneous tunnel from distal end to chest to form a breast Flap is rotated and passed through to the new location on chest wall and sutured Free Tram Flap Original blood supply of rectus abdominis muscle is severed from original source *Superior Epigastric Artery Entire pedicle is removed Rotated to under the breast Reanastomosed through microvascular surgery Tissue Expanders Mastectomy = Shortage of skin to create a breast mound Tissue expanders are plastic reservoirs implanted under the skin Expander is filled with saline by percutaneous injection over time Causes skin to stretch Patient can return at a later date for breast augmentation and will have more skin surface area Microsurgery Reconstructs or replants tissue lost through injury or disease Replantation of amputated body part Toe-to-hand transfer Maxillofacial Surgery Surgical approach to fixing fractures Trauma to the face, disease, congenital anomaly Zygomatic Fractures Mandibular Fractures Maxillary Fractures Lefort I Lefort II Lefort III Scar Revision Aesthetic surgery Reshape the scar to be less noticeable Z-plasty approach Central point of Z lies in the same direction as a natural skin line Scars parallel to skin lines are less noticeable vs perpendicular Breast Augmentation Procedure to correct hypomastia, breast asymmetry or recreate a breast after a mastectomy Silicone or Saline Extra care in handling the implant! Circulating RN documents implant information on chart References Rothrock, J. (2022). Alexander’s care of the Patient in Surgery (17th ed.) Mosby Elsevier. Tighe, S. (2015). Instrumentation for the Operating Room (9th ed.) Mosby. ORNAC Standards 2023