| Rhinoplasty Posted: 02 Oct 2010 10:05 PM PDT 
 Definition
Cosmetic reconstruction of the external nose. Discussion - In addition to cosmetic effect, a rhinoplasty can be performed to alleviate nasal airway problems usually caused by a deviated septum or nasal trauma not corrected by the closed method.
- Five interrelated steps may be used:
- Tip modeling and alr wedging (if indicated).
- Hump (bridge) removal
- Narrowing
- Septoplasty
- Turbinectomy
- The procedure must always be modified to meet the individual needs of the patient, and crucial to success is the maintenance of proper shape, symmetry, and proportion according to the size and shape of the face.
- The procedure is usually performed under local anesthesia with conscious I.V. sedation.
Positioning - Supine with arms tucked in the sides.
- The head may be supported on a headrest.
- A nasal preparation is usually performed prior to begin the skin preparation.
Packs/ Drapes - Head and neck pack or basic pack with split sheet and head drape.
Instrumentation - Nasal procedure tray
- Basic plastic tray
- Beaver knife handle
Supplies/ Equipment - Headrest
- Fiberoptic headlight and light source
- Suction
- Basin set
- Blades
- Beaver blades
- Needle counter
- Solutions
- Sutures
- Nasal preparation
- Nasal splint
- Antibiotic treatment
Procedure Overview - The surgeon operates within the nose, making an intercartilaginous incision along the rim of upper lateral cartilage bilaterally, freeing the skin from over the dorsal septum, and anteriorly, freeing the columella.
- Prominent septal lateral and alar cartilage is excised and, following reassessment, the cartilage is trimmed as needed.
- The nasal bones are then osteotomized laterally, medially, and horizontally (if needed), and compressed to infracture the bones, creating a more normal contour.
- Rasping with smooth any existing irregularities and alignment of the septum is achieved.
- The anterior septum and columella and the alar incisions are sutured, in addition to marginal incisions of the rim of the lower lateral cartilage.
- Intranasal packing is inserted, usually consisting of a Gelfoam material or petrolatum-impregnated gauze.
- An external splint made from plaster or other materials may be applied and the outside of the nose is taped for additional support.
Perioperative Nursing Considerations - Do not allow prep solutions to pool in or around the eyes and ears.
- Keep tissue specimens moistened in saline solution.
- The table may be turned and flexed for ease of access and patient comfort.
- The nasal preparation tray may be set up on a clean, nonsterile Mayo tray, according to surgeon's preference.
Related posts: - Blepharoplasty Surgery
- Rhytidectomy
- Head-To-Toe Assessment (M. Nose and Paranasal Sinuses)
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| Rhytidectomy Posted: 02 Oct 2010 09:56 PM PDT 
 Definition
The removal of excess skin of the face and neck area, and the tightening of underlying support structures, such as muscle and superficial fascia. Discussion - A rhytidectomy is often performed in combination with a blepharoplasty.
- As the natural aging takes place, skin around the face and neck begins to lose its tone and will sag.
- This procedure, commonly called a "facelift" if performed to improve the appearance of the patient, provides both emotional and social benefits.
- The procedure may be performed under general or local anesthesia, depending on the preference of the patient and the surgeon.
Positioning - Supine with arms tucked in the sides.
- The head may be supported on a headrest.
- A nasal preparation is usually performed prior to begin the skin preparation.
Instrumentation - Basic plastic tray
- Small Deaver retractors
Supplies/ Equipment - Head rest
- Restraints
- Suction
- Sitting stools
- Basin set
- Blades
- Needle counter
- Local anesthetic with epinephrine
- Syringes and needles
- Drain
- Solutions
- Sutures
Procedure Overview - The incisions are made close to the hairline or in the hair so that the resulting scars are unnoticeable.
- A small amount of hair may need to be shaved from the hairline; in most cases, this is performed by the surgeon.
- The skin and subcutaneous tissue are mobilized by undermining (separation of skin and subcutaneous tissue from their attachments underneath).
- Care is taken to avoid injury to nerves such as facial nerve branches and greater auricular nerve.
- After hemostasis is secured, placation sutures are placed in the musculofacial tissues.
- Tension is placed on the flap and traction sutures are used to pull the flap superiorly and posteriorly.
- The excess skin is trimmed.
- Wound closure is completed with fine interrupted sutures.
- A closed-suction drainage unit may be inserted before closure.
- A light pressure dressing is then applied, padding the ears.
Perioperative Nursing Considerations - Do not allow the preparation solution to pool in or around the eyes or ears.
- A head drape should be used for all facial surgery.
- The table may be flexed for added patient comfort.
- A foam mattress should be used for extra support.
Related posts: - Blepharoplasty Surgery
- Rhinoplasty
- Vasectomy
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| Augmentation Mammoplasty Posted: 02 Oct 2010 09:47 PM PDT 
 Definition
The insertion of an implant behind or under the breast tissue, to increase its size. Discussion - This procedure may be performed:
- After a subcutaneous mastectomy.
- On a patient whose breasts are asymmetrical.
- For postpartum involution.
- For patient's who's smaller than desired (aesthetic).
- The approach may be inframammary, periareolar, or flatable, or filled with gel and saline.
Positioning - Supine or modified Fowler's
Packs/ Drapes - Basic pack with transverse Lap sheet
Instrumentation - Basic plastic tray
- Freeman areolar marker
- Basic procedure tray
Supplies/ Equipment - Basin set
- Suction
- Fiberoptic headlight with light source
- Blades
- Needle counter
- Solutions
- Sutures
- Breast implant
- Surgical support bra
Procedure Overview Inframammary Approach - The line of the incision is marked.
- A 3-to-4-cm incision is made just above the inframammary crease.
- A percutaneous is developed between the pectoralis fascia.
- A plane is developed between the pectoralis fascia and the posterior capsule of the breast.
- A pocket is created by blunt dissection to accommodate the implant.
- Meticulous hemostasis is obtained, and the implant is inserted andadjusted as needed.
- The subcutaneous flap is approximated, and the skin is closed in a manner preferred by the surgeon.
Periareolar Approach - The line of the incision is marked circumferentially.
- The incision is made along the inferior border of the areola.
- The subcutaneous tissue is dissected to the inferior border of the breast.
- The retromammary space is enlarged by blunt dissection to accommodate the prosthesis.
- Hemostasis is accomplished, and the prothesis is inserted.
- The inferior border of the breast is sutured to the pectoralis fascia.
- The incision is closed according to the surgeon's preference.
Transaxillary Approach - The incision line is marked in the axilla.
- A vertical or oblique incision is carried down through the subcutaneous tissue.
- Using blunt dissection, a pocket over the upper poles of the sternum is created; hemostasis is achieved and the prosthesis is inserted.
- The wound is closed in layers according to the surgeon's preference.
Perioperative Nursing Considerations - Most implanted materials come sterile. However if they are not sterile, they should be washed first in a mild soap solution, dried carefully, and sterilized.
- To avoid dust particles settling on the implant before use, cover it with a paper drape sheet.
- Implants should be handled as little as possible and never with bare hands, since the oil from the handler's skin could rub off onto the material.
Related posts: - Reduction Mammoplasty
- Mastectomy
- Rhytidectomy
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| Blepharoplasty Surgery Posted: 02 Oct 2010 09:32 PM PDT 
 Definition
Excision of a protrusion of periorbital fat, and resection of excessive redundant skin of the eyelids. Discussion - The procedure may be performed on both the upper and lower lids, and may be both cosmetic and functional, since sagging skin from the upper lids may interfere with the patient's eye sight.
- The amount of tissue removed depends on the severity or deformity and the age of the patient.
- Local anesthesia with conscious I.V. sedation is usually the anesthesia method of choice.
Positioning - Supine with arms tucked in the sides.
- The head may be supported on a headrest.
- A nasal preparation is usually performed prior to begin the skin preparation.
Packs/ Drapes - Head and neck pack or basic pack with split sheet and head drape.
Instrumentation Supplies/ Equipment - Small basin set
- Suction
- Local anesthetic with epinephrine
- 10-ml Control Leur-lock syringes
- 25-or-27 gauge needles
- Blades
- Needle counter
- Cotton-tipped applicators or cellulose sponges
- Solutions
- Sutures
Procedure Overview - An elliptical incision is made in the recess of the upper eyelid, following the premarked lines.
- Grasping the subcutaneous fatty tissue with a fine forceps, the tissue is gently dissected with a small scissors and removed.
- The upper lid incisions are covered with moist saline sponges (or eye pads) while the resection of a portion of the lower lid is performed.
- Small bleeders are controlled with cautery.
- The skin edges are approximated and closed with fine interrupted sutures.
- A topical antibiotic ointment or dressing (nonpressure) is applied.
Perioperative Nursing Considerations - Do not allow the preparation solution to pool in or around the eyes or ears.
- A head drape should be used for all facial surgery.
- The table may be flexed for added patient comfort.
- A foam mattress should be used for extra support.
Related posts: - Rhytidectomy
- Rhinoplasty
- Vasectomy
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| Reduction Mammoplasty Posted: 02 Oct 2010 07:16 PM PDT 
 Definition
Removal of excess breast and skin tissue with reconstruction of breast tissue. Discussion - The principal indication of this procedure is the alleviation of symptoms associated with heavy, pendulous breast (larger than 1 pound), which can result in both physical and psychologic problems.
- In extreme cases, the patient may suffer from backache because of the added weight that constantly pulls the body forward, in addition to possible interference with effective respiration.
- The condition may involve one or both breast.
- The technique used is to determined by the size of the breast and the surgeon's preference.
- Two categories of procedures are performed: lateralizing procedures, in which no scar is left medially, and procedures that result in an inverted T scar.
- Proper symmetry, including nipples and areolar position, must be maintained to achieve a good cosmetic effect.
Positioning - Supine or modified Fowler's
Packs/ Drapes - Basic pack with transverse Lap sheet
Instrumentation - Basic plastic tray
- Freeman areolar marker
- Basic procedure tray
Supplies/ Equipment - Basin set
- Scales (for weighing specimens)
- Suction
- Blades
- Needle counter
- Drainage unit
- Solutions
- Sutures
- Surgical support bra
Procedure Overview - The incisions are marked, usually circumscribing the areola, which is usually left attached to underlying tissue as a pedicle graft, or removed when indicated.
- Flaps are developed that excise a wedge of excessive skin and adipose tissue inferiorly.
- A Freeman areolar marker may be used.
- The breast is reconstructed by approximating the medial and lateral breast tissue with skin flaps inferior to the nipple site, and transversely in the inframammary fold, which creates an inverted T.
- A bulky dressing is applied and a surgical bra may be used.
Perioperative Nursing Considerations - Keep the tissue removed from each breast separated.
- Weight and record the amount of tissue taken from each breast.
- A closed drainage system may be inserted before wound closure.
- A surgical bra may be applied over the dressing.
- The nipples are usually left undressed for observation of viability.
Related posts: - Augmentation Mammoplasty
- Mastectomy
- Blepharoplasty Surgery
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