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Emergencies in dermatosurgery
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
B. R. Harish Prasad, C. Madura, M. R. Kusuma
Once the cutaneous surgery is completed, the postoperative phase of patient care and instructions begins. There are two key components to the postoperative period: Bandaging the wound/surgical repair site: A typical pressure dressing involves the placement of a nonadherent film followed by one or more layers of cotton gauze, and finally, securing the dressing with adhesive tape. A pressure dressing is probably not effective beyond 24 hours, and therefore, the patient has to come for follow-up after 1 day.Educating the patient and family: Providing education to the patient and the family about proper care of the site with verbal and written instructions on wound care is important. Avoiding any strenuous exercise, bending, lifting heavy objects, or physical activity that could potentially lead to direct trauma to the surgical site is important for healing and prevention of hemorrhagic complications. In addition, sites that are in constant motion due to daily activities, such as the lips or the perioral area, require specific instructions such as minimizing talking/laughing, eating soft or well-cooked foods, avoiding sucking action via a straw, and taking care when inserting or removing dentures and also while brushing the teeth.
Ears
Published in Marie Lyons, Arvind Singh, Your First ENT Job, 2018
Initially a pinna haematoma can be aspirated under local anaesthesia. Apply a pressure dressing and give antibiotics. A pressure dressing consists of a non-adhesive dressing with an ear shape cut out of it, gauze, a large wedge of cotton wool and a firmly applied elastic bandage.
Disorders of the salivary glands
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The cruciate incision is re-approximated (Figure49.25h) and the skin incision closed. It is advised that a mastoid-type pressure dressing is always applied at the end of the procedure otherwise sialoceles can occur. The pressure dressing is kept for about 48 hours.
Complications after scrotal surgery – still a major issue?
Published in Scandinavian Journal of Urology, 2021
Anna Krarup Keller, Maiken Milly Howard, Jørgen Bjerggaard Jensen
A total of nine patients were reoperated. Four were operated on within 24 h due to bleeding with no further intervention. Five patients were reoperated later, due to infection. With one exception, all these patients were reoperated several times: First, the abscess was incised, inevitably causing a large wound. Second, several wound debridements under general anesthesia were needed and two patients underwent orchiectomy. Surgical management of scrotal infection is so far only sparsely described in the literature. Hence, best practice remains and often these operations are carried out in the afternoon or evening by a different doctor every time, which may prolong the course if no plan is made for a negative pressure dressing or second suture. The rather high number of reoperations for some patients underlines the importance of this when handling complications. Furthermore, it underlines the importance of patient selection and information as this is a benign condition where surgery may be avoided.
Clinical experience of the use of Integra in combination with negative pressure wound therapy: an alternative method for the management of wounds with exposed bone or tendon
Published in Journal of Plastic Surgery and Hand Surgery, 2021
BangZhong Zhu, DongSheng Cao, Juan Xie, HongHong Li, ZengHong Chen, Qiong Bao
Integra was grafted after the wound was debrided completely either immediately after excision or after debridement. A preconditioning procedure could have been done with negative-pressure techniques. An Integra coverage was then performed using two different techniques. The first was the conventional technique in our previous studies, Integra was adapted to the wound size and shape and then stapled to the wound edge. Postoperatively, partial packing compression dressings above the level of the grafted Integra were used to support the fixation. A strict post-surgical surveillance protocol was used to monitor for infection and hematoma which included sterile dressing changes at regular intervals. In case of an infection, the infected part of the Integra was excised, cleaned and compression dressings were applied again. After full Integra neovascularization, the patients returned to the operating room for a skin transplant. The second method combined Integra with NPWT in this study. Integra was adapted to the wound shape and size, and a negative-pressure dressing was then applied to the Integra. The protocol for the negative-pressure therapy involved applying a negative pressure of 120 mm Hg, intermittently (suction cycles; on for 5 min and off for 2 min). The vacuum dressing was sealed with the foils provided. The dressing was changed every fourth or fifth day postoperatively and the negative-pressure drainage was done every day to limit the infection and hematoma of the Integra. The patients returned to the operating room for a skin transplant after full Integra revascularization.
Modified cheek advancement flap for medial lower eyelid, nasal sidewall and infraorbital cheek reconstruction: a case series
Published in Orbit, 2020
Giorgio Albanese, Shivani Kasbekar, Lorraine C. Abercrombie
The MCAF is a one-incision flap. The incision is performed along the nasal sidewall and extended into the nasolabial fold. The length of the incision depends upon the amount of tissue to be recruited. However, crossing the midpoint between nasal ala and lip is usually not necessary and could result in lip deformity. The flap is then raised by undermining the subcutaneous tissue around the infero-lateral edges of the defect within the malar and naso-labial fat pads . The lateral edge of the defect is used as leading edge of the flap. Prolene sutures are used to anchor the flap to the periosteum in order to minimise vertical traction and eyelid distortion. Wound closure is subsequently completed in layers. Subcutaneous tissue is closed with 5–0 polyglactin sutures, whereas skin closure is achieved with vertical mattress 6–0 prolene along the nasolabial fold and interrupted 7–0 polyglactin sutures in the periorbital area. A pressure dressing was applied in all cases and kept in place for 7 days (Figure 2).