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Circumcision, meatotomy, meatoplasty, and preputioplasty
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Rachel Harwood, Simon E. Kenny
The outer skin is retracted, and any bleeding points are fastidiously coagulated with bipolar diathermy. Ligatures may be used if bipolar diathermy is unavailable. The wound is closed with an interrupted absorbable suture, such as 5/0 Vicryl rapide or Monocryl. Sutures should be placed close (<1 mm) to the wound edges to avoid unsightly scarring (Figure 77.2e). Tissue glue is an effective and quick alternative to suturing favored by the authors after placement of a stay suture ventrally and dorsally to aid approximation of the wound edges (Figure 77.2f).
Surgery of the Hand
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Norbert Kang, Ben Miranda, Dariush Nikkhah
It is not necessary to formally repair the collateral ligaments – scar tissue forms rapidly around the implant and confers stability to the joint – especially if the patient mobilises quickly after surgery. The sagittal bands are repaired with 4/0 or 5/0 PDS and are reefed as necessary if there is significant subluxation of the extensor tendons into the ulnar gutters. The skin is then closed with absorbable sutures. The senior author recommends using interrupted 5/0 Monocryl for the dermis (to approximate the wound edges) and then a running subcuticular 5/0 Monocryl or 5/0 Vicryl rapide suture for final closure.
Revision ACDF: Adjacent level
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Courtney Pendleton, Matthew S. Galetta, Jack Jallo
Final MEPs and SSEPs are obtained after placement of the graft and plate. The incision is copiously irrigated with antibiotic saline, and hemostasis is obtained. A single drain is left. The platysma is reapproximated, and the deep dermal tissues are closed with three or four vicryl sutures. The skin is closed with a subcutaneous monocryl. The drain is secured with a monocryl suture, which is removed with the drain on the first postoperative day.
Inferior and Central Mound Pedicle Breast Reduction in Gigantomastia: A Safe Alternative?
Published in Journal of Investigative Surgery, 2021
Fatma Bilgen, Alper Ural, Mehmet Bekerecioğlu
The pedicle was designed, with a base width of 10–12 cm on the inframmarial fold and 2 cm margin around areola. Areola diameter was prepared 4 cm. Afterwards, the inferior pedicle was de-epithelialized meticulously in order to avoid thinning of the dermis especially at the pedicle base. Medial and lateral dermoglandular resections were performed above the level of pectoralis fascia as standard. The superior skin flap was released to the level just below the clavicle and upper quadrants were undermined adequately. The pedicle base was kept wide enough over the area where it attaches the pectoralis fascia posteriorly. The pedicle was anchored to the level of fourth rib with two interrupted 2-0 vicryl sutures. The NAC was transferred to its new areola hole without any tension (Figures 2 and 3). Suction drains were used in each patient routinely. Most of the drains were removed on the postoperative second day. The subcutaneous tissue and skin were closed in two distinct layers with absorbable monocryl sutures. The patients are advised to apply silicone sheets and wear a full time bra for 2 months.
Impact of timing on wound dressing removal after caesarean delivery: a multicentre, randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2021
Gokhan Sami Kilic, Erhan Demirdag, Mehmet Fatih Findik, Omer Lutfi Tapisiz, Muhammet Erdal Sak, Orhan Altinboga, Sibel Sak, Bekir Serdar Unlu, Mehmet Siddik Evsen, Burak Zeybek, Mostafa Borahay, Yong-Fang Kuo
All operations were carried out using a similar technique. A single-dose intravenous antibiotic prophylaxis was administered to all women within 60 minutes before incision. Abdominal preparation in all caesareans was done by 2% Chlorhexidine Gluconate Cloth (Sage Products, Cary, IL) followed by 2% chlorhexidine gluconate/70% isopropyl alcohol (CHG/IPA) skin preparation solution (BD, Franklin Lakes, NJ). Pfannenstiel incision was performed in all of the operations. Intraoperatively, intraabdominal adhesion barriers were not used. Rectus muscle, bladder flap, and parietal peritoneum were not closed in all patients. Polyglactin 910 (Vicryl, Ethicon, Somerville, NJ) or polydioxanone (PDO, PDS; Ethicon) were used for fascia closure in all CDs. If subcutaneous depth was more than 2 cm, an approximation of tissue with 2-0 Vicryl (Ethicon) was used. Monocryl 2-0 (Ethicon) was used for subcuticular closure of skin incisions. The incisions were covered with telfa (Covidien, MA). Ten 4 × 4 gauze pads opened to a size of 8 × 4 were folded lengthwise and placed over the telfa, and then covered with perforated soft cloth surgical tape (3 M Medipore, MN) under a slight tension.
Poroid hidradenoma of the scalp in a US Veteran’s Administration (VA) patient
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
M. Mukit, M. Mitchell, I. Ortanca, N. Krassilnik, X. Jing
Most of these lesions do not require reconstruction as they are typically 1–2 cm in diameter [7]. The scalp, with its laxity in the subgaleal plane, can be undermined to primarily close defects occurring secondary to tumor resection. Galeal scoring can be done as well, perpendicular to the line of tension, to increase flap length [13]. For our patient, we closed the dermis with 3-0 monocryl and the skin with skin staples. Larger scalp lesions may require local flaps. One case report detailed the use of a transposition flap with a skin graft to close the defect [14]. For larger defects, one could use local flaps, such as Oritrochea flaps, or regional flaps, such as the trapezius or latissimus dorsi to cover occipital wounds and temporoparietal fascial flaps to cover temporal wounds [13]. Alternatively, after temporizing a wound with a split-thickness skin graft, one could use tissue expansion to cover up to 50% of the scalp [13]. Defects that cannot be covered with local or regional laps may be reconstructed with free flaps, such as the latissimus dorsi flap, serratus anterior, omental flap, radial forearm fasciocutaneous flap, rectus abdominus flap, or anterolateral thigh flap [13].