Tracheostomy
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
Throughout this phase, it is critical to maintain perfect hemostasis. The incision is carried down through the skin, subcutaneous tissue, and platysma. The plane of dissection then shifts to the midline longitudinally to divide the fascia between the strap muscles. The two strap muscles on each side (superficial sternohyoid and deeper sternothyroid) are elevated and carefully retracted off the trachea. Either a handheld or self-retaining retractor may be used for this purpose. This exposes the underlying pretracheal fascia, thyroid isthmus, and inferior thyroid veins. If large or extensive, these veins can be ligated or divided with a thermal vessel sealant. Otherwise, they can be retracted off the trachea. The pretracheal fascia is then divided longitudinally, exposing the tracheal rings.
Access to abdominal cavity - open
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
The name of an incision usually describes the location of the incision or the technique used to gain access to the abdominal cavity. Over the years, many eponyms have become associated with specific incisions. Vertical incisions include midline/median, paramedian, trans-rectus muscle-splitting, and para-rectus (Battle-Kammerer) incisions. Vertical incisions may be supra-or infraumbilical. Oblique incisions include the right subcostal (Kocher) incision, the right lower quadrant gridiron muscle-splitting (McBurney) incision, and the right lower quadrant (Rockey-Davis) incision. Transverse incisions include the transverse suprapubic (Pfannenstiel) incision, and the generic transverse abdominal incision. Special combined incisions include the upper abdominal chevron incision and the thoracoabdominal incision.
Sleep apnoea and snoring, including non-surgical techniques
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
Attention is then directed to the hyoid region. The area of planned incision directly overlying the hyoid bone is marked with a pen. An incision is then made in the skin with the scalpel. Haemostasis is obtained. Blunt dissection is continued until the hyoid is encountered. The hyoid bone is exposed. Then, infra-hyoid muscles are released. Two permanent braided synthetic nonresorbable sutures are then passed around and under the hyoid laterally and passed subcutaneously up into the genial region. Two holes in the mobilized genial segment are made with the drill and the sutures passed through them. The sutures are then passed around and under the hyoid laterally and passed subcutaneously up into the genial region. Two holes in the mobilized genial segment are made with the drill and the sutures passed through them. The sutures are then tightened to the desired level of hyoid suspension and tied securely.
Autologous fat transplantation for the treatment of abdominal wall scar adhesions after cesarean section
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Sheng-Hong Li, Yin-Di Wu, Yan-Yun Wu, Xuan Liao, Pik-Nga Cheung, Ting Wan, Li-Ling Xiao, Jian-Xing Song, Hai-Ling Huang, Hong-Wei Liu
Approval for autologous fat harvesting and transplantation was obtained from the Institutional Review Board of Medical Science, Jinan University, and written consent was obtained from the study participants. The liposuction sites were located in the lower abdomen, thigh, and knee. The incision for lower abdominal liposuction was made at the inner edge of the umbilicus. Lidocaine (0.125%) was used as a topical infiltrating anesthetic. A no. 11 scalpel was used to make an incision of approximately 3 mm in accordance with the preoperative plan. A no. 20 blunt-side-opening long needle was used to inject the tumescent anesthesia solution (25 ml of 2% lidocaine + 2 mg of adrenaline + 12.5 ml of 8.4% sodium bicarbonate + 1000 ml of normal saline). The amount of tumescent fluid injected depended on the amount of fat required and the range of liposuction. A side-opening liposuction needle with an inner diameter of 3 mm was inserted into the subcutaneous fat layer, a 20 ml syringe was connected, and subcutaneous fat was extracted using the syringe liposuction technique [14,15]. Uniform radioactivity extraction was conducted, and the amount of extracted fat depended on the amount of fat required to fill the subcutaneous tunnels of the scar. The contused tissue around the incision was trimmed, and the skin incision was sutured. The surgical area was bandaged under pressure. The collected fat was statically precipitated and filtered to remove the tumescent anesthetic fluid and was then placed in a 10 ml syringe for use.
A New Rabbit Model of Chronic Dry Eye Disease Induced by Complete Surgical Dacryoadenectomy
Published in Current Eye Research, 2019
Robert Honkanen, Wei Huang, Liqun Huang, Kevin Kaplowitz, Sarah Weissbart, Basil Rigas
The OSLG should be removed first. If it follows the removal of the ILG, its excision is considerably more difficult because it recesses deeper into the orbit and cannot be prolapsed as easily through the posterior incisure (Figure 2). An incision is made through the skin and subcutaneous tissues directly over the posterior incisure using a Colorado needle (Kalamazoo, MI 49002). Alternating medial pressure on and off the globe will cause the OSLG to prolapse and recess into the posterior incisure creating a visible change in the tissue contours that aids finding the optimal dissection location often just medial or deep to preauricular muscle fibers. Incising the remaining connective tissues over this bulge exposes the posterior incisure and the OSLG tissue, which is typically pale pink or tan in color. Using blunt, non-toothed forceps, the OSLG is harvested using traction to slowly tease the gland out from its deeper position within the orbit. This usually requires cutting small connective tissue bands as it is removed. As the OSLG is pulled out from the posterior incisure, its contour tapers as it transitions into the main excretory duct. After as much as possible of the gland and excretory duct are withdrawn, it is truncated as far inferiorly as possible using generous amounts of cautery. Cautery not only provides hemostasis but also serves to provide a visible darkening of the surrounding tissues that can often be seen when removing the superior portion of the PSLG as described below.
Surgical and non-surgical management of malignant pleural effusions
Published in Expert Review of Respiratory Medicine, 2018
Deirdre B. Fitzgerald, Coenraad F. N. Koegelenberg, Kazuhiro Yasufuku, Y. C. Gary Lee
The patient is placed under general anesthesia and intubated using a double lumen endotracheal tube to allow single-lung ventilation. Bronchoscopic assessment of tube placement and airway examination to exclude any obstructing endobronchial lesion is often performed. An incision is made, most commonly in the sixth or seventh intercostal space, between the anterior and posterior axillary lines, with a finger sweep to ensure there is no underlying adherent lung. A trochar (10–20 mm diameter) is then placed, through which the thoracoscope is inserted. Pleural fluid is evacuated and the pleural space is visualized from the apex to the diaphragm. Following this ‘exploratory thoracoscopy’, one or two more instrument ports are inserted under direct vision. These access ports are positioned within the same ‘180° arc’ such that the instruments and camera are pointed in the same general direction of any biopsy site to avoid confusion from ‘mirror imaging’.
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