DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Abdominal laxity.
POSTOPERATIVE DIAGNOSIS:
Abdominal laxity.
PROCEDURE PERFORMED:
Abdominoplasty.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF PROCEDURE: The patient was prepped and draped in a sterile fashion, and the abdominoplasty was commenced with a 10 blade used to incise the skin along the proposed incision. Bovie cautery was then used to dissect down through the subcutaneous fat and Scarpa’s fascia to the level of the anterior abdominal wall fascia. The abdominal skin was elevated in the prefascial plane up towards the level of the umbilicus. The umbilicus was secured with two double hooks and a 15 blade was used to incise the skin around the umbilicus.
Next, we dissected the umbilicus free down to the level of the anterior abdominal wall. The abdominal skin continued to be elevated up to the level of the xiphoid. The lower portion of the abdominal skin was slit in the midline from the umbilical opening distally to facilitate the dissection. At this point in time, the table was flexed. Hemostasis was attained as we went along with Bovie cautery, and 2-0 Vicryl was used to temporarily tack the midline of the abdominal wall flap to the suprapubic flap. The skin came together easily, and the inferior skin was marked for the excision. This was done symmetrically on the right and the left side, and the skin and the subcutaneous tissue weighed 530 grams. This was not sent for pathological examination. The 2-0 Vicryl suture was then removed. The wound was irrigated and hemostasis was obtained. The rectus flaps showed a very large diastasis. This was plicated with figure-of-eight interrupted 0 Ethibond suture the entire length of the rectus fascia. Care was taken not to compress the umbilicus and strangulate its blood supply.
Next, Stryker pain catheters were placed through stab incision with the sheath, one upwards along the fascial plication and one more transversely. The superior skin flap was again tacked down, and the location of the umbilicus was determined midline even at the level of the iliac crest as well as by grasping the umbilicus with the mosquito and passing anteriorly to confirm the position. The position was drawn and confirmed visually at an appropriate position and incised with a 15 blade. The tacking suture was removed. The umbilical incision opening was trimmed of its underlying fat using Metzenbaum scissors. Four 4-0 Vicryl sutures were placed along the umbilicus, one at 12 o’clock, one at 3 o’clock, one at 6 o’clock, and one at 9 o’clock position from the umbilicus to the fascia. These were brought out through the umbilical opening and tacked later.
The wound having been hemostased, closure was begun midline with 2-0 Vicryl sutures, working the lateral dog ears in as much as possible again with interrupted 2-0 Vicryl sutures. Two #15 round drains were placed coming out in the lateral portions of the incision. Two small dog ears, one on each side, were removed with 10 blade and Bovie cautery, and the defects were repaired in a similar fashion as the abdominal incision. After 2-0 Vicryl was placed throughout the inferior portion of the abdominal incision, a running 4-0 Monocryl suture was placed. The 4-0 Vicryl sutures around the umbilicus were tacked to the skin dermis at the 12 o’clock, 3 o’clock, 6 o’clock, and 9 o’clock positions and then a running 5-0 fast-absorbing gut was used to approximate the epidermis. The drains were secured with 3-0 nylon suture. Mastisol and Steri-Strips were placed along the incision. Mastisol and Steri-Strips were used to hold the pain pump catheters in place. They had been flushed and pumped prior to the insertion, and they were then connected to the pain pump with 0.5% Marcaine. The wounds were dressed with ABDs and an abdominal binder. The patient was awakened and transferred to the recovery room in stable condition. Estimated blood loss was 150 mL.
