DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Submental lipodystrophy.
2. Abdominal laxity.
POSTOPERATIVE DIAGNOSES:
1. Submental lipodystrophy.
2. Abdominal laxity.
OPERATION PERFORMED:
1. Ultrasonic liposuction, submental.
2. Abdominoplasty with diastasis repair and translocation of umbilicus.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 100 mL.
DESCRIPTION OF OPERATION: The patient was brought to the operating room in the sitting upright position. The submental area was marked for liposuction and the abdomen was marked for abdominoplasty, marking a long, low transverse incision from hip to hip, crossing the pubic hairline and moving onto the opposite side in the identical fashion. The incision was then marked from the edge of that, marking up and around the umbilicus and around to the opposite side.
The patient was then placed supine on the operating room table. General anesthesia was administered and the procedure was begun by tumescence of the submental area with 60 mL of normal saline, incorporating 10 mL of 1% lidocaine with epinephrine. After skin blanch was noted, a 3 mm incision was made in the submental area and the ultrasonic catheter was inserted and approximately 2 minutes of ultrasonic energy used in the submental and neck area, emulsifying fat, and then using a 3 mm cannula, the submental area was liposuctioned until the contour desired was achieved and the thickness of the flap was achieved. A single 6-0 nylon was used to close the incision.
Then, attention was directed to the abdomen which was prepped and draped in a routine fashion. A Foley catheter had been inserted preoperatively. SCD boots had been applied preoperatively and 1 gram of Ancef had been given preoperatively. The procedure was then begun, making a low transverse incision as marked below the top of the pubic hairline, extending from hip to hip and actually beyond the inferior iliac crest on each side. The incision was continued through the subcutaneous tissues using electrocautery down to the fascia.
The flap was then elevated, releasing the scar adhesions up to the level of the umbilicus. An incision was made around the umbilicus, which was quite retracted and scarred in, releasing the umbilicus. Then, the umbilical stalk was dissected down to the fascia. The flap was then divided from the umbilical opening to the free edge and then the flap was elevated above the umbilicus at the fascial plane, separating the subcutaneous tissue from the fascia up to the xiphoid and extending across the costal margins lateral to the xiphoid. Meticulous hemostasis was achieved.
The midline was plicated using #1 Nurolon from xiphoid to pubis and then a second layer was used from pubis to umbilicus using a running locking suture of #1 Nurolon. After this was completed, the wounds were reinspected for hemostasis. Drains were inserted. A drain on the right, lateral to the incision, was brought up and around the upper flap and from the left side across beneath the umbilicus. The bed was then placed into semi-Fowler’s position. The flap was retracted inferiorly.
The incision was then made as marked, extending from hip to hip above the old umbilical opening and the subcutaneous tissue divided with electrocautery and the lateral corners were defatted. Meticulous hemostasis was achieved and the wound was closed in layers, approximating the midline and restoring the midline, which was deviated from previous scarring.
The Scarpa’s fascia was closed with 2-0 Vicryl, the subdermal plane with 3-0 Vicryl and running intracuticular 3-0 Monocryl all the way across. The future position of the umbilicus was marked before wound closure was completed, and this ellipse was then incised and a core of fat was resected. Significant amount of defatting was required to facilitate bringing the umbilicus to the skin level and close the wound, suturing the umbilicus in position with 4-0 Vicryl and a running horizontal mattress of 5-0 nylon. Good contours were achieved.
The patient tolerated the procedure well. A chin strap had been applied around the submental area at the conclusion of the liposuction, and at this time, the wounds of the abdomen were dressed with bacitracin ointment, Adaptic, ABD pads and a gently fitting elastic abdominal binder. The patient was moved to a bed in the semi-Fowler’s position and returned to recovery in good condition after extubation.
Cosmetic/Plastic Surgery Medical Transcription Sample Report #2
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Submental lipodystrophy.
2. Postpartum atrophy of the breasts with asymmetry, left breast being smaller than the right.
3. Abdominal lipodystrophy.
POSTOPERATIVE DIAGNOSES:
1. Submental lipodystrophy.
2. Postpartum atrophy of the breasts with asymmetry, left breast being smaller than the right.
3. Abdominal lipodystrophy.
OPERATIONS PERFORMED:
1. Submental liposculpturing.
2. Bilateral breast augmentation using subpectoral saline implants.
3. Abdominoplasty.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: With the patient positioned in the sitting and the standing position preoperatively, preoperative markings were performed. The patient was then taken to the operating room where the patient was laid in the supine position on the operating room table, and a satisfactory level of general endotracheal anesthesia was obtained. Foley catheter was placed in the bladder. Thromboguards were placed on the lower extremities. and her arms were secured to the arm boards with padded blankets and Ace wraps. The chest and abdomen were prepped with Betadine gel and draped in a sterile manner.
Attention was first turned to the right breast where a submammary incision was made and carried through the subcutaneous tissue to the lateral border of the pectoralis major muscle. A subpectoral pocket was created by means of blunt and cautery dissection, and hemostasis was obtained with cautery. Several sizers were attempted. A 350 mL implant was placed, filled to 380 mL of saline. The contour looked excellent. Attention was then turned to placing sizers on the left side, and it was felt that a postoperative adjustable implant on the left side would be needed. A 325-390 range postoperative adjustable Spectrum saline implant was prepared and placed in the subpectoral pocket. The valve was positioned appropriately in the left anterior axillary line just below the inframammary crease.
After this was completed, attention was turned to irrigating the pockets with bacitracin solution, suctioning all bacitracin from the wound and checking one additional time for hemostasis and closing the wounds with 3-0 Vicryl in the deep tissue, 3-0 Vicryl in the deep dermis, and subcuticular running 4-0 Monocryl. Half-inch Steri-Strips, Xeroform gauze, 4 x 4, and Tegaderms were applied.
Attention was now turned to the abdomen where incision was made on the previously marked incisions of the abdomen and carried down through the subcutaneous tissue to the level of the anterior rectus sheath. Dissection was carried up to the level of the xiphoid. The umbilicus was released from the overlying skin. High-tension abdominoplasty was performed by undermining with sponge stick in the lateral flanks. Hemostasis was obtained with cautery and bacitracin solution was used to irrigate the wound. A Hemaduct drain was placed through the mons pubis and secured with 3-0 Vicryl suture. Attention was turned then to repair of the diastasis in the midline of the abdomen with continuous running double-stranded nylon superiorly from the xiphoid to the umbilicus and horizontal mattress of 0 Ethibond in the lower diastasis.
Once this was completed, attention was turned to bring the patient into general jackknife position. Excessive skin was marked and resected, and hemostasis was obtained. Closure of the abdominal incision was now performed with 0 Vicryl in the deep tissue, 3-0 Vicryl in the deep dermis and subcuticular running 4-0 Monocryl. Attention was then turned to make a transverse elliptical incision in the midline of the abdomen. The umbilicus was delivered and was secured with 3-0 Vicryl and half mattresses of 5-0 nylon.
After this was completed, attention was turned to application of sterile dressings to the abdomen. The patient was placed in a compression garment and a bra was applied. The patient was undraped, and the patient was repositioned. The submental area was injected with 0.5% lidocaine with adrenaline. After hemostasis was obtained as evidenced by blanching of skin, attention was turned to prepping the neck with Betadine gel and draped in a sterile manner. Cross-tunneling liposculpturing was performed using decreasing caliber Klein cannulas until adequate contour had been obtained. The areas expressed excessive fluid.
Closure with 5-0 nylon was performed and attention was then turned to the application of the compression head garment. The patient tolerated the procedure very well. Estimated blood loss was approximately 150-200 mL. The patient received approximately 2000 mL of crystalloids, had good urinary output, and was transferred to the recovery room in jackknife position in good condition. The patient will be admitted for 23-hour observation.
