introduction
a. definition
A surgery to remove fluid and cut off part of the tunica vaginalis testis
b. scope
All patients who present with scrotal swelling and on examination found a positive transillumination test.
Hydrocele is fluid buildup between the tunica vaginalis testis.
In regard to diagnosis and treatment, required related disciplines of Radiology.
c. indications of surgery
Hydrocele:
- Large that it can suppress the blood vessels to the testicles
- Interfere with or disrupt the activities of daily
- Disturbing cosmetic
d. Contra indications of operation:
general
e. Diagnoses
- Testicular Tumors
- Epididymal Cyst
- Spermatocele
- Hernia scrotalis
f. examination Support
Ultrasound examination when clinical doubt.
Technical Operations
Briefly the technique of hidrokelektomi can be explained as follows:
· With regional or general anesthesia.
· Position the patient supine (supine).
· Disinfection of surgical field with an antiseptic solution.
· Field surgically narrowed with sterile linen.
· Skin incision in the scrotum raphe on the most prominent layer by layer until it looks the tunica vaginalis.
· Guide to meluksir hydrocele blunt preparation, if done immense aspirations hidrokelnya contents of the bag first.
· Incisions are the most prominent part of the hydrocele, then do:
o Techniques Jaboulay: dimarsupialisasi parietal tunica vaginalis and when necessary diplikasi with chromic cat gut string.
Technique o Lord: the tunica vaginalis parietalis diplikasi excised and the edges with yarn chromic cat gut.
· Operation wound was closed layer by layer with threads chromic cat gut.
complications of surgery
Post-surgical complication is bleeding and surgical wound infections.
mortality
(none)
Post-Surgical Care
Treat the wound day 3.
Friday, August 26, 2011
Modified radical mastectomy (MRM)
Introductions:
a. Definition
Modified Radical Mastectomy is a surgical oncologist action on breast malignancy is to remove the entire breast tissue consisting of stroma and parenkhim entire breast, areola and nipple and the skin over the tumor with axillary lymph node dissection ipsilateral level I, II / III en bloc WITHOUT lifting m.pektoralis major and minor.
b. Scope
The breast is the breast stroma and parenkhim located in the anterior wall of the piston between the ICS II and VI and parasternal up to the line axilaris medius. Breast primary vascularization of the branch gets a. the internal mammary, a. Torakoakromialis and branch a. Intercostal 3,4,5.
Regional lymph nodes in the breast is axillary lymph nodes, supra-and infraclavicular and internal mammary. Axillary nodes are divided into three zones namely Level I, II and III. Level I is the KGB is located lateral to the pectoralis minor muscular, level II is located behind the KGB m.pektoralis minor and Level III is located medially of the KGB m.pektoralis minor. Besides, there is also a KGB interpektoral or called Rotter.
Tumors of the breast is divided into
· Benign tumors: fibroadenomas, cysts,
· Malignant tumors: invasive ductal, invasive lobular and other variants (mucoid, papillary, medullary, kribriform etc.)
· Situ malignancy: lobular in situ, in situ ductal and mikroinvasif
Until now the exact cause of breast cancer, is unknown because it is multifactorial
Breast cancer risk factors:
Age of> 35 years
· Menarche <12 years
· Menopause> 55 years
· Nullipara
· Family history (parents, siblings) with breast cancer
Breast cancer diagnosis is made by:
· Diagnosis confirmation of malignancy: clinical examination, FNA & imaging (mammography and / or breast ultrasound. (Tripple diagnostic)
· Diagnosis stage breast cancer: clinical examination, laboratory and imaging (ultrasound images toraks/paru- liver/abdomen- k / p bone scanning).
In circumstances where one component of the triple diagnostic discrepancy experienced biopsy interpretation is done by examination of frozen pieces (if there are facilities) or biopsy only had to know what type of histopatologinya. Subsequent therapy depends on the outcome histopatologinya
c. Indications of surgery
· Cancer early-stage breast (I, II)
· Cancer locally advanced breast with specific requirements
· Soft tissue malignancies of the breast.
d. Contra indications operation
· Tumor attached to the chest wall
· Edema of the arm
· Extensive satellite nodules
· Mastitis inflamatoar
e. Differential diagnosis
· Other malignancies of the breast (sarcoma, lymphoma, etc.).
· Phylodes tumors (malignant and benign).
· Mastitis spacious (especially tuberculous mastitis)
f. Investigations
· Mandatory
- Mammography and / or breast ultrasound
- CXR
- FNAB of breast tumors
- Ultrasound liver / abdomen
- Complete blood chemistry examination in preparation for surgery
· Oprional
- Bone scanning
- Chemical examination of blood / tumor markers: CEA, Ca 15-3, CA 125
Engineering operations
In brief, the operating technique of modified radical mastectomy can be explained as follows:
1. Patients in general anesthesia, the arm ipsilateral to the operated positioned abduction 900, ipsilateral to the operated shoulder propped a thin pillow.
2. Disinfection of the operating field, the upper and mid-neck, the bottom up to the umbilicus, medial to the mid mammma contralateral, lateral to the lateral edge of the scapula. Disinfected circular upper arm until the elbow is then wrapped with sterile doek followed by narrowing the operating field with sterile doek
3. When you get ulcers on the breast tumor, the ulcer should be covered with sterile gauze thick (Buick Gaas) and circular stitches.
4. Do incision (various incision is Stewart, Orr, Willy Meyer, Halsted, incision S) where the line of incision is at least within 2 cm from the edge of the tumor, then created a flap.
5. Flap top to below the clavicle, medially to parasternal ipsilateral flap, flap down to the inframammary fold, the flap lateral to the anterior edge of the m. Latissimus dorsi and identify vasa and. N. Thoracalis dorsalis
6. Mastectomy started from the medial to lateral while caring for bleeding, especially branches of the intercostal blood vessels in the parasternal area. At the time until the lateral edge of the mayor with the help of Haak m.pektoralis maamma tissue removed from the m. Pectoralis minor and serratus anterior (simple mastectomy). In a radical mastectomy pectoralis muscle has begun to
7. Axillary dissection begins with finding the existence of Level I axillary lymph nodes enlargement (lateral pectoralis minor), level II (behind the pectoralis minor) and level III (medial pectoralis minor). Dissection is not higher in vasa axillary region, because it can lead to arm edema. Veins leading to the network mamma ligated. Further identify vasa and n. Thoracalis longus, and thoracalis dorsal, interkostobrachialis. Internerural KGB and eventually further didiseksi mamma tissue and axillary lymph nodes as a single unit detached (en bloc)
8. Field operations sublimat and washed with a solution of 0.9% Nacl.
9. All the tools used during surgery was replaced with a new set, as well as handschoen operators, assistants and instruments as well as doek sterility.
10. Re-evaluation of the source of bleeding
11. 2 pieces mounted drain, a large drain (Redon no. 14) is placed under the vasa axillary, being a smaller drain (12) is directed medially.
12. Surgical wound was closed lapais by layer
Complications of surgery
Early: - bleeding,
- Lesions n. Thoracalis longus à wing scapula
- Lesions n. Thoracalis dorsalis.
Slow: - infection
- Necrosis of flap
- Wound dehiscence
- Seroma
- Edema of the arm
- Stiffness of the shoulder joint contractures à
Mortality
almost no
Post-surgical care
Post-surgical patients admitted to the room by observing the drain production, post-surgical check Hb. Rehabilitation as soon as possible by exercising the shoulder joint movement. Drain removed when the production of each drain <20 cc/24 hours. Generally medial removable drain early, because fewer production. Stitches are generally removed the day ke10 s / d 14.
Follow-up
Year 1 and 2 à controls every 2 months
Year 3 s / d 5 à controls every 3 months
After year 5 à controls every 6 months
Physical examination: each time the control
Thorax picture: every 6 months
Lab. Marker: every 2-3 months
Contralateral mammography: every year or there are indications
Abdominal ultrasound: every 6 months or no indication
Bone scanning: every 2 years or no indication
a. Definition
Modified Radical Mastectomy is a surgical oncologist action on breast malignancy is to remove the entire breast tissue consisting of stroma and parenkhim entire breast, areola and nipple and the skin over the tumor with axillary lymph node dissection ipsilateral level I, II / III en bloc WITHOUT lifting m.pektoralis major and minor.
b. Scope
The breast is the breast stroma and parenkhim located in the anterior wall of the piston between the ICS II and VI and parasternal up to the line axilaris medius. Breast primary vascularization of the branch gets a. the internal mammary, a. Torakoakromialis and branch a. Intercostal 3,4,5.
Regional lymph nodes in the breast is axillary lymph nodes, supra-and infraclavicular and internal mammary. Axillary nodes are divided into three zones namely Level I, II and III. Level I is the KGB is located lateral to the pectoralis minor muscular, level II is located behind the KGB m.pektoralis minor and Level III is located medially of the KGB m.pektoralis minor. Besides, there is also a KGB interpektoral or called Rotter.
Tumors of the breast is divided into
· Benign tumors: fibroadenomas, cysts,
· Malignant tumors: invasive ductal, invasive lobular and other variants (mucoid, papillary, medullary, kribriform etc.)
· Situ malignancy: lobular in situ, in situ ductal and mikroinvasif
Until now the exact cause of breast cancer, is unknown because it is multifactorial
Breast cancer risk factors:
Age of> 35 years
· Menarche <12 years
· Menopause> 55 years
· Nullipara
· Family history (parents, siblings) with breast cancer
Breast cancer diagnosis is made by:
· Diagnosis confirmation of malignancy: clinical examination, FNA & imaging (mammography and / or breast ultrasound. (Tripple diagnostic)
· Diagnosis stage breast cancer: clinical examination, laboratory and imaging (ultrasound images toraks/paru- liver/abdomen- k / p bone scanning).
In circumstances where one component of the triple diagnostic discrepancy experienced biopsy interpretation is done by examination of frozen pieces (if there are facilities) or biopsy only had to know what type of histopatologinya. Subsequent therapy depends on the outcome histopatologinya
c. Indications of surgery
· Cancer early-stage breast (I, II)
· Cancer locally advanced breast with specific requirements
· Soft tissue malignancies of the breast.
d. Contra indications operation
· Tumor attached to the chest wall
· Edema of the arm
· Extensive satellite nodules
· Mastitis inflamatoar
e. Differential diagnosis
· Other malignancies of the breast (sarcoma, lymphoma, etc.).
· Phylodes tumors (malignant and benign).
· Mastitis spacious (especially tuberculous mastitis)
f. Investigations
· Mandatory
- Mammography and / or breast ultrasound
- CXR
- FNAB of breast tumors
- Ultrasound liver / abdomen
- Complete blood chemistry examination in preparation for surgery
· Oprional
- Bone scanning
- Chemical examination of blood / tumor markers: CEA, Ca 15-3, CA 125
Engineering operations
In brief, the operating technique of modified radical mastectomy can be explained as follows:
1. Patients in general anesthesia, the arm ipsilateral to the operated positioned abduction 900, ipsilateral to the operated shoulder propped a thin pillow.
2. Disinfection of the operating field, the upper and mid-neck, the bottom up to the umbilicus, medial to the mid mammma contralateral, lateral to the lateral edge of the scapula. Disinfected circular upper arm until the elbow is then wrapped with sterile doek followed by narrowing the operating field with sterile doek
3. When you get ulcers on the breast tumor, the ulcer should be covered with sterile gauze thick (Buick Gaas) and circular stitches.
4. Do incision (various incision is Stewart, Orr, Willy Meyer, Halsted, incision S) where the line of incision is at least within 2 cm from the edge of the tumor, then created a flap.
5. Flap top to below the clavicle, medially to parasternal ipsilateral flap, flap down to the inframammary fold, the flap lateral to the anterior edge of the m. Latissimus dorsi and identify vasa and. N. Thoracalis dorsalis
6. Mastectomy started from the medial to lateral while caring for bleeding, especially branches of the intercostal blood vessels in the parasternal area. At the time until the lateral edge of the mayor with the help of Haak m.pektoralis maamma tissue removed from the m. Pectoralis minor and serratus anterior (simple mastectomy). In a radical mastectomy pectoralis muscle has begun to
7. Axillary dissection begins with finding the existence of Level I axillary lymph nodes enlargement (lateral pectoralis minor), level II (behind the pectoralis minor) and level III (medial pectoralis minor). Dissection is not higher in vasa axillary region, because it can lead to arm edema. Veins leading to the network mamma ligated. Further identify vasa and n. Thoracalis longus, and thoracalis dorsal, interkostobrachialis. Internerural KGB and eventually further didiseksi mamma tissue and axillary lymph nodes as a single unit detached (en bloc)
8. Field operations sublimat and washed with a solution of 0.9% Nacl.
9. All the tools used during surgery was replaced with a new set, as well as handschoen operators, assistants and instruments as well as doek sterility.
10. Re-evaluation of the source of bleeding
11. 2 pieces mounted drain, a large drain (Redon no. 14) is placed under the vasa axillary, being a smaller drain (12) is directed medially.
12. Surgical wound was closed lapais by layer
Complications of surgery
Early: - bleeding,
- Lesions n. Thoracalis longus à wing scapula
- Lesions n. Thoracalis dorsalis.
Slow: - infection
- Necrosis of flap
- Wound dehiscence
- Seroma
- Edema of the arm
- Stiffness of the shoulder joint contractures à
Mortality
almost no
Post-surgical care
Post-surgical patients admitted to the room by observing the drain production, post-surgical check Hb. Rehabilitation as soon as possible by exercising the shoulder joint movement. Drain removed when the production of each drain <20 cc/24 hours. Generally medial removable drain early, because fewer production. Stitches are generally removed the day ke10 s / d 14.
Follow-up
Year 1 and 2 à controls every 2 months
Year 3 s / d 5 à controls every 3 months
After year 5 à controls every 6 months
Physical examination: each time the control
Thorax picture: every 6 months
Lab. Marker: every 2-3 months
Contralateral mammography: every year or there are indications
Abdominal ultrasound: every 6 months or no indication
Bone scanning: every 2 years or no indication
Water Pipe Fitting Seal Intratorakal or Drainage
Introductiona. Definition
Invasive action by inserting a hose or tube into the thoracic cavity by penetrating the muscular intercostalisb. Scope
Distribute both substances in the form of solids, liquids, air or gas from the chest cavityc. Operation Indication
- More than 30% pneumothorax.
- Pneumothorax residif
- Bilateral pneumothorax
- Hematothoraks more than 300cc
- Hematothoraks bilateral
- Hemato-pneumothorax
- Flail-chest
- Fluidothoraks is superb, with shortness of
- Chylothoraks
- Empyema thoracis after dipungsi unsuccessful or pus is very thick
- Post thoracotomid. Contra Indications:
- General
- Special (no)e. Diagnoses
Nof. Examination Support
- CXRTechnical operations
Installation WSD
1. Patients in a state of half sitting position (+ 45 °).
2. Carried out disinfection and closing with doek sterile operating field.
3. Do local anesthesia with 2% lidocain in infiltration in the area of skin to the pleura.
4. Places that will be installed drain is:
- Linea front axillary line, the ICS IX-X (Buelau).
Can be more proximal, if necessary. Especially in children because the location of the diaphragm
high.
- Linea medio-clavicularis (MCL) in the ICS II-III (Monaldi)
5. Created 2 cm long skin incision until the tissue under the skin.
6. Listed vertical mattress sutures anchoring is tilted to the side 0.1.
7. With tipped curved scissors or blunt clamp curved, subcutaneous tissue freed up the pleura, the pleural penetrated slowly until you hear a sucking sound, it means that the parietal pleura was opened.
Note: on hematothoraks will soon be spraying blood out, the pneumothorax, the air comes out.
1. Drain the trocarnya inserted through the hole towards the cranial lateral skin. When using the drain without trocar, then the end of the drain is clamped with a blunt clamp, to facilitate direct drain.
2. Should be checked first, if the drain is made or there are enough holes side length approximately the distance from apex to the aperture of the skin, duapertinganya.
3. Drain then pushed while playing a little lateral direction until the tip is below about lung apex (Bulleau).
4. After the drain in position, then tied with string fastener rotating double, ending with a slip knot
5. When used according to Monaldi drainage, the drain is driven downwards and laterally until the tip approximately mid-thoracic ronga.
6. Before the drainage pipe system connected to the reservoir bottle, it must be clamped first.
7. Drainage pipe is then connected to the reservoir bottle system, which will guarantee the re-occurrence of negative pressure in the intrapleural cavity, in addition will also accommodate sekrit out of the thoracic cavity.Complication
When done correctly, complications can be avoided. But it can also occur kutis emphysema, False route on the liver when installed too low on the right, especially in children because the location of the diaphragm is still highMortality
Very low morbidity, mortality 0%Post-Installation Care WSD
1. The patient is placed on a semi-sitting position (+ 30 °)
2. The entire drainage system: pipes, bottles, should be in neat, there are no riots arrangement, and can be immediately seen.
3. pipe that comes out of the thoracic cavity must be fixed to the body with plaster wide, orange to prevent wobble.
4. By using a transparent pipe, it can be seen the release of secretions. Must be maintained that the secretions out smoothly. When visible blood clots or other, must be milked until smooth again.
5. Every day should be the control piston AP photo to see:
- Lung condition
- The position of drain
- Other abnormalities (emphyema, shadow mediastonim)
1. The number on the bottle sekrit shelters should be calculated:
- Many sekrit out (every hour - every day)
- Kinds sekrit out (pus, blood, etc.)
7. In patients with respiratory physiotherapy has always done
8. Any abnormalities in the drain should be immediately corrected.Post-Installation Care WSD
1. The patient is placed on a semi-sitting position (+ 30 °)
2. The entire drainage system: pipes, bottles, should be in neat, there are no riots arrangement, and can be immediately seen.
3. pipe that comes out of the thoracic cavity must be fixed to the body with plaster wide, orange to prevent wobble.
4. By using a transparent pipe, it can be seen the release of secretions. Must be maintained that the secretions out smoothly. When visible blood clots or other, must be milked until smooth again.
5. Every day should be the control piston AP photo to see:
- Lung condition
- The position of drain
- Other abnormalities (emphyema, shadow mediastonim)
1. The number on the bottle sekrit shelters should be calculated:
- Many sekrit out (every hour - every day)
- Kinds sekrit out (pus, blood, etc.)
1. In patients with respiratory physiotherapy has always done
2. Any abnormalities in the drain should be immediately corrected.
Revocation guidelines
1. Criteria for revocation
- Sekrit serous, not hemorage
Adults: the amount is less than 100cc/24jam
Children - children: less number 25-50cc/24jam
- Lung expands
Clinical; sound right = left lung expands
Evaluation of chest X-ray
1. Condition:
- In the trauma
Hemato / pneumothorak who already meet both criteria, immediately revoked by the water-tight (air tight).
- In thoracotomi
a. Infection: 24h clamps to prevent resufflasi first, if either unplug.
b. Post operative: if it fulfills both criteria, langsug revoked (water-tight)
c. Post pneumonectomy: day-to-3 when the mediastinum is stable (does not need water-tight
1. Alternative
1. Permanent lung collapse, suction up to 25 cmH20:
- If both krieria met, the clamps first 24 hours, fixed baikà unplug.
- If unsuccessful, wait until 2minggu à dekortikasi
1.
1. Sekrit over 200cc/24jam: suspicion of thoracic Chylo (make sure the laboratory), keep up with 4minggu.
- If unsuccessful à Toracotomi
- If less than 100cc/24jam sekrit, clamps, and then revoked.Follow - Up
Aimed at the onset of further complications such as empyema, Schwarte, impaired respiratory function.
Invasive action by inserting a hose or tube into the thoracic cavity by penetrating the muscular intercostalisb. Scope
Distribute both substances in the form of solids, liquids, air or gas from the chest cavityc. Operation Indication
- More than 30% pneumothorax.
- Pneumothorax residif
- Bilateral pneumothorax
- Hematothoraks more than 300cc
- Hematothoraks bilateral
- Hemato-pneumothorax
- Flail-chest
- Fluidothoraks is superb, with shortness of
- Chylothoraks
- Empyema thoracis after dipungsi unsuccessful or pus is very thick
- Post thoracotomid. Contra Indications:
- General
- Special (no)e. Diagnoses
Nof. Examination Support
- CXRTechnical operations
Installation WSD
1. Patients in a state of half sitting position (+ 45 °).
2. Carried out disinfection and closing with doek sterile operating field.
3. Do local anesthesia with 2% lidocain in infiltration in the area of skin to the pleura.
4. Places that will be installed drain is:
- Linea front axillary line, the ICS IX-X (Buelau).
Can be more proximal, if necessary. Especially in children because the location of the diaphragm
high.
- Linea medio-clavicularis (MCL) in the ICS II-III (Monaldi)
5. Created 2 cm long skin incision until the tissue under the skin.
6. Listed vertical mattress sutures anchoring is tilted to the side 0.1.
7. With tipped curved scissors or blunt clamp curved, subcutaneous tissue freed up the pleura, the pleural penetrated slowly until you hear a sucking sound, it means that the parietal pleura was opened.
Note: on hematothoraks will soon be spraying blood out, the pneumothorax, the air comes out.
1. Drain the trocarnya inserted through the hole towards the cranial lateral skin. When using the drain without trocar, then the end of the drain is clamped with a blunt clamp, to facilitate direct drain.
2. Should be checked first, if the drain is made or there are enough holes side length approximately the distance from apex to the aperture of the skin, duapertinganya.
3. Drain then pushed while playing a little lateral direction until the tip is below about lung apex (Bulleau).
4. After the drain in position, then tied with string fastener rotating double, ending with a slip knot
5. When used according to Monaldi drainage, the drain is driven downwards and laterally until the tip approximately mid-thoracic ronga.
6. Before the drainage pipe system connected to the reservoir bottle, it must be clamped first.
7. Drainage pipe is then connected to the reservoir bottle system, which will guarantee the re-occurrence of negative pressure in the intrapleural cavity, in addition will also accommodate sekrit out of the thoracic cavity.Complication
When done correctly, complications can be avoided. But it can also occur kutis emphysema, False route on the liver when installed too low on the right, especially in children because the location of the diaphragm is still highMortality
Very low morbidity, mortality 0%Post-Installation Care WSD
1. The patient is placed on a semi-sitting position (+ 30 °)
2. The entire drainage system: pipes, bottles, should be in neat, there are no riots arrangement, and can be immediately seen.
3. pipe that comes out of the thoracic cavity must be fixed to the body with plaster wide, orange to prevent wobble.
4. By using a transparent pipe, it can be seen the release of secretions. Must be maintained that the secretions out smoothly. When visible blood clots or other, must be milked until smooth again.
5. Every day should be the control piston AP photo to see:
- Lung condition
- The position of drain
- Other abnormalities (emphyema, shadow mediastonim)
1. The number on the bottle sekrit shelters should be calculated:
- Many sekrit out (every hour - every day)
- Kinds sekrit out (pus, blood, etc.)
7. In patients with respiratory physiotherapy has always done
8. Any abnormalities in the drain should be immediately corrected.Post-Installation Care WSD
1. The patient is placed on a semi-sitting position (+ 30 °)
2. The entire drainage system: pipes, bottles, should be in neat, there are no riots arrangement, and can be immediately seen.
3. pipe that comes out of the thoracic cavity must be fixed to the body with plaster wide, orange to prevent wobble.
4. By using a transparent pipe, it can be seen the release of secretions. Must be maintained that the secretions out smoothly. When visible blood clots or other, must be milked until smooth again.
5. Every day should be the control piston AP photo to see:
- Lung condition
- The position of drain
- Other abnormalities (emphyema, shadow mediastonim)
1. The number on the bottle sekrit shelters should be calculated:
- Many sekrit out (every hour - every day)
- Kinds sekrit out (pus, blood, etc.)
1. In patients with respiratory physiotherapy has always done
2. Any abnormalities in the drain should be immediately corrected.
Revocation guidelines
1. Criteria for revocation
- Sekrit serous, not hemorage
Adults: the amount is less than 100cc/24jam
Children - children: less number 25-50cc/24jam
- Lung expands
Clinical; sound right = left lung expands
Evaluation of chest X-ray
1. Condition:
- In the trauma
Hemato / pneumothorak who already meet both criteria, immediately revoked by the water-tight (air tight).
- In thoracotomi
a. Infection: 24h clamps to prevent resufflasi first, if either unplug.
b. Post operative: if it fulfills both criteria, langsug revoked (water-tight)
c. Post pneumonectomy: day-to-3 when the mediastinum is stable (does not need water-tight
1. Alternative
1. Permanent lung collapse, suction up to 25 cmH20:
- If both krieria met, the clamps first 24 hours, fixed baikà unplug.
- If unsuccessful, wait until 2minggu à dekortikasi
1.
1. Sekrit over 200cc/24jam: suspicion of thoracic Chylo (make sure the laboratory), keep up with 4minggu.
- If unsuccessful à Toracotomi
- If less than 100cc/24jam sekrit, clamps, and then revoked.Follow - Up
Aimed at the onset of further complications such as empyema, Schwarte, impaired respiratory function.
Repair Injuries Peripheral Nerve
Introduction
a. Definition
Repair of peripheral nerve injury is a surgery that aims to improve peripheral nerve injury.
b. Scope
Peripheral nerve injury both open and closed frequently encountered a surgeon. Principle - general principles in dealing with peripheral nerve injury based upon a good understanding of basic biological-daasr nervous system and its response to trauma.
Traditional classification of peripheral nerve injury is klasifiaksi Seddon. Seddon describes the three kinds of injuries are: neuropraksia, axonotmesis and neuotmesis.
Neuropraxia
Is non-functioning of the nervous system without the occurrence of a temporary physical disruption of axons. Usually the nerve function will return to normal after 2-4 weeks.
Axonotmesis
Is the disruption of axons and myelin. Yes sekitarn soft connective tissue including intact endoneurium. Axon degeneration occurs distal and proximal location of the trauma. Distal degeneration known as Wallerian degeneration. Axon regeneration will memngalami with speed 1mm / day. Significantly the function will return to normal after 18 months.
Neurotmesis
Is the disruption of axons and endoneurial. Peripheral components such as collagen can epineurium intact or disruption occur. Axonal degeneration occurs in the distal and proximal segments.
c. Operation Indication
* Complete nerve lesions caused by lacerations or penetrating injuries
* Other nerve lesions are quite meaningful without clinical or electrophysiological improvement after 3-6 months of clinical observation
d. Contra indications of operation (no)
d. Diagnoses
Acute inflammatory demyelinating * · Polyradiculoneuropathy
* · Cervical Spondylosis: Diagnosis and Management
* · Diabetic Neuropathy
* · Femoral Mononeuropathy
* · Guillain-Barre Syndrome in Childhood
* · HIV-1 Associated Acute / Chronic inflammatory demyelinating polyneuropathy
* · HIV-1 Associated Distal Painful sensorimotor polyneuropathy
* · HIV-1 Associated Multiple Mononeuropathies
* · HIV-1 Associated Neuromuscular Complications (Overview)
* · Leptomeningeal carcinomatosis
* · Metastatic disease to the Spine and Related Structures
* · Peroneal Mononeuropathy
* · Polyarteritis nodosa
* · Radial Mononeuropathy
* · Spinal Cord Hemorrhage
* · Spinal Cord Infarction
* · Syringomyelia
* · Vasculitic Neuropathy
e. Examination Support
EMG (Elektromyografi)
Engineering Operations
Operating techniques that can be applied to peripheral nerve repair include internal and external neurolisis. External Neurolisis done by freeing the nerve from surrounding tissues are circumferential. Internal Neurolisis indicated for partial nerve lesions that require separate reparations between fasikulus fasikulus nerve functioning nerve is not functioning. This procedure has the potential to injure the axons to regenerate and be done with electrophysiological guidance. In general, the internal neurolisis dissection segment includes non fungional. Then fasikulus already made reparations didiseksi end to end with or without a nerve graft.
Reparations end to end is preferred that occurs when a small gap and both ends can be brought near without stress / tension meaningful. Tension will hinder the healing process. If a considerable distance, it can be done graft interposition. Generally the donor nerve is taken from the superficial sensory nerves such as autologous nerve suralis. Monofilament suture (7.0 to 10.0) in the epineurium is used to bring fasikulus. Nerve ends should be resected to healthy fasikulus to get a good orientation and optimize repair functions. Yet continuity fasikulus anatomically not guarantee the regeneration of axons. Two causes of the failure is not good preparation and a tension-laden stump. Secondly it will cause the occurrence of scar interneural sarabut that would interfere with nerve regeneration.
Complications of surgery
Anastomosis failure
Mortality (none)
Postoperative care
After the occurrence of peripheral nerve injury, it is essential that patients have to undergo physiotherapy to maintain ROM and to prevent immobilization to optimize healing of motor function in conjunction with the occurrence of muscle reinervasi.
Follow-up
EMG monitoring is helpful to detect early signs of muscle reinervasi few months before the contraction is clinically available.
a. Definition
Repair of peripheral nerve injury is a surgery that aims to improve peripheral nerve injury.
b. Scope
Peripheral nerve injury both open and closed frequently encountered a surgeon. Principle - general principles in dealing with peripheral nerve injury based upon a good understanding of basic biological-daasr nervous system and its response to trauma.
Traditional classification of peripheral nerve injury is klasifiaksi Seddon. Seddon describes the three kinds of injuries are: neuropraksia, axonotmesis and neuotmesis.
Neuropraxia
Is non-functioning of the nervous system without the occurrence of a temporary physical disruption of axons. Usually the nerve function will return to normal after 2-4 weeks.
Axonotmesis
Is the disruption of axons and myelin. Yes sekitarn soft connective tissue including intact endoneurium. Axon degeneration occurs distal and proximal location of the trauma. Distal degeneration known as Wallerian degeneration. Axon regeneration will memngalami with speed 1mm / day. Significantly the function will return to normal after 18 months.
Neurotmesis
Is the disruption of axons and endoneurial. Peripheral components such as collagen can epineurium intact or disruption occur. Axonal degeneration occurs in the distal and proximal segments.
c. Operation Indication
* Complete nerve lesions caused by lacerations or penetrating injuries
* Other nerve lesions are quite meaningful without clinical or electrophysiological improvement after 3-6 months of clinical observation
d. Contra indications of operation (no)
d. Diagnoses
Acute inflammatory demyelinating * · Polyradiculoneuropathy
* · Cervical Spondylosis: Diagnosis and Management
* · Diabetic Neuropathy
* · Femoral Mononeuropathy
* · Guillain-Barre Syndrome in Childhood
* · HIV-1 Associated Acute / Chronic inflammatory demyelinating polyneuropathy
* · HIV-1 Associated Distal Painful sensorimotor polyneuropathy
* · HIV-1 Associated Multiple Mononeuropathies
* · HIV-1 Associated Neuromuscular Complications (Overview)
* · Leptomeningeal carcinomatosis
* · Metastatic disease to the Spine and Related Structures
* · Peroneal Mononeuropathy
* · Polyarteritis nodosa
* · Radial Mononeuropathy
* · Spinal Cord Hemorrhage
* · Spinal Cord Infarction
* · Syringomyelia
* · Vasculitic Neuropathy
e. Examination Support
EMG (Elektromyografi)
Engineering Operations
Operating techniques that can be applied to peripheral nerve repair include internal and external neurolisis. External Neurolisis done by freeing the nerve from surrounding tissues are circumferential. Internal Neurolisis indicated for partial nerve lesions that require separate reparations between fasikulus fasikulus nerve functioning nerve is not functioning. This procedure has the potential to injure the axons to regenerate and be done with electrophysiological guidance. In general, the internal neurolisis dissection segment includes non fungional. Then fasikulus already made reparations didiseksi end to end with or without a nerve graft.
Reparations end to end is preferred that occurs when a small gap and both ends can be brought near without stress / tension meaningful. Tension will hinder the healing process. If a considerable distance, it can be done graft interposition. Generally the donor nerve is taken from the superficial sensory nerves such as autologous nerve suralis. Monofilament suture (7.0 to 10.0) in the epineurium is used to bring fasikulus. Nerve ends should be resected to healthy fasikulus to get a good orientation and optimize repair functions. Yet continuity fasikulus anatomically not guarantee the regeneration of axons. Two causes of the failure is not good preparation and a tension-laden stump. Secondly it will cause the occurrence of scar interneural sarabut that would interfere with nerve regeneration.
Complications of surgery
Anastomosis failure
Mortality (none)
Postoperative care
After the occurrence of peripheral nerve injury, it is essential that patients have to undergo physiotherapy to maintain ROM and to prevent immobilization to optimize healing of motor function in conjunction with the occurrence of muscle reinervasi.
Follow-up
EMG monitoring is helpful to detect early signs of muscle reinervasi few months before the contraction is clinically available.
Repair Hypospadias
Introduction
a. Definition
An abnormal state of development of the anterior urethra where the external urethral meatus located on the ventral and is located more proximal than the normal location and was accompanied on the distal part of firosis MUE that cause crooked penis (chordae).
b. Scope
Hypospadias in the distal, midshaft and proximal penis.
c. Operation Indication
The purpose hypospadias surgery is to straighten the penis, allowing the process of micturition while standing and to increase fertility.
d. Contra indications of operation (no)
e. Differential diagnosis (no)
f. Examination Support
Only by clinical examination
Engineering Operations
Optimal operating time is when children aged 3 to 18 months. At this time children will have amnesia of the surgical procedure and 70-80% of abnormalities can be handled without the need to be treated.
There are two stages of hypospadias surgery, the first is the excision Korde and tunneling, and the second is the reconstruction of the urethra (uretroplasty)
Excision Korde
After incision of hypospadias has been done and the flap has been lifted, the entire network can result in bent lifted from around the meatus, and below the glans. After the artificial erection test was performed. When Korde persists, then further resection is required.
Urethroplasty
There are many techniques that can be used for urethroplasty, but that will be discussed is a fairly common technique used MAGPI.
MAGPI (meatal Advancement and Glanuloplasty Incorporated)
MAGPI technique can be used for patients with distal hypospadias glanular. Once the penis is seen straight on artificial erection test, sirkumsis incision performed. Skin hooks are placed at the edge of the end of the channel glanular urethra and then withdrawn to the lateral direction. This movement can increase the transverse bands of the mucosa which will be a longitudinal incision in the midline. Incision on the dorsal wall of the urethra glanular dengna would eventually be closed with chromic catgut sutures transverse 6-0. Skin hooks are placed on the skin edges of the corona at the ventral midline. With traction distally, tip of the glans is pulled forward and stitched on the midline with sutures subkutikuler. Epithelium of the glans was closed with interrupted sutures. Excess skin of the dorsal prepusium be sewn to skin closure.
Complications Surgery
Short-term
* Local edema and hemorrhage bintk spots can occur immediately after surgery and usually do not cause significant problems
* Postoperative Hemorrhage is rare and can usually be controlled dengna dressing press. Not infrequently this requires re-exploration to remove the hematoma and to identify and address the source of bleeding.
* Infection is a fairly rare complication of hypospadias. With skin preparation and perioperative antibiotics this can be prevented.
Long-term
* Fistula: Fistula uretrokutan is a major problem that often arises in the operation hpospadia. Fistulas rarely close spontaneously and can be repaired dengna layered closure of a local skin flap.
* Meatus stenosis: stenosis or narrowing of the urethral meatus may occur. The flow of urine which can lead to reduced vigilance over the meatus stenosis.
* Stricture: This condition can develop as long-term complications of hypospadias surgery. This situation can be corrected with surgery, and may require an incision, excision or reanastomosis.
* Diverticula: Urethral Diverticula can also form characterized by the development of the urethra during urination. Stricture at the distal obstruction can result in the flow and ended in urethral diverticula. Diverticula can form even though there is no obstruction in the distal part. This can occur related to the graft or flap in hypospadias surgery, which propped up of muscle and subcutaneous tissue from the urethra of origin.
* The presence of hair on the urethra: The skin containing hair follicles used in the reconstruction of hypospadias be avoided. When the skin is associated * with the urethra, this can cause problems in the form of urinary tract infection and stone formation during puberty. Usually to solve a laser or cautery is used, even if pretty much done on the excision of skin containing hair follicles and then repeated hypospadias repair.
Mortality
Very low
Postoperative treatment
- Day-3 post-operative care performed with a removable splint injuries
- Maintain a urinary catheter ± 10-14 days post-surgery
Follow Up
After surgery patients were given a cold compress on the area of operations during the first 2 days. This method can reduce edema and pain as well as keeping the area clean operation. Patients who use suprapubic catheter, urethral sten may also require a small and may be revoked on the fifth postoperative day. In patients who use the tube graft or flap prepusium, micturition process is done through percutaneous suprapubic catheter. Depending on the wound healing process, the catheter was closed on day 10 for experiment micturition. If there is difficulty in this method was repeated 3-4 days later. If up to 3 weeks the fistula persists, micturition process continued as usual after the patient disarankkan to improve operating results 6 months later when the inflammatory process has disappeared. Usually a small fistula may close spontaneously.
After the trial micturition, the patient can bathe as usual. Dressing can be separated spontaneously. After the release of sten, parents were asked to keep the meatus remain open using Neosporin eye ointment jar lid so that the crust at the meatus does not cause an obstruction distal to develop into a fistula.
a. Definition
An abnormal state of development of the anterior urethra where the external urethral meatus located on the ventral and is located more proximal than the normal location and was accompanied on the distal part of firosis MUE that cause crooked penis (chordae).
b. Scope
Hypospadias in the distal, midshaft and proximal penis.
c. Operation Indication
The purpose hypospadias surgery is to straighten the penis, allowing the process of micturition while standing and to increase fertility.
d. Contra indications of operation (no)
e. Differential diagnosis (no)
f. Examination Support
Only by clinical examination
Engineering Operations
Optimal operating time is when children aged 3 to 18 months. At this time children will have amnesia of the surgical procedure and 70-80% of abnormalities can be handled without the need to be treated.
There are two stages of hypospadias surgery, the first is the excision Korde and tunneling, and the second is the reconstruction of the urethra (uretroplasty)
Excision Korde
After incision of hypospadias has been done and the flap has been lifted, the entire network can result in bent lifted from around the meatus, and below the glans. After the artificial erection test was performed. When Korde persists, then further resection is required.
Urethroplasty
There are many techniques that can be used for urethroplasty, but that will be discussed is a fairly common technique used MAGPI.
MAGPI (meatal Advancement and Glanuloplasty Incorporated)
MAGPI technique can be used for patients with distal hypospadias glanular. Once the penis is seen straight on artificial erection test, sirkumsis incision performed. Skin hooks are placed at the edge of the end of the channel glanular urethra and then withdrawn to the lateral direction. This movement can increase the transverse bands of the mucosa which will be a longitudinal incision in the midline. Incision on the dorsal wall of the urethra glanular dengna would eventually be closed with chromic catgut sutures transverse 6-0. Skin hooks are placed on the skin edges of the corona at the ventral midline. With traction distally, tip of the glans is pulled forward and stitched on the midline with sutures subkutikuler. Epithelium of the glans was closed with interrupted sutures. Excess skin of the dorsal prepusium be sewn to skin closure.
Complications Surgery
Short-term
* Local edema and hemorrhage bintk spots can occur immediately after surgery and usually do not cause significant problems
* Postoperative Hemorrhage is rare and can usually be controlled dengna dressing press. Not infrequently this requires re-exploration to remove the hematoma and to identify and address the source of bleeding.
* Infection is a fairly rare complication of hypospadias. With skin preparation and perioperative antibiotics this can be prevented.
Long-term
* Fistula: Fistula uretrokutan is a major problem that often arises in the operation hpospadia. Fistulas rarely close spontaneously and can be repaired dengna layered closure of a local skin flap.
* Meatus stenosis: stenosis or narrowing of the urethral meatus may occur. The flow of urine which can lead to reduced vigilance over the meatus stenosis.
* Stricture: This condition can develop as long-term complications of hypospadias surgery. This situation can be corrected with surgery, and may require an incision, excision or reanastomosis.
* Diverticula: Urethral Diverticula can also form characterized by the development of the urethra during urination. Stricture at the distal obstruction can result in the flow and ended in urethral diverticula. Diverticula can form even though there is no obstruction in the distal part. This can occur related to the graft or flap in hypospadias surgery, which propped up of muscle and subcutaneous tissue from the urethra of origin.
* The presence of hair on the urethra: The skin containing hair follicles used in the reconstruction of hypospadias be avoided. When the skin is associated * with the urethra, this can cause problems in the form of urinary tract infection and stone formation during puberty. Usually to solve a laser or cautery is used, even if pretty much done on the excision of skin containing hair follicles and then repeated hypospadias repair.
Mortality
Very low
Postoperative treatment
- Day-3 post-operative care performed with a removable splint injuries
- Maintain a urinary catheter ± 10-14 days post-surgery
Follow Up
After surgery patients were given a cold compress on the area of operations during the first 2 days. This method can reduce edema and pain as well as keeping the area clean operation. Patients who use suprapubic catheter, urethral sten may also require a small and may be revoked on the fifth postoperative day. In patients who use the tube graft or flap prepusium, micturition process is done through percutaneous suprapubic catheter. Depending on the wound healing process, the catheter was closed on day 10 for experiment micturition. If there is difficulty in this method was repeated 3-4 days later. If up to 3 weeks the fistula persists, micturition process continued as usual after the patient disarankkan to improve operating results 6 months later when the inflammatory process has disappeared. Usually a small fistula may close spontaneously.
After the trial micturition, the patient can bathe as usual. Dressing can be separated spontaneously. After the release of sten, parents were asked to keep the meatus remain open using Neosporin eye ointment jar lid so that the crust at the meatus does not cause an obstruction distal to develop into a fistula.
Extremity Amputation Techniques
a. The basic principle of amputation
With advances in the field of prostheses is the selection of the amputation in order to maintain the limb sedistal may not be entirely correct. This applies to the superior limb amputation. Rules which states for limb mempretahankan sedistal may not be applicable to the inferior extremity amputation. Even so far as possible the knee must be saved, because the knee is very useful functionally. Problem of weight bearing and leaves soft tissue to cover the stump greatly influence the selection of the amputation of the inferior ekstremias. In below knee amputation stump that is too long is not advised because it would complicate the use of the prosthesis. Anterior border of the tibia should be available in the bevel and enough soft tissue to cover it by making a flap diposterior longer. Amputation of ankle-high enough indication has rarely, usually in trauma. Syme amputation is useful for end weight bearing prosthesis. For amputation of the foot is general agreement that is used is trans metatarsal (the level of amputation see schematic drawing).
Location to perform an amputation:
With advances in the field of prostheses is the selection of the amputation in order to maintain the limb sedistal may not be entirely correct. This applies to the superior limb amputation. Rules which states for limb mempretahankan sedistal may not be applicable to the inferior extremity amputation. Even so far as possible the knee must be saved, because the knee is very useful functionally. Problem of weight bearing and leaves soft tissue to cover the stump greatly influence the selection of the amputation of the inferior ekstremias. In below knee amputation stump that is too long is not advised because it would complicate the use of the prosthesis. Anterior border of the tibia should be available in the bevel and enough soft tissue to cover it by making a flap diposterior longer. Amputation of ankle-high enough indication has rarely, usually in trauma. Syme amputation is useful for end weight bearing prosthesis. For amputation of the foot is general agreement that is used is trans metatarsal (the level of amputation see schematic drawing).
Location to perform an amputation:
b. Operation indication
* Trauma
* Dead ganggan limb due to vascular supply
* Malignant neoplasms
* Chronic Osteomyelitis
* Life-threatening infections
* Congenital limb deformities are inoperable
c. Contra indications of operation: the general state of poor
Engineering Operations
Management of Extremity Amputation
Anesthesia
Spinal anesthesia is commonly used for lower extremity amputations, anstesia common for upper limb amputation. Can also be used leksus block anesthesia. Amputation of the finger can be used for local infiltration anesthesia.
Mechanical operation
Above-knee amputation
The best place to split the femur is 8-10 cm (the width of one hand). Use of skin markers to plan the incision, which should create a flap of anterior and posterior flaps have the same length or slightly longer anteriorly. For those of skin and subcutaneous tissue along the line are planned. Hemostasis is usually not difficult in the ischemic limb but severe bleeding can occur in the limbs are septic. Tie all of veins by using absorbent needle 2 / 0. The anterior incision is deepened to the bone, cutting the quadriceps femoris tendon. Vasa femoral together media and lateral popliteal nerves found in posteromedial position. Tie with thread veins double absorbency. Before cutting the nerve, give stress on the nerve so nerve interested in the amputation stump. If the amputation performed at a higher level, sciaticus nerve can be found. Sciaticus nerve followed by the artery to be didiseksi separately and fastened prior to nerve cut. After cutting all the muscles around the femur, the living tissue vessels and avoid the use of diathermy. Check the exact point of amputation of the femur and scrape the periosteum from the bone in this area. The muscles of the thighs must be retracted to the proximal direction to provide sufficient space in the use of chainsaws. This can be done with the help of some abdominal pads or special retractors. After cutting off the femur and lower leg, place a clean towel under the butt and rest your butt on the inverted bowl. Use stingy to smooth the edge of the femur, then bring the muscles along the front and back cover cut off the bone with suture thread absorbency size 1. Attach suction drain the skin incision below the point of cutting the bone in the muscle layer. Place the second layer of stitches is more superficial in the muscle and subcutaneous tissue as this will help close the flap of skin. Sew the edge of the skin with stitches broke up with non-absorbent yarn 2 / 0. Avoid picking the edge of the skin with toothed forceps. Close stump with gauze and cotton and dressing with crepe bandage.
Below-knee amputation
Optimum point for amputation is 14 cm from the tibial plateau, the fibula was cut 2 cm proximal from this. Tick incision, with anterior flap ends just distal of the cutting line on the tibia bone and the posterior flap extends down to the Achilles tendon. Make an incision along the lines that have been marked. In the posterior Achilles tendon cut and deepen the incision to cut the rest of the muscles and tendons to bone. Cut across the muscle into up front. Fibular oblique cut with a saw Gigli, then split the tibia 2 cm distal to this. Clean the muscle from the bone with periosteum elevator. Cut the anterior bevel first with a saw and cut perpendicular to the diagonal of the tibia. Forms angle at the lower end of the tibia towards the top and separate the muscle mass of the posterior aspect. Tie a double all the blood vessels and cut every nerve tense. Remove the distal limb. The posterior flap is pulled upward to wrap butt bone and sutured to the anterior flap. Posterior flap may need to be reduced by excision of muscle tissue. Place absorbent yarn in between the muscles in the posterior and anterior subcutaneous tissue and leave the suction drain beneath the muscle. Bring the edge of the skin with stitches drop out of non-absorbent yarn 2 / 0. Snip the corners of the posterior flap if necessary in order to form neat. Close the butt with a tight bandage with cotton and crepe bandage.
Complications of surgery
* Bleeding
* Infection
Mortality
Depending on the etiology
* Dead ganggan limb due to vascular supply
* Malignant neoplasms
* Chronic Osteomyelitis
* Life-threatening infections
* Congenital limb deformities are inoperable
c. Contra indications of operation: the general state of poor
Engineering Operations
Management of Extremity Amputation
Anesthesia
Spinal anesthesia is commonly used for lower extremity amputations, anstesia common for upper limb amputation. Can also be used leksus block anesthesia. Amputation of the finger can be used for local infiltration anesthesia.
Mechanical operation
Above-knee amputation
The best place to split the femur is 8-10 cm (the width of one hand). Use of skin markers to plan the incision, which should create a flap of anterior and posterior flaps have the same length or slightly longer anteriorly. For those of skin and subcutaneous tissue along the line are planned. Hemostasis is usually not difficult in the ischemic limb but severe bleeding can occur in the limbs are septic. Tie all of veins by using absorbent needle 2 / 0. The anterior incision is deepened to the bone, cutting the quadriceps femoris tendon. Vasa femoral together media and lateral popliteal nerves found in posteromedial position. Tie with thread veins double absorbency. Before cutting the nerve, give stress on the nerve so nerve interested in the amputation stump. If the amputation performed at a higher level, sciaticus nerve can be found. Sciaticus nerve followed by the artery to be didiseksi separately and fastened prior to nerve cut. After cutting all the muscles around the femur, the living tissue vessels and avoid the use of diathermy. Check the exact point of amputation of the femur and scrape the periosteum from the bone in this area. The muscles of the thighs must be retracted to the proximal direction to provide sufficient space in the use of chainsaws. This can be done with the help of some abdominal pads or special retractors. After cutting off the femur and lower leg, place a clean towel under the butt and rest your butt on the inverted bowl. Use stingy to smooth the edge of the femur, then bring the muscles along the front and back cover cut off the bone with suture thread absorbency size 1. Attach suction drain the skin incision below the point of cutting the bone in the muscle layer. Place the second layer of stitches is more superficial in the muscle and subcutaneous tissue as this will help close the flap of skin. Sew the edge of the skin with stitches broke up with non-absorbent yarn 2 / 0. Avoid picking the edge of the skin with toothed forceps. Close stump with gauze and cotton and dressing with crepe bandage.
Below-knee amputation
Optimum point for amputation is 14 cm from the tibial plateau, the fibula was cut 2 cm proximal from this. Tick incision, with anterior flap ends just distal of the cutting line on the tibia bone and the posterior flap extends down to the Achilles tendon. Make an incision along the lines that have been marked. In the posterior Achilles tendon cut and deepen the incision to cut the rest of the muscles and tendons to bone. Cut across the muscle into up front. Fibular oblique cut with a saw Gigli, then split the tibia 2 cm distal to this. Clean the muscle from the bone with periosteum elevator. Cut the anterior bevel first with a saw and cut perpendicular to the diagonal of the tibia. Forms angle at the lower end of the tibia towards the top and separate the muscle mass of the posterior aspect. Tie a double all the blood vessels and cut every nerve tense. Remove the distal limb. The posterior flap is pulled upward to wrap butt bone and sutured to the anterior flap. Posterior flap may need to be reduced by excision of muscle tissue. Place absorbent yarn in between the muscles in the posterior and anterior subcutaneous tissue and leave the suction drain beneath the muscle. Bring the edge of the skin with stitches drop out of non-absorbent yarn 2 / 0. Snip the corners of the posterior flap if necessary in order to form neat. Close the butt with a tight bandage with cotton and crepe bandage.
Complications of surgery
* Bleeding
* Infection
Mortality
Depending on the etiology
Postoperative care and follow-up
* Wound care in general
* Rehabilitation of the manufacture of a suitable prosthesis
* Rehabilitation of the manufacture of a suitable prosthesis
EKSKOKLEASI cyst JAW
a. Definition
An action pengerokan mucous cyst wall is concerned with tooth extraction, removal of the protruding cyst wall.
b. Scope
Odontogenic cysts are non-neoplastic cysts of the mandible or maxilla, ie when the tooth root cyst radicular cyst is facing, and follicular cysts when the cyst is facing dental crowns
c. Indications of surgery
All follicular and radicular cysts
d. Contra indications Operations
Ko severe morbidity
e. Diagnoses
Ameblastoma unilokuler
f. Investigations
Photos of the mandible (Eisler, Panoramic, Hap) photo maxillary (Waters, Hap) depending on location
Engineering Operations
Ahead of the operation:
Explanation to the patient and his family about his illness, surgery and the risk of complications is accompanied by the signature of approval and requests from patients for surgery. (Informed consent). Check and complete the preparation of tools and completeness of the operation including yarn, Redon drain done the day before surgery.
Patients with fasting at least 6 hours before surgery.
Patients with a shower, washing hair and cleaning the body using an antiseptic drugs, especially the face and the hair near the operating field, shaving the hair close to the operating field, sideburns, mustache.
Antibiotic prophylaxis with Cefazolin or clindamycin combination Garamycin, adjusting doses for prophylaxis.
Stages of operation:
Narcotics, nasotrakheal intubation, intubation tubes were fixed to the patient's forehead.
Position the patient supine, with a padded donut on the head.
Incision bukogingival cysts on the prominent areas.
Incision is deepened until it reached the wall of the cyst is made sufficiently mucosal flap, partial cyst wall excised elliptical shape. The mucosa that lines the inner surface scraped clean and the cyst removed.
Apply a paste or tooth extraction into the cyst.
Attach with ribbon gauze tampon into the cavity of the cyst, tampons were fixed to the mucosa using 3.0 silk, then surgical wound or mucosa sutured with vicryl 3.0 dexon a knot.
Complications Surgery
Early Postoperative Complications
Hematoma, will increase the risk of wound infection and dehisensi. Control of bleeding is good and the tent will reduce the risk of hematoma
Infection, minimized by avoiding the buildup of fluid, with the tent. Operational planning and good surgical technique also plays a role in controlling the infection in addition to the use of prophylactic antibiotics.
Mortality
Low Mortality
Post-Surgical Care
* Provision of adequate intravenous fluids.
* Antibiotic prophylaxis is continued until 3 days post-surgery
* Fasting for 2 days.
* Gargle with antiseptic solution.
* Tampons detachable day 3
Follow-Up
Control every 3 months for 1 year
An action pengerokan mucous cyst wall is concerned with tooth extraction, removal of the protruding cyst wall.
b. Scope
Odontogenic cysts are non-neoplastic cysts of the mandible or maxilla, ie when the tooth root cyst radicular cyst is facing, and follicular cysts when the cyst is facing dental crowns
c. Indications of surgery
All follicular and radicular cysts
d. Contra indications Operations
Ko severe morbidity
e. Diagnoses
Ameblastoma unilokuler
f. Investigations
Photos of the mandible (Eisler, Panoramic, Hap) photo maxillary (Waters, Hap) depending on location
Engineering Operations
Ahead of the operation:
Explanation to the patient and his family about his illness, surgery and the risk of complications is accompanied by the signature of approval and requests from patients for surgery. (Informed consent). Check and complete the preparation of tools and completeness of the operation including yarn, Redon drain done the day before surgery.
Patients with fasting at least 6 hours before surgery.
Patients with a shower, washing hair and cleaning the body using an antiseptic drugs, especially the face and the hair near the operating field, shaving the hair close to the operating field, sideburns, mustache.
Antibiotic prophylaxis with Cefazolin or clindamycin combination Garamycin, adjusting doses for prophylaxis.
Stages of operation:
Narcotics, nasotrakheal intubation, intubation tubes were fixed to the patient's forehead.
Position the patient supine, with a padded donut on the head.
Incision bukogingival cysts on the prominent areas.
Incision is deepened until it reached the wall of the cyst is made sufficiently mucosal flap, partial cyst wall excised elliptical shape. The mucosa that lines the inner surface scraped clean and the cyst removed.
Apply a paste or tooth extraction into the cyst.
Attach with ribbon gauze tampon into the cavity of the cyst, tampons were fixed to the mucosa using 3.0 silk, then surgical wound or mucosa sutured with vicryl 3.0 dexon a knot.
Complications Surgery
Early Postoperative Complications
Hematoma, will increase the risk of wound infection and dehisensi. Control of bleeding is good and the tent will reduce the risk of hematoma
Infection, minimized by avoiding the buildup of fluid, with the tent. Operational planning and good surgical technique also plays a role in controlling the infection in addition to the use of prophylactic antibiotics.
Mortality
Low Mortality
Post-Surgical Care
* Provision of adequate intravenous fluids.
* Antibiotic prophylaxis is continued until 3 days post-surgery
* Fasting for 2 days.
* Gargle with antiseptic solution.
* Tampons detachable day 3
Follow-Up
Control every 3 months for 1 year
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