The document discusses strategies for preventing complications during modified radical mastectomy (MRM) procedures. It outlines key steps in MRM including incision planning, flap creation, total mastectomy, axillary dissection, drain placement, and incision repair. Specific strategies are provided to minimize risks of local recurrence, dehiscence, flap necrosis, hematoma, infection, nerve injury, seroma, dog-ear deformity, and ugly scarring. These include proper incision planning, ensuring adequate but not excessive flap thickness, securing hemostasis, and maintaining sterility during the procedure. Intraoperative risk management through good planning, execution with contingency adjustments is emphasized to achieve good postoperative outcomes with no complications or side effects.
This document discusses surgical drains, including their ideal properties, classifications, indications for use, and care. Surgical drains are appliances used to drain fluid collections and can be passive or active. Passive drains rely on gravity while active drains use suction. Drains have therapeutic, diagnostic, prophylactic, monitoring, and palliative indications. Ideal drains are firm but not rigid, smooth, and resistant to blockage. Care includes proper placement, securing, and monitoring drainage output until removal when drainage decreases. Complications can include infection, displacement, and injury.
This document describes the procedure for a laparoscopic right hemicolectomy. It discusses the indications, pre-operative preparation including bowel preparation and antibiotic prophylaxis. During the procedure, ports are placed and the ileocolic vessels are divided. The right colon is mobilized and specimens are extracted either intracorporeally or extracorporeally. An ileocolic anastomosis is then performed using a stapler or hand sewing. Post-operative care includes pain control, DVT prophylaxis, and diet advancement. Potential complications are discussed.
Gastrointestinal surgery procedures involve cutting and suturing of the abdominal cavity tissues including the digestive tract, attached glands, fascia, peritoneum, muscle and skin. Common issues addressed include gastrointestinal bleeding, peptic ulcer disease, delayed gastric emptying, gastric cancer and acute appendicitis. Surgical techniques such as vagotomy, antrectomy, gastrectomy and appendectomy are used to treat these conditions. Post-operative care and dietary changes are important for recovery.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
1. Surgery for rectal cancer aims to remove the tumor and surrounding tissue while preserving nerve function to maintain bowel and bladder control.
2. The gold standard surgery is total mesorectal excision (TME), which provides a low local recurrence rate below 10% due to complete removal of surrounding tissue.
3. TME requires meticulous technique by an experienced colorectal surgeon to dissect the rectum from the surrounding tissue while preserving nerves.
Damage control surgery (DCS) is an approach used for severely injured trauma patients that focuses on rapidly addressing life-threatening issues like hemorrhage rather than fully repairing anatomy. It aims to prevent the lethal triad of hypothermia, acidosis, and coagulopathy that can result from long operations and blood loss. Key aspects of DCS include temporary measures like packing bleeding liver injuries; stapling but not repairing some intestinal injuries; leaving unrepaired vascular injuries clamped; and rapidly closing the abdomen with clips rather than drains to allow reoperation once the patient is stabilized. The goal is definitive repair within 24 hours once the patient's physiology is corrected.
Surgical retractors are instruments used to separate the edges of an incision and hold back underlying tissues, allowing access to body parts. There are two main types - hand retractors which must be held manually, and self-retaining retractors which use mechanisms like screws or clamps to hold tissues independently. Common hand retractors include Senn, Army-Navy, Ribbon, Hohmann, Farabeuf, Meyerding, Deaver, and Richardson retractors used in various procedures. Examples of self-retaining retractors are Weitlaner, Balfour Abdominal, Finochietto Rib, Hip, Gelpi, Joll, and Omni-Tract Wishbone retract
This document provides information on surgical drains, including:
- Surgical drains are tubes used to remove fluids like pus, blood or serum from surgical sites or wounds.
- Drains are classified as open or closed systems and can be active, using suction, or passive, relying on gravity. Common types include Jackson-Pratt, chest, and nasogastric tubes.
- Drains must be properly inserted, secured, and monitored for drainage volume and signs of infection. They are usually removed once drainage decreases to less than 25ml/day to avoid complications like infection or blockage.
This document discusses surgical drains, including their ideal properties, classifications, indications for use, and care. Surgical drains are appliances used to drain fluid collections and can be passive or active. Passive drains rely on gravity while active drains use suction. Drains have therapeutic, diagnostic, prophylactic, monitoring, and palliative indications. Ideal drains are firm but not rigid, smooth, and resistant to blockage. Care includes proper placement, securing, and monitoring drainage output until removal when drainage decreases. Complications can include infection, displacement, and injury.
This document describes the procedure for a laparoscopic right hemicolectomy. It discusses the indications, pre-operative preparation including bowel preparation and antibiotic prophylaxis. During the procedure, ports are placed and the ileocolic vessels are divided. The right colon is mobilized and specimens are extracted either intracorporeally or extracorporeally. An ileocolic anastomosis is then performed using a stapler or hand sewing. Post-operative care includes pain control, DVT prophylaxis, and diet advancement. Potential complications are discussed.
Gastrointestinal surgery procedures involve cutting and suturing of the abdominal cavity tissues including the digestive tract, attached glands, fascia, peritoneum, muscle and skin. Common issues addressed include gastrointestinal bleeding, peptic ulcer disease, delayed gastric emptying, gastric cancer and acute appendicitis. Surgical techniques such as vagotomy, antrectomy, gastrectomy and appendectomy are used to treat these conditions. Post-operative care and dietary changes are important for recovery.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
1. Surgery for rectal cancer aims to remove the tumor and surrounding tissue while preserving nerve function to maintain bowel and bladder control.
2. The gold standard surgery is total mesorectal excision (TME), which provides a low local recurrence rate below 10% due to complete removal of surrounding tissue.
3. TME requires meticulous technique by an experienced colorectal surgeon to dissect the rectum from the surrounding tissue while preserving nerves.
Damage control surgery (DCS) is an approach used for severely injured trauma patients that focuses on rapidly addressing life-threatening issues like hemorrhage rather than fully repairing anatomy. It aims to prevent the lethal triad of hypothermia, acidosis, and coagulopathy that can result from long operations and blood loss. Key aspects of DCS include temporary measures like packing bleeding liver injuries; stapling but not repairing some intestinal injuries; leaving unrepaired vascular injuries clamped; and rapidly closing the abdomen with clips rather than drains to allow reoperation once the patient is stabilized. The goal is definitive repair within 24 hours once the patient's physiology is corrected.
Surgical retractors are instruments used to separate the edges of an incision and hold back underlying tissues, allowing access to body parts. There are two main types - hand retractors which must be held manually, and self-retaining retractors which use mechanisms like screws or clamps to hold tissues independently. Common hand retractors include Senn, Army-Navy, Ribbon, Hohmann, Farabeuf, Meyerding, Deaver, and Richardson retractors used in various procedures. Examples of self-retaining retractors are Weitlaner, Balfour Abdominal, Finochietto Rib, Hip, Gelpi, Joll, and Omni-Tract Wishbone retract
This document provides information on surgical drains, including:
- Surgical drains are tubes used to remove fluids like pus, blood or serum from surgical sites or wounds.
- Drains are classified as open or closed systems and can be active, using suction, or passive, relying on gravity. Common types include Jackson-Pratt, chest, and nasogastric tubes.
- Drains must be properly inserted, secured, and monitored for drainage volume and signs of infection. They are usually removed once drainage decreases to less than 25ml/day to avoid complications like infection or blockage.
1) The document discusses the management of breast cancer including surgical approaches such as mastectomy, radiotherapy, hormone therapy, and chemotherapy.
2) Surgical approaches range from conservative surgeries to radical mastectomies and include procedures such as lumpectomy, quadrantectomy, and total mastectomy.
3) Management depends on the stage of breast cancer and may involve a multi-pronged approach using combinations of surgery, radiotherapy, hormone therapy, and chemotherapy. Single modalities are generally not effective.
Carcinoma esophagus is the common cause for dysphagia for solids. These patients usually present too late to do any definitive curative surgical procedure.
The document discusses the principles of damage control surgery for trauma patients. It describes the lethal triad of hypothermia, coagulopathy, and acidosis that can occur in critically injured patients and be fatal if not addressed. Damage control surgery follows a staged approach to first control bleeding and contamination, then allow resuscitation and correction of the lethal triad before definitive repair. This strategy focuses on physiological stabilization over anatomical fixation and has significantly reduced mortality rates for severely injured trauma patients.
A modified radical mastectomy removes the breast tissue, nipple, skin, and lymph nodes in levels I and II of the axilla, while the Patey modification also removes the pectoralis minor muscle to access level III lymph nodes; complications can include lymphedema if radiation is also used post-surgery or seromas which are usually drained with needles though drains placed during surgery help prevent them. The procedure involves dissecting the breast from the chest wall and axilla while preserving key nerves and blood vessels.
Preventing Surgical Complications of Modified Radical Mastectomy Reynaldo Joson
This document discusses strategies for preventing complications from modified radical mastectomy (MRM) procedures. It emphasizes the importance of thorough planning, execution with contingency adjustments, and strict adherence to aseptic technique. Key steps include carefully planning the incision to ensure adequate margins and avoid dog ears, creating a flap of appropriate thickness, performing a total mastectomy while controlling hemorrhage, and completing a thorough axillary dissection with hemostasis before closure. Drains should be placed laterally and medially as needed to reduce seroma formation post-operatively. With meticulous attention to each stage of the procedure, surgical complications and unwanted outcomes from MRM can be minimized.
This document discusses various surgical considerations for stoma formation. It addresses timing of stoma creation as preoperative, intraoperative or emergency. It also compares outcomes of colostomy versus ileostomy and loop versus end stomas. Common stoma complications like parastomal hernia are described. Studies evaluating different stoma types are summarized finding no significant difference in outcomes generally, though some stoma types may be associated with fewer complications.
Open right hemicolectomy is performed to treat malignant tumors, polyps, and other conditions in the ileocecal region, ascending colon, and hepatic flexure. The procedure involves mobilizing the right colon, ligating blood vessels, resecting the involved bowel segments, and creating an ileocolic or ileotransverse anastomosis. Key steps include careful dissection to avoid injury to nearby structures like the duodenum and ureter, and ensuring a well-vascularized, tension-free anastomosis to minimize risks of leakage. Post-operative care focuses on early ambulation and advancing diet based on progress.
Rectal carcinoma is the third leading cause of cancer death in the US. Risk factors include family history, inflammatory bowel disease, diet high in red meat and fat, and smoking. Staging follows the AJCC TNM system. Diagnosis involves history, physical exam, endoscopy, imaging like CT, MRI, PET. Treatment depends on stage but commonly includes surgery like low anterior resection or abdomino-perineal resection, with or without neoadjuvant chemoradiation, to completely remove the tumor while preserving sphincter function if possible. Ongoing surveillance after treatment monitors for recurrence or new cancers.
This PPT is mainly on the Basic Principles of Minimal Invasive Surgery. The Final Yr. MBBS - Students shouls know the principles of Lap. surgery before going to their internship.
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Vascular anomalies can be broadly divided into two groups: vascular tumors and vascular malformations. Infantile hemangiomas are the most common example of vascular tumors, which are true neoplasms arising from endothelial hyperplasia. Conversely, vascular malformations are congenital lesions resulting from errors in embryonic development and exhibit normal endothelial cell turnover. Infantile hemangiomas have a characteristic life cycle of rapid growth in the first year followed by spontaneous slow regression from ages 1 to 7 years, after which they never recur. Vascular anomalies can be further classified into hemangiomas and various types of vascular malformations.
1. A matched retrospective study found that breast-conserving therapy (BCT) performed for eligible patients is as effective as modified radical mastectomy (MRM) with respect to local tumor control, disease-free survival, and distant disease-free survival.
2. BCT may be a superior treatment option for most Chinese primary breast cancer patients.
3. The document provides details on the surgical techniques for different levels of axillary lymph node dissection.
This document discusses surgical considerations for rectal cancer, including:
1. The total mesorectal excision (TME) technique aims to remove the mesorectum containing all lymph nodes, leading to low local recurrence rates of 3-4% after 5-10 years.
2. Pre-operative chemoradiotherapy can downstage tumours and improve survival, especially for T3/T4 tumours.
3. A modified TME removing the mesorectum at least 5cm below the tumour is acceptable for high and mid rectal cancers, as distal spread beyond this is rare.
4. Good surgical outcomes depend on meticulous technique, surgeon experience operating in the pelvis, and multidis
Acs0536 Procedures For Rectal Prolapse 2004medbookonline
This document describes procedures for rectal prolapse, including mucosal sleeve resection (Delorme procedure) and perineal rectosigmoidectomy (Altemeier procedure). It discusses that rectal prolapse involves the protrusion of the rectum through the anus and can be complete or partial. Surgical options aim to correct anatomic defects and address functional disorders like constipation to prevent recurrence. The choice of surgery depends on factors like a patient's age, sex, and degree of incontinence or prolapse.
Neoadjuvant chemotherapy uses chemotherapy drugs to shrink tumors before surgery. It has several advantages, including allowing previously inoperable tumors to become operable, preserving organs, and improving long-term survival. Some studies have found higher rates of pathological complete response and progression-free survival with neoadjuvant chemoradiotherapy compared to chemotherapy alone for some cancers. Neoadjuvant chemotherapy has been shown to be as effective as adjuvant chemotherapy for some cancers. However, it can also be more difficult for patients due to its cumulative toxicity and longer duration before definitive surgery. It may be recommended as an alternative to adjuvant therapy for operable breast cancers where breast conservation is desired or surgery is not immediately possible.
This document discusses the principles and techniques of laparoscopic surgery. It begins with an introduction to minimal access surgery and its aims of reducing somatic and psychological trauma while allowing for shorter hospital stays and faster recovery. The document then covers the categories of minimally invasive procedures and diagnostic and therapeutic applications of laparoscopic surgery. It provides details on preoperative evaluation and preparation, creating pneumoperitoneum, intraoperative equipment and techniques, postoperative care, and examples of common laparoscopic procedures like cholecystectomy, hernia repair, and fundoplication. Throughout it includes diagrams to illustrate surgical anatomy and procedure steps.
1) The document discusses the diagnosis and treatment of intra-abdominal injuries, including the external anatomy of the abdomen, classification of injuries as blunt, penetrating, or iatrogenic, signs and symptoms of potential abdominal injury, and priorities for diagnosis and management.
2) Key diagnostic tests discussed are physical exam, plain films, FAST ultrasound, CT scan, diagnostic peritoneal lavage, and exploratory laparotomy. Indications, advantages, limitations, and sensitivities of each test are provided.
3) Treatment priorities and approaches are outlined, including resuscitation, damage control resuscitation, identifying the source of bleeding, and surgical procedures for exploratory laparotomy and repair of specific organ injuries
The document discusses endovenous radiofrequency ablation (RFA) for treating varicose veins caused by venous reflux disease. It notes that over 25 million Americans suffer from venous reflux disease, which often leads to varicose veins. RFA uses a catheter-based approach to deliver radiofrequency energy to heat and collapse the vein, providing an alternative treatment to surgery. Studies show RFA results in high occlusion rates with less pain and bruising than laser ablation treatment.
The document discusses the anatomy and types of skin grafts and skin flaps. It describes that skin has two layers, the epidermis and dermis. There are two types of skin grafts - partial thickness grafts which remove some dermis and full thickness grafts which remove the full dermis. Skin flaps differ in that they maintain the blood supply of the transferred tissue. Local flaps use nearby tissue while distant flaps require long pedicles. The techniques, indications, and advantages/disadvantages of various skin grafts and flaps are outlined.
1) Mastectomy is the surgical removal of breast tissue, either partially or completely. It is commonly performed to treat breast cancer.
2) There are several types of mastectomy procedures including simple/total mastectomy, modified radical mastectomy, and breast conserving surgery.
3) Factors such as tumor size, lymph node involvement, and patient preferences help determine which mastectomy procedure is most suitable. Post-operative care and follow up is also important after mastectomy.
Surgical Anatomy of Breast and Approach to Breast Carcinoma. Basic idea on the significance of important surgical anatomy landmarks/ fact of the breast. Ideas/approach to identify red flags of breast carcinoma. Compare breast carcinoma and aberrant benign causes.
1) The document discusses the management of breast cancer including surgical approaches such as mastectomy, radiotherapy, hormone therapy, and chemotherapy.
2) Surgical approaches range from conservative surgeries to radical mastectomies and include procedures such as lumpectomy, quadrantectomy, and total mastectomy.
3) Management depends on the stage of breast cancer and may involve a multi-pronged approach using combinations of surgery, radiotherapy, hormone therapy, and chemotherapy. Single modalities are generally not effective.
Carcinoma esophagus is the common cause for dysphagia for solids. These patients usually present too late to do any definitive curative surgical procedure.
The document discusses the principles of damage control surgery for trauma patients. It describes the lethal triad of hypothermia, coagulopathy, and acidosis that can occur in critically injured patients and be fatal if not addressed. Damage control surgery follows a staged approach to first control bleeding and contamination, then allow resuscitation and correction of the lethal triad before definitive repair. This strategy focuses on physiological stabilization over anatomical fixation and has significantly reduced mortality rates for severely injured trauma patients.
A modified radical mastectomy removes the breast tissue, nipple, skin, and lymph nodes in levels I and II of the axilla, while the Patey modification also removes the pectoralis minor muscle to access level III lymph nodes; complications can include lymphedema if radiation is also used post-surgery or seromas which are usually drained with needles though drains placed during surgery help prevent them. The procedure involves dissecting the breast from the chest wall and axilla while preserving key nerves and blood vessels.
Preventing Surgical Complications of Modified Radical Mastectomy Reynaldo Joson
This document discusses strategies for preventing complications from modified radical mastectomy (MRM) procedures. It emphasizes the importance of thorough planning, execution with contingency adjustments, and strict adherence to aseptic technique. Key steps include carefully planning the incision to ensure adequate margins and avoid dog ears, creating a flap of appropriate thickness, performing a total mastectomy while controlling hemorrhage, and completing a thorough axillary dissection with hemostasis before closure. Drains should be placed laterally and medially as needed to reduce seroma formation post-operatively. With meticulous attention to each stage of the procedure, surgical complications and unwanted outcomes from MRM can be minimized.
This document discusses various surgical considerations for stoma formation. It addresses timing of stoma creation as preoperative, intraoperative or emergency. It also compares outcomes of colostomy versus ileostomy and loop versus end stomas. Common stoma complications like parastomal hernia are described. Studies evaluating different stoma types are summarized finding no significant difference in outcomes generally, though some stoma types may be associated with fewer complications.
Open right hemicolectomy is performed to treat malignant tumors, polyps, and other conditions in the ileocecal region, ascending colon, and hepatic flexure. The procedure involves mobilizing the right colon, ligating blood vessels, resecting the involved bowel segments, and creating an ileocolic or ileotransverse anastomosis. Key steps include careful dissection to avoid injury to nearby structures like the duodenum and ureter, and ensuring a well-vascularized, tension-free anastomosis to minimize risks of leakage. Post-operative care focuses on early ambulation and advancing diet based on progress.
Rectal carcinoma is the third leading cause of cancer death in the US. Risk factors include family history, inflammatory bowel disease, diet high in red meat and fat, and smoking. Staging follows the AJCC TNM system. Diagnosis involves history, physical exam, endoscopy, imaging like CT, MRI, PET. Treatment depends on stage but commonly includes surgery like low anterior resection or abdomino-perineal resection, with or without neoadjuvant chemoradiation, to completely remove the tumor while preserving sphincter function if possible. Ongoing surveillance after treatment monitors for recurrence or new cancers.
This PPT is mainly on the Basic Principles of Minimal Invasive Surgery. The Final Yr. MBBS - Students shouls know the principles of Lap. surgery before going to their internship.
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Vascular anomalies can be broadly divided into two groups: vascular tumors and vascular malformations. Infantile hemangiomas are the most common example of vascular tumors, which are true neoplasms arising from endothelial hyperplasia. Conversely, vascular malformations are congenital lesions resulting from errors in embryonic development and exhibit normal endothelial cell turnover. Infantile hemangiomas have a characteristic life cycle of rapid growth in the first year followed by spontaneous slow regression from ages 1 to 7 years, after which they never recur. Vascular anomalies can be further classified into hemangiomas and various types of vascular malformations.
1. A matched retrospective study found that breast-conserving therapy (BCT) performed for eligible patients is as effective as modified radical mastectomy (MRM) with respect to local tumor control, disease-free survival, and distant disease-free survival.
2. BCT may be a superior treatment option for most Chinese primary breast cancer patients.
3. The document provides details on the surgical techniques for different levels of axillary lymph node dissection.
This document discusses surgical considerations for rectal cancer, including:
1. The total mesorectal excision (TME) technique aims to remove the mesorectum containing all lymph nodes, leading to low local recurrence rates of 3-4% after 5-10 years.
2. Pre-operative chemoradiotherapy can downstage tumours and improve survival, especially for T3/T4 tumours.
3. A modified TME removing the mesorectum at least 5cm below the tumour is acceptable for high and mid rectal cancers, as distal spread beyond this is rare.
4. Good surgical outcomes depend on meticulous technique, surgeon experience operating in the pelvis, and multidis
Acs0536 Procedures For Rectal Prolapse 2004medbookonline
This document describes procedures for rectal prolapse, including mucosal sleeve resection (Delorme procedure) and perineal rectosigmoidectomy (Altemeier procedure). It discusses that rectal prolapse involves the protrusion of the rectum through the anus and can be complete or partial. Surgical options aim to correct anatomic defects and address functional disorders like constipation to prevent recurrence. The choice of surgery depends on factors like a patient's age, sex, and degree of incontinence or prolapse.
Neoadjuvant chemotherapy uses chemotherapy drugs to shrink tumors before surgery. It has several advantages, including allowing previously inoperable tumors to become operable, preserving organs, and improving long-term survival. Some studies have found higher rates of pathological complete response and progression-free survival with neoadjuvant chemoradiotherapy compared to chemotherapy alone for some cancers. Neoadjuvant chemotherapy has been shown to be as effective as adjuvant chemotherapy for some cancers. However, it can also be more difficult for patients due to its cumulative toxicity and longer duration before definitive surgery. It may be recommended as an alternative to adjuvant therapy for operable breast cancers where breast conservation is desired or surgery is not immediately possible.
This document discusses the principles and techniques of laparoscopic surgery. It begins with an introduction to minimal access surgery and its aims of reducing somatic and psychological trauma while allowing for shorter hospital stays and faster recovery. The document then covers the categories of minimally invasive procedures and diagnostic and therapeutic applications of laparoscopic surgery. It provides details on preoperative evaluation and preparation, creating pneumoperitoneum, intraoperative equipment and techniques, postoperative care, and examples of common laparoscopic procedures like cholecystectomy, hernia repair, and fundoplication. Throughout it includes diagrams to illustrate surgical anatomy and procedure steps.
1) The document discusses the diagnosis and treatment of intra-abdominal injuries, including the external anatomy of the abdomen, classification of injuries as blunt, penetrating, or iatrogenic, signs and symptoms of potential abdominal injury, and priorities for diagnosis and management.
2) Key diagnostic tests discussed are physical exam, plain films, FAST ultrasound, CT scan, diagnostic peritoneal lavage, and exploratory laparotomy. Indications, advantages, limitations, and sensitivities of each test are provided.
3) Treatment priorities and approaches are outlined, including resuscitation, damage control resuscitation, identifying the source of bleeding, and surgical procedures for exploratory laparotomy and repair of specific organ injuries
The document discusses endovenous radiofrequency ablation (RFA) for treating varicose veins caused by venous reflux disease. It notes that over 25 million Americans suffer from venous reflux disease, which often leads to varicose veins. RFA uses a catheter-based approach to deliver radiofrequency energy to heat and collapse the vein, providing an alternative treatment to surgery. Studies show RFA results in high occlusion rates with less pain and bruising than laser ablation treatment.
The document discusses the anatomy and types of skin grafts and skin flaps. It describes that skin has two layers, the epidermis and dermis. There are two types of skin grafts - partial thickness grafts which remove some dermis and full thickness grafts which remove the full dermis. Skin flaps differ in that they maintain the blood supply of the transferred tissue. Local flaps use nearby tissue while distant flaps require long pedicles. The techniques, indications, and advantages/disadvantages of various skin grafts and flaps are outlined.
1) Mastectomy is the surgical removal of breast tissue, either partially or completely. It is commonly performed to treat breast cancer.
2) There are several types of mastectomy procedures including simple/total mastectomy, modified radical mastectomy, and breast conserving surgery.
3) Factors such as tumor size, lymph node involvement, and patient preferences help determine which mastectomy procedure is most suitable. Post-operative care and follow up is also important after mastectomy.
Surgical Anatomy of Breast and Approach to Breast Carcinoma. Basic idea on the significance of important surgical anatomy landmarks/ fact of the breast. Ideas/approach to identify red flags of breast carcinoma. Compare breast carcinoma and aberrant benign causes.
This document discusses mastectomy, which is the surgical removal of all or part of the breast tissue. It describes different types of mastectomies, including simple, skin-sparing, and radical mastectomies. Indications for mastectomy include large cancerous tumors, inflammatory breast conditions, and high risk of invasive cancer. Potential complications include lymphedema, nerve damage, infection, and changes in body image or quality of life. Reconstruction options are also discussed.
This is a paper which describes an innovative approach for skin sparing mastectomy. This incision tends to distract the eye and be less noticeable. Additionally it allows excellent access to the axilla for lymph node sampling and reduces the excessive retraction on the skin flaps.
How to Do Physical Examination of the BreastsReynaldo Joson
The document outlines the steps for performing a physical examination of the breasts. The examination involves inspection of each breast followed by palpation of each breast one at a time using both hands in a wedge pattern with light and deep pressures to cover all areas. The nipples are pressed to check for any discharge and the underarms are palpated to check for enlarged lymph nodes. If a dominant breast mass is found, its characteristics are determined to aid in clinical diagnosis.
This document provides a rapid review of breast prosthesis implantation for reconstructive and cosmetic surgery. It summarizes the current treatment options, methodology of the review, safety and effectiveness for reconstructive and augmentation indications based on the peer-reviewed literature. Key findings include that for reconstruction, silicone gel-filled implants have higher rupture rates compared to saline-filled implants. For augmentation, silicone gel-filled implants are associated with capsular contracture at higher rates than other implant types. Limitations of the evidence are also discussed.
Farmer Bailey hits a stranger with his car and brings him home to recuperate. The stranger is unable to speak but helps out on the farm. He bonds with the farmer's daughter by watching geese together. Though the family wants him to stay, the stranger realizes he must leave. Before departing, he hugs the family goodbye and leaves a note saying "see you next fall."
Breast cancer is the most common cancer in women worldwide. The document outlines the surgical anatomy of the breast and discusses epidemiological factors such as incidence, mortality, age, sex, and race. It also examines various risk factors for breast cancer including family history, reproductive history, obesity, and genetic mutations. The anatomy, epidemiology, and risk factors of breast cancer are explored in detail.
This document provides an overview of head injuries, including definitions, surgical anatomy of relevant structures like the scalp, skull, meninges and brain, epidemiology, etiology, classifications, pathophysiology, clinical presentation, workup and management. It discusses different types of head injuries such as blunt and penetrating injuries, and classifications based on integrity of the dura mater, site of injury and pathology. Specific types of injuries like fractures, hematomas, and brain injuries are described in detail.
Breast Preservation Foundation: Oncoplastic Talk, Dallas, 12/5/09SDG
The document discusses the principles of oncoplastic breast surgery and mastectomy techniques. It provides a brief history of mastectomy and describes the physics of breast shape. It advocates for using the Wise pattern incision technique for mastectomies, as it better preserves the skin envelope and shape compared to transverse incisions. Clinical examples are presented showing reconstruction outcomes using implants, flaps and skin-sparing techniques based on these principles.
This document provides guidance on examining benign skin swellings. It describes classifying swellings by origin and consistency, and outlines the steps of clinical examination including inspection, palpation, and special tests. Inspection involves assessing features like site, size, shape, surface, color, and pulsations. Palpation evaluates temperature, tenderness, consistency, edge, and relationships to surrounding structures. Special tests for cystic swellings include fluctuation, transillumination, compressibility, and fixity to skin. A thorough examination provides clues to diagnose the type and cause of the swelling.
Mastectomy Morbidities: Prevention, Detection, and Treatment (Focus: Seroma, ...Reynaldo Joson
The document discusses mastectomy morbidities, focusing on seroma, infection, and bleeding. It provides data from a Philippine hospital showing that hematoma, infection, and seroma are the most common morbidities seen. It also summarizes surveys of surgeons which found seroma, hematoma, and infection or wound issues within the top 5 morbidities. The document discusses preventing and treating seroma by avoiding fluid accumulation under surgical flaps and continuing drainage until fluid stops accumulating. It recommends closed tube drainage and needle aspiration based on evidence and consensus among surgeons.
This document defines appendicitis and provides details about its historical perspective, epidemiology, etiology, classification, pathophysiology, clinical presentation, differential diagnosis, workup, treatment, and complications. Specifically, it notes that appendicitis is inflammation of the vermiform appendix and was first described in 1886. It occurs most commonly in the second and third decades of life and has a higher incidence in males. Obstruction of the appendix is a major cause and results in increased intraluminal pressure and bacterial overgrowth. Clinical presentation involves shifting pain from the periumbilical region to the right lower quadrant. Treatment is an appendectomy, which can be open or laparoscopic. Complications include appendiceal
This document discusses the management of early stage breast carcinoma. It covers the work up, types of surgery including lumpectomy and mastectomy, reconstructive options, complications of surgery, sentinel lymph node biopsy, radiotherapy techniques including whole breast irradiation and boost to tumor bed, and partial breast irradiation methods like intraoperative radiation therapy. It provides guidelines on indications for radiotherapy and highlights several large randomized trials investigating radiotherapy after lumpectomy and breast conservation surgery.
This document discusses splenectomy, the surgical removal of the spleen. It defines splenectomy and outlines the relevant anatomy of the spleen. The document then discusses the indications for splenectomy, including trauma, hematological disorders, tumors, and vascular abnormalities. It covers the preoperative preparation, anesthesia, positioning, exposure, closure, and postoperative management of splenectomy. Finally, it lists some potential complications of splenectomy.
This document provides information on breast swelling including:
- Definitions of breast swelling and a short anatomy of the breast.
- Differential diagnoses of breast swelling including physiological causes like puberty, menstruation, pregnancy, breastfeeding, menopause, and contraceptives. Pathological causes include fibroadenoma, fibroadenosis, mastitis, fat necrosis and more.
- Clinical evaluations for breast swelling including history, physical examinations, and investigations like mammograms, ultrasounds, biopsies and blood tests.
- Management of breast swelling depends on the underlying cause and may include observation, medications, surgery, radiation or chemotherapy.
At Rodriguez Plastic you will meet Dr. Wilfredo Rodriguez Peña a Dominican doctor, specializing in General Surgery and then Plastic, Reconstructive and Aesthetic which performs in Caracas Venezuela.
This document provides information on surgical endodontics procedures performed by Dr. Osama Mushtaq. It discusses the reasons for endodontic treatment failure and describes objectives and indications for endodontic surgery, including managing periapical disease and lesions that cannot be treated via nonsurgical root canal treatment. The document outlines the surgical procedure, covering topics like flap design, root resection, root-end filling materials, and postoperative care. It also discusses factors associated with success and failure of periapical surgery, and indications and contraindications for corrective endodontic surgery to repair procedural errors or resorptive defects.
The document discusses various preprosthetic surgical procedures used to improve the denture foundation for patients requiring removable dentures. Some common procedures mentioned include tuberosity reduction, removal of palatal papillary hyperplasia and fibrous lesions caused by denture irritation, frenectomies, and alveoloplasty to reshape sharp bony ridges. Reconstructive procedures like vestibuloplasty and bone grafting are also briefly covered. The goal of these procedures is to enhance denture support, retention, and stability.
Mastectomy and its physiotherapy managmentShubham Singh
Mastectomy is the surgical removal of part or all of the breast. Physiotherapy management of mastectomy involves pre-operative and post-operative care. Pre-operatively, assessment is done and exercises are prescribed to maintain range of motion and strength. Post-operatively, the goals are to restore range of motion, reduce pain and swelling, prevent stiffness, and improve function. A protocol of exercises like deep breathing, walking, pendulums, and stretches are followed to regain mobility and strength while avoiding complications like lymphedema and limited range of motion.
Recent advancements in spine surgery.pptxssusereea748
The document discusses recent advancements in spine surgery, including microscopic minimal invasive spine surgery, 3D navigation-guided surgeries, laser guided spine surgery, robotic-assisted spine surgeries, and fusionless surgery for spinal deformities. It provides details on the applications and benefits of minimally invasive spine surgery techniques as well as newer technologies like computer navigation systems and robotic systems that improve accuracy and reduce radiation exposure compared to traditional techniques. Limitations of some methods are also outlined.
This document discusses computer guided treatment planning and implant placement. It describes how computer guided planning allows visualization of potential implant sites in 3D and more precise placement compared to free-hand drilling. Fully guided surgery uses surgical templates to control position, angle, depth and diameter of osteotomies, while semi-guided surgery controls initial position and angle only, allowing more flexibility. Fully guided is used for edentulous patients, while semi-guided is preferred for partially edentulous patients where soft tissue manipulation or bone grafting may be needed.
This presentation highlights a wide variety of malocclusion's treated with Invisalign, including:
- Class II
- Class III
- Open bite
- Deep bite
- Extraction
- TMD cases
Participants will garner how to Properly design the ClinCheck treatment plan, including a better understanding of seeking movements as torque, expansion, and anterior intrusion in order to avoid possible iatrogenic sequelae (i.e. posterior open bites).
Dr. Moshiri will therefore discuss how to mate adjunct mechanics like lingual bite ramps, elastic buttons, and I expander phase to Ensure your Invisalign cases finish predictably. If you're looking to pick up several pearls on diagnosing and executing your Invisalign cases Effectively, then you will not want to miss this presentation.
This document discusses the history and benefits of gynaec endoscopic surgery, also known as minimal access surgery. It notes that minimal access surgery has revolutionized gynaecological surgery by allowing for less invasive procedures with reduced trauma through small incisions. While some simple procedures like treating ectopic pregnancies were adopted quickly, more advanced procedures required additional training. The document emphasizes the importance of training the next generation of gynaecologists to perform these surgeries safely and conferring the benefits of minimal access surgery broadly. It concludes by encouraging overcoming fears of new techniques and ensuring adequate structured training is provided.
1) Proper proximal fixation of the femoral implant is crucial for the success of Austin Moore's prosthesis (AMP) surgery to provide mechanical stability and allow bone grafts to consolidate.
2) Inadequate proximal fixation is one of the primary reasons for painful failure of AMP, which can result in prosthesis subsidence, loosening, and loss of alignment.
3) Achieving good proximal fixation requires careful pre-operative planning, preservation of femoral neck bone stock, impaction grafting of the proximal area, and selection of an appropriately sized implant.
Breast Conservation Surgery is defined as the complete removal of the tumour with a concentric margin of surrounding healthy tissue with maintenance of acceptable cosmesis, and should be followed by radiation therapy to achieve an acceptably low rate of local recurrence. Breast conservation treatment is BCS with radiotherapy.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses Bioprogressive Therapy, which is an orthodontic treatment approach developed from edgewise and Begg techniques. It focuses on treating the total facial profile rather than just teeth and occlusion. The principles of BPT include using a systems approach to diagnosis and treatment planning, maintaining torque control throughout treatment, and segmental arch treatment. BPT utilizes light continuous forces, cortical and muscular anchorage, and the development of utility arches to efficiently move teeth while respecting supporting structures.
MRI is useful for staging cervical, endometrial, and vaginal cancers. It can determine tumor size and extent, parametrial invasion, lymph node involvement, and distant metastases. Accurate staging helps guide treatment decisions such as surgery versus radiation or chemotherapy. Diffusion-weighted imaging may help identify malignant lymph nodes and assess tumor response to treatment.
1. Oncoplastic breast surgery (OPBS) combines oncological surgery with plastic surgery techniques to allow for wide excision of breast cancer tumors while maintaining the natural shape of the breast.
2. OPBS techniques have evolved since the 1980s and can be used for breast-conserving surgery, post-mastectomy reconstruction, or correction of defects after standard breast-conserving surgery.
3. OPBS is generally indicated for early-stage breast cancers less than 4cm and can extend the use of breast-conserving surgery to larger tumors. Selection depends on factors like excision volume, tumor location, and breast density.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, has a shorter recovery time, and allows the uterus to be preserved. The document provides details on the various techniques for endometrial ablation as well as preoperative preparation and counseling. It emphasizes the importance of completely ablating the entire endometrial thickness for treatment to be effective.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, allows the uterus to be preserved, and has a shorter recovery time. The document provides details on the various techniques for endometrial ablation and notes it is most effective when performed hysteroscopically to allow direct visualization. Preparation of the endometrium and cervix is recommended to improve outcomes.
Extra Levator Abdomino Perineal Resection Dr Harsh Shah
This document discusses extralevator abdominoperineal excision (ELAPE) for rectal cancer. It describes how ELAPE aims to improve on conventional abdominoperineal resection (APR) by removing a larger volume of tissue, including the levator muscles, to obtain clear margins. Meta-analyses have found ELAPE results in lower rates of circumferential resection margin involvement, local recurrence, and involved nodes compared to APR. However, ELAPE also increases morbidity risks and requires perineal wound reconstruction. While ELAPE shows potential oncological benefits, more high-quality studies are still needed to prove its superiority over selective approaches.
ORTHODONTIC CONSIDERATION IN SURGICAL ORTHODONTICS.pptxDr. Genoey George
This document discusses orthodontic considerations in surgical orthodontics. It covers the history and definitions of orthognathic surgery, indications and contraindications, advantages and disadvantages. It also discusses the roles of the orthodontist and surgeon in treatment planning, sequencing of treatment, and important orthodontic procedures like decompensation and presurgical orthodontics. Presurgical orthodontics aims to correct dental alignment, leveling, and removing natural compensation in order to allow for optimal surgical correction of jaw discrepancies. Close collaboration between the orthodontist and surgeon is important for achieving the best functional and aesthetic results.
ORTHODONTIC CONSIDERATION IN SURGICAL ORTHODONTICS.pptxDr. Genoey George
This document discusses orthodontic considerations in surgical orthodontics. It covers the history and definitions of orthognathic surgery, indications and contraindications, advantages and disadvantages. It also discusses the roles of the orthodontist and surgeon in treatment planning, sequencing of treatment, and important orthodontic procedures like decompensation and presurgical orthodontics. Presurgical orthodontics aims to correct dental alignment, leveling, and removing natural compensation in order to allow for optimal surgical correction of jaw discrepancies. Close collaboration between the orthodontist and surgeon is important for achieving the best functional and aesthetic results.
Similar to Preventing Surgical Complications of Modified Radical Mastectomy - ROJoson - 14sept5 (20)
ROJoson PEP Talk: High Blood Pressure (Hypertension) ManagementReynaldo Joson
The document provides information about a zoom session on April 13, 2024 from 1400H to 1500H on High Blood Pressure (Hypertension) Management. The objective is for laypeople to have an essential understanding of managing hypertension as part of their health management. The session will include a presentation, group pictures, an online test for a certificate, and feedback in the chat box. [/SUMMARY]
ROJoson PEP Talk: Does Biopsy Make Cancer Spread?Reynaldo Joson
This document contains information from a presentation on whether biopsies can cause cancer to spread. It defines a biopsy as a procedure that removes a sample of tissues, cells, or fluid from the body to examine for diagnosis. Different types of biopsies are described, including those that remove samples versus whole masses. Benefits of biopsies include obtaining a definite diagnosis to guide treatment planning. The document discusses the fear that biopsies may cause cancer seeding or spread, and defines cancer seeding as cancer cells spreading along the needle track during a biopsy.
ROJoson PEP Talk: Developing a Breast Self-Exam Habit through a Motivating AwardReynaldo Joson
This document outlines a Zoom presentation on developing a breast self-exam habit through motivating awards. It provides logistical details for the event, including the date, time, and instructions for participants. The presentation aims to teach laypeople how to perform breast self-exams and develop the habit through an awards program. It will cover what breast self-exams are, their importance, and how to properly conduct one. The speaker will advocate for their breast self-exam awards initiative to motivate more women to regularly perform self-exams.
ROJoson PEP Talk: CAN ONE SKIP RADIOACTIVE IODINE THERAPY IN THYROID CANCER T...Reynaldo Joson
The document discusses radioactive iodine therapy (RAIT) for thyroid cancer treatment. RAIT involves using radioactive iodine-131, which is taken orally and concentrates in thyroid tissue to destroy cancer cells. It is effective for papillary and follicular thyroid cancers. RAIT is used for remnant ablation after surgery, adjuvant therapy to prevent recurrence, and treatment of known disease. While commonly recommended in the past, the use of RAIT has evolved to focus on patients at higher risk, as not all thyroid cancers require aggressive treatment like RAIT. The document questions whether RAIT can be skipped in some patients.
ROJoson PEP Talk: Can one skip RADIOACTIVE IODINE THERAPY in Thyroid Cancer T...Reynaldo Joson
The document discusses radioactive iodine therapy (RAIT) for thyroid cancer treatment. RAIT involves using radioactive iodine-131, which is taken orally and concentrates in thyroid tissue to destroy cancer cells. It is effective for papillary and follicular thyroid cancers. RAIT is used for remnant ablation after surgery, adjuvant therapy to prevent recurrence, and treatment of known disease. While commonly recommended in the past, the use of RAIT has evolved to focus on patients at higher risk of recurrence rather than applying it routinely, as many thyroid cancers have excellent outcomes with surgery alone. The document questions whether RAIT can be skipped in some patients with a very low risk.
ROJoson PEP Talk: DOES EVERYONE HAVE CANCER CELLS IN THEIR BODY?Reynaldo Joson
The document discusses whether everyone has cancer cells in their body. It explains that while our bodies are constantly producing new cells, not all of these cells are destined to become cancerous. A typical healthy cell goes through cycles of growth, division and death, while a cancer cell does not follow this normal cycle and keeps reproducing abnormally. Not everyone inherently has cancer cells in their body from the beginning - it is possible for initially normal cells to eventually develop into cancer cells due to certain risk factors.
ROJoson PEP Talk: Can one skip CHEMOTHERAPY in BREAST CANCER TREATMENT?Reynaldo Joson
Chemotherapy is a systemic cancer treatment that uses powerful drugs to destroy fast-growing cancer cells. It works by keeping cancer cells from growing and dividing. Chemotherapy can be given alone or with other treatments depending on the cancer type and stage. Factors like a person's age, health, and the cancer details help determine the chemotherapy plan and drugs. Chemotherapy aims to cure cancer, shrink tumors before other treatments, destroy remaining cancer cells after treatment, or slow cancer progression and relieve symptoms.
ROJoson PEP Talk: Do all patients need painkillers after an operation?Reynaldo Joson
This document provides information from a Patient Empowerment Program (PEP) Talk on the use of painkillers after an operation. The PEP Talk aims to give laypeople an essential understanding of painkiller use after surgery in managing their health. It discusses that not all patients need painkillers after an operation, as some procedures do not involve cutting or cause pain. It also outlines factors that govern physician prescription and patient intake of postoperative painkillers.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
1. Preventing Surgical Complications of Modified
Radical Mastectomy – Improving Outcomes
How I Usually Do it
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
September 5, 2014
2. Preventing Surgical Complications of Modified
Radical Mastectomy – Improving Outcomes
How I Usually Do it
MRM
Procedure
To remove the whole breast and the ipsilateral
axillary lymph nodes that contain or may contain
cancer
3. Preventing Surgical Complications of Modified
Radical Mastectomy – Improving Outcomes
How I Usually Do it
MRM
Procedure
To remove the whole breast and the ipsilateral axillary
lymph nodes that contain or may contain cancer
GOOD-EXCELLENT POSTOPERATIVE OUTCOMES
Complete extirpation
NO surgical complications and unwanted side-effects
(or lowest acceptable rate)
4. Preventing Surgical Complications of Modified
Radical Mastectomy – Improving Outcomes
How I Usually Do it
Good-Excellent Postoperative Outcomes
NO local recurrence
NO surgical complications
(dehiscence, flap necrosis, hematoma, infection,
major axillary vascular and nerve injury)
NO unwanted side-effects
(seroma, dog-ear, ugly scar)
5. Preventing Surgical Complications of Modified
Radical Mastectomy – Improving Outcomes
How I Usually Do it
Good-Excellent Postoperative Outcomes
NO local recurrence
NO surgical complications
(dehiscence, flap necrosis, hematoma, infection,
How do we prevent
major axillary vascular and nerve injuries)
these?
NO unwanted side-effects
(seroma, dog-ear, ugly scar)
6. Preventing Surgical Complications of Modified Radical
Mastectomy – Improving Outcomes
How I Usually Do it
For every intraoperative move made,
there is a risk for surgical complications and
unwanted side effects!
Intraoperative Risk Management
7. Preventing Surgical Complications of Modified
Radical Mastectomy – Improving Outcomes
How I Usually Do it
Good-Excellent Postoperative Intraoperative Outcomes
Risk
NO local recurrence
Management
NO surgical complications
(dehiscence, flap necrosis, • hematoma, Good Planning
infection,
major axillary vascular and • nerve Good injuries)
Execution
NO unwanted side-effects
• Good Contingency
(seroma, dog-ear, ugly scar)
Adjustment during
Execution
8. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Asepsis
Incision
Flap Creation
Total Mastectomy
Axillary Dissection
Drain
Incision Repair
Risks
Local
recurrence
Surgical
complications
Unwanted
side-effects
9. Preventing Surgical Complications of Modified Radical Mastectomy – Improving
Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Asepsis
Incision
Flap Creation
Total Mastectomy
Axillary Dissection
Drain
Incision Repair
Local Recurrence
Dehiscence
Flap Necrosis
Hematoma
Infection
Major Axillary Vascular / Nerve Injury
Seroma
Avoidance
of
Others
Dog-ear Deformity
Ugly Scar
10. Preventing Surgical Complications of Modified Radical
Mastectomy – Improving Outcomes
How I Usually Do it
Surgical Complications and
Unwanted Side-effects
Key Strategies on Prevention
Flap necrosis Provide an adequate layer of
subcutaneous tissue in the flap
Dehiscence Plan incision properly to avoid
tension; close and repair wound
securely
Seroma Provide adequate drainage
Bleeding and hematoma Ensure effective and adequate
hemostasis
11. Preventing Surgical Complications of Modified Radical
Mastectomy – Improving Outcomes
How I Usually Do it
Surgical Complications and
Unwanted Side-effects
Key Strategies on Prevention
Infection Maintain sterility of the
operative field
Iatrogenic injuries Dissect carefully and precisely
Dog ear Plan and close incision properly
(with trimming if needed to
avoid dog ear)
Ugly scar Plan and close incision properly
to promote a cosmetically
acceptable scar
Local recurrence Provide adequate surgical
margins around the breast cancer
mass
12. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Asepsis Infection
Key Strategies on
Prevention
• Asepsis
• Maintain sterility of
the operative field
13. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Asepsis Infection
Procedures to eliminate / reduce
microorganisms in operative field
Suture drapes
along the posterior axillary line
to avoid contamination of the lateral field
(close to operating table) and
during axillary dissection
14. Suturing of the Drape along the Posterior Axillary Line to
Prevent Contamination in the Lateral Field
15. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Incision
Local Recurrence
Tension-Dehiscence
Dog-ear Deformity
Key Strategies on
Prevention
• Proper and accurate
planning of incision
before and during
operation
16. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Key Strategies on
• Proper and accurate
Procedure
MRM
Outcomes
Evaluation
Prevention
planning of incision
before and during
operation
Planning
Execution with contingency
adjustment
Incision Local Recurrence
Adequate margin
At least 2 cm around palpable tumor on the surface
17. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Key Strategies on
• Proper and accurate
Procedure
MRM
Outcomes
Evaluation
Prevention
planning of incision
before and during
operation
Planning
Execution with contingency
adjustment
Incision
Tension-Dehiscence
Determine the axis/ direction of the elliptical incision that
will best promote primary closure without tension.
18. Planning an Incision to Determine Direction of Elliptical Incision
1° Objective: Primary closure without tension
19. Planning an Incision to Determine Direction of Elliptical Incision
1° Objective: Primary closure without tension
20. Planning an Incision to Determine Direction of Elliptical Incision
1° Objective: Primary closure without tension
4
5
22. Planning an Incision
Avoid placement of the scar
at the upper and mid-sternal
areas (areas known to be
keloid prone).
Place at the lower part.
23. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Key Strategies on
• Proper and accurate
Procedure
MRM
Outcomes
Evaluation
Prevention
planning of incision
before and during
operation
Planning
Execution with contingency
adjustment
Incision
Dog-ear Deformity
Plan out incision to avoid dog-ear deformities!
Frequent, particularly in patients with large
body habitus and large breast
Unsightly and source of long-term discomfort!
24. Planning an Incision to Avoid Lateral Dog-ear Deformity
Sliding-suturing
(Devalia Technique)
Devalia H, Chaudhry A, Rainsbury RM, Minakaran N, Banerjee D. An oncoplastic
technique to reduce the formation of lateral 'dog-ears' after mastectomy. Int Semin
Surg Oncol. 2007 Dec 17; 4:29.
25. Planning an Incision to Avoid Lateral Dog-ear Deformity
D-incision with Triangular Advancement
IC Bennett and MA Biggar . A triangular advancement technique to avoid
the dog-ear deformity following mastectomy in large breasted women Ann
R Coll Surg Engl. 2011 October; 93(7): 554–555.
26. Techniques to Avoid Lateral Dog-ear Deformity
Tear-drop / Waisted Teardrop
Y-incision / Fish-tail
Sliding-suturing
Planning preoperatively (standing, lying down, with arms on the side
and extended) and before the incision is the strategy to avoid a dog-ear
deformity!
27. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Incision
Dog-ear Deformity
Plan out incision to avoid dog-ear deformities!
28. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Flap Creation Flap Necrosis
Not TOO thick to include breast tissue
Not TOO thin to cause flap necrosis
Local Recurrence
Key Strategies on Prevention
29. Flap Creation – How I Usually Do It
1-cm of subcutaneous tissue
(subcutaneous tissues only –
pink-whitish tissues stay away)
30. Flap Creation – How I Usually Do It
Control thickness / thinness of flap
31. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Total Mastectomy Local Recurrence
Hematoma
Ensure TOTAL mastectomy!
Ensure adequate and secure hemostasis!
32. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Total Mastectomy Local Recurrence
Flap not TOO thick to include breast tissue
Be guided by the usual boundaries
of the breast (clavicle, latissimus dorsi,
parasternal, rectus sheath)
Remove part of the pect major if too near
34. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Total Mastectomy Hematoma
Ligate transected blood vessels ≥ 2 mm
In diameter
Cauterize fully – transected vessels not to be
ligated
Ligate and cauterize blood vessels
right away
Check hemostasis prior to wound closure
35. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Total Mastectomy Hematoma
Promote a taut flap over the chest wall
Ensure ever-functional tube drain
36. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Local Recurrence
Hematoma
Axillary Dissection
Major Axillary
Vascular / Nerve
Injury
37. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Axillary Dissection Local Recurrence
Remove ALL grossly palpable
masses / nodes
guided by the usual boundaries
of the axilla
38. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Axillary Dissection Major Axillary
Avoid injury
Careful dissection when near the areas
Vascular / Nerve
Injury
39. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Axillary Dissection Hematoma
Adequate and secure hemostasis.
40. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Axillary Dissection Hematoma
Ligate transected blood vessels ≥ 2 mm
In diameter
Cauterize fully – transected vessels not to be
ligated
Ligate and cauterize blood vessels
right away
Check hemostasis prior to wound closure
41. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Axillary Dissection Hematoma
Checking hemostasis prior to wound closure
42. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Axillary Dissection Hematoma
Promote a taut flap over the chest wall
Ensure ever-functional tube drain
43. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Drain Seroma
Drain lateral
Medial as indicated
44. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Drain Seroma
Closed tube suction drain at axillary space
Medial drain indicated
if there is a significant cavity
after laying down of flaps prior to wound repair
Drain removed if output is less than 50 cc
past 24 hours (assumption: tube functional)
45. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Incision Repair
Dehiscence
Ugly Scar
Dog-ear Deformity
46. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Incision Repair Dehiscence
Avoid tension
Secure knots
47. Preventing Surgical Complications of Modified Radical Mastectomy –
Improving Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Incision Repair Ugly Scar
Avoid excessive stitch marks
Railroad tracks
Avoid dog-ear deformity
Dog-ear Deformity
51. Preventing Surgical Complications of Modified Radical
Mastectomy – Improving Outcomes
How I Usually Do it
For every intraoperative move made,
there is a risk for surgical complications and
unwanted side effects!
Intraoperative Risk Management
52. Preventing Surgical Complications of Modified Radical Mastectomy – Improving
Outcomes
How I Usually Do it
Procedure
MRM
Outcomes
Evaluation
Planning
Execution with contingency
adjustment
Asepsis
Incision
Flap Creation
Total Mastectomy
Axillary Dissection
Drain
Incision Repair
Local Recurrence
Dehiscence
Flap Necrosis
Hematoma
Infection
Major Axillary Vascular / Nerve Injury
Seroma
Avoidance
of
Others
Dog-ear Deformity
Ugly Scar
53. Preventing Surgical Complications of Modified
Radical Mastectomy – Improving Outcomes
How I Usually Do it
Good-Excellent Postoperative Outcomes
NO local recurrence
NO surgical complications
(dehiscence, flap necrosis, hematoma, infection,
major axillary vascular and nerve injury)
NO unwanted side-effects
(seroma, dog-ear, ugly scar)
54. Preventing Surgical Complications of Modified Radical
Mastectomy – Improving Outcomes
How I Usually Do it
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
September 5, 2014
For further reading and copies of my slides:
http://www.slideshare.net/rjoson/mastectomy-morbidities-pghrj08sept11
http://www.slideshare.net/rjoson/preventing-complications
For feedback and queries:
rjoson2001@yahoo.com
0918-804-03-04 (text me if you like my lecture now)
Facebook / rjoson2001
Editor's Notes
Modified radical mastectomy is a surgical procedure that removes the whole breast and the ipsilateral axillary lymph nodes that contain or may contain cancer.
Good-excellent postoperative outcomes means complete or adequate removal of the whole breast and the ipsilateral axillary lymph nodes that contain or may contain cancer with NO surgical complications and unwanted side-effects as much as possible, if not, with the lowest acceptable frequency such as 1-2%.
More specifically, we are talking of NO local recurrence; NO surgical complications; and NO unwanted side-effects. Examples of surgical complications to avoid are dehiscence; flap necrosis; hematoma; infection; major axillary vascular and nerve injury. Examples of unwanted side-effects are seroma, dog ear deformity, and ugly scar. There are others. For today, I will focus on the items listed.
So how to prevent these complications?
Let me start by saying that for every intraoperative move made by a surgeon, there is always a risk for surgical complications and unwanted side effects. Thus, every surgeon has to do an intraoperative risk management.
It consists of good planning; good execution and good contingency adjustments during the execution.
There must be good planning on asepsis; incision; flap creation; total mastectomy; axillary dissection; use of drain; and incision repair with good execution and contingency adjustments during execution to avoid the risks of local recurrence; surgical complications; and unwanted side-effects.
As I said, we will focus on these nine risks today.
Let’s start with asepsis. There must be good planning and execution of the plan with contingency adjustment to reduce the risk of postoperative wound infection.
Another recommended procedure is to suture drapes along the posterior axillary line to avoid contamination of the lateral field, which is close to the operating table, and during axillary dissection.
Like so.
For the incision, there must be good planning and execution of the plan with contingency adjustment to reduce the risk of local recurrence; tension during closure which may lead to dehiscence; and dog-ear deformity, particularly, on the axillary area.
The first thing to do to lessen the risk of local recurrence is to have an adequate margin with at least 2 cm around the palpable tumor on the surface.
The strategy that I usually use is to determine the long axis or direction of the elliptical incision that will best promote primary closure of the resultant mastectomy wound without tension.
In this slide, the manuevers are being done to see whether a vertical elliptical incision can facilitate primary closure without tension. In this slide, the vertical direction of the elliptical incision cannot be done as the nipple-areola complex is far away.
In this slide, the manuevers are being done again to see whether the decided elliptical incision can really facilitate primary closure without tension. With such maneuvers, one can be confident there will be no problem of primary closure and no tension and therefore, prevent or minimize risk of dehiscence related to tension.
If there are several directions that can be used to promote primary closure, factor in cosmetic goal to make the final choice. The final elliptical incision does not have to be completely transverse, oblique, or vertical in a straight line. There may be curvings at both ends of the elliptical incision, as illustrated in No. 3 planned incision here. The lateral curving is done for cosmetic reasons, such as avoiding a scar that can be seen when patient wears a bra; to avoid risk of keloid in the sternal area; and to avoid lateral dog-ear deformity.
such as avoiding a scar that can be seen when patient wears a bra (put the incision-line in the lower part of the sternum).
to avoid risk of keloid in the sternal area (avoid placement of the scar at the upper and mid-sternal areas as these ae areas known to be keloid prone). Place at the lower part.
The other consideration in the incision planning is to avoid lateral dog-ear deformity. This is frequently seen in obese patients and those with large breasts. This is not only unsightly but a source of long-term discomfort.
There are several techniques that are being proposed to avoid a lateral dog-ear deformity. Shown here is the sliding-suturing technique in which the upper flap is divided into 2 parts and lower flap into 3 parts. The distal 1/3 of the lower flap is slided and sutured to to upper ½ of the upper flap.
Another technique is the D-incision with triangular advancement meaning initially draw a D-incision as shown and then make a triangular extension of the incision and then suture the outer upper flap to the outlined triangular area.
Thus, there are various techniques that one can choose from to avoid a lateral dog-ear deformity. I have tried all of them. At the moment, my stand is that there is no so-called one and only one-best technique. It will depend on the patient’s body stature, the location and size of the breast cancer; etc. What I can say is planning preoperatively (in standing, lying down, with arms on the side and extended) and before the incision at the operating table is the strategy to avoid a lateral dog-ear deformity. Choose from whichever technique that are being proposed with some adjustment if needed to avoid the dog-ear deformity as much as possible.
Always have in mind this target - no or minimal lateral dog-ear deformity – like those seen in this slide.
Let us now go to flap creation. There must be planning and execution with contingency adjustments on flap creation to prevent flap necrosis and local recurrence. The principle to follow is NOT too thick to include breast tissue to lessen the risk for local recurrence and NOT too thin to cause flap necrosis.
What I usually do are the following: I make sure there is about 1-cm layer of subcutaneous tissue in the flap and I stay only at the layer of the yellow subcutaneous tissue – I stay away from pinkish and whitish tissues which I consider are breast tissues.
I usually use my fingers, not clamps, when I establish the flaps, as I have better control of the thickness or thinness of the flap.
Let us now go to total mastectomy. There must be planning and execution with contingency adjustments on total mastectomy to prevent local recurrence and hematoma. The strategies to follow are to ensure total removal of the breast to minimize the risk of local recurrence and adequate and secure hemostasis to minimize the risk of bleeding and hematoma.
To minimize the risk of local recurrence during mastectomy, I am guided by these principles: 1) I ensure my flap is not too thick to include breast tissue (I am guided by the color of the tissue I am cutting when I am establishing the flap – I stay only the layer of the yellow subcutaneous tissue – I stay away from pinkish and whitish tissues which I consider are breast tissues); 2) I am guided by the usual boundaries of the breast (clavicle; latissimus dorsi; parasternal line; and rectus sheath); and 3) I remove part of the pectoralis muscle or other underlying tissue if the breast cancer mass is too near it.
Like so.
To minimize the risk of postoperative bleeding and hematoma, I am guided by these principles: 1) Ligate transected blood vessels ≥ 2mm in diameter; 2) Cauterize fully transected vessels which will not be ligated; 3) Ligate and cauterize transected blood vessels right away; 4) Checking of hemostasis prior to wound closure;
Promoting a taut flap over the chest wall and ensuring ever-functional tube drain or drains.
In the axillary dissection, there must be planning and execution with contingency adjustments to prevent local recurrence, hematoma, and injury to major axillary vascular and nerve.
The strategy to minimize the risk of local recurrence is to remove all palpable masses or nodes in the axilla guided by the usual boundaries of the axilla.
The strategy to minimize the risk of injury to the major axillary vessels and nerves is careful dissection when near the usual location of these structures.
The strategy to minimize the risk of bleeding and hematoma is adequate and secure hemostasis.
To minimize the risk of postoperative bleeding and hematoma, I am guided by these principles: 1) Ligate transected blood vessels ≥ 2mm in diameter; 2) Cauterize fully transected vessels which will not be ligated; 3) Ligate and cauterize transected blood vessels right away; 4) Checking of hemostasis prior to wound closure.
Procedures that I usually use in checking hemostasis prior to wound closure consist of directly looking for bleeding in the whole operative field and using a maneuver of pouring sterile water into the axillary space to facilitate detection of bleeding, if present. There will be red staining of the water if there is bleeding.
Promoting a taut flap over the chest wall and axilla; and also ensuring an ever-functional tube drain or drains.
As to the use of drain, consider its use to prevent seroma formation. I usually use drain on the axilla. I use a drain in the parasternal area only there is a big dead space that I cannot obliterate.
Thus, the principles that I follow are: 1) closed tube suction drain at the axillary space; 2) medial drain is indicated if there is a significant cavity after laying down the flaps prior to wound repair; and 3) drain/s are removed if the output is less than 50 cc during the past 24 hours.
As to the repair of the mastectomy wound, there must be planning and execution with contingency adjustments to minimize risk of a dehiscence, an ugly scar and dog-ear deformity.
Avoiding tension and providing well-secured knots are the two key strategies in avoiding dehiscence. Tension-avoidance is considered early on in the phase of incision planning.
To prevent ugly scar, avoid excessive stitch marks which may resemble railroad tracks. Avoid dog-ear deformity.
A close-up of an ugly scar with plenty of stitch marks and dog-ear deformity. Avoid this kind of an outcome.
What I usually do, I usually use embedded absorbable sutures. I put attention in avoiding dog-ears like this.
Always end with a wound repair that is appreciated as beautiful, not ugly, such as this, taut, no dog-ears, with minimal stitch mark.
I am done with sharing with you what I usually do to prevent surgical complications of MRM thereby improving outcomes. In closing, if I may, my general take-home messages for you will be, one, for every intraoperative move made by a surgeon, by us, by you, always remember there is always a risk for surgical complications and unwanted side effects. Thus, all of us have to do an intraoperative risk management.
I have shared with you how to do an intraoperative risk management using this slide. Essentially, the intraoperative risk management consists of planning and execution with contingency adjustments in consideration of the risks that may be involved with every surgical move.
If you follow such an approach, I assure you (based on my experience), you will produce good-excellent postoperative outcomes in your modified radical mastectomy in terms NO or minimal local recurrence; NO or minimal surgical complications; and NO or minimal unwanted side-effects.
On that note, I end my presentation. I hope I have shared things that you like. For further reading and copies of my slides, you may visit these sites which contain the lecture that I made in 2008 with focus on seroma, bleeding, and infection. For queries and feedback, you may email me; you can text me; or interact with me in Facebook. Thank you.