Suture techniques, Z-plasty
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The document describes various suture techniques including simple interrupted sutures, which are the gold standard, subcuticular sutures which avoid external knots, half-buried horizontal mattress sutures which keep knots on one side, continuous over-and-over sutures which can be placed rapidly but are less precise than interrupted sutures, skin staples which are a timesaving alternative to sutures, skin tapes and adhesives which can be used in low tension areas, and Z-plasties which help prevent or limit scarring and contractures. It also outlines indications, contraindications and potential complications of Z-plasty techniques.
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figures with amputated stumps. In the olden times, amputations
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figures with amputated stumps. In the olden times, amputations
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criminals and as rituals to appease Gods or even in the practice of
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treated by amputations, but in some advanced centers limb
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usability of the prostheses continue to advance, a well performed
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when the blood supply of a limb is irreparably destroyed or when
the limb is so severely damaged that reasonable reconstruction is
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if three or more out of the five components (blood vessels, nerves,
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considered . The amputation can be early, intermediate
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burns are other injuries that may require amputation.
Residual short stump can have excellent function.1 In the past,
amputation through specific levels was necessary for proper fitting
of prosthesis. The accepted ideal stump lengths are 23–28 cm from
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tibial articular surface in below-knee amputations, 10 cm above
elbow in amputations through arm, and 17 cm from olecranon in
forearm amputations. With modern prosthetic fitting techniques,
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Determining the level of amputation requires an understanding
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This document discusses dorsal reduction rhinoplasty to reduce a hump on the nasal dorsum. It describes the anatomy of the nasal dorsum and different types of humps. Techniques for reducing both bony and cartilaginous humps are covered, including dehump, osteotomies, rasping, drilling, and spreader grafts. Complications like ski slope nose and inverted V deformity are also mentioned. The goal of dorsal reduction rhinoplasty is to reshape the nasal dorsum and improve nasal aesthetics or breathing.
Surgicalincisions 150519180458-lva1-app6892
The skin is composed of two main layers, the epidermis and dermis. Various types of incisions can be made through the skin for surgical procedures, with considerations including accessibility, extensibility, security, and following natural lines of tissue tension. Different suturing methods can be used to close wounds, including everting, inverting, interrupted, running, and locking stitches.
Flap Design for Minor Oral Surgery
This document discusses principles of incisions and flap design for minor oral surgery. It describes five basic principles of incisions, including using a sharp blade, making firm continuous strokes, avoiding cutting vital structures, holding the blade perpendicular to epithelial surfaces, and properly placing incisions. It also outlines various types of mucoperiosteal flaps like envelope, three-corner, four-corner, semilunar, Y-incision, and pedicle flaps. Complications of flap design like necrosis, dehiscence, tearing, and injury are addressed. Considerations for flap design include ensuring an adequate blood supply, avoiding tension, and not crossing bony prominences.
Grafts and flaps in head and neck
This document provides an overview of grafts and flaps used in head and neck reconstruction. It discusses the history of reconstructive surgery dating back 5000 years. Grafts are pieces of tissue without their own blood supply that rely on the recipient bed, while flaps have their own blood supply. Flaps are useful for larger defects and where radiation is planned. The document describes various local and distant pedicled and free flaps used to reconstruct different areas of the head and neck, including the forearm flap, rectus abdominis flap, and anterolateral thigh flap. Factors affecting graft and flap survival include adequate blood supply, wound conditions, and patient comorbidities. The key principles of reconstruction are to
(General surgery Lab 1) Dr. Haydar Muneer
This document discusses different types of sutures and wound closure techniques. There are two basic types of sutures: absorbable sutures that dissolve in the body and non-absorbable sutures that are permanent. Common suturing techniques include the simple interrupted suture, which is the most commonly used technique, and vertical and horizontal mattress sutures that evert the skin edges. Other closure methods discussed are continuous sutures, skin staples, skin tapes, and skin adhesives.
pterional articulo viejo.pdf
The pterional approach provides an effective method for decompressing the orbits to treat conditions like malignant exophthalmos and remove orbital tumors. It involves making a single trephine opening at the pterion bone and using rongeurs to remove the orbital roof, lateral wall, and part of the sphenoid ridge. This exposes approximately a third more of the orbit than alternative approaches like the transfrontal method. The procedure can be used to decompress both orbits in a single session and has advantages like good cosmetic outcomes with invisible scarring and fewer complications compared to other techniques.
pterional articulo viejo.pdf
The pterional approach provides an effective method for decompressing the orbits to treat conditions like malignant exophthalmos and remove orbital tumors. It involves making a single trephine opening at the pterion bone and using rongeurs to remove the orbital roof, lateral wall, and part of the sphenoid ridge. This exposes approximately a third more of the orbit than alternative approaches like the transfrontal method. The procedure can be used to decompress both orbits in a single session and has advantages like good cosmetic outcomes with invisible scarring and fewer complications compared to other techniques.
Types of suturing word document
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Types of suturing /oral surgery courses by indian dental academy
The document discusses various types of suturing techniques including continuous sutures, vertical mattress sutures, horizontal mattress sutures, simple interrupted sutures, running locked sutures, and pulley sutures. It provides details on how each technique is performed, its advantages and disadvantages, and appropriate uses for closing wounds and approximating tissue.
Incision, suture & suture meteri al
This document discusses incisions, sutures, and suture materials used in surgery. It defines incision as a cut made using a sharp instrument to expose underlying structures. Various types of incisions are described, including horizontal, vertical, and semilunar incisions. Flaps are sections of tissue outlined by incisions that can be replaced after surgery. Complications of flap surgery like tearing and necrosis are mentioned. The document also describes different suture materials, needles, and suturing techniques like interrupted, mattress, and figure-of-eight sutures. Knot tying is an important part of suturing, and various knot types like square and surgeon's knots are defined.
Implant course main
This document discusses principles of implant dentistry including flap design, implant placement, soft and hard tissue healing, and suturing techniques. It notes that ideal implant flaps are minimal, spare the papilla if possible, allow for primary closure without tension, and can replicate gingival anatomy. Different flap designs like trapezoidal or papilla inclusion/exclusion are discussed. Suturing techniques like figure-of-eight or vertical mattress sutures are covered. Flap advancement of less than 3mm, 3-6mm, or greater than 7mm is described for different surgical procedures.
Principles of, incisions in oral surgery.ppt
This document discusses principles of incisions, flaps, and suturing in oral surgery. It describes the basic principles of incisions including using sterile blades and making incisions at right angles to bone. It defines flaps as sections of soft tissue outlined by incisions that carry blood supply and allow surgical access. It discusses different types of flaps including envelope, two-sided, three-sided, and semilunar flaps. It also covers principles of flap reflection, suturing wounds, and types of suture materials including absorbable catgut.
Seminar on suture
Suturing is performed to approximate tissue and hold wounds closed until healing occurs. There are various suture materials that can be used including natural, synthetic, and metallic options. Key factors in choosing a suture include tensile strength, biocompatibility, absorption rate, and handling properties. Common techniques for placing sutures include simple interrupted, continuous, mattress stitches, and subcuticular sutures. Proper knot tying is also important to secure tissues without causing damage or tension.
Clinical management of edentulous maxillectomy patient / dental courses
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Flaps in plastic surgery
This document discusses different types of flaps used in plastic surgery for tissue reconstruction. It begins by explaining that flaps are vascularized tissue transferred from one part of the body to another to reconstruct areas of tissue loss. The document then categorizes flaps based on their components, configuration, congruity, circulation, and conditioning. It provides examples of various local, regional, pedicled, and free flaps. Key advantages and disadvantages of different flap types are highlighted. Monitoring techniques and potential complications of flap surgery are also summarized.
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Types of suturing /oral surgery courses by indian dental academy
Types of suturing /oral surgery courses by indian dental academy
Clinical management of edentulous maxillectomy patient / dental courses
Clinical management of edentulous maxillectomy patient / dental courses
More from Dr Sourabh Shankar Chakraborty
Eyelid reconstruction
The document discusses eyelid reconstruction, including:
1. It describes the anatomy of the eyelid, including the palpebral fissure size, positions of the canthi and eyelid margins, and layers of the eyelid.
2. Common reasons for eyelid reconstruction include congenital anomalies, tumors, and trauma. Principles of reconstruction include thorough evaluation, debridement of nonviable tissue, and aligning all tissue layers.
3. Various flap techniques are described for reconstructing different areas of the eyelid, including tarsoconjunctival flaps, cheek flaps, forehead flaps, and V-Y flaps. Complications of reconstruction include issues like corneal abrasion
Vascular anomalies
This document discusses vascular anomalies including infantile hemangioma and various types of vascular malformations such as capillary, venous, arteriovenous, and lymphatic malformations. It covers the classification, clinical features, investigations, management, and complications of these conditions. Key points include that infantile hemangiomas have a distinct growth cycle of proliferation, involution, and involuted phases while vascular malformations are present at birth and grow proportionally with the child. Management involves observation, medications like corticosteroids and propranolol, laser therapy, surgery, and embolization depending on the specific anomaly and risk of complications.
Tissue expansion- principles and techniques
Tissue expansion is a surgical technique used to generate additional skin and soft tissue for reconstructive purposes. It involves inserting a temporary implant called a tissue expander under the skin and gradually inflating it with saline over 6-12 weeks to stretch the overlying tissue. This causes mechanical and biological tissue growth. The expander is then removed and the expanded skin is advanced to reconstruct areas of skin loss or defects. Complications can include hematoma, seroma, expander deflation or migration, and skin thinning or necrosis but tissue expansion provides a good source of autologous tissue for reconstruction when other options are limited.
Principles of tendon transfer
Tendon transfers involve rerouting a functioning muscle tendon unit to restore lost function according to established principles. The key principles are having supple joints at the donor and recipient sites, maintaining soft tissue equilibrium, ensuring the donor has adequate excursion and strength, choosing an expendable donor, maintaining a straight line of pull, selecting donors and recipients with synergistic functions, and performing single tendon transfers for single functions. Tendon transfers can restore grasp, pinch and upper extremity motions according to these principles.
Tenosynovitis
This document discusses tenosynovitis, including its definition, etiology, prognosis, pathophysiology, history, physical examination findings, workup, treatment, and postoperative care. Tenosynovitis is inflammation of the tendon sheath that can be caused by overuse, infection, or inflammatory conditions like rheumatoid arthritis. Physical exam may reveal tenderness, swelling, or limited range of motion. Treatment depends on the cause but may include rest, splinting, anti-inflammatories, corticosteroid injections, or surgery. Prognosis is generally good if treated early without comorbidities, while complications can include adhesion formation or tendon rupture if left untreated.
Tendon transfer- principles and techniques
1. Tendon transfers involve rerouting a functioning muscle tendon unit to restore a function lost due to nerve injury or other conditions. Common indications include nerve injuries or trauma.
2. Key principles of tendon transfer include having supple joints, adequate excursion of the donor muscle, and maintaining a straight line of pull. Common procedures restore functions like finger extension, thumb opposition, and wrist extension.
3. Rehabilitation after tendon transfer focuses on immobilization followed by gentle range of motion and strengthening exercises over 8-12 weeks before returning to full activity.
Temporomandibular joint
- The temporomandibular joint (TMJ) is located between the condylar process of the mandible and the mandibular fossa and articular eminence of the temporal bone. It is a bi-arthroidal hinge joint containing synovial fluid that allows for translational and rotational movements.
- Temporomandibular disorders (TMD) is a collective term used for clinical problems involving the masticatory muscles, TMJ, and associated structures. Common signs and symptoms include pain and limited opening of the mouth.
- Disc displacement is the most common TMJ articular disorder and can involve reduction or lack of reduction of the articular disc. Conservative treatments include
Replantation of the hand and Upper extremity
1. Replantation involves reattaching a completely amputated body part to restore blood flow, while revascularization reattaches incompletely amputated parts.
2. Factors that determine replantation success include patient health, injury details, and surgical team skill.
3. The operative technique prioritizes veins, arteries, bones, tendons, and nerves with the goal of minimizing warm ischemia time.
Skin donation, skin banking, skin culture
1. Skin banking involves procuring skin from donors after death, processing it which may include cryopreservation or lyophilization, and storing it to be used for burn patients or other wounds.
2. The first skin bank was established in 1971 and they continue to improve techniques like reducing immunogenicity and potential for disease transmission.
3. Skin culture techniques also allow creating skin substitutes using fibroblasts, keratinocytes and endothelial cells grown on collagen gels or cadaver dermis in organotypic culture.
Nerves of hand
The document summarizes the anatomy and branches of the ulnar, radial, and median nerves in the upper limb. It describes the course and branches of each nerve in the axilla, arm, and forearm. It also discusses the separation of motor and sensory components within the nerves and provides diagrams of fascicular patterns. Key points include that the ulnar nerve supplies medial forearm muscles and skin of the little and half of the ring finger, the radial nerve innervates posterior forearm muscles and skin of the dorsal hand, and the median nerve gives branches in the forearm and palm.
Neck lift, forehead and thread lift
This document discusses various surgical approaches for forehead and brow lifting as well as neck lifting. For forehead lifts, it describes techniques like the coronal approach and its disadvantages like scalp numbness. It also covers other approaches like the temple approach and endoscopic approach. For neck lifts, it discusses factors to consider like skin elasticity and platysma muscle treatment. It provides details on the surgical process for different grades of neck laxity and describes techniques like subcutaneous lipectomy and platysma plication. Post-operative care is also outlined for both forehead and neck procedures.
Mandibular fracture- diagnosis
This document discusses the classification, diagnosis, and treatment of mandibular fractures. Key points include:
- Mandibular fractures are classified based on location and examined clinically and radiographically.
- Treatment options include closed or open reduction, with closed reduction used for minimally displaced fractures and open reduction for more complex cases.
- Internal fixation methods like miniplates are used to achieve rigid stabilization during open reduction, while intermaxillary fixation can be used short-term for closed reduction.
- Potential complications include hemorrhage, infection, nonunion, and neurosensory changes. Proper treatment aims to restore occlusion and minimize complications.
Skin healing and repair
This document discusses the stages of skin graft take, including plasmatic imbibition, inosculation and capillary ingrowth, and revascularization. It describes graft fixation, contraction, reinnervation, pigmentation, and factors that can lead to graft failure. The stages of graft take typically involve serum imbibition for 24-48 hours, development of fine vasculature in a fibrin layer, and eventual blood flow as the graft becomes pink. Revascularization may occur through direct vessel anastomoses, new vascular channel formation, or a combination. Proper fixation and aftercare are important for successful graft take.
Liposuction- techniques and indications
Liposuction is a surgical procedure to remove unwanted fat deposits from beneath the skin. It was originally introduced in the 1980s and involves using suction to aspirate fat through small incisions. There are several techniques including traditional suction-assisted liposuction, ultrasound-assisted, power-assisted, vaser-assisted, and laser-assisted liposuction. Patient selection, pre-operative evaluation and planning, anesthesia technique, and post-operative care are important considerations to achieve optimal results and avoid complications from liposuction.
Local flaps classifications
This document describes different types of local flaps that can be used in skin grafting and reconstructive procedures. It outlines pivotal flaps, advancement flaps, and hinge flaps. Pivotal flaps involve rotation, transposition, or interpolation of skin and come in various shapes. Advancement flaps can be unipedicled, bipedicled, or in a V-Y or Y-V configuration. They take advantage of skin elasticity or use Burrow triangles to advance the skin. Pantographic expansion is another advancement technique but carries more risk.
Flexor tendon repair
Flexor tendon repair requires protecting the tendon repair while allowing early controlled motion to minimize adhesions. This involves splinting the fingers in flexion after primary repair or tendon grafting, followed by progressive range of motion exercises. Complications can include infection, scarring and joint contractures, but good outcomes are achieved with protocols emphasizing early motion like Duran or Kleinert methods.
Parascapular and free fibula flaps
The parascapular flap uses skin and bone from the back to reconstruct large cheek defects. It provides reliable reconstruction with appropriate bulk and contour for the cheek. The flap has the disadvantages of a tedious dissection due to numerous branches that must be divided and no possibility for a sensate flap.
The free fibula osteocutaneous flap uses the fibula and overlying skin to reconstruct mandibular, maxillary and other bone defects. It has advantages of large vessels, long vascular pedicle, well-vascularized bone that can be shaped. Disadvantages include donor site morbidity such as delayed wound healing and nerve injury. Preoperative vascular problems and poor skin quality can also be issues.
Gracilis and Latissimus Dorsi flap
The gracilis muscle is a thin muscle in the thigh that can be used as a free flap for reconstruction. It is 25-30 cm in length with a 10-12 cm tendon. The muscle is innervated by the obturator nerve and receives its blood supply from the gracilis vessels of the medial femoral circumflex artery system. It is commonly used in head and neck reconstruction or to repair soft tissue defects. The latissimus dorsi muscle is one of the largest muscles in the body and can be harvested as a pedicled or free flap, often with a skin paddle. It is innervated by the thoracodorsal nerve and receives its blood supply from the thoracod
Gastrocnemius and Forehead flap
This document describes two types of flaps: the gastrocnemius flap and the forehead flap. The gastrocnemius flap uses the medial or lateral head of the gastrocnemius muscle and surrounding tissue to cover defects of the proximal or anterior leg. The forehead flap uses skin and tissue from the forehead, supplied by the supratrochlear artery, to reconstruct nasal or periorbital defects. Key details about the vascular anatomy, dimensions, and applications of each flap are provided.
Electric burn injury- diagnosis and management
Electrical injuries can cause damage through direct tissue damage, thermal energy, and mechanical injury. They result in around 1000 deaths and 3000 burns center admissions per year in the US. The main mechanisms of injury are electrical energy altering cell membranes, massive tissue destruction from heat, and physical trauma. Management involves following ATLS protocols, monitoring for cardiac issues, treating potential myoglobinuria, aggressive wound care, and surgery as needed. Prevention focuses on electrical safety practices and seeking shelter during storms.
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Suture techniques, Z-plasty
- 3. Simple Interrupted Suture. • Gold standard • most commonly employed suture • Sutures are usually placed approximately 5 to 7 mm apart and to 2 mm from the skin edge
- 6. Subcuticular suture obviates the need for external skin sutures circumvents the possibility of suture marks in the skin. Absorbable or nonabsorbable suture can be used, with the latter to be removed at 1 to 2 weeks after suturing
- 7. Half-Buried Horizontal Mattress Suture used when it is desirable to have the knots on one side of the suture line with no suture marks on the other side. For example, when insetting the areola in breast reduction
- 8. Continuous Over- and-Over Suture known as running simple sutures, can be placed rapidly but depend on the wound edges being more or less approximated beforehand. not nearly as precise as interrupted sutures Can also be placed in a locking fashion to provide hemostasis by compression of wound edges. They are especially useful in scalp closures
- 9. Skin Staples useful as a timesaver Grasping the wound edges with forceps to evert the tissue is helpful when placing the staples to prevent inverted skin edges. Staples must be removed early to prevent skin marks and are ideal for the hair-bearing scalp
- 10. Skin Tapes. .
- 11. Skin Adhesives in areas where there is no tension on the closure, or where strength of closure has been provided by a layer of buried dermal sutures. Adhesives, by themselves, however, do not evert the wound edges. Eversion must be provided by deeper sutures.
- 12. Z-PLASTY
- 13. 1856, Denonvilliers first described the Z-plasty technique as a surgical treatment for lower lid ectropion. The first reference to this technique in American literature was in 1913, by McCurdy, as treatment for contracture at the oral commissure. Limberg, in 1929, provided a more detailed geometric description
- 14. indications Limiting/preventing contracture of linear scars, especially when they cross the border of a facial aesthetic unit (eg, vermillion border) or when scars cross a concave surface (eg, the medial canthus) Changing scar length (eg, scar contracture of lip, eyelid, or neck) Changing scar vector (eg, repositioning a scar across the nasolabial fold) Repositioning malposed tissues (useful for "trapdoor" or "pin-cushion" defects)
- 15. Effacing web/release contracture (similar to first listed use) Closing cutaneous defects (eg, large oval defects, pharyngocutaneous fistulae) Correcting stenosis (eg, tracheostoma, nares, external auditory canal) using single or multiple Z-plasties [3] Transposing healthy tissue to close a fistula (eg, tracheostoma closure after irradiation)
- 16. contraindications health risks that affect vascular supply to the skin (eg, atherosclerotic heart disease, diabetes, smoking, collagen vascular disease, prior irradiation, anticoagulation). A history of poor wound healing, hypertrophic scarring, or keloid formation is a relative contraindication to Z-plasty
- 30. complications Hematoma Dehiscence Trap door Flap necrosis infection
- 32. FREE TISSUE TRANSFER REGIONAL TISSUE TRANSFER LOCAL TISSUE TRANSFER SKIN GRAFT DIRECT TISSUE CLOSURE ALLOW WOUND TO HEAL BY SECONDARY INTENTION