DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Complex multiple anterior abdominal wall scars.
POSTOPERATIVE DIAGNOSIS:
Complex multiple anterior abdominal wall scars.
OPERATION PERFORMED:
Scar revisions of anterior abdominal wall.
SURGEON: John Doe, MD
ANESTHESIA: General.
BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPECIMENS: Skin discarded.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old Hispanic male who presents today with multiple abdominal wall scars, which are wide, flat, adherent with criss-crossing bands consistent with retention suture scars. He presents today for revision.
DESCRIPTION OF OPERATION: The patient was seen in the preoperative area where in the standing position, the abdominal skin was wiped with alcohol and marked with a marking pen for surgery. The length of the vertical scar was 20 to 22 cm. The length of the transverse scar was approximately 10 to 12 cm. They were additionally wide with two parallel running scars in the vertical aspect of the mid abdomen and one transverse scar very adherent in the right lower quadrant, which was wide and separated. Those scars had a focal area of fascial weakness where there was a small palpable hernia.
The patient was brought into the operating room, placed supine on the operating table, and administered general anesthesia successfully. A total of 12 mL of 50:50 mixture of 1% lidocaine with epinephrine with 0.25% Marcaine with epinephrine was infiltrated along the scar edge, proposed incision lines.
The abdomen was prepped and draped in the usual sterile fashion. Beginning with the short transverse scar, thin elliptical excision was then performed with the knife and then carried down to the subcutaneous plane to the fascia with cautery. The entire area of the scar was then elevated up off the fascial defect. The small focal hernia with fat was encountered. This was only about a 0.5 cm in diameter. It was reduced and closed with figure-of-eight 3-0 Vicryl suture. The skin edges were undermined above and below approximately 3 cm to each side. Hemostasis was obtained with cautery. Field was irrigated with bacitracin solution. Closure completed with 3-0 Vicryl interrupted sutures in the deep subcu fascia, 3-0 Vicryl buried inverted suture in the subcu and deep dermis, running 4-0 PDS in the dermal subcuticular.
Attention was then turned to the vertical side where a long, broad scar was encountered. It was marked with a marking pen for long vertical elliptical excision. It encompassed the umbilicus. Circle incision was drawn around the umbilicus and then this was cut and it was released from the surrounding fat with cautery to its fascial layer. The long, broad, vertical, elliptical excision was then performed with a knife through the skin and into the subcutaneous plane. It was adherent in multiple areas, and it was released along the area of adherent scar, along the fascial layer.
Small pinpoint hernia was encountered in the mid aspect of the scar. This was closed with a figure-of-eight 3-0 Vicryl suture. Small 0.5 cm hernia, no greater, was also encountered in the umbilical stalk. This was then reduced and also closed with a 3-0 Vicryl suture. Skin edges were then undermined just above the fascial plane, and the skin edges were then undermined medial and lateral approximately 7 to 8 cm lateral to the left and about 5 cm medial to the right. Field was irrigated with bacitracin solution. Hemostasis was obtained with cautery.
We were worried about the size of the defect and seroma collection, so we did place a 7 mm Jackson-Pratt drain through a small stab wound, and it was brought through. It was cut to the appropriate length and sutured in placed with 2-0 silk drain suture. Skin edges were then gently approximated with staples for alignment. Closure completed in three layers with 3-0 Vicryl interrupted suture in the deep subcu fascia with a few sutures down in the underlying rectus muscle fascia followed by 3-0 Vicryl buried inverted sutures in the subcu deep dermis, running 4-0 PDS in the dermal subcuticular. A 5-0 nylon was used to close around the umbilicus.
Wounds were all cleaned with saline solution, dried, and dressed with benzoin and Steri-Strips. Polysporin on the umbilicus. Gauze dressings, ABD pads, tape, binder were then applied. Some local anesthetic mixture was injected through the drain; it was clamped, not yet placed to suction to complete suction recovery. The patient tolerated the procedure well with no apparent complications. The patient was extubated in the operating room and transferred to the recovery room in satisfactory condition.
