DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Excessive abdominal skin and soft tissue after massive weight loss.
2. Intertrigo and back pain secondary to large pannus.
POSTOPERATIVE DIAGNOSES:
1. Excessive abdominal skin and soft tissue after massive weight loss.
2. Intertrigo and back pain secondary to large pannus.
OPERATION PERFORMED: Fleur-de-lis panniculectomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
SPECIMENS: None.
ESTIMATED BLOOD LOSS: 150 mL.
COMPLICATIONS: None immediate.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old Hispanic female who underwent a laparoscopic gastric bypass approximately two years ago. She subsequently lost well over 100 pounds and has stabilized and plateaued at her current weight for the past three to six months. The patient came to the plastic surgery clinic complaining of intertrigo and back pain. She was approved for a panniculectomy. She was consented and explained the risks of the procedure, which include hematoma, seroma, wound breakdown. This was stressed that being on steroids she has a high probability of having wound complications. She has a history of DVT that has prompted us to preoperatively give her Fragmin as well as pneumatic compression boots. Her Fragmin will be continued postoperatively. The patient has signed consent saying that she understands the risks and benefits of the procedure.
DESCRIPTION OF OPERATION: After explaining the potential risks and benefits of the procedure to the patient, informed consent was obtained. The patient was taken to the operating room by gurney and transferred to the operating room table in the supine position. An endotracheal tube was placed. General anesthesia was induced. One gram of Ancef was given preoperatively. The patient was then prepped with Betadine from table to table and from nipples to mid thigh with Betadine, draped in standard sterile fashion. A timeout was performed indicating patient, procedure, and site to be operated on.
The previously marked fleur-de-lis panniculectomy incision was followed on the table with a #10 blade. Electrocautery was used to dissect down to the level of the fascia. The skin and subcutaneous tissue was elevated up to the level of the umbilicus. The umbilicus was circumscribed and dissected down to its insertion into the abdominal wall fascia. We then continued the elevation of the skin and subcutaneous flap superiorly to a line above the umbilicus. We then had a vertical component that was incised in the midline from the xiphoid down to the umbilicus. We then dissected down with electrocautery to the level of the fascia. Her previous laparotomy incision was seen and the sutures were all in place. There were no hernias noted. We dissected out laterally from the midline along the vertical axis just down enough to mobilize tissue. Given the patient’s steroid use and history of smoking in the past, we decided to undermine as little as possible to maintain viability of the flaps and try to limit any complications. The patient is aware that she has a high probability of complications pertaining to this surgery.
After completing our dissections, we then achieved hemostasis with electrocautery. Three 19-French Blake channel drains were placed over the pubis and placed in the gutters in the midline. The incisions were all then closed in a layered fashion with 2-0 Vicryl sutures, deep 3-0 Vicryl sutures in the dermis, and a running 4-0 subcuticular suture. The umbilicus was pulled out and an area trimmed for it. It was placed then and secured with 5-0 nylon half-buried horizontal mattress sutures. Drains were placed on suction. All wounds were cleaned and benzoin and Steri-Strips applied as well as sterile gauze. Bacitracin and Adaptic were placed over the umbilicus. The patient tolerated the procedure well without any immediate complications. The patient was extubated, transferred back to a gurney, and taken back to the PACU. The patient left the operating room in good condition.
