Hillcrest Medical Skill Building Report 7

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OPERATIVE REPORT

Patient Name: Olivia CarpenterDOB:01/15 Sex: FAge: 40 Patient ID: 110901
Admitting Physician: Dr. Leon Medina, MD Internal Medicine Date of Admission: 11/12/13
Date of Procedure: 11/13/13
Surgeon: Dr. Bernard Kester
Assistant: Jason Wagner PA-C
Preoperative Diagnosis: 1) History of breast intertriginous skin irritations. 2) Abdominal wall contour irregularities. Postoperative Diagnosis: same.
Operative procedures: 1) Bilateral Reduction mammoplasty. 2) Abdominal wall/flank suction assisted lipoplasty Anesthesia: Endotrachial with local tumescent. See op. note below. Specimens removed: 1) Right breast 60 grams breast tissue to Pathology. 2) Left breast 68 grams breast tissue to Pathology. IV Fluids: 2700mL crystalloid, 500ml hespan.

Blood Loss: 100mL.
Urine Output: 1200mL.
Complications: None.
Sponge Count: Verified. Corrected end of case.
Indications: The pleasant 40 year old female was seen and evaluated in the plastic surgery clinic. She had a significant weight loss via exercise. As a result, she had breastosis resulting in bilateral Intertriginous skin irritations. She never did require hospitalization or antibiotics, however the skin irritation was problematic. We discussed breast reduction/ mastopexy with the patient and she elected to proceed with small reduction with concomitant breast lift to minimize the skin irritation. Further, patient is status post abdominoplasty in California many years ago. She continues to have slight contour irregularities between the abdominal skin and the super pubic skin transition area. (Continued)

OPERATIVE REPORT

Patient Name: Olivia CarpenterDOB:01/15 Sex: FAge: 40 Patient ID: 110901
Date of Procedure: 11/13/13
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She also had bilateral abdomen/flank lipodystrophy, which we felt we could address with liposuction. Patient was seen one day prior to surgery and preoperative marking for reduction mammoplasty was performed. Abdominal lipoplasty regions were outlined as well. PARQ carried out with family, consent was signed. In the preoperative area, all risks and benefits were reviewed. There were no barriers to communication. Patient verbalized her understanding and wishes to proceed. Sounds of adherence were also outlined to minimize injury to these regions, DESCRITION OF OPERATION: After appropriate indentification, patient was taken back to the operating suite and positioned supine. Patient was then intubated by anesthesia, intravenous antibiotics administered and Foley catheter placed. Bileteral lower extremety SCDs were placed. In addition, the arms were positioned and secured. After prepping and draping in the usual sterile fashion, we then placed patient in the left lateral decubitus position, anticipating beginning with liposuction of the lateral abdomen flank region. Some 700mL of 0.05 percent lanocaine with 1/1,000,00 epinephrine tumescent was infiltrated into the subcutaneous planes along the lateral abdomen/flank regions. Posterior paraspinal incision was used for administration of the tumescent in addition to lateral thigh and lateral abdomen port. After placement of the tumescent, a 4mm cannula was then used to pre-tunnel the entire region from all three port sites, ensuring honeycombing of the region. After pre-tunneling had been performed, lipoplasty was initiates using a combination of 4mm and 3mm cannula for final feathering and contouring. Some 465mL of aspirate was then suctioned from the lateral abdomen and flank regions. Suction canister was approximately one atmosphere. A combination of the incision allowed for crisscrossing to help preform the lipoplasty more evenly and efficiently. End points of our lipoplasty included a combination of pinch and roll tests, manual manipulation and palpation as well as visualization of the bloody aspirate. After this had been accomplished, the port sites were then closed using 50 fast suture and...
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