Lainie0559
Networker
The patient had breast reduction surgery earlier in the day. During postop checks she was noted to have venous congestion which was worsening and did not improve with conservative measures.
The patient was taken back to the OR for re-exploration:
I began by removing the previous 15 French Blake drain. All sutures to the nipple areolar complex, vertical limb, T-junction and inframammary fold incisions were removed. There was noted to be some compression of the pedicle inferior to the nipple, as well as some compression of the nipple-areolar complex from the overlying breast tissue superiorly. The superior aspect of the pedicle did appear to have poor arterial perfusion as well as some venous congestion. After a period of time, as the wound had been left open, bright red bleeding began to occur around the nipple-areolar complex and along the pedicle itself. I did remove some tissue superior to the nipple that looked questionably viable as well as some tissue from around the keyhole portion of the incision. This was sent for pathology. Wound was irrigated with antibiotic irrigation. The nipple-areolar complex appeared pink and viable and therefore a partial closure was undertaken. I placed 4 cardinal sutures in the nipple-areolar complex in the keyhole portion of the incision. Vertical limb was loosely approximated using 2-0 Vicryl deep dermal sutures. Inframmammary fold was approximated using 2-0 Vicryl deep dermal sutures. Prior to beginning closure, a 15 French Blake drain was palced and brought out through the previous stab incision. After closure of the deep dermis, 2-0 PDO Quill was used to perform a running superficial dermal suture along the inframammary fold followed by 3-0 Monocryl running subcuticular suture.
Any suggestions would be greatly appreciated.
The patient was taken back to the OR for re-exploration:
I began by removing the previous 15 French Blake drain. All sutures to the nipple areolar complex, vertical limb, T-junction and inframammary fold incisions were removed. There was noted to be some compression of the pedicle inferior to the nipple, as well as some compression of the nipple-areolar complex from the overlying breast tissue superiorly. The superior aspect of the pedicle did appear to have poor arterial perfusion as well as some venous congestion. After a period of time, as the wound had been left open, bright red bleeding began to occur around the nipple-areolar complex and along the pedicle itself. I did remove some tissue superior to the nipple that looked questionably viable as well as some tissue from around the keyhole portion of the incision. This was sent for pathology. Wound was irrigated with antibiotic irrigation. The nipple-areolar complex appeared pink and viable and therefore a partial closure was undertaken. I placed 4 cardinal sutures in the nipple-areolar complex in the keyhole portion of the incision. Vertical limb was loosely approximated using 2-0 Vicryl deep dermal sutures. Inframmammary fold was approximated using 2-0 Vicryl deep dermal sutures. Prior to beginning closure, a 15 French Blake drain was palced and brought out through the previous stab incision. After closure of the deep dermis, 2-0 PDO Quill was used to perform a running superficial dermal suture along the inframammary fold followed by 3-0 Monocryl running subcuticular suture.
Any suggestions would be greatly appreciated.