Introduction
The word plastic derives from the Greek work plastikos and means to mold or shape (Plastic surgery, 2015). Many modern plastic surgery techniques evolved from devastating wartime reconstructive needs: Sir Harold Gillies in England, one of the pioneers of modern plastic surgery, took care of victims of trench warfare who suffered from disfiguring facial, trunk, and extremity injuries requiring both functional and aesthetic coverage (Gillies, 1983).
Plastic and reconstructive surgery is becoming more prevalent and more of a topic of interest. While plastic surgical procedures are generally separated into cosmetic and reconstructive, there is often a blurred boundary between the two. While breast augmentation may seem to be cosmetic, in a teenage girl with developmental deformity and significant asymmetry, breast augmentation serves a reconstructive purpose. Similarly, in a massive weight loss patient with severe skin excess, an abdominoplasty serves a much greater purpose beyond a straightforward aesthetic definition.
While much of plastic surgery is performed in the hospital setting, more procedures are moving into an ambulatory surgery setting, converting the recovery room into an area with much higher turnover. This chapter will review several of the common plastic surgery procedures performed and the perianesthesia nursing needs of the plastic surgery patient.
Reconstructive Plastic Surgery Procedures
1.What are some of the common reconstructive plastic surgery procedures performed in a hospital setting?
2.What plastic surgery methods are used in these common procedures?
3.What occurs during a skin graft procedure?
4.What are the primary differences between STSG and FTSG? Why are they clinically important?
5.What are some of the postoperative nursing considerations for patients with skin grafts?
6.What are some causes for graft failure?
7.What are flaps and what are the clinical indications for flap surgery?
8.What are the postoperative nursing considerations for flap procedures?
Cosmetic Plastic Surgical Procedures
9.What are the five most common surgical cosmetic procedures?
10.Which cosmetic procedure was the most common?
11.What is the purpose of breast augmentation?
12.Are silicone implants safe to use?
13.How does breast reconstruction differ from breast augmentation procedures?
14.Which complications may occur following breast augmentation?
15.What is the role of the perianesthesia nurse for augmentation mammoplasty procedures?
17.Are there postoperative concerns for rhinoplasty patients?
19.What does tumescent mean and how does it relate to liposuction?
20.What is the advantage of the tumescent technique?
21.What role does lidocaine play in liposuction?
22.What complications can occur following liposuction?
23.What is the role of the perianesthesia nurse following liposuction procedures?
24.Are there contraindications to liposuction?
25.What can patients expect following liposuction?
27.What complications can occur after blepharoplasty?
28.What should the perianesthesia nurse look for following blepharoplasty?
30.What are some complications following abdominoplasty?
31.What is the role of the perianesthesia nurse following abdominoplasty?
Burns
Patients with major burns with ventilator dependence are often transported directly from the burn unit to the operating room and directly back to the unit for postoperative care. Patients with less severe injuries and patients who are undergoing reconstruction secondary to past burn injury will be recovered in the postanesthesia care unit. Knowledge of burn injury and care for these patients is critical.
32.What kind of procedures do burn care patients have?
34.What influences the mortality of a patient with a burn?
35.What are the most common types of burn injury?
36.What should the perianesthesia nurse know when caring for the burn patient?
Plastic Surgery in/for Trauma
Trauma cases requiring plastic surgery involve the face, upper and lower extremities, and trunk. Soft tissue trauma such as lacerations and animal bites tend to be treated in the emergency room unless the degree of tissue injury is extensive or the individual is a child (Burns & Blackwell, 2007). Patients with facial fractures have sustained their injuries from high-energy forces such as motor vehicle accidents, blunt trauma, penetrating trauma, and falls, and depending on the injury, may present with cranial nerve involvement or cervical spine injury. A detailed evaluation is critical preoperatively and following surgery. Plastic surgeons also assist general surgeons, vascular surgeons, neurosurgeons, and other surgical subspecialists in stability and closure of complex wounds (Doherty, 2010).
37.What are the most common facial fractures requiring plastic surgery?
38.How are nasal fractures treated?
39.What are the clinical considerations for patients with mandibular fractures?
40.What is intermaxillary fixation and why is it important in facial fractures?
41.What should the perianesthesia nurse anticipate postoperatively in patients with mandibular and maxillary fractures?
Plastic Surgery Emergencies
As in all surgical procedures, uncontrolled bleeding may occur. Postoperatively, this can be detected in the recovery room and often requires a reexploration in the operating room. Complications from flap procedures should be anticipated; a baseline exam upon entry to the recovery room serves as a critical frame of reference if the patient’s status deteriorates. Compartment syndrome, ischemia, and amputations of digits are some of the most common plastic surgery emergencies (Burns & Blackwell, 2007).
42.Which types of amputations are suitable for replantation?
43.What are the absolute contraindications to replantation?
44.What are the relative contraindications to replantation?
45.Which type of injury has a better outcome?
46.What role does ischemia time play in the amputation?
47.What should the perianesthesia nurse keep in mind when caring for patients who have undergone replantation?
48.What should the perianesthesia nurse suspect when the digit is pale or blue?
49.What additional parameters should be monitored by the nurse?
50.What are the complications of replantation?
51.What seems to be the leading and most common cause of mortality among cosmetic surgery?
52.What does risk stratification for VTE include?
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