By Courtney M. Townsend Jr. JR. MD, B. Mark Evers MD
Atlas of basic Surgical thoughts covers the total spectrum and breadth of basic surgical procedure via approximately 1200 easy-to-follow anatomic drawings. Drs. Courtney M. Townsend, Jr. and B. Mark Evers current step by step information for universal and intricate approaches, together with open and minimally invasive thoughts. The hugely constant procedure and outsized layout enable for giant academic illustrations with pearls and pitfalls on the finish of every bankruptcy. complete insurance contains sizzling subject matters akin to Thyroidectomy, Parathyroidectomy, Hepaticojejunostomy, Choledochojejunostomy, Splenectomy,Hernia fix, Exploration of Neck for Trauma, and Subclavian Artery Stab. you will have a whole array of surgeries at your fingertips-in print and on-line at expertconsult.com! 2009 PROSE Awards (awarded by means of organization of yank Publishers for pro and scholarly excellence)Finalist/Honorable point out, medical medication comprises entry to the totally searchable textual content on-line at expertconsult.com, besides downloadable photos. beneficial properties 1200 easy-to-follow, step by step anatomic drawings that truly depict the complete spectrum and breadth of surgical techniques-both open and minimally invasive. Covers sizzling subject matters resembling Thyroidectomy, Parathyroidectomy, Hepaticojejunostomy, Choledochojejunostomy, Splenectomy,Hernia fix, Exploration of Neck for Trauma, and Subclavian Artery Stab. offers step by step directions for every process in a hugely constant structure that makes making use of suggestions effortless. Highlights pearls and pitfalls on the finish of every bankruptcy so that you be aware of what to anticipate sooner than getting into the working room. offers the designated information of specialists on what you want to find out about universal and difficult methods.
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Extra resources for Atlas of General Surgical Techniques
If tumor is believed to be malignant, preoperative counseling should include possible facial nerve sacriﬁce, neck dissection, reconstruction of the facial nerve, and possible facial reanimation surgery. ◆ Indications for lateral lobectomy include the following: ◆ Benign or malignant tumor (exceptions include benign lymphoepithelial cysts and parotid lymphoma) ◆ Refractory sialolithiasis, sialoadenitis (chronic parotitis), and chronic sialorrhea; some authors advocate total parotidectomy for chronic parotitis ◆ As part of lymph node dissection for other head and neck primary tumors, primarily cutaneous malignancies of the face and scalp ◆ Excision of ﬁrst branchial cleft cyst involving parotid gland ◆ Although superﬁcial parotidectomy is performed for tumors located in the lateral lobe of the parotid, most authors now recommend excision of the tumor with a healthy cuff of normal gland, particularly if the tumor is located in the tail.
The wound is copiously irrigated with normal saline. ◆ Two 10-mm Jackson-Pratt drains are placed into the wound through separate stab incisions; one is placed posteriorly in the neck along the trapezius muscle and the other is placed anteriorly in the neck, parallel to the strap muscles. To prevent suction on the carotid artery, the drains may be loosely sewn to the fascia of the deep muscles of the neck using an absorbable suture to hold them in place. ◆ The incision is closed in two layers; the platysma is tightly closed using an absorbable stitch, and the skin is closed using surgical staples or suture.
Once the parathyroid adenoma is mobilized, care is taken to ensure that the vascular supply is isolated and secured with either clips or ties, and the gland is then completely excised (Figure 3-10). If a unilateral exploration had been undertaken with preoperative localization, then many endocrine surgeons will obtain a rapid parathyroid hormone (PTH) assay to conﬁrm the adequacy of resection. Right recurrent laryngeal nerve Right inferior thyroid gland FIGURE 3–8 FIGURE 3–9 FIGURE 3–10 CHAPTER 3 • ◆ Parathyroidectomy 47 If the operation being performed was for parathyroid gland hyperplasia, then a total parathyroidectomy would be performed with autotransplantation of a portion of one of the glands into, most commonly, the forearm or the sternocleidomastoid muscle.