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general surgery

Hernia anatomical location

Groin
Ventral
Incisional

Hernia Conditions

Reducible
Incarcerated
Strangulated
Direct
Indirect
Pantaloon

Reducible(hernia)

Manual manipulation can return the hernia contents to the abdominal cavity

Incarcerated(hernia)

Manual manipulation cannot return the hernia contents to the abdominal cavity

Strangulated(hernia)

Hernia with luminal viscera entrapment that compromises the vascularity of the viscera

direct hernia

occur within hesselbach's triange and protrude into the inguinal canal but not into the spermatic cord

Indirect hernia

protrudes through the internal inguinal ring and pass with the spermatic cord structures down the inguinal canal; may descend into the scrotum

femoral hernia

Hernia medial to femoral vessels (under
inguinal ligament)

Inguinal hernia setup

Basic LAP set
Synthetic mesh w/0 proleneCT
Penrose drain

Hernia Prep

Anesthesia-General
Position-Supine
Skin Prep-Umbilicus to pubic symphysis

Hernia Procedure(in sequence)

1. Oblique or transverse incision
2. Deeper W/Metz&Bovie THEN retract
3.Wet penrose is placed around spermatic cord
4. Indirect hernia sac dissected away from cord. Contents are pushed back into abdominal cavity
5. Pursestring suture technique is used and the sac is excised(STSR HAVE SUTURE READY)
6. The tranversalis fascia is either sutured to coopers ligament or mesh is used if defect is large
7. If mesh is used it is sutured in place.

Breast anatomy(women)

Mammary glands are modified sweat glands located anterior to the pectoralis major muscle between the second and sixth rib

Breast cancer Stage 1

1.Tumor 2cm or less
2. No evidence of regional or distal spread

Breast cancer Stage 2

1. Tumor 2>5cm in diameter
2. Without distal spread

Breast cancer Stage 3A

1. Tumor up to or greater than 5cm
2. May or may not be fixed
3. No evidence of distant metastases

Breast cancer Stage 3B

1. Tumor of any dimension
2. Unequivocal homolateral metastatic supraclavicular or interclavicular nodes
3. Edema of the arm, but without distant metastases

Breast cancer Stage 4

1. Tumor of any size
2. With or without regional spread
3. Evidence of distant metastases

Radical Mastectomy

is the removal of the breast and pectoralis minor muscle, and division of the medial and lateral pectoral nerves

Modified radical mastectomy

is the same as the radical but the pectoralis muscels and fascia are preserved and axillary dissection proceeds.

Mastectomy instruments

1.Plastics set may be needed for reconstruction
2.Major instrument tray
3. Ligating clip appliers

Mastectomy Prep

Anesthesia- General
Position-supine
Skin prep- Neck to xyphoid process(side to side)
Draping-Chest/breast sheet, Draping of the arm includes placement of a sheet on the armboard and application of a stockinette

Mastectomy Procedure(in sequence)

1. Elliptical transverse incision
2. Dissection continues down the chest muscles
3. The pectoralis minor may be divided, stripped, or excised. Excision is used when a lesion is present of the muscle
4. Two wound drains are usually placed, one in the anterior chest and the other in the axilla.

Laparotomy

A surgical opening through the skin layer an abdominal wall in the the peritoneal cavity

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