Breast reconstruction 3D Animation
on Friday, December 17, 2010




The primary part of the procedure can often be carried out immediately following the mastectomy. As with many other surgeries, patients with significant medical comorbidities (high blood pressure, obesity, diabetes) and smokers are higher-risk candidates. Surgeons may choose to perform delayed reconstruction to decrease this risk. Patients expected to receive external beam radiation as part of their adjuvant treatment are also commonly considered for delayed autologous reconstruction due to significantly higher complication rates with tissue expander-implant techniques in those patients. Breast reconstruction is a large undertaking that usually takes multiple operations. Sometimes these follow-up surgeries are spread out over weeks or months. If an implant is used, the individual runs the same risks and complications as those who use them for breast augmentation but has higher rates of capsular contracture (tightening or hardening of the scar tissue around the implant) and revisional surgeries. Outcomes based research on quality of life improvements and psychosocial benefits associated with breast reconstruction served as the stimulus in the United States for the 1998 Women's Health and Cancer Rights Act which mandated health care payer coverage for breast and nipple reconstruction, contralateral procedures to achieve symmetry, and treatment for the sequelae of mastectomy. This was followed in 2001 by additional legislation imposing penalties on noncompliant insurers. Similar provisions for coverage exist in most countries worldwide through national health care programs. There are many methods for breast reconstruction. The two most common are: * Tissue Expander - Breast implants This is the most common technique used in worldwide. The surgeon inserts a tissue expander, a temporary silastic implant, beneath a pocket under the pectoralis major muscle of the chest wall. The pectoral muscles may be released along its inferior edge to allow a larger, more supple pocket for the expander at the expense of thinner lower pole soft tissue coverage. The use of acellular human or animal dermal grafts have been described as an onlay patch to increase coverage of the implant when the pectoral muscle is released, which purports to improve both functional and aesthtic outcomes of implant-expander breast reconstruction. o In a process that can take weeks or months, saline solution is percutaneously injected to progressively expand the overlaying tissue. Once the expander has reached an acceptable size, it may be removed and replaced with a more permanent implant. Reconstruction of the areola and nipple are usually performed in a separate operation after the skin has stretched to its final size. * Flap reconstruction The second most common procedure uses tissue from other parts of the patient's body, such as the back, buttocks, thigh or abdomen. This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply (the vessels are tunnelled beneath the skin surface to the new site) or it may be cut off and new blood supply may be connected. o The latissimus dorsi muscle flap is the donor tissue available on the back. It is a large flat muscle which can be employed without significant loss of function. It can be moved into the breast defect still attached to its blood supply under the arm pit (axilla). A latissimus flap is usually used to recruit soft-tissue coverage over an underlying implant. Enough volume can be recruited occasionally to reconstruct small breasts without an implant. o Abdominal flaps The abdominal flap for breast reconstruction is the TRAM flap or its technically distinct variants of microvascular "perforator flaps" like the DIEP/SIEP flaps. Both use the abdominal tissue between the umbilicus and the

This is a 4 minute video depicting the basic technique of the Mohs micrographic procedure and how the tissue is processed in the lab. Visit us @ www.skincancercentre.com

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Intramuscular Injection Techniques (Nursing Skills)

In this video, we’re going to look at proper administration techniques for intramuscular medication administration. Of course, always follow your 5 rights and calculate the correct volume for administration. We love you guys! Go out and be your best selves today! And, as always, happy nursing!

Bookmarks:
0.05 Introduction to Intramuscular injections
0.16 site and needle selection
0.35 site sterilization
0.43 Z track method
0.58 needle insertion
1.10 medication injection
1.14 needle removal
1.25 bandaging and needle disposal
1.30 documentation and patient monitoring
1.35 Outro

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Causes are chronic inflammation due to infection, allergies, drug sensitivity, or immune disorders. Symptoms may include a runny nose, stuffiness, or post-nasal drip. In some cases, there may be no symptoms. The condition can be treated with corticosteroids, other medications, or surgery.

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Could this be a viable alternative to open heart surgery?

Heparin is an anticoagulant (blood thinner) that prevents the formation of blood clots. Heparin is used to treat and prevent blood clots in the veins, arteries, or lung. It is also used before surgery to reduce the risk of blood clots.

Juvenile polyposis syndrome (JPS) is a hereditary condition that is characterized by the presence of hamartomatous polyps in the digestive tract. Hamartomas are noncancerous (benign) masses of normal tissue that build up in the intestines or other places. These masses are called polyps if they develop inside a body structure, such as the intestines. The term “juvenile polyposis” refers to the type of polyp (juvenile polyp) that is found after examination of the polyp under a microscope, not the age at which people are diagnosed with JPS.

The majority of all headaches are tension related headaches. The blockage of blood circulation along with contraction/shortening of muscles is what causes this condition. This simple technique can take away most tension related headaches in seconds.

The fetal circulation is the circulatory system of a human fetus, often encompassing the entire fetoplacental circulation that also includes the umbilical cord and the blood vessels within the placenta that carry fetal blood.

The fetal circulation works differently from that of born humans, mainly because the lungs are not in use: the fetus obtains oxygen and nutrients from the mother through the placenta and the umbilical cord.

This video documents the experience of one of our Mommy Makeover patients. She is 39 years old, 5’4” tall, and of average weight. Following the birth of her twins, she wanted to improve her abdominal wall contour and correct the lack of shape and firmness in her breasts.

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Tracheotomy and tracheostomy are surgical procedures that create an opening in the trachea (windpipe) to help patients breathe when they have difficulty doing so through the nose or mouth. Though they are similar in purpose, there are some key differences between them.

Tracheotomy is a temporary procedure that involves creating a small incision in the trachea to insert a breathing tube. The tube is typically removed once the patient no longer requires it, and the incision heals on its own. Tracheostomy, on the other hand, is a more permanent solution that involves creating a hole in the trachea and inserting a tracheostomy tube, which remains in place for an extended period.

Indications for these procedures include:

Airway obstruction due to trauma, tumors, or infection
Severe respiratory distress or failure
Prolonged mechanical ventilation
Inability to protect the airway due to neurological disorders or impaired consciousness
Steps for performing a tracheotomy and tracheostomy:

Preparation: The patient is positioned, and the neck area is cleaned and draped. Local anesthesia is often administered, although general anesthesia may be used in some cases.
Incision: A small incision is made in the neck, and the muscles and tissues are carefully separated to expose the trachea.
Tracheal opening: A small opening is made in the trachea, typically between the second and third tracheal rings.
Tube insertion: A tracheotomy tube is inserted through the incision and into the trachea for a tracheotomy, while a tracheostomy tube is inserted for a tracheostomy. Both tubes are secured in place.
Confirmation: Proper placement of the tube is confirmed by listening for breath sounds and checking for adequate ventilation.
Pre-operative care typically involves a thorough assessment of the patient's medical history, as well as any necessary imaging studies or lab tests to ensure the procedure is appropriate and safe. Informed consent should be obtained from the patient or their legal representative.

Post-operative care includes monitoring the patient's vital signs, ensuring the tube remains secure and patent, and managing any pain or discomfort. For tracheostomy patients, regular cleaning and maintenance of the stoma (the opening in the trachea) and the tracheostomy tube are essential to prevent infection and other complications. Long-term care may involve speech therapy, respiratory therapy, and support from a multidisciplinary team to address any ongoing needs.

It's crucial to remember that these procedures should only be performed by trained medical professionals in a clinical setting.



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Barrett's esophagus is a complication of chronic (long lasting) and usually severe gastrointestinal reflux disease (GERD), but occurs in only a small percentage of patients with GERD. Criteria are needed for screening patients with GERD for Barrett's esophagus. Until validated criteria are available, it seems reasonable to do screening endoscopies in GERD patients who cannot be taken off acid suppression therapy after two to three years. The diagnosis of Barrett's esophagus rests upon seeing (at endoscopy) a pink esophageal lining that extends a short distance (usually less than 2.5 inches) up the esophagus from the gastroesophageal junction and finding intestinal type cells (goblet cells) on biopsy of the lining. There is a small but definite increased risk of cancer of the esophagus (adenocarcinoma) in patients with Barrett's esophagus.

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This video illustrates an IM injection for deltoid muscle.
Note that vaccines and other medications can be administered through the deltoid muscle. I will give you some tips through this video.

It is important to check your client’s details such as their medication, time, dose, and the route to be used. Different research works are subject to change the protocols for insertion thus, it is necessary to be up to date with the current changes.

Assemble all the supplies and conduct hand sanitation. Usually, I wear gloves before giving any injection in as much as the CDC may state it is optional unless the patient has an open lesion and contact of body fluids is likely to happen.

Use the acromion process landmark to locate the deltoid muscle. Move your fingers about two widths below the landmark. The patient’s adipose tissue determines the choice of needle length. Note that the needle gauge is determined by the type of medication you plan to give to the patient.

The Z-track technique is recommended rather than pinching the patient’s skin. Pull the patient’s skin to the side using one hand. Use a 90 degree angle to insert the needle to the patient’s skin. At the rate of 10 seconds per mL gently depress the plunger.

Remove the needle carefully and engage the safety precautions then dispose of the needle appropriately in the sharps container. Gauzing helps to cover the injection site.

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