Description
General anesthesia is used. Subtotal thyroidectomy is the removal of greater than
90 % of the thyroid gland, leaving the posterior aspects of the gland, and is used
for patients with hyperthyroidism due to diffuse hyperfunction, or rarely for multinodular
goiter. The nature of the pathology has almost always been determined
prior to surgery.
Saturday, June 28, 2014
Partial Thyroidectomy (Hemithyroidectomy, Thyroid Lobectomy)
Description
General anesthesia is used. Partial thyroidectomy is the removal of an entire thyroid
lobe and isthmus or a portion of a lobe. The nature of the lesion has almost always
been determined prior to the operation. Nodules are confi ned to a single thyroid
lobe or the isthmus. Most often a certain or suspected diagnosis of malignancy is
the indication for surgery; less often the nodule(s) is either hyperfunctional or is
enlarged and causing obstructive symptoms. The patient is supine with a roll placed
transversely under the scapulae to allow optimal neck extension.
General anesthesia is used. Partial thyroidectomy is the removal of an entire thyroid
lobe and isthmus or a portion of a lobe. The nature of the lesion has almost always
been determined prior to the operation. Nodules are confi ned to a single thyroid
lobe or the isthmus. Most often a certain or suspected diagnosis of malignancy is
the indication for surgery; less often the nodule(s) is either hyperfunctional or is
enlarged and causing obstructive symptoms. The patient is supine with a roll placed
transversely under the scapulae to allow optimal neck extension.
Thyroid Surgery
Useful Risk Reduction and Management Strategies
Acute respiratory distress following thyroidectomy can be of several types:
• Postoperative hemorrhage and hematoma – usually within 24 h, often 6–8 h after
thyroidectomy, causing laryngeal edema, which if uncorrected may prove fatal
• Excessive wound edema – causing pressure on the larynx and surrounding tissues
• Post-traumatic from endotracheal intubation
• Idiopathic – no apparent cause
Management
• Treat major bleeding with urgent surgical drainage.
• Ice packs on the neck after thyroidectomy – routine use may reduce wound
edema.
• Humidifi ed respiratory environment can relieve all local forms of laryngeal
edema.
• Check for inspissated subglottic mucus sputum retention (plug) – endotracheal
suction.
• Tracheostomy is rarely required.
Acute respiratory distress following thyroidectomy can be of several types:
• Postoperative hemorrhage and hematoma – usually within 24 h, often 6–8 h after
thyroidectomy, causing laryngeal edema, which if uncorrected may prove fatal
• Excessive wound edema – causing pressure on the larynx and surrounding tissues
• Post-traumatic from endotracheal intubation
• Idiopathic – no apparent cause
Management
• Treat major bleeding with urgent surgical drainage.
• Ice packs on the neck after thyroidectomy – routine use may reduce wound
edema.
• Humidifi ed respiratory environment can relieve all local forms of laryngeal
edema.
• Check for inspissated subglottic mucus sputum retention (plug) – endotracheal
suction.
• Tracheostomy is rarely required.
Free Transverse Rectus Abdominis Myocutaneous
(TRAM) Flap Reconstruction
Description
The operation is performed under general anesthesia, sometimes supplemented by a
paravertebral or epidural block. Adequate preoperative planning and preparation is key
to the success of TRAM fl ap breast reconstruction. Good lighting, careful positioning,
and high-quality equipment simplify the procedure. Appropriate intravenous antibiotics
are given for 24 h or more. An island of skin and underlying rectus abdominis muscle is
raised from the lower abdomen attached to its inferior vascular pedicle (inferior epigastric
vessels) and divided. Immediate free-TRAM fl ap breast reconstruction (ITRAM)
is carried out at the same time as mastectomy (Figs. 2.6 , 2.7 and 2.8 ).
Description
The operation is performed under general anesthesia, sometimes supplemented by a
paravertebral or epidural block. Adequate preoperative planning and preparation is key
to the success of TRAM fl ap breast reconstruction. Good lighting, careful positioning,
and high-quality equipment simplify the procedure. Appropriate intravenous antibiotics
are given for 24 h or more. An island of skin and underlying rectus abdominis muscle is
raised from the lower abdomen attached to its inferior vascular pedicle (inferior epigastric
vessels) and divided. Immediate free-TRAM fl ap breast reconstruction (ITRAM)
is carried out at the same time as mastectomy (Figs. 2.6 , 2.7 and 2.8 ).
Pedicled Transverse Rectus Abdominis Myocutaneous (TRAM)
Flap Reconstruction
Description
The operation is performed under general anesthetic, sometimes supplemented by
a paravertebral or epidural block. Adequate preoperative planning and preparation
is key to the success of TRAM fl ap breast reconstruction. Good lighting, careful
positioning, and high-quality equipment simplify the procedure.
Description
The operation is performed under general anesthetic, sometimes supplemented by
a paravertebral or epidural block. Adequate preoperative planning and preparation
is key to the success of TRAM fl ap breast reconstruction. Good lighting, careful
positioning, and high-quality equipment simplify the procedure.
Latissimus Dorsi Flap Breast Reconstruction
Description
The operation is performed under general anesthetic, often supplemented by a
paravertebral block. Adequate preoperative planning and preparation is key to the
success of latissimus dorsi (LD) breast reconstruction. Good lighting, careful positioning,
and high-quality equipment simplify the procedure. Appropriate intravenous
antibiotics are given for 24 h. An island of skin and underlying latissimus
dorsi muscle is raised from the back attached to its thoracodorsal vascular pedicle
and tunneled anteriorly to reach the ipsilateral chest. Immediate LD breast reconstruction
(IBR) is carried out at the same time as mastectomy.
The operation is performed under general anesthetic, often supplemented by a
paravertebral block. Adequate preoperative planning and preparation is key to the
success of latissimus dorsi (LD) breast reconstruction. Good lighting, careful positioning,
and high-quality equipment simplify the procedure. Appropriate intravenous
antibiotics are given for 24 h. An island of skin and underlying latissimus
dorsi muscle is raised from the back attached to its thoracodorsal vascular pedicle
and tunneled anteriorly to reach the ipsilateral chest. Immediate LD breast reconstruction
(IBR) is carried out at the same time as mastectomy.
Reconstructive Breast Surgery
Breast Implants: Insertion of Saline- or Silicone-Filled
Prosthesis
Description
Implants are normally inserted under general anesthesia, as adequate local anesthesia
is diffi cult to achieve. Implants are artifi cial devices for providing additional
breast volume and are of various types, shapes, sizes, and contents (saline, silicone,
emulsion, or other). They are used in three main areas of surgical practice.
Firstly, for cosmetic bilateral breast augmentation, secondly to achieve symmetry
in patients with congenital conditions leading to asymmetry or where breast
reconstruction has failed to achieve symmetry, and thirdly as an integral part of
immediate or delayed subpectoral reconstruction or with latissimus dorsi breast
reconstruction.
Prosthesis
Description
Implants are normally inserted under general anesthesia, as adequate local anesthesia
is diffi cult to achieve. Implants are artifi cial devices for providing additional
breast volume and are of various types, shapes, sizes, and contents (saline, silicone,
emulsion, or other). They are used in three main areas of surgical practice.
Firstly, for cosmetic bilateral breast augmentation, secondly to achieve symmetry
in patients with congenital conditions leading to asymmetry or where breast
reconstruction has failed to achieve symmetry, and thirdly as an integral part of
immediate or delayed subpectoral reconstruction or with latissimus dorsi breast
reconstruction.
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