Abstract
TECHNIQUE A skin reducing mastectomy is performed via Wise pattern incisions, retaining an extensive inferior dermal sling of de-epithelialised tissue. A sizer is used to ensure the skin envelope meets the inframammary fold before an anatomical implant is placed on the pectoralis major. Complete coverage is achieved with the inferior dermal sling, which is sutured to the pectoralis superiorly. The superior skin can then be draped to the inframammary fold and sutured in the usual manner.
Highlights
Wrong level spine surgery dominates malpractice claims.[1]
We have defined a reliable technique that confirms with absolute certainty the correct level for discectomy before, during and after the procedure
We have performed 64 open lumbar discectomies using this technique with no cases of incorrect level discectomy
Summary
The development of pancreatic necrosis is a significant complication of acute pancreatitis and can result in progressive multiple organ failure and death. In an attempt to reduce the high morbidity and mortality from open necrosectomy, minimal access techniques have been developed.[1]. TECHNIQUE With the recent advent of single port laparoscopic surgery, a single access port (SILSTM; Covidien, Mansfield, MA, US) can be used to gain retroperitoneal access (Fig 1) and allow necrosectomy to be performed. Irrigation with warmed 0.9% saline or low CO2 pressure (8mmHg) permits visualisation of the retroperitoneum, and standard laparoscopic graspers and a suction device can be placed through additional port sites in the unit to allow removal of necrotic tissue (Fig 2). 1. Raraty MG, Halloran CM, Dodd S et al Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach. 3. van Santvoort HC, Besselink MG, Bakker OJ et al A step-up approach or open necrosectomy for necrotizing pancreatitis.
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