Pinwheel flaps are useful for reconstruction of defects all over the scalp.
This photo shows a man with a large ulcerated cancer on the back of his head – the occiput of the scalp.
The pinwheel was marked out. The patient was given a general anesthetic and positioned face down for the operation to excise the cancer and perform the pinwheel flap. See next post for intra-operative photos.
Skin Cancers on Scalp? Benefits of using a pinwheel flap
Often I see people who have had skin grafts on their scalp. They have had a skin cancer removed and then a piece of skin taken from elsewhere has been placed in the hole. There are major disadvantages to this.
1. The skin graft often falls off.
2. The skin graft looks different. You will always have a bald spot.
3. There is another wound in the body where the graft was taken.
Therefore, where possible, I try to use a flap, meaning rotation of skin from surrounding the defect to fill the hole. The advantages of this are:
1. No bald spot.
2. Same color and skin thickness as the rest of the scalp
3. No separate wound and therefore less pain.
This unfortunate lady has a cancer measuring about 3 by 3 cm on the back of her head just above the ear.
A pinwheel flap has been designed. Four bits of skin are rotated to fill the defect created by excising the skin cancer.
The end result looks like this.
The really good thing is that in three months time, all the hair will have grown back and no scars will be seen. Unlike a skin graft, which will always present as a discoloured bald patch.
Often patients and soon to be patients wonder what diet to have immediately after gastric sleeve surgery.
The aim is to avoid stress to the new stomach which has just been significantly reduced in sized and needs about four weeks to heal.
Therefore, we tell our patients to avoid solid foods for four weeks and gradually increase the texture of fluids intake. Aim to have less than 100mls per hour and stay in an upright position. Gravity will help the fluids go down and minimise vomiting.
Another important point is to avoid non-steroidal anti-inflammatory drugs such as Nurofen or Indocid or Voltaren for the first four weeks.
Diet after gastric sleeve surgery
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Infographic Source http://www.centralcoastsurgery.com.au/sleeve-gastrectomy-surgery
At Central Coast Surgery, if there are any dietary concerns before and after surgery, we encourage patients to contact our dietitian at any time.
Our clinic is seeing more and more people who are regaining weight after gastric sleeve surgery. In fact, it is estimated that up to one in three people can regain all their weight within five years of gastric sleeve surgery.
One of the current options being touted as a rescue option for the person gaining weight some years after gastric sleeve surgery is the Mini-gastric bypass. This procedure is also known as the Omega loop gastric bypass or single anastomosis gastric bypass.
This procedure may well stimulate further weight loss. It is done with keyhole techniques and requires two nights in hospital. It involves joining the small bowel directly to the previous gastric sleeve so that food does not pass through the whole length of small bowel , therefore the name, gastric bypass.
The risks of this procedure include:
- Weight regain over time
- Narrowing of the join between bowel and stomach, requiring repeated trips to hospital for dilation
- Twisting of the bowel requiring re-operation
- Malnutrition leading to osteoporosis, foot drop and fragile teeth
- Reflux requiring further surgery
- Constant nausea from dumping syndrome.
Therefore, gastric bypass, although it creates weight loss, does come at a price of multiple potential complications over a lifetime.
After gastric sleeve surgery, many patients will notice a change in bowel habit. This is not a cause for concern and alarm.
Some patients become constipated and others notice loose stools. The reasons for change in bowel habits after gastric sleeve surgery are many:
1. Change in diet: Optifast before weight loss surgery and fluid diet afterwards
2. Anesthetic and surgery: this affects bowel performance
Generally, most people will return to their pre-existing bowel function within six weeks after surgery. This correlates with return to a normal diet and lifestyle.
If diarrhoea or loose stools persist, then we recommend some Gastrostop. Bulking agents such as Metamucil may be helpful.
If constipation persists, try extra fluid, high fiber and exercise.
As always please feel free to contact the dietitian at our clinic on (02) 4323 7000 for further clarification.
Weight loss surgery is a time of change and the bowels do change but time should fix this.