dr. Deddy Saputra, Sp.

BP-RE

BASIC PLASTIC SURGICAL

IN DAILY PRACTICE
 Plan carefully and Precisely
Principle 1 : Before You Operate

Step 4
Step 1 Step 2 Step 3

Mostly, one’s surgical planning Decisions Back up plan ! the Prevent Wasting
should be performed before intraoperative primary plan might fail or Precious Time and
the procedure. need alteration. Patient Safety
 Principle 2
Ensure That Your Operative Goals Are in Alignment with the
Patient’s Preoperatively
Initial
The Day Of
Consultation
Surgery

Be honest with the Establishing open

patient and yourself communication and
about the limitations clear expectations is key

define and articulate the Note the patient’s goals in Ask the patient preoperatively
patient’s goals, and find what the chart explicitly and let it to reiterate their main goals
can be achieved reasonably. guide the operative plan that must be achieved for them
 Principle 3
When in Doubt, Don’t

P R E V E N T
HESITANCY

1 Let your training,

experience, and
expertise guide you

2 Always side with

patient safety,
Principle 4
Incise Skin under Tension, and Close with No Tension

Measure twice and

incise once

incising the skin: do so under tension, which allows for

more precision, and minimizes tissue trauma and the
need to connect multiple shorter hesitation cuts

Stop; readjust your position, retractors, or

your assistant; and incise the tissue precisely.

Reapproximate the skin edges with minimal to

no tension after a layered closure.

This is a fundamental principle in surgery, which

contributes to optimal wound healing and final
scar appearance.
Measure twice and
incise once
Removal a Dog Ear
Principle 5
Close Wounds in Layers, and Approximate Wound Edges Meticulously

Skin closure is ultimately the only part of Overeversion of wound edges does not necessarily
your work that the patient sees directly. produce better cosmesis

Use pear-shaped deep layer sutures Precise approximation of the wound edges with
(fascia or dermis only) uniformity and without palpable edges or irregularities
Approximate but do not strangulate wound
edges with slight eversion
Use pear-shaped deep layer sutures
(fascia or dermis only)
DO NOT OVER EVERSION !!

approximation of the wound edges with

uniformity and without palpable edges or
irregularities
 Overeversion of wound
edges does not necessarily
produce better cosmesis
Principle 6 Close Dead Space
Closing dead space is important in all
of surgery especially plastic surgery

Prevention of hematomas, seromas, and

optimizes wound healing by avoiding
undue tension.

When in doubt, use a drain to evacuate

fluid from dissected tissue planes and
encourage tissue adherence.
Closing dead space is important
Prevention of hematomas,
seromas, and optimizes wound
healing
 Principle 7
Respect the Soft Tissue and Visualize the Tissue Planes

Handle tissue gently 01 04 Minimizing tissue trauma

When dissecting in tissue planes or

Be mindful of how much 05 elevating flaps, be precise and
02
tension is on your maintain the appropriate plane
retractors

Be mindful how hard you

03
squeeze the skin between the
forceps
Principle 8
Achieve Meticulous Hemostasis and Irrigate the You can simply impress your audience and
add a unique zing before
Wound Closure
and appeal to your
Presentations. Easy to change colors,
photos and Text. Get a modern
PowerPoint Presentation that is beautifully
- Hemostasis at the end of your designed. You can simply impress your
audience and add a unique zing and
procedure appeal to your Presentations. Easy to
change colors, photos and Text. Get a
modern PowerPoint Presentation that is
- Close the skin with the patient beautifully designed.

normotensive
Modern
- Use a drain to maximize tissue
Portfolio
layer adherence and diminish
early postoperative swelling and
Presentation
bruising
Minimizing postoperative complications and optimizing wound
healing
Principle 9
Repeat and Refine Your Technique Continuously—
Being Self-Critical Is Essential to Becoming an Expert

Continue asking how Study the masters of

an operation can be individual techniques
performed better to develop a deeper
understanding

Ensure that your Present your work and

operative procedure results honestly,accept
is not limited by your criticism with an open
knowledge alone mind
 Principle 10
Missteps in Surgery Are Unforgiving

smallest errors can have

A catastrophic consequences

meticulous attention to detail is essential

B in both cosmetic and reconstructive surgery

revision procedures are exponentially

C more difficult and more challenging
Principle 11:
Just Because You Can Consider all aspects of the
Doesn’t Mean You Should decision, and always use the best
judgment to do what’s right for the
patient.
01

Surgeons determining 02
“how much,” “how big,”
or “how far.”
Principle 12
If It Doesn’t Look Good on the Operating Table,
Won’t Look Any Better Later

Make sure that you are 1

happy with your result before
concluding the procedure

the result you see on the

2
operating table is about as
good as you can expect later
after the resolution of swelling
3
Never leave the operating room
unless the result is as good as it can
be with your very best effort.
Make sure that you are
happy and satisfied with
your result because you
do the best things to the
patient
Principle 13
Apply Dressings Meticulously

Dressings are often the only thing visible to a

patient or their family following a procedure.

Ensure that dressings and incisions are clean,

and if possible, remove all blood stains

An extra minute can make a considerable

difference in the perceived outcome
Principle 14
Keep the Patient’s Family Informed during and after Surgery

Speak with the component of the

family in a timely trust that exists
manner to let them between the
know how the surgeon and the
procedure went patient/families
 Principle 15
Underpromise and Overdeliver—Honesty Is the Best Policy

Doctors/ surgeons must be honest with their self and the

patient when it comes to what you can do, and more
importantly, what you cannot do.

Advise your patient that you will do your very

best, but can never guarantee a result.

Honesty and integrity will gain the confidence of your

patients and colleagues alike

Adhering to these principles will guide you

along the path to success but it's not right to hold
them in obstinate blindness
THANK YOU