sábado, 19 de abril de 2008

BLEFAROPLASTIA

O que é?

Blefaroplastia é uma cirurgia plástica ou estética das pálpebras que tem por finalidade remover o excesso de pele e/ou bolsas de gordura das pálpebras superiores e/ou inferiores.


No pré operatório pede-se:
Hemograma completo
Coaculograma
Avaliação cardiológica - risco cirúrgico

Com o paciente em decúbito dorsal demarca-se as áreas de excesso cutâneo a ser removido da pálpebra superior e identificação das bolsas adiposas na qual uma leve compressão do bulbo ocular avalia-se a presença das bolsas palpebrais medial e lateral e a necessidade de retirada. Na pálpebra inferior é realizada a mesma manobra citada para avaliar as três bolsas medial, mediana e lateral, já aqui dispensa de marcação prévia sendo a incisão próxima ao tarso.
A anti-sepsia feita com povidine degermante, Após,devida paramentação , montagem da mesa de instrumentação e ajuste dos campos cirúrgicos.
Inicia o procedimento com a anestesia local xilocaina + vasoconstritor(adrenalina) e com agulha de insulina aplica o anestésico nas camadas superficiais da pálpebra já soltando a pele.
Feito isso faz se a incisão com lamina de bisturi numero 15 delimitando a demarcação e posteriormente com uma tração palpebral solta-se praticamente só a pele. Utilizando tesoura, por divulsão o cirurgião exterioriza as bolsas de gordura . No intra-operatório, a quantidade de bolsa de gordura a ser ressecada pode ser estimada por meio de leve compressão do bulbo ocular, na qual o excesso de gordura exteriorizada com essa manobra corresponde, aproximadamente, à quantidade ideal a ser removida naquele caso em particular. Essa manobra deve ser repetida para certificar o resultado desejado. A ressecção em excesso pode deixar concavidades na região orbital, cujo resultado é exatamente o oposto àquele que motivou o paciente a procurar o cirurgião além de provocar ruptura de vasos posteriormente localizados.
É importante diferenciar a bolsa medial, de tonalidade mais clara, da lateral, mais escura
Após a exteriorização faz uma tração delicada com pinça e resseca-se utilizando eletrocautério ou com o próprio, pode-se cauterizar o tecido adiposo no qual diminui o seu volume com bom resultado final. Lembrando que o eletrocauterio estará com 0 de corte e 15 de coagulção para que não lese demasiadamente os tecidos
O importante neste ato cirúrgico é sempre estar seguro quanto a coagulação dos vasos sangüíneos para evitar a formação de equimoses, hematoma que, em situações extremas, pode levar à cegueira.
Outro detalhe é que com eletrocautério faz-se a demarcação do sulco para que fique mais natural possível.
A síntese é feita por sutura contínua intradermica com naylon 6.0, fazendo uma interrupção mediana da sutura para evitar deiscência total da ferida.
A indicação da blefaroplastia inferior apresenta os mesmos objetivos que os da superior, ou seja, correção dos excessos de pele e gordura.
Na cirurgia realizada fez-se o retalho miocutâneo para que tenha um acesso melhor as três bolsas que localizam na parte inferior. O músculo orbicular é seccionado no sentido de suas fibras com tesoura após incisão com bisturi da pele A remoção das bolsas se faz com a mesma técnica da parte superior. Um detalhe cirúrgico aqui é a precaução para evitar eversão ou melhor queda da pálpebra inferior para isso faz um ancoramento de segurança com um nó invertido do músculo inferior da incisão com o parte lateral da órbita (ligamento cantal externo).
Sutura também intradérmica e naylon 6.0.
Os pontos são retirados em media com 7 dias

Pós operatório:
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4)Soro glicosado 5% 1000ml ev 12/12 h
5)novalgina 2ml ev 6/6 h se necessario
6)plasil 8/8 h se necessário
7) compressas frias ou geladas

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