Positioning Techniques in Surgical Applications - part 8

Bụng, nách, transdeltoid truy cập vào các khớp vai, xương đòn và khớp acromioclavicular cho gãy xương, pseudarthrosis, không thẳng hàng posttraumatic, sự sai khớp xương, sự mất ổn định, khối u, viêm và vỡ của dây chằng bắp tay. | 218 Chapter 17 Upper extremities Shoulder Supine position D Figs. . Indications Ventral axillary transdeltoid access to the shoulder joint access to the clavicle and to the acromioclavicular joint for fractures pseudarthrosis posttraumatic misalignment luxation instability tumours inflammation and rupture of the biceps tendon. Preparations 4 Arm positioning devices 4 Remove Gilchrist bandage 4 Gel ring 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Standard operating table position 1 position 2 or universal operating table with X-ray protection clavicle remains available for scanning 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Crosswise positioning of the operating table in the theatre 4 When positioning the patient take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 Tilt the operating table in the Trendelenburg position raise the back plate by 20-30 lower the leg plates and the head section by hand 4 Position the head on a gel ring possibly slightly turned to the other side and reclined 4 Position the infusion arm on an arm positioning device 4 Pad the shoulder with a positioning aid thus raising the operating site or joint being operated 4 Cover the arm on the side being operated while leaving it free to move and position it at the body with arm protection or place it on the arm positioning device 4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system 219 Shoulder 17 o Fig. . Supine position with arms positioned at the body arm protection with padding o Fig. . Supine position on special shoulder plate with the advantage of scanning and the head on a one-piece horseshoe-shaped headrest 220 Chapter 17 Upper extremities Beach-chair position D Figs. . .