Информированное согласие на круропластику
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Согласие пациента на операцию по коррекции формы голеней с помощью эндопротезов
Цель данного документа - предоставить пациенту до подтверждения им согласия на операцию полную информацию об особенностях послеоперационного периода и осложнениях, которые могут возникать при данном виде лечения.
Ф. И. О. Пациента _______________________________________________________________________________________________________________
1. Я уполномочиваю доктора ______________________________________________________ (далее - Врача) и его ассистентов выполнить мне операцию по коррекции формы голеней (увеличение объема внутренней части голени) с помощью эндопротезов
(эндопротезирование).
2. Содержание и результаты операции, возможные опасности и осложнения, а также возможности альтернативных методов лечения мне полностью объяснены Врачом, и я их полностью поняла.
Особенно важными и полностью ясными для меня являются следующие положения об особенностях послеоперационного периода:
а) операция направлена на коррекцию формы голеней однако ее отдаленные результаты зависят от многих факторов и не могут быть заранее определены на много лет вперед;
б) многолетними исследованиями доказано, что материал, помещаемый в ткани для увеличения объема внутренней поверхности голеней, не вызывает со временем злокачественного роста тканей или увеличения частоты развития других
заболеваний;
в) форма голеней зависит от многих факторов, и операция, как правило, не может привести к созданию идеальной формы;
г) после операции на месте разрезов остаются постоянные рубцы; их качество не может быть в полной мере предсказано, так как процессы формирования рубцов индивидуальны;
д) после купания в холодной воде температура голеней в течение некоторого времени может быть ниже, чем температура других тканей тела;
3. После операции возможно развитие любых общехирургических осложнений (нагноение раны, кровотечение, тромбофлебит, тромбоэмболия, образование келоидных рубцов и др.), а также следующих осложнений, характерных для данной операции:
а) у некоторых пациентов с тонкой кожей могут ощущаться края протезов; вероятность этого связана и с конструкцией протезов;
б) в незначительном проценте случаев существует возможность того, что ткани организма не переносят материал импланта, что может потребовать удаления протезов;
в) в 3 - 5% случаев голени со временем могут стать более плотными в результате образования более грубой капсулы (рубцовой оболочки) вокруг протеза и развития капсулярной контрактуры (утолщение и сжатие рубцов вокруг протеза); это
состояние может вызвать дискомфорт и даже боль и потребовать проведения повторной операции (рассечение рубцов с установкой того же или нового протеза);
r) вокруг протезов могут возникать послеоперационные скопления крови или развиваться нагноение; это может потребовать проведения дополнительных операций.
д) Оболочка имплантата изготовлена из прочного силиконового эластомера, однако, в результате сильного давления или удара, а также по неустановленным причинам в некоторых случаях бывают разрывы оболочки, что требует удаления
имплантата. Повторная операция по установке имплантатов возможна через некоторый срок, который индивидуален.
4. Я понимаю, что практическая хирургия это не точная наука и что даже авторитетный специалист не может дать стопроцентную гарантию успеха лечения. Поэтому Врач, так же как и любой другой хирург, не. может мне гарантировать
достижение отличного результата.
5. Я понимаю, что две половины человеческого тела всегда имеют различия в форме и размерах и эти различия остаются после операции.
6. Мне неизвестно о моей повышенной чувствительности к медикаментам, кроме__________________________________________________________________________________
Я удостоверяю, что Я ознакомилась с приведенной выше информацией, что полученные мной объяснения меня полностью удовлетворяют и что Я полностью понимаю назначение данного документа, и подтверждаю свое согласие на операцию.
Пациент:____________ Дата: _______________
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[1] => Array
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[2] => Array
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[TEXT] => Информированное согласие на подтяжку груди
[LINK] => /plastika-grudi/podtyazhka-grudi/informirovannoe-soglasie-na-podtyazhku-grudi/
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[3] => Array
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[TEXT] => Показания к подтяжке груди
[LINK] => /plastika-grudi/podtyazhka-grudi/pokazaniya-k-podtyazhke-grudi/
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[4] => Array
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[TEXT] => Противопоказания к подтяжке груди
[LINK] => /plastika-grudi/podtyazhka-grudi/protivopokazaniya-k-podtyazhke-grudi/
[SELECTED] =>
[PERMISSION] => R
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[3] => Array
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[TEXT] => Уменьшение груди
[LINK] => /plastika-grudi/umenshenie-grudi/
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[PERMISSION] => R
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(
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[0] => Array
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[TEXT] => Договор на уменьшение груди
[LINK] => /plastika-grudi/umenshenie-grudi/dogovor-na-umenshenie-grudi/
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[PERMISSION] => R
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[1] => Array
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[TEXT] => Информированное согласие на уменьшение груди
[LINK] => /plastika-grudi/umenshenie-grudi/informirovannoe-soglasie-na-umenshenie-grudi/
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[1] => Array
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[TEXT] => Пластика лица
[LINK] => /plastika-lica/
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[ADDITIONAL_LINKS] => Array
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)
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[0] => Array
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[TEXT] => Блефаропластика
[LINK] => /plastika-lica/blefaroplastikaplastika/
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[0] => Array
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[TEXT] => Договор на блефаропластику
[LINK] => /plastika-lica/blefaroplastikaplastika/dogovor-na-blefaroplastiku/
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[PERMISSION] => R
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[1] => Array
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[TEXT] => Информированное согласие на блефаропластику
[LINK] => /plastika-lica/blefaroplastikaplastika/informirovannoe-soglasie-na-blefaroplastiku/
[SELECTED] =>
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[TEXT] => Золотые нити (нитевой лифтинг)
[LINK] => /plastika-lica/zolotie-niti/
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[0] => Array
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[TEXT] => Договор на нитевой лифтинг
[LINK] => /plastika-lica/zolotie-niti/dogovor-na-nitevoy-lifting/
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[PERMISSION] => R
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[1] => Array
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[TEXT] => Информированное согласие на нитевой лифтинг
[LINK] => /plastika-lica/zolotie-niti/informirovannoe-soglasie-na-nitevoy-lifting/
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[TEXT] => Ментопластика
[LINK] => /plastika-lica/mentoplastika/
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(
)
[ITEM_TYPE] => D
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[CHILD] => Array
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[0] => Array
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[TEXT] => Договор на отопластику ментопластику
[LINK] => /plastika-lica/mentoplastika/dogovor-na-otoplastiku-mentoplastiku/
[SELECTED] =>
[PERMISSION] => R
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[3] => Array
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[TEXT] => Отопластика
[LINK] => /plastika-lica/otoplastika/
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(
)
[ITEM_TYPE] => D
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[CHILD] => Array
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[0] => Array
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[TEXT] => Договор на отопластику
[LINK] => /plastika-lica/otoplastika/dogovor-na-otoplastiku/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
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[1] => Array
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[TEXT] => Информированное согласие на отопластику
[LINK] => /plastika-lica/otoplastika/informirovannoe-soglasie-na-otoplastiku/
[SELECTED] =>
[PERMISSION] => R
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[4] => Array
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[TEXT] => Пластика лба
[LINK] => /plastika-lica/plastika-lba/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
(
)
[ITEM_TYPE] => D
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[IS_PARENT] => 1
[CHILD] => Array
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[0] => Array
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[TEXT] => Договор на пластику лба
[LINK] => /plastika-lica/plastika-lba/dogovor-na-plastiku-lba/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
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[DEPTH_LEVEL] => 3
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[1] => Array
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[TEXT] => Информированное согласие на пластику лба
[LINK] => /plastika-lica/plastika-lba/informirovannoe-soglasie-na-plastiku-lba/
[SELECTED] =>
[PERMISSION] => R
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[DEPTH_LEVEL] => 3
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[5] => Array
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[TEXT] => Ринопластика
[LINK] => /plastika-lica/rinoplastika/
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[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
(
)
[ITEM_TYPE] => D
[ITEM_INDEX] => 44
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[0] => Array
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[TEXT] => Договор на ринопластику
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[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
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[DEPTH_LEVEL] => 3
[IS_PARENT] => 0
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[1] => Array
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[TEXT] => Информированное согласие на ринопластику
[LINK] => /plastika-lica/rinoplastika/informirovannoe-soglasie-na-rinoplastiku/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
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[ITEM_INDEX] => 46
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[ICON] =>
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[IS_PARENT] => 0
[PICTURE] => 4923
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[DEPTH_LEVEL] => 3
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)
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[6] => Array
(
[TEXT] => Фейслифтинг
[LINK] => /plastika-lica/feslifting/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
(
)
[ITEM_TYPE] => D
[ITEM_INDEX] => 47
[PARAMS] => Array
(
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[IS_PARENT] => 1
[CHILD] => Array
(
[0] => Array
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[TEXT] => Договор на фейслифтинг
[LINK] => /plastika-lica/feslifting/dogovor-na-feyslifting/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
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[ITEM_TYPE] => D
[ITEM_INDEX] => 48
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[IS_PARENT] => 0
[PICTURE] => 4925
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[DEPTH_LEVEL] => 3
[IS_PARENT] => 0
)
[1] => Array
(
[TEXT] => Информированное согласие на фейслифтинг
[LINK] => /plastika-lica/feslifting/informirovannoe-soglasie-na-feyslifting/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
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[ITEM_INDEX] => 49
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)
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[2] => Array
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[TEXT] => Пластика тела
[LINK] => /plastika-tela/
[SELECTED] => 1
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
(
)
[ITEM_TYPE] => D
[ITEM_INDEX] => 50
[PARAMS] => Array
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[SORT] => 500
[UF_TOP_SEO] =>
[ICON] =>
[TRANSPARENT_PICTURE] =>
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[PICTURE] => 4927
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[DEPTH_LEVEL] => 1
[IS_PARENT] => 1
[CHILD] => Array
(
[0] => Array
(
[TEXT] => Абдоминопластика
[LINK] => /plastika-tela/abdominoplastika/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
(
)
[ITEM_TYPE] => D
[ITEM_INDEX] => 51
[PARAMS] => Array
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[DEPTH_LEVEL] => 2
[IS_PARENT] => 1
[CHILD] => Array
(
[0] => Array
(
[TEXT] => Договор на абдоминопластику
[LINK] => /plastika-tela/abdominoplastika/dogovor-na-abdominoplastiku/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
(
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[ITEM_TYPE] => D
[ITEM_INDEX] => 52
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[DEPTH_LEVEL] => 3
[IS_PARENT] => 0
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[1] => Array
(
[TEXT] => Информированное согласие на абдоминопластику
[LINK] => /plastika-tela/abdominoplastika/informirovannoe-soglasie-na-abdominoplastiku/
[SELECTED] =>
[PERMISSION] => R
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)
)
[1] => Array
(
[TEXT] => Глютеопластика
[LINK] => /plastika-tela/gluteoplastika/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
(
)
[ITEM_TYPE] => D
[ITEM_INDEX] => 54
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[DEPTH_LEVEL] => 2
[IS_PARENT] => 1
[CHILD] => Array
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[0] => Array
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[TEXT] => Договор на глютеопластику
[LINK] => /plastika-tela/gluteoplastika/dogovor-na-glyuteoplastiku/
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[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
(
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[ITEM_INDEX] => 55
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[DEPTH_LEVEL] => 3
[IS_PARENT] => 0
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[1] => Array
(
[TEXT] => Информированное согласие на глютеопластику
[LINK] => /plastika-tela/gluteoplastika/informirovannoe-soglasie-na-glyuteoplastiku/
[SELECTED] =>
[PERMISSION] => R
[ADDITIONAL_LINKS] => Array
(
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О докторе
За 20 лет в пластической хирургии я выполнил сотни различных операций и выработал собственный подход и техники их исполнения.
