Extremity Expansion with Tissue Expanders

Print Card

  • Dr. Brown:
    • Gown – XL, XL Length
    • Gloves – 8 under glove, 7.5 over glove
  • Dr. Chandler:
    • Gown – L
    • Gloves – 5.5, 6 if no 5.5 available
  • Sean Kirby PA-C:
    • Gown – XL
    • Gloves – 7.5 Indicator Glove, 7 Nonlatex Glove
  • Pre-operative Medications
    • Night before:
      • Scopolamine patch placed behind ear
      • Shower with Hibiclens for couple days before surgery 4% topical chlorhexidine soap.
    • Upon check in for surgery:
      • Tylenol 975mg PO x1
      • Gabapentin 600mg PO x1
      • Celebrex 400mg PO x1
  • Intra-operative Medications
    • Ancef 2 grams IV (ok if allergic to Penicillins).
    • Vancomycin 1g IV (if allergic to Ancef)
    • Infiltration Solution (Dr. Brown will inject):  PHARMACY TO PREPARE – IN PREOP ORDERS
      • NS or LR 500 mL
      • Ropivicaine 300mg
      • Clonidine 0.3mg
      • Dexamethasone 4mg
    • Nitrobid ointment to rub on skin flaps at the end of the operation.  2 packs for each side.
  • Post-operative Medications (Prescribed pre-op)
    • Tylenol 650mg PO q6 hours scheduled
    • Methocarbamol 1500mg PO q6 hours scheduled
    • Gabapentin 300mg PO q6 hours scheduled
    • Celebrex 200mg PO BID for 2 days
    • Vancoymycin 1g IV q12 hrs, pharmacy to dose.  While in hospital.
    • Pericolace 1 tab PO BID scheduled
    • Phenergan 25mg PO q8 hours PRN nausea
    • Oxycodone 5mg tabs, 1-3 tabs PO q4 hours PRN pain
    • Ibuprofen 600mg PO q6 hours scheduled, starting 48 hours after surgery
  • Anesthesia
    • Anesthesia choice
  • Patient Position
    • Lateral.  Have patient prepped from midline back to midline abdomen.
  • Bed Attachments
    • Arm boards, Ulnar nerve pads, Kerlex.  Lateral positioning set.
  • Patient Warming
    • Bair Hugger
    • IV fluid warmer (hotline for anesthesia)
  • DVT Prophylaxis
    • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
  • Foley Catheter
    • Yes – secure in SCD
  • Instrument Sets
    • Breast & Body Set  OR
    • Minor plastic set with
      • Tebbetts retractor
      • Need a long skinny retractor.
  • Surgical Packs
    • Body
  • Surgical Prep
    • Chloraprep x 4
  • Irrigation Solutions
    • Warmed Normal Saline
    • Sterile water in basin for washing instruments
    • Iodine/Antibiotic Solution:
      • Ancef 2g
      • Genamycin 160mg
      • 100mL of full strength 10% stock providone-iodine (This is PAINT not scrub)
      • Mixed into 1000cc Normal Saline
  • Blades
    • 10 x 2
    • 15 x 1
  • Bovie
    • Short Protected ENT tip x 1
    • Long Protected ENT tip x 1
    • Set at coagulate 40 fulgurate /  cut 40 pure
  • Suture
    • 2-0 PDS Large taper x 4
    • 3-0 Monocryl Large cutting x 4
    • 3-0 v-Loc (absorbable) Long, Large Cutting  x 2
    • 2-0 Nylon Large cutting x 1 for drains
  • Drains
    • 10mm perforated flat JP drain, on trocar if availalbe, 100mL bulb suction
  • Additional Supplies
    • Marking pens, Paper Ruler
    • 18G spinal, 60cc syringe for injection of local x2
    • Injectable saline 1 Liter  for TEs (end of case)
    • Facility to order and provide:
      • Tissue Expanders see consult note and orders
      • Acellular Dermal Matrix
  • Dressing
    • Dermabond or similar
    • NitroBid oinment, 2 packs per side
    • For each drain:  Biopatch + 1/2 of a medium Tegaderm
Print Card