Abdominoplasty + Liposuction Flanks/Back + Fat Transfer to C-Points

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  • 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 (prescribed Pre-op)
    • 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 (PHARMACY TO PREPARE, IN PRE-OP ORDER SET):
      • NS or LR 500 mL
      • Ropivicaine 300mg
      • Clonidine 0.3mg
      • Dexamethasone 4mg
    • Tumescent solution for Liposuction
      • 1L LR or NS + 2 amps of 1:1000 epi
      • Be able to make approximately 1-5 bags of this depending on amount of fat to be sucked out.
      • Place in towel/blanket warmer
    • Ancef 1g and Vancomycin 1g reconstituted into 10mL syringes to “squirt” from off the field to on the field – into the fat graft solution before Dr. Brown injects the fat.
    • 2G if Vancomycin powder for abdominal closure
  • Post-operative Medications (Prescribed pre-op)
    • Tylenol 650mg PO q6 hours scheduled
    • Methocarbamol 1500mg PO q6 hours scheduled
    • Gabapentin 300mg PO q6 hours scheduled
    • Cephalexin 500mg PO q6 hours scheduled for 4 doses starting after surgery
    • 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
    • GETA.  Will need paralysis during abdominal wall plication.
    • Easy on the IV fluids as I will be infusing a tumescent solution.
  • Patient Position
    • Supine and Lateral
    • Will roll side to side during prep and case for flank and back liposuction.  Please perform circumferential prep.
    • Will need to reflex hips during closure.
  • Bed Attachments
    • Arm boards, Ulnar nerve pads
    • No kerlex – only straps because we will be rolling into lateral multiple times.
  • Patient Warming
    • Lower Body Bair Hugger AND upper body bair hugger AFTER liposuction and fat grafting.
    • Place Liposuction tumescent into towel warmer.
    • Place Chloroprep sticks into towel warmer.
    • IV fluid warmer for anesthesia
  • DVT Prophylaxis
    • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
  • Foley Catheter
    • YES.  Run tube thru part of an SCD so it won’t pull on bladder when we roll side to side.
  • Instrument Sets
    • Breast & Body or Minor plastic set.
    • Need long narrow retractor for abdominal plication
    • Power Liposuction System (Vibrastat or Microaire)
  • Surgical Packs
    • 3/4 sheet x2
    • Universal pack
  • Surgical Prep
    • Chloraprep circumferential.   Will need 8 sticks, pre-warmed in towel warmer.
  • 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
    • 11 x 1
    • 10 x 2
  • Bovie
    • Short Protected ENT tip x 2
    • Long protected ENT tip x 2
    • 60/60 pure and fulgarate
  • Suture
    • #1 Prolene – largest taper needle x 2
    • 2-0 PDS Large taper x 8
    • 3-0 Monocryl Large cutting x 6
    • 3-0 v-Loc (absorbable) Long, Large Cutting x 2
    • 4-0 Plain Gut Large cutting (have in room, do not open)
    • 2-0 Nylon Large cutting x 2
  • Drains
    • 10F perforated flat JP drain, on trocar if available, 100mL bulb suction
  • Additional Supplies
    • Marking pen, Paper Ruler
    • 18G Spinal needles and 60cc syringes for infiltration
    • Absorbable antibiotic beads – Stimulan
  • Dressing
    • Mastisol
    • Wide Long Steri strips
    • Xeroform for umbilicus
    • Kerlex to fluff under binder/bra

 

Order of procedure:

  1. circumferential prep:  side, tuck, other side, anterior then universal drapes
  2. set up liposuction and fat grafting systems.    Infusion tubing will start on sterile field, pass spike off field to insert into tumescent bag.     This tubing will then be passed thru the pump.   The remaining sterile end will go onto the 5mm basket or double basket liposuction cannula which may require an adapter depending on the type of infusion tubing used.    The suction tubing will consist of 2 tubes.  One sterile tube from lipo cannula to sterile cannister then a second tube from sterile cannister to the off field suction machine (that end will no longer be sterile).
  3. Anterior liposuction:  infuse tumescent, suck it out.  Collect fat in sterile canister on field.
  4. Right lateral liposuction:   infuse tumescent, suck it out.  Collect fat in sterile canister on field.
  5. Left lateral liposuction:   infuse tumescent, suck it out.  Collect fat in sterile canister on field.
  6. Process and homogenize fat:     Dr. Brown will then drain off the fluid from the bottom of the cannisters.  Nurse 1g Ancef and 1g Vancomycin into fat (reconstitute in a 10cc syringe and squirt into fat in cannister).  Dr. Brown will then homogenize the fat and split it in half using the 2 cannisters.
  7. Fat grafting into left butt while still in right lateral.  Close those incisions with 3-0 monocryl.
  8. Roll into left lateral with 5 rolled up towels wedged into waist to protect new hourglass shape on left
  9. Fat grafting into right butt while in left lateral.  Close those incisions with 3-0 monocryl.
  10. Supine for Abdominoplasty.  Will not need bovie or 10 blade until this step.
  11. Irrigate with NS, place one 15 round drain with trocar.  Suture in with 2-0 nylon.
  12. Close skin (0-vicryl, 3-0 monocryl, 3-0 barbed suture, 4-0 plain)
  13. Dressings (mastisol and long wide steris, fluffed kerlex, loose binder)
  14. Transfer to stretch KEEPING the patient in the reflex position.
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