Latissimus Flap for Chest Wall Reconstruction (NOT Breast Recon)

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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 
    • ~2 hours before surgery or 5am if inpatient.
      • Tylenol 975mg PO x1
      • Gabapentin 600mg PO x1
      • Celebrex 400mg PO x1
  • Instrument Sets
    • Breast & Body Set
  • Surgical Packs
    • Body
  • Intra-operative Medications – RN TO PULL
    • Ancef 2 grams IV (ok if allergic to Penicillins).
    • Vancomycin 1g IV (if allergic to Ancef)
    • Infiltration Solution (Dr. Brown will inject):
      • NS or LR 500 mL
      • Ropivicaine 300mg
      • Clonidine 0.3mg
      • Dexamethasone 4mg
      • Epinephrine 2mg
  • Post-operative Medications (Prescribed pre-op)
    • Tylenol 650mg PO q6 hours scheduled
    • Methocarbamol 1500mg PO q6 hours scheduled
    • Gabapentin 300mg PO PO q6 hours scheduled  (if not too expensive)
    • Ancef 2g IV q8 hours OR Vancomycin 1g IV q12 with pharmacy consult for dosing.
    • Celebrex 200mg PO BID scheduled for first 48 hours OR Toradol while inpatient
    • 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 with paralytic at beginning of case only.  ~30 min of paralytic
  • Patient Position
    • Lateral Decubitus with operative side UP.  I do not need to move the arm intra-op.  The arm will only be prepped to the elbow. Axilla accessible in field.
    • Bean bag
    • Axillary roll
    • Special head pillow
  • Bed Attachments
    • Arm board for the arm that is DOWN
    • Arm holder (like they use in shoulder cases) for arm that is UP but both will be on the same side of the bed.
      • For right sided wound, right side up, left side down, both attachments on the left side.
      • For left sided wound, left side up, right side down, both attachments on the right side.
  • Patient Warming
    • Lower body Bair Hugger.  Mid buttock inferiorly.  Any higher and it might be in my way.
  • DVT Prophylaxis
    • Bilateral SCDs in OR.  ON and working BEFORE induction of anesthesia.
  • Foley Catheter
    • Yes – secured inSCD
  • Off Sterile Field on Side Table (to be used before prep)
    • None
  • Surgical Prep (CART)
    • Chloraprep for intact skin x 4
    • Betadine scrub and Paint for open wounds.
  • Irrigation Solutions – PULL
    • Warmed Normal Saline on field.
    • Also have these if there is an open wound.
      • Hydrogen Peroxide if there is an open wound.
      • 1L NS or LR hooked up to BATTERY powered Pulse-Lavage
  • Blades (CART)
    • 10 x 3
    • 15 x 1
  • Bovie (CART)
    • Short Protected ENT tip x 1
    • Long Protected tip x 1
    • Set at coagulate 60 fulgurate /  cut 60 pure
  • Suture (CART)
    • 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 2
  • Drains (CART)
    • 10mm flat perforated drains with 100mL bulb suction
  • Additional Supplies (CART)
    • Marking pen, Paper Ruler x 4
    • 18G Spinal needle x 2
    • 60cc Leur Lock syringes x2
  • Dressing (CART)
    • Dermabond for back
    • Mastisol and Wide Long Steri strips for chest.
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