Free Omentum Flap to Upper Extremity for Lymphedema

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  • Dr. Brown
    • Gown – XL, XL length
    • Gloves – 8.0 Indicator glove, 7.5 Biogel glove
  • Dr. Chandler
    • Gown – L
    • Gloves – 5.5, 6 only if 5.5 unavailable
  • Sean Kirby PA-C
    • Gown: XL
    • Gloves – 7.5 under glove, 7 over glove
  • Pre-operative Medications (prescribed pre-0p)
    • Night before:
      • Scopolamine patch placed behind ear
      • Shower with Hibiclens for couple days before surgery 4% topical chlorhexidine soap.
    • At check in for surgery with a sip of water:
      • 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 PRE-OP ORDERS
      • NS or LR 500 mL
      • Ropivicaine 300mg
      • Clonidine 0.3mg
      • Dexamethasone 4mg
  • 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)
    • Cephalexin 500mg PO q6 hours scheduled for 4 doses starting after surgery
    • Celebrex 200mg PO BID scheduled (if not too expensive)
    • 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
    • Aspirin
    • Lovenox
  • Anesthesia
    • Anesthesia choice
  • Patient Position
    • Supine
  • Bed Attachments
    • Hand table
  • Patient Warming
    • Bair Hugger
    • IV fluid warmer
    • Arctic Sun under body warmer
  • DVT Prophylaxis
    • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
  • Foley Catheter
    • Yes
  • Instrument Sets
    • Major Plastic Set
    • Microsurgery Set
    • Advanced Laparoscopy set / Nissen set
    • Harmonic Maryland Dissector (laparoscopic)
  • Surgical Packs
    • Laparoscopic
    • Extremity
  • Surgical Prep
    • Chloraprep x 5
  • Irrigation Solutions
    • Warmed Normal Saline
    • Sterile water in basin for washing instruments
    • Iodine/Antibiotic Solution:   PHARMACY TO PREPARE, IN PRE-OP ORDERS
      • Ancef 2g
      • Genamycin 160mg
      • 100mL of full strength 10% stock providone-iodine (This is PAINT not scrub)
      • Mixed into 880cc Normal Saline
    • Heparin Vessel Irrigation PHARMACY TO PREPARE, IN PRE-OP ORDERS
      • 10,000 units in 500mL LR.
  • Blades
    • 15 x 2
    • 10 x 3
  • Bovie
    • Short Protected ENT tip x 2
    • Set at coagulate 40 fulgurate /  cut 40 pure
    • Bipolar at 22.  Need special disposable bipolars.  Disposable Kirwan Bipolar Forceps, 0.5mm, www.KSP.com. Ref# 19-3002AU
  • Suture
    • 2-0 PDS Large taper x 4
    • 3-0 Monocryl Large cutting x 3
    • 3-0 v-Loc (absorbable) Long, Large Cutting x 2
    • 5-0 fast gut – have in room but do not open
    • 2-0 Nylon Large cutting x 2
    • 8-0 Nylon microsuture BV 130-5 – ETHICON ONLY, not Covidien x 3
  • Drains
    • 10mm flat drain, on trocar if available, 100mL bulb suction
  • Additional Supplies
    • Marking pen, Paper Ruler x 4
    • Synovis Flow Coupler Monitor
    • Microscope on side of operative arm
    • Light source and cord to transilluminate omentum after removed
    • SPY
    • Pencil Doppler, sterile
    • Electrolube and sponge
    • Large yellow Lone Star Retractors
    • Small and Medium Clip appliers
  • Dressing
    • Xeroform x 3
    • Bacitracin
    • Soft roll x 2
    • Cling wrap x 2
    • 4in plaster
    • ACE 4″ x 3

 

ROOM SET UP
NOTHING MAGNETIC ON FIELD, THROW ALL AWAY BEFORE INSTRUMENTS CAN TOUCH
Microscope in Room but out of the way, drape
Arctic Sun stuck to back or underbody Bair Hugger
IV Fluid Warmer
Saline irrigation warmer
Head padded with gel donut or foam.
Non-op arm out, well padded with foam sleds, kerlex secured. Operative arm on hand table.
Heels padded. Strap around thighs.
Lower body Bair Hugger, mid thighs down
SCDs
Foley with temp sensor
Chloraprep
Rolling stool on each side for Dr. Brown
Pencil doppelr box hanging on IV pole for anesthesia to turn on/off, sterile pencils and cord, lube
Synovis Flow Coupler box on IV pole ready to be hooked up
Dr. Brown – Long XL gown, 8 indicators, 7.5 Biogels
Electrolube and sponge on field
MICROSURGERY MAYO
Nylon Suture 8-0 BV 130-5
6 Weck Cell sponges (eye spears)
10mL syringe of hep saline on ~22G angiocath x2 (10,000 units in 500mL)
Rizutti (clamp applying forceps)
Disposable bulldog vessel clamp – single (green) x1
Disposable bulldog vessel clamp – double (yellow) x1
Synovis Venous coupling device itself
Coupler measuring device (stick with knobs)
Couplers of varying sizes off field but available 2mm-3.5mm
Curved micro needle driver S&T B-18-8.2 x2
Curved micro scissors x2
Straight micro scissors
curved dilators
Striaght jewlers forceps x2
Straight platform forceps x2
Micro Debakey’s x2
Synovis Flow Coupler on back table
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Merocel instrument sponge
Micro background
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