Pressure Ulcer Excision and VAC

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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
  • Instrument Sets
    • Minor plastic set (need knife handle, skin hooks, Alice/Lehey/Kocher)
    • Small Bone set (need large currettes and large rongeurs and mallet and osteotomes).
  • Surgical Packs
    • Horizontal Laparotomy
  • Intra-operative Medications – RN TO PULL
    • Ancef 2 grams IV (ok if allergic to Penicillins).
    • Vancomycin 1g IV (if allergic to Ancef).
    • Scheduled antibiotics if inpatient
    • Infiltration Solution (Dr. Brown will inject):
      • NS or LR 500 mL
      • Ropivicaine 300mg
      • Lidocaine 500mg = 50mL of a 1% solution
      • Clonidine 0.3mg
      • Epinephrine 2mg
  • Anesthesia
    • Anesthesia choice.  If insensate in area (usually the case) can do local only or MAC and local.
    • Duration of this procedure is generally less than 30 min.
  • Patient Position
    • Prone or Lateral Decub.   Circulating nurse and Anesthesia to choose.
  • Bed Attachments
    • Arm boards
    • Arm holder if in lateral decubitus position
  • Patient Warming
    • Bair Hugger
  • DVT Prophylaxis
    • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
  • Foley Catheter
    • No
  • Surgical Prep (CART)
    • Chloraprep intact skin x 2
    • Betadine scrub and Paint open wounds
  • Irrigation Solutions – PULL
    • Warmed Normal Saline
    • Hydrogen Peroxide in basin mixed 50-50 with normal saline
  • Blades (CART)
    • 10x 2
  • Bovie (CART)
    • Short Protected ENT tip x 1
    • Set at coagulate 80 fulgurate /  cut 60 pure
  • Suture (CART)
    • NONE
  • Drains (CART)
    • NONE
  • Additional Supplies (CART)
    • Marking pen, Paper Ruler x 4
    • 18G spinal needle x 2
    • 60cc leur lock syringe x 2
    • wound culture swabs x2 for pre debridement and post debridement
      • Send for Aerobic, Anerobic, Gram Stain, Fugal, AFB
    • Skin to path:  rule out malignancy and vasculitis
    • Bone to path:  evaluate for osteomyelitis
  • Dressing (CART)
    • Mastisol
    • Wound VAC machine and Sponge kit (regular Black one) large size to make bridge around to anterior side so they don’t lie on hose and get pressure ulcer from that.
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