Brachioplasty & Thighplasty

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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
    • 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).  Please start infusion in prep
    • Infiltration Solution for breasts (PHARMACY to prepare, in pre-op order set – NO EPI):
      • NS or LR 500 mL
      • Ropivicaine 300mg   OR  (Bupivicaine 150mg = 30mL of 0.5% Bupivicaine)
      • 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
  • Post-operative Medications (Prescribed pre-op)
    • Tylenol 650mg PO q6 hours scheduled
    • Methocarbamol 1500mg PO q6 hours scheduled
    • Gabapentin 300mg PO q6 hours scheduled x3 days
    • Celebrex 200mg PO BID x3 days
    • 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
    • Anesthesia choice.  IV in either hand is ok.  Hands will not be in the field.
    • Will do Thighs first, rolling side to side. then prep and drape and do arms at the end.
    • Start with BP cuff on arms, then move to legs.
  • Patient Position
    • Supine, able to roll side to side for thighs.
  • Bed Attachments
    • Arm boards, Ulnar nerve pads, Kerlex
  • Patient Warming
    • Bair Hugger.  Upper body at beginning.  Lower body if needed when working on arms.
    • IV fluid warmer
  • DVT Prophylaxis
    • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.  Will prep them in using stockinettes & Coban
  • Foley Catheter
    • Yes.  Run tubing through SCD so it won’t pull catheter.
  • Instrument Sets
    • Body
  • Surgical Packs
    • Body
    • Stockinettes for legs so SCDs can stay on.
  • Surgical Prep
    • Chloraprep x4.  Place in fluid warmer prior to use.
  • Irrigation Solutions – PULL
    • Warmed Normal Saline
    • Sterile water in basin for washing instruments
    • Standard irrigation solution (PHARMACY TO PREPARE, IN PRE-OP ORDER SET)
      • NS 1L
      • Ancef 2g
      • Gentamicin 160mg
      • Betadine Paint (10% Povidone-Iodine) 100mL
  • Blades (CART)
    • 11 x 2
    • 10 x 3
  • Bovie (CART)
    • Short Protected ENT tip x 1
    • Short unprotected tip x 1
    • Set at coagulate 60 fulgurate /  cut 60 pure
  • Suture (CART)
    • 2-0 PDS Large taper x 6
    • 3-0 Monocryl Large cutting x 6
    • 4-0 Nylon x 6
    • 2-0 Nylon Large cutting x 2
  • Drains (CART)
    • 10mm flat perforated Drain on Trocar with 100mL Bulb Suction
  • Additional Supplies (CART)
    • Marking pen x 4
    • Paper Ruler
  • Dressing (CART)
    • Bacitractin
    • Xeroform
    • Kerlex
    • Paper tape
    • Compression Garments
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