Breast Reconstruction with pedicled TRAM flap

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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 (Dr. Brown will inject):
      • NS or LR 500 mL
      • Ropivicaine 300mg
      • Clonidine 0.3mg
      • Dexamethasone 4mg
    • Nitrobid ointment to rub on mastectomy skin flaps.  2 packs for each side.
  • 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
    • 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, Able to sit up 90 degrees (make sure bed can do this)
  • Bed Attachments
    • Arm boards, Ulnar nerve pads, Kerlex
  • Patient Warming
    • Bair Hugger (mid thigh & down)
    • IV fluid warmer
  • DVT Prophylaxis
    • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
  • Foley Catheter
    • Yes – have tubing run down leg and secured in SCD
  • Instrument Sets
    • Breast & Body OR Minor plastic set
    • Long, skinny retractor
  • Surgical Packs
    • Breast
  • Surgical Prep
    • Chloraprep neck to mid thigh x 6
  • 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
    • 10 x 2
    • 15 x 1
  • Bovie
    • Short Protected ENT tip x 1
    • Long protected tip x 1
    • Set at coagulate 60 fulgurate /  cut 60 pure
  • Suture
    • #1 Prolene on large 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 3
    • 2-0 Nylon Large cutting x 2 for drains
  • Drains
    • 10mm perforated flat JP drain, on trocar if available, 100mL bulb suction
  • Additional Supplies
    • Medium oval Ventrio Hernia patch 11cm x 14cm (do not open) – have two in room
    • Marking pen, Paper Ruler
    • 18G spinal, 60cc syringe for injection of local on field
  • Dressing
    • Wide Long Steri strips and Mastisol
    • Fluffed Kerlex (1 roll)
    • Xeroform for umbilicus
    • Incisional wound vac – medium/large black or silver sponge
    • Adaptic x 5
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