DIEP Flap Preference Card

  •  This Card is to be used for:
    • Delayed DIEP flaps
    • Immediate DIEP Flaps
  • Dr. Brown:
    • Gown – XL, XL Length
    • Gloves – 8 Indicator Glove, 7.5 Biogel Glove
  • Dr. Chandler:
    • Gown – L
    • Gloves – 5.5, 6.0 if 5.5 unavailable
  • Sean Kirby PA-C:
    • Gown – XL
    • Gloves – 7.5 Indicator Glove, 7 Nonlatex Glove
  • Pre-operative Medications:
    • Lovenox 40mg to be injected in preop prior to rolling to OR to be injected in thigh
  • Intra-operative Medications
    • Ancef 2 grams IV or Vancomycin 1g IV to be administered in pre-op prior to procedure
    • Infiltration Solution (PHARMACY TO PREPARE, IN PRE-OP ORDERS):
      • NS or LR 500 mL
      • Ropivicaine 300mg
      • Clonidine 0.3mg
      • Dexamethasone 4mg
    • Heparin Solution (PHARMACY TO PREPARE, IN PRE-OP ORDERS:
      • Heparin 10000 units in 500mL normal saline – place in 10mL syringe with 24 angiocath tip
    • Papaverine 30mg/mL – 2mL in 3mL syringe – have in room but do not open
    • Nitrobid ointment to rub on mastectomy skin flaps at the end of the case.  Two (2) packs for each side.
  • Patient Position
    • Supine
    • The bed must be able to sit up 90 degrees for abdominal closure
    • One pillow under patient’s knees
    • Foam pad wrapped around patient’s heel
  • Bed Attachments
    • Arm boards with purple pads underneath arms and then wrap the arms in Kerlix
    • Martin’s arm on the other side of the microscope
  • Patient Warming
    • Blanketrol, Arctic Sun, or underbody warmer
    • IV fluid warmer
    • Sterile fluid warmer with 2L of Normal Saline
  • 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
    • DIEP Set
    • Microsurgery Set
    • Breast Set
  • Surgical Packs
    • DIEP/Micro Pack
  • Surgical Prep
    • Chloraprep x 5 – place in fluid warmer prior to use
  • Irrigation Solutions
    • Warmed Normal Saline (as mentioned in patient warming)
    • 1L sterile water in basin for washing instruments
    • Iodine/Antibiotic Solution:
      • Ancef 2g
      • Gentamycin 160mg
      • 100mL of full strength 10% stock providone-iodine (This is PAINT not scrub)
      • Mixed into 1L Normal Saline
  • Suction
    • When under the microscope, turn one suction system to low suction power
  • Blades
    • 10 x 4
    • 15 x 1
    • 11 x 1
  • Bovie
    • Short Protected ENT tip  x2
    • Long Protected ENT tip x 1
    • Set at coagulate 40 fulgurate /  cut 40 pure
    • Bipolar x 2 
    • Will need two BOVIE and two BIPOLAR for case
  • Drains
    • 10mm perforated flat JP drain, on trocar if available x 4 
    • 100mL bulb suction x 4 
  • Additional Supplies
    • Marking pen x 6
    • Paper Ruler x 2 
    • Ventrio Mesh Patch 11cm x 14 cm – TWO OF THEM
    • Eight (8) AA batteries for the Flow Coupler Black Box
    • Flow Coupler Black Box
    • Flow Couplers, Sizes 2.0, 2.5, and 3.0 (must keep minimum of two of each)
    • Regular Coupler Devices, Sizes 1.5, 2.0, 2.5, 3.0, 3.5 (must keep minimum of two of each)
    • Lonestar x 2
    • Weck Cel x 1 pack
    • Merocel x 1 piece
    • Bulldog Vessel Clamps – one single and one double
    • Synovis Microsurgery Background
    • 8-0 Nylon Suture x 3, Mfr#2808G
    • Scale to weigh flaps
  • Dressing
    • Mastisol x 4 
    • 1 inch steri strips x 3 packs
    • Mepilex Ag Border Dressing x 3

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