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This Card is to be used for:
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All cases with latissimus pedicled flap (for breast reconstruction or chest wound reconstruction)
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If it is a latissimus free flap, please refer to DIEP flap preference card but refer to latissimus preference card for positioning
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Dr. Brown:
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Gown – XL, XL Length
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Gloves – 8 Indicator Glove, 7.5 Biogel Glove
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Dr. Chandler:
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Gown – L
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Gloves – 5.5, 6.0 if 5.5 unavailable
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Sean Kirby PA-C:
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Gown – XL
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Gloves – 7.5 Indicator Glove, 7 Nonlatex Glove
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Pre-operative Medications:
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None
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Intra-operative Medications
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Ancef 2 grams IV or Vancomycin 1g IV to be administered in pre-op prior to procedure
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Infiltration Solution (PHARMACY TO PREPARE, IN PRE-OP ORDERS):
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NS or LR 500 mL
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Ropivicaine 300mg
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Clonidine 0.3mg
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Dexamethasone 4mg
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Patient Position
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Lateral Decubitus with operative side UP. I do not need to move the arm intra-op. The arm will only be prepped to the elbow. Axilla accessible in field.
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Bean bag
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Axillary roll
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Special head pillow which can be decided per anesthesia
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One pillow under patient’s knees
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Foam pad wrapped around patient’s heel
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Bed Attachments
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Arm board for the arm that is DOWN
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Arm holder (like they use in shoulder cases – lateral positioning device) for arm that is UP
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Both arms will be on the same side of the bed.
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For right sided wound or breast, right side up (right latissimus will be transferred), left side down, both attachments on the left side.
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For left sided wound or breast, left side up (left latissimus will be transferred), right side down, both attachments on the right side.
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Patient Warming
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Blanketrol, Arctic Sun, or underbody warmer
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IV fluid warmer
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Sterile fluid warmer with 2L of Normal Saline
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DVT Prophylaxis
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Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia
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Foley Catheter
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Yes – have tubing run down leg and secured in SCD
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Instrument Sets
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Breast Set
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Body Set
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Surgical Packs
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Body Pack
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Surgical Prep
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Chloraprep x 5 – place in fluid warmer prior to use
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If for chest wound reconstruction, we will need Betadine for the wound
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Irrigation Solutions
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Warmed Normal Saline (as mentioned in patient warming)
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1L sterile water in basin for washing instruments
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Iodine/Antibiotic Solution:
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Ancef 2g
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Gentamycin 160mg
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100mL of full strength 10% stock providone-iodine (This is PAINT not scrub)
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Mixed into 1L Normal Saline
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Suction
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Medium Suction with Yankeur tip
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Blades
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10 x 3
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15 x 1
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Bovie
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Short Protected ENT tip x2
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Long Protected ENT tip x 1
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Set at coagulate 40 fulgurate / cut 40 pure
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Drains
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15Fr Round JP drain, on trocar if available x 2
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100mL bulb suction x 2
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One drain for the back, one for the breast/chest
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Additional Supplies
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Marking pen x 6
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Paper Ruler x 2
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Dressing
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Mastisol x 4
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1 inch steri strips x 3 packs
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Dermabond x 4 for the back