Latissimus Flap Preference Card

  • This Card is to be used for:

    • All cases with latissimus pedicled flap (for breast reconstruction or chest wound reconstruction)

    • If it is a latissimus free flap, please refer to DIEP flap preference card but refer to latissimus preference card for positioning

  • 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:

    • None

  • 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

  • Patient Position

    • 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.

    • Bean bag

    • Axillary roll

    • Special head pillow which can be decided per anesthesia

    • One pillow under patient’s knees

    • Foam pad wrapped around patient’s heel

  • Bed Attachments

    • Arm board for the arm that is DOWN

    • Arm holder (like they use in shoulder cases – lateral positioning device) for arm that is UP

      • Both arms will be on the same side of the bed.

        • For right sided wound or breast, right side up (right latissimus will be transferred), left side down, both attachments on the left side.

        • For left sided wound or breast, left side up (left latissimus will be transferred), right side down, both attachments on the right side.

  • 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

    • Breast Set

    • Body Set

  • Surgical Packs

    • Body Pack

  • Surgical Prep

    • Chloraprep x 5 – place in fluid warmer prior to use

    • If for chest wound reconstruction, we will need Betadine for the wound

  • 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

    • Medium Suction with Yankeur tip

  • Blades

    • 10 x 3

    • 15 x 1

  • Bovie

    • Short Protected ENT tip  x2

    • Long Protected ENT tip x 1

    • Set at coagulate 40 fulgurate /  cut 40 pure

  • Drains

    • 15Fr Round JP drain, on trocar if available x 2 

    • 100mL bulb suction x 2

    • One drain for the back, one for the breast/chest

  • Additional Supplies

    • Marking pen x 6

    • Paper Ruler x 2 

  • Dressing

    • Mastisol x 4 

    • 1 inch steri strips x 3 packs

    • Dermabond x 4 for the back

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