TRAM Flap Preference Card

  • This Card is to be used for:
    • All cases with pedicled TRAM flap breast reconstruction
    • If it is a free TRAM flap, please refer to DIEP flap preference card
  • 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
    • Nitrobid – 2 packets per breast to rub onto mastectomy skin flaps at conclusion of case
  • 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
  • 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
    • Body Set
    • Breast Set
  • Surgical Packs
    • Body 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
    • Medium Suction with Yankeur tip
  • Blades
    • 10 x 4
    • 15 x 1
    • 11 x 1
  • Bovie
    • Short Protected ENT tip  x 2 
    • Long Protected ENT tip x 1
    • Set at coagulate 40 fulgurate /  cut 40 pure
    • Bipolar x 1
    • Will need two BOVIE and one BIPOLAR for case
  • Drains
    • 10mm perforated flat JP drain, on trocar if available x 3 
    • 100mL bulb suction x 3
  • Additional Supplies
    • Marking pen x 6
    • Paper Ruler x 2 
    • Ventrio Mesh Patch 11cm x 14 cm – ONE OF THEM
  • Dressing
    • Mastisol x 4 
    • 1 inch steri strips x 3 packs
    • Mepilex Ag Border Dressing x 2 

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