OR Preparation: Bilateral Latissimus Dorsi flap surgery

Bilateral Latissimus Dorsi flap surgery

Dr. Wu


Two (2) operating tables needed for this case –
Pt will start the case supine
Pt will be turned prone onto a sterile (second) operating table for flap harvesting.
Pt will be turned back supine onto the original table, to finish the case.

Instruments needed:
-Lighted retractor, medium and large Rakes, - Webster needle holder x 2
- 2 irrigation Aseptos
- Adson forceps with teeth and grooves
- Brown Adsons forceps
- malleable (1- inch)
- Bovie with the suction apparatus attachment
- lighted mammary retractor
- Sens retractors
- Deavers
- Medium to Large Rakes-Disposable medium hemoclip applier- 4 #19 French Blake drains- #10, #15 blades (at least 3 of each to start)
- Stapler
- 2 Don-Joy pain pumps to be opened in the beginning of the procedure; Local anesthetic to be used is 0.5% Lidocaine with 1:100,000 epi


Sutures:
-3-0, 4-0 Monocryl sutures (at least five of the 3-0 and four of the 4-0 to start)-two 3-0 Nylon sutures to suture drains in place.

Four (4) 19-French Blake drains
1/2-inch Sterri Strips to secure the suction attachment to the Bovie – see below #9.

vascular Doppler – make sure that it is a functional one.

Two Bovies in room with two grounding pads and two separate machines

Suction attachment to the Bovie (ask Ken Themm or Spanos court) to both Bovie cautery units

Four 10-10 drapes available on the field for the implants

Room-temperature irrigation – NOT WARM- (mixed with Bacitracin or Kantrex)

One pack of pop-off 0-Ethibod sutures for correction of symmastia.

Have 3 pairs of 6 Biogel gloves available for Dr. Wu for changing during surgery.


For the Circulating Nurse –

1. Patient will need to have three (3) straps for each side of the arm board. - Patient’s arms to be abducted at 90 degrees on arm boards secured with 3 arm straps on each side when supine.
-When patient is prone, will need appropriate padding on arm boards and face – please obtain the padding for face and arm boards at the start of the procedure.

2. Patient will need a Foley catheter.
- Foley, SCDs, Lower Body warmer

3. Patient will need to have SCDs working prior to induction of general anesthesia.

4. The operating table (the original one, or the one that the patient will be on to finish the case) will need to be able to sit the patient up completely to 90 degrees for assessment of symmetry prior to the end of the surgery.

5. For prep: - Betadine scrub and paint (DO NOT ERASE THE MARKINGS; DAB OVER THE MARKINGS!!!)
- Prep patient from neck to umbilicus, table to table when supine
- Prep patient from neck to hips when prone

6. Need 3 sets of sterile drapes (supine; prone; supine)


5. Dressings for the end of the case: - large Adaptic x 2
- 2 boxes of fluffs
- Kerlix rolls x 2
- 6-inch ACE bandage x 2