Free Flap Upper Extremity
GLOVES: 6.5 Micro Indicator/6.5 Micro
Anesthesia: General or by Choice. 3000-5000 units IV Heparin on stand-by
PREP: Hibiclens
POSITION: SUPINE, OR Bed, Regular Hand Table, Tourniquet with “10 x 10” around Tourniquet, Extremity Drape, Sitting Stools. Ask-May need to drape another extremity for donor sites, Foley (ask). Extra Tourniquet for Thigh for lower extremity flap.
MEDICATIONS: 0.9% NACL IRRIGATION
Heparin Solution 5000 units in 500 ml 0.9 NS
Warm Irrigation or Fluid Warmer
3% Papaverine Undiluted (hold)
Mineral Oil (If doing Skin Graft)
INSTRUMENTS: Plastic Surgery Soft Tissue Tray (Curved Littler Scissors, Curved Tenotomy Scissors, Fine Adson Pickup with Teeth), Lead Hand or Tupper Hand Retractor, Hand Kit (Smooth Jacobson Forceps or McCabe Facial Nerve Dissector, Freer Elevator, Cottle Elevator, Baby Mixter Right Angle), Adson-Beckman Retractors, Rakes 6-Prone, Large Gelpis (For Big muscle flap such as Latissimus or Gracilis Flap or Anterolateral Thigh (ALT), Ortho Tray/Debridement Tray
EQUIPMENT: Bipolar, Tourniquet, Fine Adson Bovie, Micro-Instruments and GEM Micro Clip Applier and Clips Cartridges, Microvascular Clip (Acland Bulldog) Tray, Microscope Available Outside (Leica or Zeiss). Zimmer Dermatome/Blade/Mesher/Carrier (Do Not Open), GEM Coupler Device/Couplers Available (Do Not Open), SharpPoint Nerve Stimulator (Do not Open). Cook Implantable Doppler (Hold)
SUPPLIES:
HALF SHEET
Tongue Depressor
Suction
Extremity Drape
Ray-Tech
Surgical Towels
Doppler, Pencil, and Gel
Microsurgical Wipes
LIGHT HANDLE COVER
15 BLADE (3)
#6900 Beaver Blade
10CC SYRINGE (1)
25 GAUGE HYPO (1)
30G Anterior Chamber Irrigation Cannula
Lone Star Elastic Retractors
BASIN FOR NACL (1)
BIPOLAR CORD
TOURNIQUET 18”
4” ESMARK (OPEN, STERILE)
4” WEBRIL (UNDER TOURNIQUET)
CLIP APPLIER 106781 MULTI SMALL
CLIP APPLIER 106781 MULTI Medium
VESSEL LOOPS MINI
Neurosurgial Patties 1/2” x 1”
Cellulose Eye Spears
Microsurgical Background
Drains: 10 mm Flap JP Drain
SUTURES: Ask. 8.0 Ethilon BV 130-4 4-0, and 9.0 Ethilon BV-130-4 Chromatic, 4-0 and 5-0 NYLON and 3-0 Monocryl. 2-0 PDS.
DRESSINGS: ADAPTIC, WET 4X4, DRY 4X4, 4″ WEBRIL or 4″ Cast Paddings, 4″ PLASTER, 3″/4″ ACE WRAP, SLING (IF BLOCKED), Jones Cotton (A roll of Cotton)
NOTES: Ask. May need Axogen Products (Nerve Allograft). Tisseel Fibrin Glue. Set up for 2 Surgeons if 2 Surgeons are available (2 Bovie Machines to allow 1 bipolar and 1 bovie functionating independently for each surgeon)