Hand and Finger Replant
/Revascularzation
/Mangled Hand

By Dr. Kevin Han

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GLOVES:   6.5 Micro Indicator/6.5 Micro  

Anesthesia:   General or by Choice. Prefer General and Block with Pain Catheter for post-operative pain and sympathectomy 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

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), Tupper Hand Retractor, Hand Kit (Smooth Jacobson Forceps or McCabe Facial Nerve Dissector, Freer Elevator, Cottle Elevator, Baby Mixter Right Angle).

EQUIPMENT:   Bipolar, Tourniquet, Fine Adson Bovie, Micro-Instruments and GEM Micro Clip Applier and Clips (Do Not Open), Microvascular Clip (Acland Bulldog) Tray, Microscope Available Outside (Leica or Zeiss). Zimmer Dermatome/Blade/Mesher/Carrier (Do Not Open), SharpPoint Nerve Stimulator (Do not Open). Mini-C arm (drape), Synthes Small Battery Driver/Stryker Core Drill Set, Pin Cutter, unthreaded k-wire set. Synthes Variable Angle Locking Modular Hand system (1.3, 1.5, 2.0mm plates) (Do not open)

SUPPLIES:  

HALF SHEET

Tongue Depressor

Suction with Frazer Tip Sets

Extremity Drape

Ray-Tech

Surgical Towels

Doppler, Pencil, and Gel

Microsurgical Wipes

LIGHT HANDLE COVER

15 BLADE (3)

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-100-4, 10-0 BV 75-3, 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 or a type of Fibrin Glue.

BACK TABLE SPARE PART SET UP If waiting for patient or 2 surgeons: Microscope, Sterile Back Table, Battery Drill, 21 Gauge Wire, Basic Micro instruments to work on the spare parts.