Lower Extremity Local Flap and Skin Graft

By Dr. Kevin Han

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GLOVES:  6.5 Micro Indicator/6.5 Micro 

 

Anesthesia:  General

 

PREP:  Hibiclens circumferential all the way to groin. Ability to Frog leg for Gastro Flap.

Shave Thigh and Leg.

 

POSITION:  SUPINE, OR Bed, Sterile Tourniquet Available,  Lower Extremity Drape, Sitting Stools, SCD on and working prior to induction on uninvolved leg. Foley (Ask).

 

MEDICATIONS: 0.9% NACL IRRIGATION 3L

30 ML 1% LIDOCAINE with Epinephrine add to 70 ml of Injectable Saline (A solution to tumescent the skin graft donor site) on 20 cc syringe with 18 Gauge Spinal Needle on the Field. Mineral Oil X 2 Bottle (If doing Skin Graft)

 

INSTRUMENTS: Plastic Surgery Soft Tissue Tray ( Curved Tenotomy Scissors, Fine Adson Pickup with Teeth, Smooth Fine Jacobson Forceps or McCabe Facial Nerve Dissector, Freer Elevator, Cottle Elevator, Baby Mixter Right Angle), Orthopedic Large Bone Tray, Debridement Set (Rongours, and Curettes), Adson-Beckman Retractors, Rakes 6-Prone, Gelpis, Richardson Retractors, Amy Navy, Deaver Retractors, Appendiceal Retractor 

 

EQUIPMENT:  Sterile Thigh Tourniquet, Bovie, Bipolar Forceps/Bipolar Foot Pedal,

Sterile Doppler Pencil on the field and Doppler Machine

Dermatome/Blade and 3 inch Guard/Mesher and 1 x 1.5 Skin Carrier

 

SUPPLIES:  HALF SHEET

  • Suction 
  • CYSTO IRRIGATING SET with 3L 0.9% NaCL
  • Large Basin to collect Irrigation
  • Lower Extremity Drape
  • Ray-Tech
  • Surgical Laps 
  • LIGHT HANDLE COVER
  • 15 BLADE (3)
  • 10CC SYRINGE (1)
  • 25 GAUGE HYPO (1)
  • BIPOLAR CORD and Foot Pedal
  • BOVIE with protected tip
  • CLIP APPLIER 106781 MULTI SMALL
  • CLIP APPLIER 106781 MULTI Medium
  • Round 15F with trocar and drain bulb

 

SUTURES: 3-0 Chromatic x 3, 3-0 Monocryl, 2-0 PDS x 2, 0 Prolene x 2, Skin Staplers X 2 

 

DRESSINGS:  Skin Graft: 1. Large Xeroform x 2 and Wound Vac/Cannister/Sponge if requested

If not using wound vac, thenXeroform, Cotton Bolster (Ask)

Always, Mastisol, A box 4×4 Gauze, 4” Kerlex, 4” Casting Padding/Webrill, and 4” ACE Wrap x 2

 

Donor Site:  Large Xeroform, a box 4×4 Gauze, ABD Pads, 4” Kerlex, 4” Casting Padding/ Webrill x2, and 4” ACE Wrap x 2

 

NOTES: BIPOLAR 15, BOVIE with protected tip 30/30, If requested, have VAC with medium sponge in the room (Do not open). Patient may bring their own home vac machine and supplies.

Integra (Meshed Bilayer If asked).