Blepharoplasty
Cleft Alveolar Bone Graft
Surgical cosmetic procedure that adds bone to the gum ridge, usually in patients born with a cleft lip and/or cleft palate.
01 - Patient Setup
Pre-op Meds: Ancef or Clindamycin
Anesthesia: General, midline oral RAE tube
Patient position: Supine, hip roll, neck roll
Bed position: 90°
DVT ppx: Compression boots on - working BEFORE induction of anesthesia
Side Table: Hip bone graft table to remain sterile + separate from facial table, have hand bone currettes
Lights: Surgical headlamp for face
Power: None
Bovie Settings: 2 Bovies (1 face, 1 hip)
Preinjection: Inject hip prior to prepping w/ 1% lidocaine 1/100 K epinephrine. 27gauge needle on a 10 mL syringe
Prep: Chloraprep on hip, Betadine on face
Drapes: 4 towels around hip stapled. 4 towels around face + split sheet w/ a hole cut out for hip.
Instrument sets: Cleft palate instrument set; iliac bone harvest set with hand currtettes for bone
Anesthesia: Midline oral RAE tube
Patient position: Supine, hip roll, neck roll
02 - Instrument Sets
Have Cleft Palate set and the ABG hip harvest instrument set (shown to left)
03 - Case Details
Special Instruments: #9 periosteal elevator, Castroviejo forceps
Devices/Implants: None
Meds: Afrin with pledgets on face set
Hypodermic needles: 27 gauge
Syringes: 10 mL syringe x2. One for face and one for hip
Drains: none
Suture: Face: 5-0 vicryl on P2 needle, 4-0 vicry RB1, 4-0 chromic RB-1. Hip: 0 vicryl on a CT1 needle, 3-0 monocryl on RB1 and 4-0 monocryl on cutting needle.
Anesthesia on field: 10 mL lidocaine epinephrine on a 27gauge needle + a 10 mL syringe for injection into face
Dressing: Hip dressing: Steri-Strips, Telfa, Tegaderm
04 - Post-Op Information
Admission status: A.M. admission
Estimated time: 90 mins
Coding: ICD-9 is 526.89, 749.12, 749.00
Post-op wound care: Avoid water submersion to hip for 10 days. Full liquid diet for 2 wks.
Post-op activity restrictions: Light activity as tolerated
Follow up: 2 wks