Blepharoplasty
Free Flap/Flap Takeback
A free flap involves transplanting tissue from one part of the body to another with its blood supply to reconstruct a defect, while flap takeback refers to the surgical procedure of re-evaluating and potentially reattaching a flap if initial outcomes are unsatisfactory.
01 - Patient Setup
Pre-op Meds: Ancef, Clindamycin if PCN allergy
Anesthesia: General
Patient position: Supine
Bed position: No turn
DVT ppx: Compression boots on - working BEFORE induction of anesthesia
Side Table: N/A
Lights: Overhead only
Power: 2 Bovie Machines
Bovie Settings: 50/50
Preinjection: None
Prep: Chloraprep
Drapes: Universal
Instrument sets: Red microsurgery cart, pink plastic surgery cart
02 - Case Details
Special Instruments: Mitaka microscope, fluid warmer, heparinized saline (must be kept in the warmer, can be made with 10,000 units of heparin in 100 cc of injectable normal saline for final concentration of 100 units/cc), papaverine, Koven doppler on the field, anterior chamber needle, Weck-Cel, neuropatty, fishhook/lonestar.
*The remaining special equipment can be opened on an as-needed basis (coupler, background, vessel loop, etc., these are all found in the red microsurgery cart)*
Devices/Implants: N/A
Hypodermic needles: N/A
Syringes: 21-gauge Angiocath
Drains: 2 #15 Blake Drains
Suture: 8-0 nylon, 2-0 PDS CT1
Anesthesia on field: None
Dressing: Prineo
03 - Post-Op Information
Admission status: Same Day Surgery
Estimated time: 3 hrs
Coding: 19318-50, 611.1, 724.2, 724.4
Post-op wound care: Drains out AM prior to D/C
Post-op activity restrictions: No heavy activity for 24 wks
Follow up: 1 wk
Post-Op Instructions obtain from MedConnect
04 - HY Tips
Typically performed overnight with potentially unfamiliar team members, booking the case as a free flap formation (CPT 15757) ensures access to a pick list with all necessary equipment.
Tips for Set-Up:
-
Ensure the patient is wheeled to the operating room as soon as possible; assist with minimal setup to expedite the process, acquiring additional materials once the patient is in the room.
-
Confirm with the attending if the leg should be prepped for possible vein graft harvest.
-
Ensure a micro set is available; it’s crucial. If SPD cannot locate one, check the cart or shelf outside ORs 5 and 6 for an extra set.