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Free Flap (Microvascular) Room Setup

last modified on: Tue, 12/19/2023 - 08:35

Prep and Drape Anterolateral Thigh Free Flap

Prep and Drape Radial Forearm and Pectoralis Major Free Flap

Prep and Drape for Latissimus Dorsi Free and Pedicled Flap also relevant for scapula flap

Prep and Drape Osteocutaneous Fibula Free Flap

see also: Microvascular Surgery Protocols

Note: Most head and neck cases are “clean contaminated” based on the exposed nose and mouth and the inability to sterilize. Many cancer cases have active cancer as well.
For those reasons, two separate setups are usually employed.

EQUIPMENT

  • Surgical loupes
  • 3080 operating room table in reverse orientation with foot extension
  • Arm boards x 3 (for radial arm)
  • Mayfield headrest with adapter
  • Back tables x 2
  • Mayo stands x 2
  • Gown table
  • Ring stands x 2
  • Hypothermia-hyperthermia unit
  • Sequential compression device
  • Action gel pad, full body
  • Sandbags, medium, x 2
  • Foam pad, self adhering
  • Foam padding
  • Pillows x 3
  • Iowa elbow guards
  • Pilling fiberoptic luminator
  • Fiberoptic light projector with headlights x 3
  • Unipolar cautery units x 2 with REM-compatible Pt return electrode pad
  • Bipolar cautery units x 2
  • Tourniquet regulator assembly, hose assembly
  • Varidyne vacuum suction controller
  • Dermatome motor
  • Nerve stimulator unit/grounding cord
  • Ultrasonic doppler flow detector
  • Suction bottle machines x 2
  • IV stands x 2

SUPPLIES FOR STERILE FIELD

  • Soft tissue supply pack x 2
  • 4 x 4 x-ray detectable sponges
  • 18 x 18 x-ray detectable sponges
  • Peanut sponges 3/8 in, x-ray detectable
  • Unipolar cautery pencil
  • Dual frequency bidirectional doppler probe
  • Tourniquet cuff with soft roll, fibula/forearm
  • Instrument pouch
  • Light handle covers x 4
  • Pitchers, 1,000 x 2
  • Pitcher, insulated, poly-lined carafe
  • Retinal mitts, 10-pack
  • Microvascular clamps, 3V single x 8 and 3V double x 4
  • Atraumatic surgical spring clips, 6 mm x 2
  • Wound clip applier package 15 x 4
  • Weck-cell (cel-ophtho) sponges x 6
  • Cup, prep, 4 oz, sterile x 2
  • Syringe Luer lock 5 cc x 2
  • Syringe Luer lock, 10 cc x 2
  • Bishop Harmon anterior chamber irrigators x 2
  • IV cannula-winged 24-gauge x 5/8 in x 2
  • IV cannula-winged 18-gauge x 1 3/4 in x 2
  • Varidyne vacuum suction drains, 7 mm or 10 mm

SPECIAL INSTRUMENTATION

  • Micro-line forceps
  • Jacobsen hemostatic forceps, slightly curved

SPECIAL CONSIDERATIONS

  • The surgical bed will be turned 180° away from anesthesia.
  • The bed will be made by placing the heating pad on first, then the gel pad, and finally sheets and blankets.
  • The patient's temperature should stay between 37.5° and 38.0°.
  • No epinephrine on setup at any site for free tissue transfers.
  • Keep the flap moist and warm with heated Physiosol.