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 return to: Prep and Drape Free Flap

	Note use of gel donut, gel pad, and bean bag.		Knees must be properly padded as patient will be turned for flap harvesting.
Patient must be secured to the table and contralateral side padded with care for position changes. This patient had a g-tube prior to surgery, which was excluded from the prep/drape.
	Note prior tracheotomy. Prep should go well into hairline. We also use clear plastic adhesive dressings over the eyes.

Prep and Drape for Latissimus Dorsi Free and Pedicled Flap 

1. Standard prep, 10% providone iodine
   1. Prep the head and neck separately from free flap operative site.
   2. A surgical assistant will be lifting the ipsilateral arm during the axillary dissection; therefore, the entire arm needs to be sterile.
   3. Prep back from hairline to level of iliac crest 3 cm past midline and staple a waterproof barrier and drape up the midline from the bottom to the top of the back prep.
   4. Prep ipsilateral thigh for possible skin graft.
   5. The entire prep of the back is done prior to starting the head and neck procedure so that all that needs to be done to harvest the flap is to roll the patient and deflate the bean bag.
2. Drape
   1. Head drape
   2. Patient will need to be in the lateral position at times during the procedure, so place towels and drapes so the entire face (from below eyes to both mastoid tips), both sides of neck, chest, shoulder over deltoid including ipsilateral arm, axilla, and back to midline on down to ilium are included in the operative site.
   3. Towels to square off operative site including ipsilateral arm, chest, abdomen, and back to midline (also include ipsilateral thigh for possible skin graft)
   4. Patient will be in a lateral decubitus position with contralateral axillary roll during flap harvest.
   5. Impervious drape underneath patient as far as possible so back stays sterile while patient is supine
   6. Split sheet

Prep and Drape for Scapula Osteocutaneous Free Flap

1. Standard prep, 10% providone iodine
   1. Prep accordingly for specific procedure done in conjunction with the scapula flap.
   2. Shave chest and axilla. Prep the entire donor side arm and hand, axilla, and back to 3 cm beyond the midline of the back.
   3. Prep back from hairline to level of iliac crest 3 cm past midline and staple a waterproof barrier and drape up the midline from the bottom to the top of the back prep.
   4. The entire prep of the back is done prior to starting the head and neck procedure so that all that needs to be done to harvest the flap is to roll the patient and inflate the bean bag.
   5. Prep ipsilateral thigh for possible skin graft.
2. Drape
   1. Drape the head and neck separately from free flap operative site.
   2. Patient will be in a lateral decubitus position with contralateral axillary roll during flap harvest.
   3. Place towels to separate the ipsilateral arm from head incision.
   4. Towels to square off operative site including ipsilateral arm, chest, abdomen, and back to midline (also include ipsilateral thigh for possible skin graft)
   5. Impervious drape underneath patient as far as possible so back stays sterile while patient is supine
   6. Split sheet