214 TONGUE FLAP for CLOSURE of PALATE FISTULA

       and DIVISION of TONGUE FLAP (2-3 weeks later)

This is a two stage operation.

A flap of tongue tissue is created and attached to cover the palate fistula.

2 weeks later, the flap is divided from the tongue and inset into the palate.

The table is not turned.

Setup is the same for creation and division of flap. Usually requires naso-tracheal intubation.

Usual age is older child or adolescent. PET are not done.

page 1 updated November 17, 2016

 

OPERATIVE TIME: 1½ hours

LOCATION: Pres Main only

 

ANESTHESIA NOTES

HI RISK AIRWAY ANESTHESIA

NASO-TRACHEAL INTUBATION with FIBEROPTIC SETUP and

GLIDESCOPE

straight anesthesia connector with extension

Kefzol IV 25mg/kg

Anesthesia to tape eyes

Anesthesia to suction at end of surgery

PATIENT POSITION | SETUP

TABLE IS NOT TURNED

Rolled towels under shoulders

Large round gel doughnut under head

Lower body Baer hugger, blanket

TABLE POSITION

Lower foot, close head gap, Do Not Remove Head Piece

Large round gel donut head rest.

ROOM SETUP

Warm room 72o, warm bed and head rest w/ Baer

Separate mayo stand for video equip





 

EQUIPMENT and SPECIALS

Light source w/headlight on patient’s right side

Baer hugger

IV pump plugged in

***NO VIDEO SETUP***

PREP

PCMX with minimal water, cotton tip applicators to clean nose, wipe gently inside mouth, lightly over eyelids

DRAPING and PACKS

Cleft Palate Custom Pack, Towel Pack

White towels for Mayo stand

Square off with blue towels, towel clips and split sheet

2" Kling - NOT NEEDED

CAUTERY

Bovie 10/10 pure,

[1] #0118A Megadyne needle tip w/ holster

SUCTION

[2] suctions: [1] 7fr Frazier tip, [1] baby Yankauer

 

SOLUTIONS | IRRIGATION

Kefzol/TXA/NS irrigation: MIX

           500mg Kefzol + 500mg tranexamic acid in 500cc NS

plain saline

water

LOCAL ANESTHETIC

peds mixture: 50/50 -

    ● 1% lidocaine w/ epi 1:100,000 +

    ● 0.5% Ropivicaine plain

NEEDLES | SYRINGES

[2] 3cc syringes w/ [2] 30g needle 5/8" for infiltration

[1] 10cc syringe w/ [2] 27g 1 1/4" needle for infiltration

[1] 20cc syringe w/ [1] 14g angiocath for irrigation

MEDICATIONS

Kefzol

Bacitracin ointmentTranexamic acid for irrigation (500mg)

 

214 TONGUE FLAP for CLOSURE of PALATE FISTULA

       including division and inset of tongue flap 3 weeks later

page 2

 

SETS TO OPEN Cleft Palate Set & Plastic/Breast Set

 

INSTRUMENTS USED (ON 3 MAYO STANDS)

     FORCEPS

Packing, [3] Cushings, Debakey

     SCISSORS

Reynolds, Joseph, str Metz, str Mayos

     NEEDLE HOLDERS

[2] Crile Wood, [2] Aesculup. [2] Mayo Hagar, [2] Sontec angled

     SUCTION

7fr Frazier tip, fluted peds suction

     RETRACTORS

Weitlaner, Army Navy, Weider tongue retractor

     KNIFE | BLADES

[2] No. 15 BP

     ELEVATORS

McCullough, Tebbetts, hockey stick

OTHER

NO DRILL, NO OSTEOTOME

   

 

STERILE SUPPLIES

[2] marking pens with ruler

bacitracin ointment

non-disposable light handles

7½ Protegrity latex gloves

SPONGES

Raytec

 

 

 

NO

TYPE

SN

STATUS

 

SUTURES

for creation flap

[ 1 ]

2-0 Silk SH

K 833

open

 

[ 2 ]

2-0 PDS CT2

2333

open

 

[ 2 ]

3-0 Monocryl SH

 

 

hold

[ 2 ]

3-0 PDS SH

2316

open

 

[ 2 ]

3-0 Chromic RB-1

U204

 

hold

[ 2 ]

4-0 Monocryl RB-1

Y214

open

 

 

SUTURES

for division flap

2 weeks later

[ 1 ]

2-0 Silk SH

K 833

open

 

[ 2 ]

3-0 Monocryl SH

 

 

hold

[ 2 ]

3-0 PDS SH

2316

 

hold

[ 2 ]

3-0 Chromic RB-1

U204

 

hold

 

DRAINS

none

DRESSINGS

Bacitracin to lips

 

POSTOPERATIVE

call for pediatric bed (6th floor)

oxygen for transport

NOTES

 

 

COMMENTS

 

DATES MODIFIED

Jan 2013, Mar 2016, Jun 2016, Nov 2016

 



See next page for diagram and photos of tongue flap

     214 TONGUE FLAP for CLOSURE of PALATE FISTULA

       and DIVISION of TONGUE FLAP (2-3 weeks later) page 3

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