404 Limited Facelift - NO NECK

***** If opening neck, then use FULL FACELIFT CARD 403 *****

    Set up is same as Full Facelift but has fewer sutures, less local, no bipolar

    There is no submental incision or platysma repair.


updated January 20, 2017– PAGE 1/3

 

OPERATIVE TIME:

3 hours

 

ANESTHESIA NOTES



Note: for general anesthesia use ENT position

Local Anesthesia with Intravenous Sedation: Patient receives preop Valium, Demerol, and Clonidine prn.

Nasal O2 cannula with CO2 monitor

General Anesthesia: SCD’s, Foley catheter,

✔ regular OR table in ENT position - rotate clockwise after induction

✔ Dr. C to sew in tube with 0-Vicryl CT1, needle holder, scissors

✔ Accordion extension, ✔ straight connector, ✔ long circuit , ✔ regular ET tube

PATIENT POSITION | SETUP

Holding Area: On Stryker eye bed. Start IV on right side. Baer hugger.

   Apply warm Bovie pad, EKG pads, wrist restraints, etc. in holding.

   Give IV Kefzol, Zofran, Decadron and ½ to 1 mg Versed.

   Warm blankets, kisses and hugs.

In OR: Position patient bed flat, pillow under knees, terry cloth towel, gel pad, towels for headrest. [2[ blue Chux under head, blankets to tuck arms.

Rotate clockwise 135O. Nasal prongs with CO2 monitor.

- Aquaphor to lips. - Kerlix roll wrist restraints.

- Hair ties, comb and shaver box - extra pillow in room for end of case

ROOM SETUP

Warm room to 70O, then lower to 68O after patient. draped

Warm up Bovie grounding pad and EKG leads in warmer [for local]

[2] ring stands for dirty sponges; [1] Double ring stand for ice bath

[3] Mayo stands, [1] large back table

Bovie machine at foot of bed; bipolar foot pedal taped to floor

 

EQUIPMENT

Headlight w/ [2] light sources, Gwen’s foot pad

[2] white hydraulic pump up stools

PREP

Chlorxylenol (PCMX), 4x4 sponge box - do not add water.

Prep lightly to face, eyelids, forehead, neck, hair

DRAPING

Head sheet w/ 2 green towels, 1000 drape, split sheet

CAUTERY

note [2] tips

✔ Valleylab flat short silver tip (E1450-X)

✔ Megadyne pencil tip (0013A)

✔ Safe-t-Vac, ✔ [2] holsters, ✔ Bovie 20/20 pure

SUCTION

[2] blue 3/16" suction tubing for Saf-T-Vac & Yankauer

 

SOLUTIONS | IRRIGATION

[3] liters NS irrigation, [2] Asepto syringes, [1] saline bowl

COLD SALINE BATH SETUP: get crushed ice in cooler,

place ice into large basin on double ring stand, cover with warmer drape,

place small sterile basin on top of warmer drape, pour saline in sterile basin

NEEDLES | SYRINGES

[6] 22g long Quincke spinal needles (405181)

[6] 25g 1½" needle

[6] 20cc syringes ➤ for solution C

[6] 10cc syringes ➤ for 0.5% lidocaine w/epi

[2] 16g angiocath [2] 30cc syringes ➤ for Gwen

LOCAL ANESTHETIC &

SOLUTIONS


Solution C: 200cc mixture of

   2% lidocaine w/epi 50cc + 0.5%Marcaine w/epi 50cc + Normal Saline 100cc

Solution F: Lidocaine 0.5% w/epi 100cc + NaBicarb 8.4% 10cc

Marcaine: 0.25% w/epi 30cc

MEDICATIONS (for local)

[4] Versed; [4] Fentanyl; [1] Zofran; [1] Kefzol;

[2] Bactroban ointment tubes

 

404 Limited Facelift - NO NECK

 PAGE 2/3

 

SETS TO OPEN

Dr C Facelift & Dr. C Special Plastic set

INSTRUMENTS USED ON 3 MAYO STANDS:

  ► 1st MAYO – Opening and dissection

      ► 2nd MAYO – Local infiltration, syringes and needles; then dressings or bleph/brow

         ► 3rd MAYO – Neck and face closure

     FORCEPS

01's Adsons, 08's 6" Adsons, smooth Adson, 9" DebakeyDressing forceps, Cushings, 6" Gold Adson Browns

     SCISSORS

short Freemans, long Freemans, Gorneys, gold curved defatting,

str Metz, str Mayo, Reynolds

     NEEDLE HOLDERS

[4] 6" smooth Crile Wood NH

[1] 6" Debakey NH

[2] Mayo Hagar NH

[8] Aesculup serr NH

     RETRACTORS

Breast, Maxwell, Freeman facelift, L-shaped retractor

     KNIFE | BLADES

[6] No. 10 blades

     OTHER

Titanium spoon, kidney basins, baby Yankauer, large Yankauer

 

STERILE SUPPLIES

● 1000 Steri-drape

● [2] needle counters

● cotton balls for ears

● ½" steri-strips (hold for general)

● warmer plastic drape for iced saline

● [8] surgical marker pens

● Mastisol vial (hold for general)

● magnetic pad

● [4] blue plastic bowels

● Plastic Yankauer

● [3] med glasses

General : add [2] Tegaderm for eyes, NO steri strips, NO Mastisol

SPONGES

[6] Raytec, [1] Lap

 

 

No

Type

SN

status

        SUTURES   

[ 4 ]

3-0 nylon PS-1

1663

open

 

[ 2 ]

2-0 Vicryl SH

J417

open

 

[ 2 ]

5-0 Monocryl P-3

Y493

open

 

[ 4 ]

3-0 Chromic PS-2

1638

open 2

hold 2

[ 6 ]

4-0 Chromic PS-2

1637

open

 

[ 4 ]

5-0 Chromic P3

687

open 2

hold 2

[ 2 ]

5-0 Prolene PC-3

8635

open

 

[ 3 ]

5-0 Plain P3

686

open

 

[ 2 ]

3-0 Stratafix FS-2, 19mm

SXMD2B-408

 

hold 2

[ 2 ]

2-0 Stratafix FS, 26mm

SXPD2B-420

 

hold 2

 

HOLD DRAINS

[2] 7mm flat Blake drains w/ connectors and bulbs #2211 full fluted - HOLD

DRESSINGS

place on Mayo stand

● Knife blade to cut rubber bands

● [2] Bactroban ointment tubes

● tongue blade

● [2] packs 4x4's soft sponges

● [1] Abd pad

● Lister bandage scissors

● [1] 4" Ace

● [2] 3x18 Vaseline gauze

● [2] Kerlix

● [2] Safety pins

● Dr. C sterile gloves

 

POSTOPERATIVE

Remove head cushion, put 2nd pillow under head

 

DATES MODIFIED

May 2014, July 2014, Jan 2017


1st MAYO – Opening and dissection 404 Limited Facelift, NO NECK

 

Knife handles [3] Round w/ [4] blades


Cautery tips

     Valleylab flat short silver tip


Retractors

     Maxwell facelift

     Weider cheek

     breast retractor

     Freeman facelift

     Baby deaver

     L-retractor

Scissors

     Freemans TC

     De-fatters TC

Scissors

    Ceramic short

    Ceramic long Gorney

Scissors

     Str Mayo’s TC

     Str Metz TC

     Reynolds

Tissue forceps

     01 Adsons

     08 long Adsons

     6" Gold Adson-Brown


Other

    Baby Yankauer

    Marking Pens

    Titanium Spoon

    Raytecs folded 2 x 8


 

2nd MAYO – Local infiltration: syringes and needles, then dressings

 

Solution C:

     [6] 20cc syringe w/ 22g spinal Quinke needle


Lidocaine 0.5% with epi:

     [6] 10cc syringe w/ 25g 1½” needle mixed with NaBicarb (1:10)


Marcaine 0.25%with epi for end of case:

     [2] 5cc syringe w/ 25 g 1½” needle


Smooth Adson, cotton balls, ½” Steri-strips, Mastisol, moist and dry sponges.


Note: after local dissection, change local Mayo stand to bleph setup or dressings

3rd MAYO – Neck and Facelift closure instruments

 

NO Neck dissection


Facelift closure needle holders and suture

     [4] Aesculup needle holders loaded with 3-0 Nylon for drain and traction sutures

     [2] Mayo-hagar needle holders loaded with 2-0 Vicryl for cheek SMAS

     [2] Aesculup needle holders loaded with 3-0 Quill

     [2] Aesculup needle holders loaded with 3-0 Chromic and 4-0 Chromic

     [4] Crile-Wood needle holders loaded with 5-0 Chromic, 5-0 Plain, 5-0 Prolene