415 SUBMENTAL LIPECTOMY (neck lift)

       with or w/out Tulip LIPOSUCTION, can be EXTENDED

this operation is done through the neck incision ONLY. It is a limited procedure that includes platysmaplasty

Updated July 3, 2016

 

CPT CODE(S):

15829NECK LIFT WITH SMAS

 

ANESTHESIA NOTES

Local Anesthesia: patient receives preop Valium, Demerol, and Clonidine. Moderate sedation protocol. Nasal O2 cannula with CO2 monitor

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 pt. draped [call x1690]

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 marked with orange tape

SPECIALS

none

PREP

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

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

DRAPING

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

CAUTERY

note [4] tips

✔ Valleylab flat short silver tip (E1450-X)

✔ Valleylab silver extended needle tip (E1452-6)

✔ Megadyne needle tip (0118A); ✔ Megadyne pencil tip (0013A)

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

✔ Disposable bipolar cord (#10-4001), Bipolar setting @ 10

✔ insulated Bayonet bipolar forceps

SUCTION

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

 

for EXTENDED add

Dr. C will make additional incision behind neck and do dissection and suturing. Will need facelift scissors, sutures. May use drains [HOLD]

 

for LIPOSUCTION

Dr. C will bring Tulip cannulas; NO suction required

 

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

[5] 22g long Quincke spinal needles (405181); [10] 25g 1½" needle

[5] 20cc syringes ➤ for solution C

[5] 10cc syringes ➤ for solution F]

[1] 16g angiocath [1] 30cc syringes ➤ for Gwen irrigation

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

MEDICATIONS

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

[2] Bactroban ointment tubes

 

415 SUBMENTAL LIPECTOMY

 PAGE 2/3

 

SETS TO OPEN

Dr C Facelift & Dr. C Special Plastic set

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

01's Adsons, 08's 6" Adsons, smooth Adson, 9" Debakey

Dressing 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

[1] 9" Debakey NH

[2] Mayo Hagar NH

[8] Aesculup NH

     RETRACTORS

Breast, Maxwell, Freeman facelift, Chin hook, 3/8" peds Deaver,

L-shaped retractor

     KNIFE | BLADES

[2] No. 10 blades

     OTHER

kidney basin, insulated Bayonet bipolar forceps,

baby Yankauer, large Yankauer

     LIPOSUCTION & INFILTRATION CANNULAS

HOLD HOLD HOLD. Dr. C will bring Tulip cannulas; NO suction required

 

STERILE SUPPLIES

● 1000 Steri-drape

● [2] needle counters

● cotton balls for ears

● [3] med glasses

● ½" steri-strips (hold for general)

● Disposable bipolar cord #10-4001

● [6] surgical marker pens

● Mastisol vial (hold for general)

● labels for local

● magnetic pad

● [4] blue plastic bowels

● Plastic Yankauer

SPONGES

[6] Raytec, [1] Lap

NON-STERILE SUPPLIES

 

 

 

No

Type

SN

status

        SUTURES   

[ 1-2 ]

3-0 nylon PS-1

1663

 

hold

[ 2 ]

3-0 Vicryl SH

J416

 

hold

[ 2 ]

2-0 Vicryl SH

J417

 

hold

[ 1 ]

5-0 Monocryl P-3

Y493

 

hold

[ 2 ]

4-0 Chromic PS-2

1637

 

hold

[ 2 ]

5-0 Chromic P-3

687

 

hold

[ 2 ]

5-0 Plain P3

686

open

 

 

DRAINS

[1-2] small 10fr round Jackson Pratt with bulb and connector - HOLD

DRESSINGS

● [2] Bactroban ointment tubes

● tongue blade

● [2] packs 4x4's

● [1] Abd

● Lister bandage scissors

● [1] 4" Ace

● [2] 3x18 Vaseline gauze

● [2] Kerlix

● [2] Safety pins - HOLD

● Dr. C sterile gloves

 

POSTOPERATIVE

Remove head cushion, put pillow under head, lift head of bed

 

COMMENTS

Procedure is very similar to neck portion of facelift with or without addition of liposuction. Usually includes suturing of platysma in midline. Extended version includes incision behind ear.

DATE MODIFIED

March 2008, December 2008, Oct 2013, May 2015, July 2016