415 SUBMENTAL LIPECTOMY, NECK LIFT OR CERVICOPLASTY

       (includes Mayo stand setup)

This operation is done through the neck incision ONLY. It is a limited procedure that includes platysmaplasty. Procedure is very similar to neck portion of facelift. Usually includes suturing of platysma in midline.

Updated February 7, 2018 PAGE 1/3

 

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, blue towels for headrest. [2[ blue Chux under head, blankets to tuck arms.

Position bed 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 66O after pt. 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

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,

Dornoch suction machine

 

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

[ 4 ] 22g long Quincke spinal needles (405181); [4] 25g 1½" needle

[ 4 ] 20cc syringes ➤ for solution C

[ 4 ] 10cc syringes ➤ for solution F

[ 2 ] 16g angiocath [1] 30cc syringes ➤ for Gwen irrigation

LOCAL ANESTHETIC &

SOLUTIONS

****NOTE: ONLY NEED ½ AMOUNT****

********NOTE: ONLY NEED ½ OF USUAL AMOUNT********

 Solution C 100cc: 100cc mixture of

   2% lidocaine w/epi 25cc + 0.5%Marcaine w/epi 25cc + Normal Saline 50cc

Solution F 50cc: Lidocaine 0.5% w/epi 50cc + NaBicarb 8.4% 5cc

***NO MARCAINE***

MEDICATIONS

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

[ 1 ] Bactroban ointment tubes

 

415 SUBMENTAL LIPECTOMY

   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, 81's, 83's, 05's Adson, smooth Adson, 9" Debakey, 7" Debakey,

Dressing forceps, Cushings

     SCISSORS

short Freemans, long Freemans, Large ceramics, short ceramics, ceramic Metz, gold TC curved defatting, str Metz, str Mayo, Reynolds

     NEEDLE HOLDERS

[2] 6" smooth Crile Wood NH

[1] 6" Debakey NH

[1] 9" Debakey NH

[2] Mayo Hagar NH

[2] Aesculup NH

     RETRACTORS

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

L-shaped retractor

     KNIFE | BLADES

[2] No. 15 blade

     OTHER

 insulated Bayonet bipolar forceps, pediatric suction, plastic Yankauer suction

 

STERILE SUPPLIES

● 1000 Steri-drape

● [2] needle counters

NO cotton balls for ears

NO ½" steri-strips

● Disposable bipolar cord #10-4001

● warmer plastic drape for iced saline

● [2] surgical marker pens

NO Mastisol vial

● magnetic pad

● [4] blue plastic bowels

● Plastic Yankauer

● [3] med glasses

SPONGES

[ 2 ] Raytec, 1] Lap

 

 

No

Type

SN

status

        SUTURES   

[ 1 ]

3-0 nylon PS-1

1663

 

hold

[ 1 ]

4-0 nylon PS-2

 

 

hold

[ 2 ]

2-0 Vicryl SH

J417

open 1

hold 1

[ 2 ]

5-0 Plain P3

686

open 1

hold 1

 

DRAINS

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

[ 1 ] 7mm flat Blake drains - with connectors and bulbs cat#2211 - HOLD

DRESSINGS

only [ 1 ] Bactroban ointment tube

● tongue blade

● [ 2 ] packs 4x4's

● [ 1 ] Abd

● Lister bandage scissors

● [ 1 ] 4" Ace

only [ 1 ] 3x18 Vaseline gauze

● [ 2 ] Kerlix

only [ 1 ] Safety pin

● 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, Nov 2017, Feb 2018


1st MAYO – Opening and dissection Submental Lipectomy PAGE 3/3

 

Knife handles [2] Round w/ [2] #15 blades


Cautery tips

     Valleylab/Covidien flat short silver tip

     Valleylab/Covidien silver extended needle tip

     Megadyne green needle tip (18A)

     Megadyne green crayon tip (13A)

     Insulated bayonet bipolar w/ foot pedal

Retractors

     Weider cheek

     Breast retractor

     3-prong chin hook

     Freeman narrow facelift

     Baby Deaver

     L-shaped retractor

Scissors

    Freemans scissors TC

    Long Freemans scissors TC

    De-fatters curved scissors TC

    Ceramic scissors short

    Ceramic Gorney scissors big

    Ceramic Metz scissors

    Stille stealth scissors black


Suture Scissors

     Straight Mayo scissors TC

     Straight Metz scissors TC

     Reynolds scissors 

 

Tissue forceps

     01's Adsons forceps

      Smooth Adsons

     81's – 6" long Adsons forceps

     6" Dressing forceps packers

      7" Debakey forceps

      9" Debakey forceps

Other

    Pediatric suction

    Plastic Yankauer suction

    Marking Pens

    Raytecs folded into 2"x8" & 1"x16"

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

 

Solution C:

     [4] 20cc syringe w/ 22g spinal Quinke needle


Solution F - Lidocaine 0.5% w/epi and bicarb:

     [4] 10cc syringe w/ 25g 1½” needle mixed with NaBicarb (1:10)


NO Marcaine 0.25% w/ epi for end of case


NO Smooth Adson, cotton balls, ½” Steri-strips or Mastisol.


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

3rd MAYO – Neck and Facelift closure instruments and sutures

 

Neck dissection and platysma repair:

     [1] 6" Debakey needle holder loaded with 2-0 Vicryl

     [1] 9" Debakey needle holder (empty)

     7" Debakey tissue forceps, 9" Debakey tissue forceps, 7" Cushings forceps


Neck closure needle holders and suture

     [1] Aesculup needle holders loaded with 4-0 or 3-0 Nylon for drain

     [1] Crile-Wood needle holders loaded with 5-0 Plain