602 MICROTIA RECONSTRUCTION STAGES - 2nd, 3rd, 4th, etc.

            for Split Thickness Skin Graft w/ Padgett dermatome - pull card # 808

            for Otoplasty - pull card # 603

updated December 17, 2011

May include one or more of the following procedures:

     ● Earlobe Transposition Flap (2nd stage)

     ● Concha & Tragus Reconstruction (3rd stage)

     ● Elevation of Helix with skin graft (4th stage)

     ● Porex implant

     ● Split thickness skin graft

● Full Thickness Skin Graft

● Composite Graft

● Cartilage Graft

● Skin Flap

● Otoplasty

 

OPERATIVE TIME 2 hours

ICD9 CODE: 744.23 MICROTIA

CPT CODES

15760COMPOSITE GRAFT

21235EAR CARTILAGE GRAFT

69300OTOPLASTY

14060 ADJ TISSUE TRANSFER

15576 SKIN FLAP EAR

69110EXCISION OF VESTIGIAL EAR REMNANT

21208POREX IMPLANT

15576PEDICLED EAR LOBE TRANSFER

15260 FULL THICKNESS SKIN GRAFT

15120 SPLIT THICKNESS SKIN GRAFT

 

ANESTHESIA NOTES

General ETT or LMA, Kefzol 25mg/kg, will be turning bed

PATIENT POSITION | SETUP

● If patient small, lower foot.

● Terry cloth towel roll under shoulders.

● Large round gel headrest.

● Lower body Baer hugger.

● 4" Coban (#15845) to wrap hair. Hair tie if long.

TABLE POSITION

Will turn bed 180°

ROOM SETUP

Pre-warm bed

 

EQUIPMENT

Headlight w/ two light sources

SPECIALS

none

IMPLANT

POREX if needed – will be ordered

PREP

Technicare or PCMX to entire face, both ears, and donor site

DRAPING

Head drape with medium sheet and 2 towels, 1000 drape, split sheet (89301), basic pack

for DSU - open ENT pack

CAUTERY

Colorado tip, Bovie flat , 18A Megadyne needle, 10/10 pure.

Holster

SUCTION

regular

 

SOLUTIONS | IRRIGATION

Saline. Antibiotic irrigation.

Blue bulb syringe and irrigation catheter

NEEDLES | SYRINGES

Syringes:

[2] 3cc syringe

[2] 10cc syringe

[1] 30cc syringe

Needles:

[2] 30g ½" needle

[2] 27g 1" needle

[2] 25g ½" needle

[1] 14g angiocath

LOCAL ANESTHETIC

● 1% lidocaine w/epi in 3cc syringe, 30g ½" needle

● Ropiviciaine 0.5 % mixed with 1% Lidocaine w/epi:

          In 10cc syringe w/ 27g 1" needle

MEDICATIONS

● Bacitracin ointment 2 oz

● Kefzol for irrigation

602 MICROTIA RECONSTRUCTION STAGES - 2nd, 3rd, 4th, etc.

Page 2

 

SETS TO OPEN

Plastic, fine instruments

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

.5 Castroviejo, 05 Adson, 03Adson, Smooth Adson

     SCISSORS

baby bears, mama bears, papa bears, stevens

cvd Iris, str Iris, str Metz, str Mayo

     NEEDLE HOLDERS

[2] smooth Websters, [2] sm Crile Woods, [2] Castro Viejo

     RETRACTORS

Senn, Ragnell, 2mm 5mm 7mm 10mm skin hooks

     KNIFE | BLADES

[2] No 15 [2] No. 10

     OTHER

 

 

STERILE SUPPLIES

■ Hard light handles

■ Asepto syringe

■ marking pens with rulers

■ needle counter

■ Bovie pencil

■ med glasses

■ towel pack

■ Bovie pad

■ prep cups

■ mag pad

SPONGES

[4] Raytec, lap sponges, towel pack

NON-STERILE SUPPLIES

 

 

 

No

Type

SN

status

SUTURES

[ 2 ]

4-0 Monocryl P-3

Y494

hold

 

 

[ 2 ]

4-0 Monocryl PS-2

Y426

hold

 

[ 2 ]

5-0 Monocryl P-3

Y493

hold

 

[ 2 ]

4-0 Chromic P-3

1654

hold

 

[ 2 ]

5-0 Chromic P-3

687

hold

 

[ 2 ]

6-0 Chromic G-1

790

hold

 

[ 2 ]

5-0 Plain P-3

686

hold

 

[ 2 ]

Dermabond

DHV12

hold

 

 

DRAINS

none

DRESSINGS on Mayo stand

● 4x4 sponges #8047

● 3" Kling

● Bacitracin ointment

● 3 x 18 Vaseline gauze #414600

● 1" Xeroform strip

● straight scissors

● 9" Spandage - size 12 #GL-710

● Large Glasscock ear cup

 

POSTOPERATIVE

Call peds for bed, if minor procedure.

May also go to Short Stay [ask]

NOTES

Dr. Burt Brents website http://www.earsurgery.com/ for details on technique

See Burt Brent Article: Microtia Reconstruction

 

SEE ALSO, SAME AS

Microtia First Stage with Costal Cartilage Graft, Otoplasty, STSG

DATE MODIFIED

May 2007, October 2007, July 2009, Mar 2010, Apr 2010, Aug 2011,

 Dec 2011