SCDs were placed on bilateral lower extremities. arms were outstretched on padded foam arm rests and abducted to less than 90 degrees at the shoulder. underwent general anesthesia. was prepped and draped in the usual sterile fashion. I began by injecting 150 cc of a mixture of 266 mg exparel in 20 cc and 50 cc 0.25% marcaine diluted in 100 cc normal saline split equally as a field block into bilateral axillas and left anterolateral thigh. Her right axilla was then marked and it is 16 x 13 cm area of skin with skin pits, scarring and nodularity. This is also the hairbearing area of her right axilla. It was incised down into the subcutaneous fat and removed with cautery. The skin was sent to pathology for examination. Hemostasis was achieved. The wound was irrigated with normal saline. Using a 2-0 Vicryl pursestring suture in the dermis the wound was narrowed to dimensions measuring 10.5 x 6 cm in preparation for skin grafting. Attention was then turned to the left axilla. The same procedure was performed. On the left side to the area marked for excision measured 15 x 12 cm. After the Vicryl pursestring suture I was able to narrow the dimensions down to 10 x 6 cm. The left anterolateral thigh was then prepared for graft harvest. A dermatome mesher was used with a 4 inch blade. A 1/12 inch thick skin graft was harvested after applying mineral oil. It was meshed at a 1-1.5 ratio. 2 10 cm long passes were made with the 4 inch wide blade. The grafts were sewn into the axillas using a 5-0 chromic running suture. The donor site was dressed with Xeroform, Tegaderm, ABD and Ace wrap. Adaptic and black foam wound VAC spongewere placed over the axillary skin grafts. Both of the back to her bridged to beneath her clavicles. The VAC’s were then connected through Y adapter to a single machine and set at 125 mm of continuous pressure. The system was functioning with a slight leak but was holding pressure. Patient was then awakened from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
thank you so much