Today we’re going to do a delayed right latissimus dorsi reconstruction.
This young lady is 45 years old. She had a mastectomy, chemotherapy,
and radiation. She finished her radiation over a year ago. I think it’s
important to use the EXPAREL, particularly with this population
because I do all my lat dorsi’s as an outpatient. So, they don't come into
the hospital at all. What I found with EXPAREL is that patients tolerate this
very well. Similar to abdominoplasties. Our abdominoplasties come back the
next day, again outpatient, and they’ve tolerated their procedure very well.
I think that lat dorsi’s may be less intense than an abdominoplasty.
So, what we do is take the EXPAREL and dilute it to 100 and I inject the
EXPAREL as a field block prior to the operative intervention. So, before we
make any incisions in the back, of these or recreate the mastectomy site,
the EXPAREL is injected.
So, I used a, just a 16-gauge needle, or a 14-gauge needle, whichever you
have. Just make a little, make a little stab incision where you want to, and
the coleman cannula slides into that and we do a field block.
So outlined you can see this is where they were the latissimus dorsi muscle actually is.
This is going to be the skin paddle. We’re going to go around the periphery
of the dissection.
And it's kind of in divided aliquots throughout the periphery of the dissection.
20 more.
The patient’s note, particular that the
inferior portion of this, where we detach the muscle is pretty sore after surgery,
so we’re really paying close attention to getting a good infiltration of the product there.
And it's nice, the canula’s nice and long, so you just need 1 infiltration.
So, we use about 60 in the back and 40 in the front. This site, the axilla is also a
site that's particularly tender, so we kind of really want to pay close
attention to that.