WEBVTT - Dr Brzezienski_Mastectomy w Breast Reconstruction_PP-EX-US-7265 CC Transcript_09FEB22 1 00:07.500 --> 00:10.499 Today we’re going to do a delayed right latissimus dorsi reconstruction. 2 00:10.500 --> 00:17.000 This young lady is 45 years old. She had a mastectomy, chemotherapy, 3 00:17.001 --> 00:22.499 and radiation. She finished her radiation over a year ago. I think it’s 4 00:22.500 --> 00:25.499 important to use the EXPAREL, particularly with this population 5 00:26.500 --> 00:30.000 because I do all my lat dorsi’s as an outpatient. So, they don't come into 6 00:30.001 --> 00:36.000 the hospital at all. What I found with EXPAREL is that patients tolerate this 7 00:36.001 --> 00:42.499 very well. Similar to abdominoplasties. Our abdominoplasties come back the 8 00:42.500 --> 00:48.499 next day, again outpatient, and they’ve tolerated their procedure very well. 9 00:48.500 --> 00:53.499 I think that lat dorsi’s may be less intense than an abdominoplasty. 10 00:53.500 --> 01:00.499 So, what we do is take the EXPAREL and dilute it to 100 and I inject the 11 01:00.500 --> 01:05.499 EXPAREL as a field block prior to the operative intervention. So, before we 12 01:05.500 --> 01:11.000 make any incisions in the back, of these or recreate the mastectomy site, 13 01:11.001 --> 01:12.499 the EXPAREL is injected.   14 01:12.500 --> 01:20.000 So, I used a, just a 16-gauge needle, or a 14-gauge needle, whichever you 15 01:20.001 --> 01:26.000 have. Just make a little, make a little stab incision where you want to, and 16 01:26.001 --> 01:33.499 the coleman cannula slides into that and we do a field block. 17 01:35.500 --> 01:40.000 So outlined you can see this is where they were the latissimus dorsi muscle actually is. 18 01:40.001 --> 01:44.000 This is going to be the skin paddle. We’re going to go around the periphery 19 01:44.001 --> 01:46.499 of the dissection.   20 01:51.500 --> 01:56.000 And it's kind of in divided aliquots throughout the periphery of the dissection. 21 02:10.500 --> 02:12.500 20 more.   22 02:24.500 --> 02:26.499 The patient’s note, particular that the   23 02:26.500 --> 02:33.499 inferior portion of this, where we detach the muscle is pretty sore after surgery, 24 02:33.500 --> 02:39.000 so we’re really paying close attention to getting a good infiltration of the product there. 25 02:44.500 --> 02:52.499 And it's nice, the canula’s nice and long, so you just need 1 infiltration. 26 03:02.500 --> 03:09.000 So, we use about 60 in the back and 40 in the front. This site, the axilla is also a 27 03:09.001 --> 03:14.000 site that's particularly tender, so we kind of really want to pay close 28 03:14.001 --> 03:15.499 attention to that.