Plastics

• Idaho State University, Bachelor of Science, Biochemistry - Summa Cum Laude: August 1997 - June 2001
• University of Washington School of Medicine, Doctor of Medicine with Honors: August 2001 - June 2005
• Residency - Plastic and Reconstructive Surgery - University of Washington Department of Surgery: July 2005 - June 2011
  
• Fellowship - Pediatric Craniomaxillofacial Surgery, The Hospital for Sick Children, Toronto, ON - July 2011-June 2012

Specialty: Pediatric Craniomaxillofacial Surgery and Plastic & Reconstructive Surgery

Recommended Papers Link

Dr. Khechoyan Publications Link

Post Operative Home Care Instructions for Dr. David Khechoyan

Pediatric Plastic Surgery and Craniofacial Plastic Surgery

Primary lip Repair
Hospital Admission and Immediate Post Operative Recovery Period: What to expect
1. Your child will day overnight in the hospital following the primary cleftlip and noscream
2. Your child will be admitted to the Pediatric Hospitalist team. The team and Di Khechoyan will Tollow your child while in the hospital
3. You inay start feeding your child from his/her home boltle immediately after surgery as tolerated.
4. The nurses on the ward will teach you how to care the lip incision site and the nostri splint (if present)
a. Clean the site with tQ-tip applicators dipped in normal saline b. Roll the Q-tip over the upper lip incision line to remove dried blood and the accumulated antibiotic ointment.

5. There is no need for “No-No's” (arm restraints) following the primary lip and nose repair. Please avoid the use of pacifiers.

6. Criteria for Discharge
a. Stable patient with normal vital signs and no tevers
b. Adequate pain control with oral pain medications
Ć Adequate oral intake with formula or breast milk
d. Parents comfortable with incision care and feedings

7 Discharge Medications
a. Tylenol
b. Oxycodone or Lortab
c. We encourage you to transition to Tylenol and off the narcoticas soon as tolerated(usually 2-3 days after surgery)

8 Home care Instructions
a. Clean the lip incision site daily or more frequently as needed to removed the accumulated dried blood from the incision site and the nostri conformer (sprint)
b. Clean with clean bottled water (rather than saline); roll the Q-tip over the incision site la remove dried blood and residual antibiotic oinuent or vaseline Apply topical bacitracin to the lip incision site twice daily (minimum) for 3 days then discontinue the antibiotic ointment and apply Vaseline to keep the incision site most (apply at least twice daily).
c. The upper lip should be cleaned as often as needed to keep the site free of dried blood and sections. Your child may have a bath 24 hours after surgery. The lip incision site may be washed gently with run down baby shampoo and the pad of your fingerti

9. Lollow up: Outpatient Care
l. Your child will follow up in the clinic on day 5 or 6 for a wound check and suture removal if needed. Nostrii conformers will be kept in for approximately 1 month as tolerated by your child. The rose conformers are loosely stitched in place. ( Alter the upper lip sulires are removed. The lip will be taped across the incision fir 0.5 inch 3M hypoallergenic white or tan tape. The tape will be provided to you at the clinic visil
d. The tape should stay on the upper lip as much as possible for the first month (night and day) to assist with scar maturation and to prevent thickening of the lipscal You may start scar massage of the lip incision site once the site has actequately healed This is usually 2-3 weeks after surgery. This is done 3-4 times a day for approximately 5 minutes as tolerated. Apply vaseline to the scar and grasp the upper lip gently between the bumb and index finger of your dominant hand, Ruby the scar the entire length of the seal and down and in a circular motion. Most infants are fussy the list low times the site is massage but will become more tolerant over time. You may give lylento por to the massage if needed for lussiness. You should continue will scar massage as above for approximately 3-6 months. If the Scul becomes thickened despite massage, Dr. Khechoyan might recommend application of a silicone sheet/dressing (Cico Care) or massage using a silicone based cream (scar fade or Biocomeum). Protect the surgical site from direct sunlight by using an infant sale sunscreen and applying a hat when outside
h. Your follow up visit should be scheduled with De Khechoyan at the time of the scheduled surgery. If you do not have a follow up appointment, please call Kathy Vavrina at 720-777-6409.

If your child has a nasal conformer, it will be removed lry Dr Khechoyan at the visit
If you have concerns about your child after discharge home, you may call De Khechoyan's office at 720-777-6409 to schedule a clinic appointment or to speak to Do Khechoyan, one of the nurses, or the on call provider.

(this is preliminary and may change, but at least gives you an overview)

MEDICATIONS:

IV unasyn while in house; augmentin (high-dose, 875 mg) po BID for 2 weeks; substitute clindamycin if penicillin allergic.

Peridex mouthwash four times a day for 6 weeks.

Oxycodone for pain on discharge.

DIET:

Clear liquid diet for 48 hours in the hospital.

Then, blenderized (full liquid diet) for 2 weeks thereafter; nutrition consult in hospital.

Soft (no chew) diet after 2 weeks until 8 weeks post-op (6 weeks total). Diet restriction for a full 8 weeks.

IMAGING:

On discharge, patients will go from main hospital to Dental Center for Panorex, lateral cephalogram and PA cephalogram xrays. Maureen and Tracy/Alma will need to communicate close to day of discharge to coordinate/arrange this.

ELASTICS:

Elastics will be initiated in hospital on POD#1 based on recommendations by Dr. Lowe. Maureen will teach patients on elastics application/wear in hospital.

DENTAL HYGIENE and ORAL/LIPS CARE:

Peridex QID Full glass of water after every meal. Peridex after every meal, swish and spit. Vaseline to upper and lower lips QID. Hydrocortisone 1% cream to upper and lower lip BID while in hospital. May brush teeth with soft pediatric tooth brush twice a day starting on POD#2. Avoid brushing close to gingiva or sutures.

ACTIVITIES & RESTRICTIONS:

No sports or exercise or strenuous activity for 8 weeks post-operatively. Sleep with head of bed elevated at 45 degrees for 2 weeks post-operatively. Ice packs to face for first 72 hours: 30 minutes on/30 minutes off.

FOLLOW-UP VISITS:

1 week post-op with Dr. Lowe for dental hygiene/irrigation with dental assistant and check on healing and initiation of elastics. Weekly or every 2 weeks follow-ups with Dr. Lowe at her discretion to continue post-operative elastics care.

1 week post-op with Maureen for check on healing, oral hygiene, etc. 2-3 week post-op visit with me AND Maureen together (or sooner if there are concerns re healing or occlusion). 6-8 week follow-up visit with me AND Maureen together

Cleft Lip
Antibiotics No (intraop)
Bottle yes
Restraints no
Spoon Feeding yes
Pain Medications
Tylenol yes
Motrin yes
Oxycodone yes
Lortab yes
Length of Stay 1 day typical
Incision site care
Glue no
Stiches yes
Tape NO
Nutritional Consult Yes
Follow up 1-2 weeks/then 1 month

Cleft Palate
Antibiotics intraop
Bottle
Restraints yes x 3 weeks
Spoon Feeding yes sideways
Type of feeding blenderized x 2 weeks and then soft x 2 weeks.
Pain Medications
Tylenol Yes
Motrin NO
Oxycodone Yes
Lortab NO
Length of Stay Depends on po
Incision site care
Dissolvable sutures yes
Nutritional Consult yes if able
Oxycodone yes
Lortab no
Length of Stay depends on po
Nutritional Consult pre discharge yes
When they can go back to ST 4 weeks
Follow up 1 we; 1 mo

Ear Tubes
Follow up per ENT
Antibiotics
Drops/Duration
Swimming/Ear submersion
Drainage
Automatic renewal of Drops with Drainage
Follow up audio

Pharyngeal Flap
Antibiotics home on po 7-10 days
OTC medications
Tylenol yes
Motrin Check with him case by case
Oxycodone yes
Lortab no
Diet Restrictions Blenderized x 2 and soft 2-4.
Follow up 7-10 days; then 4-6 weeks.
When to resume speech 1 month
Activity Restricitons 2 weeks for all and 1 month for contact.
? Automatic referral to VPI No
Length of stay 1-2 nights

Alveolar Bone Graft
BMP No
Iliac Crest Yes
Pre-op Panos/Peri apical yes w/in 3-4 mo
Post-op Panos/Peri apical yes at 3 mo
Cone Beam yes if available
Follow up 7-10 days; 4-6 weeks
Diet restrictions
OTC medications
Tylenol yes
Motrin care dependent; no if raw surfaces
Oxycodone Yes
Lortab ?
Mouth rinse (peridex) yes qid x 4-6 weeks; also rinse with H20
tooth brushing Not at surgical site for 4-6 weeks
Activity restrictions No contact 4-6 weeks
nutrition consult/teaching prior to d/c yes

?restraints for 2 or 3 weeks
Dr D prefers no motrin x 7 days
*will discuss when has more pts in this age range

Updated: 1/17/19 MSA