Post-op Diagnosis:
Partial amputation left middle finger-S68.122A
Partial transection flexor digitorum superficialis left middle finger-S66.123A
Partial tendon injury left middle finger flexor digitorum profundus-S66.123A
Left middle finger extensor tendon transection- S66.232A
A2 pulley injury left middle finger-S66.193A
A3 pulley injury left middle finger-S66.193A
Transection radial digital artery left middle finger-S65.513A
Transection ulnar digital artery left middle finger-S65.513A
Avulsion injury and transection of left middle finger ulnar digital nerve-S64.493A
Open fracture of the left middle finger proximal phalanx-S62.613B
Open fracture left middle finger distal phalanx with avulsion of nail plate-S62.633B, S61.303A
Laceration and avulsion injury left ring finger -S61.205A
Procedure:
Open reduction internal fixation left middle finger open proximal phalanx fracture -26746 F2
Irrigation and excisional debridement left middle finger wound 2cmx2cmx2cm to the level of bone-11012
Primary repair left middle finger extensor tendon-26418 F2
Excision of radial slip of flexor digitorum superficialis left middle finger-26356 F2
Debridement of partial tendon laceration left middle finger flexor digitorum profundus-26418 F2
Primary repair of A2 pulley rupture left middle finger-26502 F2
Primary repair with use of microscope left middle finger radial digital artery-35207 F2
Primary repair with use of microscope left middle finger ulnar digital artery 35207 59 F2
Primary repair with use of microscope left middle finger ulnar digital nerve-64836
Revision amputation left middle finger distal phalanx - Idk code
Repair of left ring finger laceration-12001
Findings: The patient had multiple injuries. He had a near complete amputation
but his flexor digitorum profundus was intact. He had a complete
circumferential laceration through the skin. He had complete loss of both
radial digital arteries. His ulnar digital nerve had a traction injury and was
significantly attenuated and transected. This was repaired with the conduit.
Patient had a significant traction injury but an intact radial digital nerve.
The after mentioned injuries have an A2 pulley injury as well as a flexor
digitorum superficialis partial transection and FDP partial transection and open
fractures were all noted. We were able to stabilize the fracture obtain
revascularization of the digits and repair his injured nerves and tendons. The
patient unfortunately had some difficulty maintaining patency of his vascular
repairs. He required multiple takedowns to remove small fibrinous clots which
had formed in the area. Ultimately we were able to reach hip point of stability
to the patient's injuries and maintain perfusion to his digit. At the time of
discharge to the PACU area the patient had a warm pink and bleeding middle
finger. He had bone loss mostly on the dorsal aspect with near complete loss of
the nailbed. This necessitated a revision amputation to remove devitalized and
injured bony tissue we were able to close this primarily with the patient's own
soft tissues.
Technique/Procedure Description: The patient is identified in the preoperative
holding area. The procedure to be performed was confirmed. Site was marked.
Patient was brought back to the operating room was prepped and draped in normal
sterile fashion. This was done in emergent fashion. Patient succumbed to
general anesthetic and we started first by copiously irrigating the wound there
is a significant amount of debris which was above and beyond the normal nature
for this. This required a significant amount of time performing excisional
debridement with Littler scissors. Approximately half an hour was spent just in
removal of necrotic and contaminated tissues. There is significant mount of
sand as well as other debris within the area. A curette was used to remove the
bony impaction as well as significant amount of contamination within the tendon
structures themselves. This was an excisional debridement down to the level of
the bone. Total area of debridement was 2 cm x 2 cm x 2 cm excisional
debridement was performed using Littler scissors as well as a curette. Once
this was complete this completed the irrigation debridement portion of the case.
We then irrigated with an additional 3 L of normal sterile saline and then
proceeded to perform a open reduction internal fixation of the proximal phalanx
we used to cross Kirschner wires these were cut and buried. We then held the
digit in extension and performed a extensor tendon repair. He did have what
appeared to be some partial tissue loss here but we were able to get good
approximation with interrupted sutures for his extensor apparatus. With dorsal
structures intact we then turned volar. Patient had a complete avulsion of the
radial slip of his flexor digitorum superficialis and this was excised and
debrided. The tendon itself was contoured to allow better passage through the
adjacent pulley. We then debrided the frayed portion of the volar aspect and
lateral aspect of the flexor digitorum profundus tendon. This encompassed only
approximately 10% of the tendon itself. This completed the tendinous portion of
the case and attention was turned to the pulleys. His A2 and A3 pulley was
ruptured he may have a proximal A1 pulley injury but this was not visualized.
We then used 2 juggernaut suture anchors into the bone and performed a primary
repair of the A2 pulley where he had on sleeve from the bone. There was
actually a small slip of bone which had peeled off and we were able to suture
around this and see if this in an effort to heal bone to bone from this bony
avulsion of the A2 pulley. After his pulley was repaired we turned our
attention to the distal phalanx. There is an open distal phalanx fracture we
debrided the exposed bone and allow the volar skin flap to cover this area. We
left this open for later repair to allow for evaluation visualization of distal
bleeding during the next portion of the case. We then brought in the
microscope after we had identified the artery and nerves on the radial and ulnar
aspect. We started with the ulnar digital artery were able to get this
revascularized. There unfortunately was some level of loss to the artery itself
as there was a small hole and approximately 3 mm of the artery itself had to be
resected to accommodate a large tear within the vessel itself we were able to
recannulate this and get excellent blood flow we performed an interrupted repair
with nylon suture and had excellent distal blood flow with bleeding through the
tip of the finger. We turned our attention to the radial digital artery.
Similarly, we were able to get this recannulated and remove a clot. We then
repaired the artery and we maintain distal blood flow. While we were repairing
the digital nerves we found that the patient digit had no longer a pink
appearance to it and we took down both repairs and found that each had a small
fibrinous clot in it after removal and of her repeat repair the finger pinked
back up and had excellent distal blood flow. We then performed a repair to the
ulnar digital nerve with use of a conduit. At this point the finger continued
to maintain decent blood flow and we closed the skin flap over the distal aspect
of the digit completing the revision amputation portion of the case with
revision amputation of the distal phalanx. We then copiously irrigated all the
wounds and the circumferential wounds on the finger itself was loosely
approximated. We then repaired the laceration in interrupted fashion to the
ring finger with absorbable suture. Patient was placed in dry sterile dressing and placed in a splint.
Partial amputation left middle finger-S68.122A
Partial transection flexor digitorum superficialis left middle finger-S66.123A
Partial tendon injury left middle finger flexor digitorum profundus-S66.123A
Left middle finger extensor tendon transection- S66.232A
A2 pulley injury left middle finger-S66.193A
A3 pulley injury left middle finger-S66.193A
Transection radial digital artery left middle finger-S65.513A
Transection ulnar digital artery left middle finger-S65.513A
Avulsion injury and transection of left middle finger ulnar digital nerve-S64.493A
Open fracture of the left middle finger proximal phalanx-S62.613B
Open fracture left middle finger distal phalanx with avulsion of nail plate-S62.633B, S61.303A
Laceration and avulsion injury left ring finger -S61.205A
Procedure:
Open reduction internal fixation left middle finger open proximal phalanx fracture -26746 F2
Irrigation and excisional debridement left middle finger wound 2cmx2cmx2cm to the level of bone-11012
Primary repair left middle finger extensor tendon-26418 F2
Excision of radial slip of flexor digitorum superficialis left middle finger-26356 F2
Debridement of partial tendon laceration left middle finger flexor digitorum profundus-26418 F2
Primary repair of A2 pulley rupture left middle finger-26502 F2
Primary repair with use of microscope left middle finger radial digital artery-35207 F2
Primary repair with use of microscope left middle finger ulnar digital artery 35207 59 F2
Primary repair with use of microscope left middle finger ulnar digital nerve-64836
Revision amputation left middle finger distal phalanx - Idk code
Repair of left ring finger laceration-12001
Findings: The patient had multiple injuries. He had a near complete amputation
but his flexor digitorum profundus was intact. He had a complete
circumferential laceration through the skin. He had complete loss of both
radial digital arteries. His ulnar digital nerve had a traction injury and was
significantly attenuated and transected. This was repaired with the conduit.
Patient had a significant traction injury but an intact radial digital nerve.
The after mentioned injuries have an A2 pulley injury as well as a flexor
digitorum superficialis partial transection and FDP partial transection and open
fractures were all noted. We were able to stabilize the fracture obtain
revascularization of the digits and repair his injured nerves and tendons. The
patient unfortunately had some difficulty maintaining patency of his vascular
repairs. He required multiple takedowns to remove small fibrinous clots which
had formed in the area. Ultimately we were able to reach hip point of stability
to the patient's injuries and maintain perfusion to his digit. At the time of
discharge to the PACU area the patient had a warm pink and bleeding middle
finger. He had bone loss mostly on the dorsal aspect with near complete loss of
the nailbed. This necessitated a revision amputation to remove devitalized and
injured bony tissue we were able to close this primarily with the patient's own
soft tissues.
Technique/Procedure Description: The patient is identified in the preoperative
holding area. The procedure to be performed was confirmed. Site was marked.
Patient was brought back to the operating room was prepped and draped in normal
sterile fashion. This was done in emergent fashion. Patient succumbed to
general anesthetic and we started first by copiously irrigating the wound there
is a significant amount of debris which was above and beyond the normal nature
for this. This required a significant amount of time performing excisional
debridement with Littler scissors. Approximately half an hour was spent just in
removal of necrotic and contaminated tissues. There is significant mount of
sand as well as other debris within the area. A curette was used to remove the
bony impaction as well as significant amount of contamination within the tendon
structures themselves. This was an excisional debridement down to the level of
the bone. Total area of debridement was 2 cm x 2 cm x 2 cm excisional
debridement was performed using Littler scissors as well as a curette. Once
this was complete this completed the irrigation debridement portion of the case.
We then irrigated with an additional 3 L of normal sterile saline and then
proceeded to perform a open reduction internal fixation of the proximal phalanx
we used to cross Kirschner wires these were cut and buried. We then held the
digit in extension and performed a extensor tendon repair. He did have what
appeared to be some partial tissue loss here but we were able to get good
approximation with interrupted sutures for his extensor apparatus. With dorsal
structures intact we then turned volar. Patient had a complete avulsion of the
radial slip of his flexor digitorum superficialis and this was excised and
debrided. The tendon itself was contoured to allow better passage through the
adjacent pulley. We then debrided the frayed portion of the volar aspect and
lateral aspect of the flexor digitorum profundus tendon. This encompassed only
approximately 10% of the tendon itself. This completed the tendinous portion of
the case and attention was turned to the pulleys. His A2 and A3 pulley was
ruptured he may have a proximal A1 pulley injury but this was not visualized.
We then used 2 juggernaut suture anchors into the bone and performed a primary
repair of the A2 pulley where he had on sleeve from the bone. There was
actually a small slip of bone which had peeled off and we were able to suture
around this and see if this in an effort to heal bone to bone from this bony
avulsion of the A2 pulley. After his pulley was repaired we turned our
attention to the distal phalanx. There is an open distal phalanx fracture we
debrided the exposed bone and allow the volar skin flap to cover this area. We
left this open for later repair to allow for evaluation visualization of distal
bleeding during the next portion of the case. We then brought in the
microscope after we had identified the artery and nerves on the radial and ulnar
aspect. We started with the ulnar digital artery were able to get this
revascularized. There unfortunately was some level of loss to the artery itself
as there was a small hole and approximately 3 mm of the artery itself had to be
resected to accommodate a large tear within the vessel itself we were able to
recannulate this and get excellent blood flow we performed an interrupted repair
with nylon suture and had excellent distal blood flow with bleeding through the
tip of the finger. We turned our attention to the radial digital artery.
Similarly, we were able to get this recannulated and remove a clot. We then
repaired the artery and we maintain distal blood flow. While we were repairing
the digital nerves we found that the patient digit had no longer a pink
appearance to it and we took down both repairs and found that each had a small
fibrinous clot in it after removal and of her repeat repair the finger pinked
back up and had excellent distal blood flow. We then performed a repair to the
ulnar digital nerve with use of a conduit. At this point the finger continued
to maintain decent blood flow and we closed the skin flap over the distal aspect
of the digit completing the revision amputation portion of the case with
revision amputation of the distal phalanx. We then copiously irrigated all the
wounds and the circumferential wounds on the finger itself was loosely
approximated. We then repaired the laceration in interrupted fashion to the
ring finger with absorbable suture. Patient was placed in dry sterile dressing and placed in a splint.