Hi list,
I am still fairly new to surgeries and need some guidance
TIA
Melissa Bedford,CCS,CPC
History of Present Illness
HPI Comments: 56 yo RHD WF administrator here 3 +weeks s/p left index/long finger complex lac with "butcher knife. It was deep on long finger" atv lake house. Self rx and c/o pain long PIP with use /typing at work and deformity. Index OK now - min sx /stiffness. O/w healthy. + PCN allergy but tolerated keflex in past well. nO RA/DM/ Rt sx/CTS/TF
A. Left long finger complex laceration/open Boutonniere deformity
POSTOP DIAGNOSES:
A. Left long finger complex laceration with:
1. Extensor tendon laceration ( central slip, complete)
2. Open 3rd PIP joint
PROCEDURES:
1. Left long finger extensor tendon repair
2. I&D/ repair open 3rd PIP joint
ANESTHESIA:
LMA.
TOURNIQUET TIME:
10 minutes.
BLOOD LOSS:
Minimal.
FLUIDS:
Per anesthesia record.
OPERATIVE FINDINGS:
1. Left long finger healed complex laceration with complete extensor tendon laceration/gap/ Boutonniere deformity/open PIP joint. No residual loose body/infection/ OC fx. Moderate amount devitalized tissue/ subacute-chronic scar
OPERATIVE SUMMARY IN DETAIL:
Following appropriate informed consent, patient identification, and operative limb, the patient was brought to the operating suite where smooth induction of LMA anesthesia was accomplished by Anesthesiology Service and he received broad-spectrum IV antibiotic prophylaxis. The upper extremity was prepped and draped in the usual sterile fashion. Time-out procedure performed. The limb was exsanguinated with an Esmarch bandage prior to tourniquet inflation to 275 mmHg. A lazy S was performed over the 3rd PIP traumatic laceration. Blunt dissection was carried down through the subcutaneous tissues. Neurovascular bundles to each side were identified and protected. The 3rd Extensor tendon, lateral bands and P1 head were identified and meticulously debrided with findings as above. Soft tissues, joint capsule and the extensor tendon margins were then debrided and irrigated.The joint capsule was then repaired beneath the ET laceration affording good joint closure and reapproximation ot the ET laceration. The central slip tendon was then repaired with a 3-0 Ethibond sutures with excellent restoration of resting tone and correction of the Boutonniere deformity. Tenodesis effect and stable centralization of the tendon over the PIP joint was present with passive flexion/extension of the joint. Excellent excursion and stable tendon repair was noted. The procedure was terminated and the tourniquet let down. There was no undue bleeding. Hemostasis performed using electrocautery. The wounds were reapproximated with nonabsorbable sutures and infiltrated with 0.5% Marcaine for perioperative pain relief. Sterile nonadherent dressing was applied. The patient was extubated and transported to the recovery area in stable condition. There were no intraoperative complications
I am still fairly new to surgeries and need some guidance
TIA
Melissa Bedford,CCS,CPC
History of Present Illness
HPI Comments: 56 yo RHD WF administrator here 3 +weeks s/p left index/long finger complex lac with "butcher knife. It was deep on long finger" atv lake house. Self rx and c/o pain long PIP with use /typing at work and deformity. Index OK now - min sx /stiffness. O/w healthy. + PCN allergy but tolerated keflex in past well. nO RA/DM/ Rt sx/CTS/TF
A. Left long finger complex laceration/open Boutonniere deformity
POSTOP DIAGNOSES:
A. Left long finger complex laceration with:
1. Extensor tendon laceration ( central slip, complete)
2. Open 3rd PIP joint
PROCEDURES:
1. Left long finger extensor tendon repair
2. I&D/ repair open 3rd PIP joint
ANESTHESIA:
LMA.
TOURNIQUET TIME:
10 minutes.
BLOOD LOSS:
Minimal.
FLUIDS:
Per anesthesia record.
OPERATIVE FINDINGS:
1. Left long finger healed complex laceration with complete extensor tendon laceration/gap/ Boutonniere deformity/open PIP joint. No residual loose body/infection/ OC fx. Moderate amount devitalized tissue/ subacute-chronic scar
OPERATIVE SUMMARY IN DETAIL:
Following appropriate informed consent, patient identification, and operative limb, the patient was brought to the operating suite where smooth induction of LMA anesthesia was accomplished by Anesthesiology Service and he received broad-spectrum IV antibiotic prophylaxis. The upper extremity was prepped and draped in the usual sterile fashion. Time-out procedure performed. The limb was exsanguinated with an Esmarch bandage prior to tourniquet inflation to 275 mmHg. A lazy S was performed over the 3rd PIP traumatic laceration. Blunt dissection was carried down through the subcutaneous tissues. Neurovascular bundles to each side were identified and protected. The 3rd Extensor tendon, lateral bands and P1 head were identified and meticulously debrided with findings as above. Soft tissues, joint capsule and the extensor tendon margins were then debrided and irrigated.The joint capsule was then repaired beneath the ET laceration affording good joint closure and reapproximation ot the ET laceration. The central slip tendon was then repaired with a 3-0 Ethibond sutures with excellent restoration of resting tone and correction of the Boutonniere deformity. Tenodesis effect and stable centralization of the tendon over the PIP joint was present with passive flexion/extension of the joint. Excellent excursion and stable tendon repair was noted. The procedure was terminated and the tourniquet let down. There was no undue bleeding. Hemostasis performed using electrocautery. The wounds were reapproximated with nonabsorbable sutures and infiltrated with 0.5% Marcaine for perioperative pain relief. Sterile nonadherent dressing was applied. The patient was extubated and transported to the recovery area in stable condition. There were no intraoperative complications