Preprocedure diagnosis: left pectoralis major rupture
Post-Procedure Diagnosis: Left pectoralis major rupture
Procedure(s) (Description):
left pectoralis exploration with attempted repair
Anesthesia: Regional and General
Findings:
SEE ABOVE
Exploration of the left axilla, identified the pectoralis major rupture
with no significant remaining tendon for attachment. Had
musculotendinous junction area of tearing, which after extensive
dissection could not get the pectoralis to pull back with division
tendon. As such, I did not feel repair was possible and that could not
get the tendon back to the arm even with it in a completely adducted
position. Tendon was seen at the pec attachment site with noted injury.
Procedure:
The patient was identified preoperatively in surgical holding and marked
with surgeon's initials identifying site and confirming procedure.
Subsequently, the patient was taken to OR suite and placed in supine
position. Anesthesia was then obtained for standard technique. All
pressure points were well padded prior to initiating procedure, placing
him into a beach chair position with padding as appropriate for
positioning. Subsequently, left upper extremity was then prepped and
draped in normal sterile fashion. Standard timeout was carried out with
all staff in agreement for side, site, and procedure. A longitudinal
incision was carried out just under the deltoid extending distally. The
bleeding at the skin was cauterized with electrocautery. Good
hemostasis was obtained. Blunt dissection was carried down under the
deltoid until the hematoma around the injured pec was identified. Scar
around the pec was removed as well as the hematoma. Placing retractor
holding the deltoid superior, biceps was identified. The short head of
biceps was also identified and the humerus attachment site for the pec
was identified. Subsequently, after isolating the pec major itself, it
was noted that there was no good tendon. Suture was placed into the
muscle belly, after which finger dissection to release any adhesions
medially were carried out between the deltoid, the skin and the
undersurface of the pec. Trying to pull the pec laterally to see if any
potential for repair with possible, could not get the pec major to the
humeral shaft even with the arm in an abducted position. As such, felt
repair was not possible. Copious irrigation with pulse lavage as well
as hydrogen peroxide wash was carried out. Suture was taken off of the
pec and vancomycin placed into the surgical site. Retractors were
removed. Subsequently, 0 Vicryl was used to repair subcutaneous
tissues. A subcuticular 2-0 was then used followed by staples for skin.
It should be noted that platelet rich plasma with thrombin was placed
deep in the area of the unrepaired pec prior to closure. Incision was
then subsequently dressed sterilely with Adaptic, 4 x 4's, sterile ABDs
after previously injecting with a postop pain cocktail for pain control.
Operative field was taken down. Dressings were taped in place with 1
ABD in the axilla as well as 1 over the incision. The patient
subsequently had anesthesia reversed. He was then taken to recovery
room in stable condition.
Skilled assistance of an physician was necessary for the successful completion of the case and was essential for positioning, manipulation of the arm and instruments, exposure, manipulation of tissue and assisting with wound closure and dressing application.
Post-Procedure Diagnosis: Left pectoralis major rupture
Procedure(s) (Description):
left pectoralis exploration with attempted repair
Anesthesia: Regional and General
Findings:
SEE ABOVE
Exploration of the left axilla, identified the pectoralis major rupture
with no significant remaining tendon for attachment. Had
musculotendinous junction area of tearing, which after extensive
dissection could not get the pectoralis to pull back with division
tendon. As such, I did not feel repair was possible and that could not
get the tendon back to the arm even with it in a completely adducted
position. Tendon was seen at the pec attachment site with noted injury.
Procedure:
The patient was identified preoperatively in surgical holding and marked
with surgeon's initials identifying site and confirming procedure.
Subsequently, the patient was taken to OR suite and placed in supine
position. Anesthesia was then obtained for standard technique. All
pressure points were well padded prior to initiating procedure, placing
him into a beach chair position with padding as appropriate for
positioning. Subsequently, left upper extremity was then prepped and
draped in normal sterile fashion. Standard timeout was carried out with
all staff in agreement for side, site, and procedure. A longitudinal
incision was carried out just under the deltoid extending distally. The
bleeding at the skin was cauterized with electrocautery. Good
hemostasis was obtained. Blunt dissection was carried down under the
deltoid until the hematoma around the injured pec was identified. Scar
around the pec was removed as well as the hematoma. Placing retractor
holding the deltoid superior, biceps was identified. The short head of
biceps was also identified and the humerus attachment site for the pec
was identified. Subsequently, after isolating the pec major itself, it
was noted that there was no good tendon. Suture was placed into the
muscle belly, after which finger dissection to release any adhesions
medially were carried out between the deltoid, the skin and the
undersurface of the pec. Trying to pull the pec laterally to see if any
potential for repair with possible, could not get the pec major to the
humeral shaft even with the arm in an abducted position. As such, felt
repair was not possible. Copious irrigation with pulse lavage as well
as hydrogen peroxide wash was carried out. Suture was taken off of the
pec and vancomycin placed into the surgical site. Retractors were
removed. Subsequently, 0 Vicryl was used to repair subcutaneous
tissues. A subcuticular 2-0 was then used followed by staples for skin.
It should be noted that platelet rich plasma with thrombin was placed
deep in the area of the unrepaired pec prior to closure. Incision was
then subsequently dressed sterilely with Adaptic, 4 x 4's, sterile ABDs
after previously injecting with a postop pain cocktail for pain control.
Operative field was taken down. Dressings were taped in place with 1
ABD in the axilla as well as 1 over the incision. The patient
subsequently had anesthesia reversed. He was then taken to recovery
room in stable condition.
Skilled assistance of an physician was necessary for the successful completion of the case and was essential for positioning, manipulation of the arm and instruments, exposure, manipulation of tissue and assisting with wound closure and dressing application.