ggparker14
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Please help with bone shortening, irrigation debridement, full thickness pinch graft.
op note reads: The patient's nail bed needed to be removed to evaluate the nail bed. Patient did have an injury at the very distal end of the nail bed. Patient was missing skin over approximately 2.5 cm area over the radial aspect of the index finger. The wound was irrigated. I opted to partially trim some of the bone and rearrange the distal skin flap. Some of the distal tuft of the bone was removed and image intensification confirmed the residual amount of bone left. The distal skin flap was rearranged to allow for full thickness skin with sensibility. The portion of the nail bed that was lacerated was actually trimmed since this was over the distal tuft that was trimmed for primary shortening. The subcutaneous tissues were gently reapproximated to decrease the skin gap over the radial aspect fo the fingertip. Patient had a small portion of full thickness skin loss over the radial aspect of the fingertip. In order to provide biologic coverage, a pinched full thickness skin graft was taken from the proximal medial forearm. The skin graft was taken and it was pie crusted with 11 blade to allow for drainage of any potential subcutaneous hematoma. The skin graft was subsequently sutured in place with 4-0 Monocryl. The nail plate was trimmed and placed back in position over the nail bed to protect the nail bed adn sutured lossely into position with 4-0 Vicryl.
op note reads: The patient's nail bed needed to be removed to evaluate the nail bed. Patient did have an injury at the very distal end of the nail bed. Patient was missing skin over approximately 2.5 cm area over the radial aspect of the index finger. The wound was irrigated. I opted to partially trim some of the bone and rearrange the distal skin flap. Some of the distal tuft of the bone was removed and image intensification confirmed the residual amount of bone left. The distal skin flap was rearranged to allow for full thickness skin with sensibility. The portion of the nail bed that was lacerated was actually trimmed since this was over the distal tuft that was trimmed for primary shortening. The subcutaneous tissues were gently reapproximated to decrease the skin gap over the radial aspect fo the fingertip. Patient had a small portion of full thickness skin loss over the radial aspect of the fingertip. In order to provide biologic coverage, a pinched full thickness skin graft was taken from the proximal medial forearm. The skin graft was taken and it was pie crusted with 11 blade to allow for drainage of any potential subcutaneous hematoma. The skin graft was subsequently sutured in place with 4-0 Monocryl. The nail plate was trimmed and placed back in position over the nail bed to protect the nail bed adn sutured lossely into position with 4-0 Vicryl.
