Jamie Dezenzo
True Blue
PREOPERATIVE DIAGNOSIS: Right high radial nerve palsy.
PROCEDURES PERFORMED:
1. Multiple tendon transfers, right forearm (specifically pronator teres to extensor carpi radialis brevis with extensor carpi radialis longus free graft reinforcement).
2. Right flexor carpi radialis to extensor digitorum communis index finger, long finger, ring finger, small finger tendon transfer.
3. Palmaris longus to extensor pollicis longus tendon transfer.
PROCEDURE:
A volar radial hockey-stick incision carried out distal volar forearm. Antebrachial fascia longitudinally incised. Bipolar electrocautery used to control localized bleeders. Loupe magnification utilized. Flexor carpi radialis distal tenotomy performed at scaphoid tubercle and freed proximal to musculotendinous juncture 10 cm proximal. Palmaris longus identified. Tenotomy performed at volar wrist crease and again freed proximal to musculotendinous juncture. Donor site irrigated. Then 4-0 undyed Vicryl for subcutaneous tissue reapproximation. Multiple skin staples for skin closure. Local infiltrate 0.5% plain Marcaine solution.
A dorsal apex ulnar distal to midforearm incision then carried out, distal radial at dorsal wrist crease, extending proximal forearm volar radial. Bipolar electrocautery used to control localized bleeders. Radial artery and superficial radial nerve identified and protected throughout. Extensor mechanism of volar radial forearm identified. The extensor pollicis longus was released from its 3rd compartment and transposed radialward. Proximal tenotomy performed allowing end-to-end tendon transfer with thumb in maximal abduction and extension, under maximal tension, of both distal and proximal stumps with Pulvertaft weave with 4-0 Prolene, assessing tension under passive tenodesis. Flexor carpi radialis to extensor digitorum communis tendon transfer performed individually on initial 45 degree obliquity Pulvertaft with 4-0 Prolene as well. This was proximal to the extensor retinaculum. Pulvertaft weave extended distally x2 with side-to-side x1. Passive tenodesis assessed. Able to passively obtain pulp-to-palm flexion with passive digit extension on passive wrist flexion and relaxation of digits with passive extension.
Our first tendon transfer was pronator teres to extensor carpi radialis brevis (ECRB) tendon transfer. This was performed, taking down the pronator teres from its radial shaft insertion, using resection of periosteum with mobilization of pronator into the proximal volar forearm to allow better excursion. This was performed under maximal tension of pronator teres with wrist in 45 degrees of extension. This was oversewn with a slip of extensor carpi radialis longus and again secured with 4-0 Prolene.
I see 25310 x 5 and 25312 354.3....???
THANKS!!!
Jamie
PROCEDURES PERFORMED:
1. Multiple tendon transfers, right forearm (specifically pronator teres to extensor carpi radialis brevis with extensor carpi radialis longus free graft reinforcement).
2. Right flexor carpi radialis to extensor digitorum communis index finger, long finger, ring finger, small finger tendon transfer.
3. Palmaris longus to extensor pollicis longus tendon transfer.
PROCEDURE:
A volar radial hockey-stick incision carried out distal volar forearm. Antebrachial fascia longitudinally incised. Bipolar electrocautery used to control localized bleeders. Loupe magnification utilized. Flexor carpi radialis distal tenotomy performed at scaphoid tubercle and freed proximal to musculotendinous juncture 10 cm proximal. Palmaris longus identified. Tenotomy performed at volar wrist crease and again freed proximal to musculotendinous juncture. Donor site irrigated. Then 4-0 undyed Vicryl for subcutaneous tissue reapproximation. Multiple skin staples for skin closure. Local infiltrate 0.5% plain Marcaine solution.
A dorsal apex ulnar distal to midforearm incision then carried out, distal radial at dorsal wrist crease, extending proximal forearm volar radial. Bipolar electrocautery used to control localized bleeders. Radial artery and superficial radial nerve identified and protected throughout. Extensor mechanism of volar radial forearm identified. The extensor pollicis longus was released from its 3rd compartment and transposed radialward. Proximal tenotomy performed allowing end-to-end tendon transfer with thumb in maximal abduction and extension, under maximal tension, of both distal and proximal stumps with Pulvertaft weave with 4-0 Prolene, assessing tension under passive tenodesis. Flexor carpi radialis to extensor digitorum communis tendon transfer performed individually on initial 45 degree obliquity Pulvertaft with 4-0 Prolene as well. This was proximal to the extensor retinaculum. Pulvertaft weave extended distally x2 with side-to-side x1. Passive tenodesis assessed. Able to passively obtain pulp-to-palm flexion with passive digit extension on passive wrist flexion and relaxation of digits with passive extension.
Our first tendon transfer was pronator teres to extensor carpi radialis brevis (ECRB) tendon transfer. This was performed, taking down the pronator teres from its radial shaft insertion, using resection of periosteum with mobilization of pronator into the proximal volar forearm to allow better excursion. This was performed under maximal tension of pronator teres with wrist in 45 degrees of extension. This was oversewn with a slip of extensor carpi radialis longus and again secured with 4-0 Prolene.
I see 25310 x 5 and 25312 354.3....???
THANKS!!!
Jamie