DESCRIPTION OF PROCEDURE:After informed consent was obtained, the patient was brought to the operating room suite, and placed on the table in supine position. A pause was undertaken, to confirm the patient as well as location of surgery. Once this was confirmed, general anesthesia was induced, and the patient's hand and forearm were prepped with chlorhexidine and alcohol, and draped in a normal sterile fashion. His previous sutures were removed, and the wound was opened. There was no necrotic tissue, and no purulence. The wound was irrigated copiously. A series of Brunner incisions were made, to allow for visualization of the deeper structures. All thumb and index finger structures were identified, and complete laceration of the flexor digitorum profundus to the index finger was identified. There was a 30% laceration to the flexor pollicis longus, which was not repaired. The index radial digital nerve, and thumb radial and ulnar digital nerves were found to be completely lacerated. Proximal and distal ends were identified. To identify the proximal end of the flexor tendon, an incision was made at the level of the distal wrist. The tendon was then identified and placed distally into the distal incision. The tendon was repaired using a series of 2-0 Ethibond core sutures. A total of a 4 strand repair was performed. 4-0 Prolene epitendinous suture was placed, as well. After this, nerve proximal and distal ends were reapproximated using a series of interrupted 6-0 Prolene suture, under loupe magnification. Tourniquet was released with a total tourniquet time of 62 minutes. Hemostasis was obtained using bipolar electrocautery. The wounds were irrigated with normal saline, and the incisions were closed using a series of interrupted 4-0 nylon horizontal mattress sutures. A dressing was applied, consisting of Xeroform, dry gauze, and a dorsal blocking splint. This was secured with an Ace wrap. The patient was awakened from anesthesia, transferred to the hospital but, and taken to the postanesthesia care unit in stable condition. An axillary block had been administered preoperatively for postoperative analgesia.
26350 x3 882.2
I need someones opinion on this to make sure I am not missing something Please!!!!