i was looking at 26160 or 26080??? which one is best for the op note???

Gouty tophus of the right index finger at the distal interphalangeal joint.

POSTOPERATIVE DIAGNOSIS: Gouty tophus of the right index finger at the distal interphalangeal joint.

PROCEDURE: Excision of gouty tophus, right index finger.



TOURNIQUET TIME: 30 minutes.


SPECIMENS: Gouty tophus from the right index finger.

CLINICAL NOTE: This is a 46-year-old gentleman with a history of gout who has a painful nodule on the dorsal aspect of the right index finger DIP joint, measuring about 1.5 cm x 2 cm. After a discussion of treatment options, he has opted for excision of the gouty tophus. Informed consent was obtained prior to coming to the operating room.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed supine on the operating room table where general anesthetic was administered by the Anesthesia Department. One gram of Kefzol was administered intravenously prior to beginning the procedure. A tourniquet was placed on the right upper arm. The hand was prepped and draped in the usual sterile fashion, exsanguinated with an Esmarch, and tourniquet inflated to 250 mmHg.

A Z-shaped incision was made on the dorsal aspect of the index finger, beginning along the radial border of the distal phalanx extending into the fascia and across the DIP, and then proximally along the ulnar border of the finger. This was carried down sharply through skin and subcutaneous tissues, and full-thickness skin flaps were elevated exposing a large gouty tophus arising from the DIP joint of the index finger. Careful dissection was performed to remove the chalky uric acid deposits which were intimately entwined with the extensor mechanism at the dorsal aspect of the finger as well. Carefully maintaining the extensor tendon, as much of the gouty material as possible was debrided. The wound was then copiously irrigated and closed with 3-0 Vicryl in the subcutaneous tissues and 4-0 nylon in the skin. A finger block was performed with 0.5% plain Marcaine, and the wound was then dressed with Polysporin, Adaptic, and dry sterile dressings.

The tourniquet was deflated. The patient was awakened and transferred to the recovery room in good condition having tolerated the procedure well.