DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Painful hardware, right wrist.
2. Flexor tenosynovitis, right wrist.
POSTOPERATIVE DIAGNOSES:
1. Painful hardware, right wrist.
2. Complete attrition of flexor pollicis longus tendon.
3. Partial attrition of flexor carpi radialis tendon.
OPERATIONS PERFORMED:
1. Removal of painful hardware, deep.
2. Flexor carpi radialis tenolysis.
3. Flexor pollicis longus tenolysis.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
COMPLICATIONS: None.
SPECIMENS REMOVED: None.
DESCRIPTION OF OPERATION: The patient was brought back to the operating room and placed supine on the hand table. She was prepped and draped in the usual standard sterile fashion over a nonsterile upper arm-based tourniquet. Esmarch was utilized to exsanguinate the arm, and tourniquet was inflated to 250 mmHg. Total tourniquet time was 60 minutes.
An incision was carried down through her previous incision over the flexor carpi radialis tendon and carried down sharply through the scar until the flexor carpi radialis tendon was identified. This was then retracted ulnarly, and dissection was continued down along the flexor carpi radialis tendon through a massive amount of scar down to the plate. The entire flexor carpi radialis tendon was encased in a very thick layer of scar, as was the flexor pollicis longus tendon.
Dissection was then carried proximally and distally over the plate until the entire extent of the plate was identified and was cleared of soft tissue attachments. Using a Synthes screwdriver as well as a hand-modulated screwdriver, all screws were removed from the distal radius plate, and the plate was able to be lifted off the bone without complication. Following this, there were no areas of bone that were felt to be sharp or would need to be rasped down.
Attention was then turned to the flexor carpi radialis tendon where a tenolysis was performed, and a thick amount of scar tissue was removed from the tendon. There was a small amount of attrition on the undersurface of the flexor carpi radialis tendon where it was rubbing over the plate.
The flexor pollicis longus tendon was then identified, and dissection was carried proximally and distally over that tendon. The tendon was noted to have severe complete attrition from the proximal extent of the plate up into the carpal tunnel at the distal end of the incision. Pulling on it did not move any joints, except through adhesive tenodesis. The wounds were irrigated copiously, and the wounds were closed with interrupted 5-0 nylon sutures without complication.
