DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Dupuytren contracture, left hand, right and little finger.
POSTOPERATIVE DIAGNOSIS: Dupuytren contracture, left hand, right and little finger.
OPERATION PERFORMED: Palmar and digital fasciectomy.
SURGEON: John Doe, MD
ANESTHESIA: MAC with regional block by Anesthesia.
BLOOD LOSS: Minimal.
TOURNIQUET TIME: 1 hour 10 minutes.
COMPLICATIONS: None immediate.
DISPOSITION: Stable to PACU.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old Hispanic male who presented with progressive contracture of his MP and PIP joints of his left ring and little fingers. The patient stated that this is starting to affect his ability to perform day-to-day functions. The patient was diagnosed with Dupuytren disease and booked for fasciectomies. The patient was consented for the procedure and understands the risks including, but not limited to, potential recurrence, neurovascular injury, wound breakdown, and scarring. The patient signed written consent stating that he understood these risks and the benefits of the above-stated procedure.
DESCRIPTION OF OPERATION: After obtaining consent, an axillary block was placed by Anesthesia. The patient was taken to the operating room by gurney and transferred to the operating table in the supine position. Monitored anesthesia care was initiated. The patient’s left hand was prepped and draped with Betadine and draped in the standard sterile fashion. A time-out was performed indicating the patient, procedure, and site to be operated on. Ancef 1 g was given preoperatively. A sterile tourniquet was placed on the patient’s left forearm, his hand was exsanguinated, and the tourniquet raised to 250 mmHg.
The left hand was then placed palm up, and a longitudinal incision along the palmar band was marked out and incised with a 15 blade. Sharp dissection was used to dissect down and isolate the diseased tissue. A combination of blunt and sharp dissection was used to isolate the common and digital neurovascular bundles. These were seen from both the ring and the small fingers. Once we were sure that the nerves had been well isolated from the disease, the disease was removed by sharp excision. The specimen was sent to pathology.
Once all of the disease had been resected, we then took the tourniquet down. Total tourniquet time was 1 hour 10 minutes and two Z-plasties were planned out over the DIP and MP joints of the small finger and one Z-plasty was mapped out over the MP joint of the ring finger. Once again, pressure was held, hemostasis was achieved by pressure and electrocautery, and the Z-plasties were advanced and closed with 5-0 nylon sutures.
The remainder of the wounds were likewise closed with 5-0 nylon sutures. The hand was then cleaned, bacitracin and Adaptic placed over the incisions, as well as a bulky fluff dressing and Ace wrap. At the end of the procedure, all of the patient’s digits on the left hand were pink and viable. Sponge, instrument, and needle counts were correct.
