DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Degloving injury to left antecubital fossa.
POSTOPERATIVE DIAGNOSIS: Degloving injury to left antecubital fossa.
PROCEDURE PERFORMED: Repair of complex laceration and debridement of tissues associated with open laceration.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
COMPLICATIONS: None.
SPECIMENS REMOVED: None.
TOURNIQUET: None.
DRAINS: None.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old female who was trying to remove the parking brake from her car and was unable to do so and unable to bend down in her car secondary to being 7-1/2 months pregnant. She then got out of the car and released the brake. The car was not in park and it began to roll. She tried to get into the car and got run over by the car. She sustained a degloving injury with a complex laceration measuring approximately 15 cm long. She was seen and evaluated in an outside hospital and was transferred here for further care by the hand service.
DESCRIPTION OF PROCEDURE: In the emergency room, the patient’s wounds were prepped and draped and infiltrated with 20 mL of 1% lidocaine for anesthesia. The wounds were then washed with Betadine wash, and she was draped in sterile fashion, isolating the wound. The wound was then irrigated copiously with 500 mL of normal saline solution.
Adequate debridement was obtained. Necrotic areas were trimmed off, and a layer of interrupted 3-0 Vicryl sutures was placed to repair the curvilinear laceration. Once Vicryl sutures had been obtained and skin tension had been relieved, 3-0 nylon vertical mattress sutures were placed in an interrupted fashion throughout the wound to obtain a good everted skin closure. The wounds were washed again and covered with bacitracin and Adaptic gauze and dry gauze dressing. A well-padded posterior splint was applied to protect the flexion crease.
The patient will be discharged to home with a week of antibiotics, as well as pain medication. She will be sent to OB triage to make sure her baby is okay. Otherwise, the patient will be seen for followup in the Hand Clinic in two weeks for suture removal.
Preoperative examination documented no neurovascular injury. Radial, ulnar, and median nerves were intact, as well as posterior interosseous nerve. This was verified during the procedure. There were no tendon lacerations or neurovascular structure injury. Several subcutaneous veins were noted to be intact. The wound was just to the fascia and not through the fascia.
