DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right full-thickness rotator cuff tear with AC arthritis and impingement.
POSTOPERATIVE DIAGNOSIS: Right full-thickness rotator cuff tear with AC arthritis and impingement.
OPERATION PERFORMED:
1. Open anterior acromioplasty.
2. Excision of the right distal clavicle.
3. Bursectomy and exploration of a massive right rotator cuff tear.
4. Repair of massive rotator cuff tear with mobilization of supraspinatus and infraspinatus tendons and closure.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was brought to the operating room in the supine position. After induction of anesthesia, the right upper extremity was then prepped and draped into a sterile field in the usual fashion. The patient was placed in a beach chair position. A saber incision over the acromioclavicular joint was made. This was carried through the skin and subcutaneous tissue. The anterior deltoid was then peeled off the anterolateral aspect of the distal clavicle and acromion and down the anterolateral raphe. This exposed the distal clavicle and a resection of the clavicle was done.
Following this, an anterior acromioplasty was performed to clean out and allow exposure. This converted the hook acromion with its corresponding calcified CA ligament, which was excised to a type I acromion, though it was flattened. Following this, a large amount of bursa was identified. The head was noted to be protruding from the wound. There was a large rotator cuff tear with retraction of both the supraspinatus and infraspinatus tendons and part of the subscapularis.
Following a bursectomy, the edges of the tendon were first tagged with gentle mobilization by following it and dissecting it from the undersurface and then the top was done by gradual mobilization and placement of sutures. Most of the infraspinatus tear was able to be identified and brought toward the wound. This allowed us to be able to get a good closure of the cuff with not as much tension.
A bony trough was then made over the greater tuberosity region and then the tendon, using #2 Ethibond sutures with two big sutures with a good bone bridge, was used to repair most of the infraspinatus and part of the supraspinatus tendon. After this was done, the anterolateral corner of the subscapularis and the supraspinatus could then be tagged for the closure of the rest of the rotator cuff. A suture anchor was then placed in the corner and the two leaves then used to repair and reattach the infraspinatus to the lateral corner of the subscapularis tendon. This allowed for a good watertight and secure closure of the rotator cuff, which was reapproximated in spite of the large size that we started out with.
Irrigation was carried out. The shoulder was carried through a range of motion to make sure that the repair held and was not under undue tension. Closure was then done by reattaching the anterior deltoid using 0 Mersilene sutures. The 2-0 Vicryls were used for the subcutaneous with benzoin and Steri-Strips for the skin. Dressings were applied with an ABD in the armpit. The patient was brought to the recovery room in stable condition.
