DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right index finger necrosis.
POSTOPERATIVE DIAGNOSIS: Right index finger nail bed laceration.
PROCEDURE PERFORMED: Superficial debridement of right index finger.
SURGEON: John Doe, MD
ANESTHESIA: Local/monitored anesthesia care.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None noted.
DISPOSITION: Stable to postanesthesia care unit.
INDICATIONS FOR PROCEDURE: The patient is a right-hand dominant male with a history of Asperger’s syndrome and diabetes. He sustained a fall where he was found down after a prolonged period of time approximately two weeks prior to presenting to the clinic. It was noted on presenting to the office that he had necrosis of his right index finger tip as well as swelling and erythema. Radiographs were negative for fracture. There was concern that he had a necrotic right index finger tip, and he was scheduled for exploration of his right index finger and a possible amputation of that digit. The risks and benefits were discussed with the power-of-attorney, and an informed consent was obtained.
DESCRIPTION OF PROCEDURE: The patient was brought back to the operating room and placed with his right arm extended on a hand table. After satisfactory sedation per anesthesia, a digital block was performed with 1% lidocaine 0.5% Marcaine infiltrate into the right index finger. A well-padded tourniquet was applied to the right forearm. The right arm was then prepped and draped in usual sterile manner. A time-out was performed to confirm the patient’s site of surgery and type of surgery to be performed.
With the index finger able to be more adequately examined, the epithelial skin surrounding the distal phalanx of the index finger was removed, and it was noted that the patient had good healthy granulating tissue underlying this area. A Freer elevator was inserted under the nail plate and the nail removed. It was noted the patient had a transverse laceration of the nail bed; however, there was no necrotic tissue that was present on the right index finger. The nail bed injury was slightly crushed in nature, and it was not felt that it may be reapproximated. Therefore, the decision was made at that time to allow for the finger to granulate and heal on its own accord. It was noted that he did not require an amputation of his digit.
The wound was copiously irrigated with sterile saline and necrotic epithelium removed. An Adaptic was slid underneath the proximal nail fold to assist with growing of the nail plate. A sterile dressing of bacitracin, Adaptic, dry gauze, Kling and Coban was applied. The tourniquet had not been inflated during the surgery. It was noted the patient had good perfusion of his digit throughout the surgery.
