DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right cubital tunnel syndrome.
POSTOPERATIVE DIAGNOSIS: Right cubital tunnel syndrome.
OPERATION PERFORMED: Right ulnar nerve transposition.
SURGEON: John Doe, MD
ANESTHESIA: Axillary block and LMAC.
ESTIMATED BLOOD LOSS: Minimal.
TOURNIQUET TIME: 40 minutes at 250 mmHg.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and laid supine on the operating table. General anesthetic was administered and LMAC placed. IV antibiotics were administered preoperatively. The patient was positioned comfortably with all bony prominences well padded. The correct limb was identified as marked preoperatively in conjunction with the patient and then confirmed by oral consent and then by a time-out prior to the procedure. An axillary block was administered to the right upper extremity. The right upper extremity was then prepped with ChloraPrep and draped down in the usual sterile fashion. The limb was exsanguinated using an Esmarch and the tourniquet inflated to 250 mmHg.
A curvilinear incision was made along the medial aspect of the right elbow behind the medial epicondyle. The incision was carried down to the skin only. Tenotomy scissors were used to divide the underlying subcutaneous tissue. Bipolar was used to coagulate small crossing vessels for hemostasis. The medial epicondyle was identified and the fascia behind it was carefully dissected. The ulnar nerve was identified more proximally, and then, by placing the Freer elevator on top of it, the fascia was carefully divided. The nerve was carefully dissected out and transposed anteriorly. Full release was done proximally up along the intermuscular septum to allow mobilization of the nerve.
Distally, the fascia over the flexor carpi ulnaris was divided so as to allow mobilization distally. Once the nerve was freed, a fascial sling was made by cutting sharply three sides of a rectangle with the base anteriorly off the fascia overlying the pronator flexor mass. In the corners of this fascia, a sling was placed, a 2-0 Ethibond. The nerve was transposed anteriorly and then the corners of the sling were tacked into the subcutaneous and dermal layer of the anterior skin flap. These were secured down and then the elbow was placed through range of motion to ensure that the nerve moved freely with no adhesions or abnormal bends.
The wound was then irrigated with antibiotic solution. The subcutaneous tissue was closed with inverted 2-0 Vicryl, and the skin was closed with a running 3-0 PDS. Steri-Strips were applied. A sterile compressive dressing was applied with Betadine-soaked Adaptic, 4 x 4s, Webril, and an Ace wrap. The patient tolerated the procedure well. The patient was awoken from anesthesia and brought to the recovery room in stable condition.
