DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Status post right middle finger trigger release with flexor tendon adhesion.
2. Probable flexor sheath ganglion.
POSTOPERATIVE DIAGNOSES:
1. Status post release right middle finger flexor tendon sheath with flexor tendon adhesions.
2. Flexor sheath ganglion off of A1 pulley.
3. Synovitis, flexor tendons.
4. Dupuytren change, right palm.
PROCEDURES PERFORMED:
1. Re-release right middle finger flexor tendon sheath with excision of Dupuytren disease.
2. Excision of flexor sheath ganglion.
3. Flexor tenolysis.
SURGEON: John Doe, MD
ANESTHESIA: Bier block.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room where Bier block was placed by the anesthesia department. The right upper extremity was prepped and draped in the usual manner for hand surgery. Under tourniquet control and loupe magnification, a zigzag incision was placed in the palm in line with the middle finger, centered in the area of the prominent scarring and soft tissue change from the previous surgery.
Starting proximally and distally in the area of more normal-looking tissues, the subcutaneous tissues were bluntly divided. As the more thickened tissues were encountered, sharp dissection was performed elevating the dermis. The change appeared to be consistent with Dupuytren disease. This abnormal tissue was then isolated by blunt dissection. The two adjacent common neurovascular bundles were identified and carefully protected. Tissue was excised and sent for pathologic examination.
The area of the middle finger A1 pulley was identified. The A1 was then released from its proximal edge up to its distal edge. There were flexor tendon adhesions and scarring. This was released by combination of blunt and sharp dissection. Traction tenolysis was also performed. Synovium was excised. During exposure of the A1 pulley, a flexor tendon sheath ganglion was identified. This was excised and also sent for pathologic examination.
The wound was irrigated. The surgical area was infiltrated with 0.25% Marcaine without epinephrine. The skin was closed with nylon suture. The wound was sterilely dressed, and a bulky dressing was applied. The operative course was uneventful with no complications. The patient tolerated the procedure and was brought to the recovery room in good condition.
